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One 's ability to express himself is a reflection of the integration of concentration, comprehension, memory, and initiation. To express himself, a person must concentrate on what the other person is saying, understand it correctly, remember it, formulate the appropriate thought, and initiate a verbal, gestured, or written response to the other person. We do this automatically every day as we talk, gesture, or write memos.

Your family member may have difficulty in one or all of these avenues of expression. Verbally, he may not be able to find the correct word or he may use inappropriate grammatical structures. One of two types of expressive difficulties is usually present after TBI: (1) either a person will talk much less than he did before the TBI, using a less sophisticated vocabulary and speaking in shorter sentences, or (2) he will talk more than he did before TBI, but say less. His speech will be characterized by much off-topic irrelevant information and repetition.

Nonverbal expressions (gestures, body language, eye contact, or facial expressions) are as important to the communication process as the words that are used. You may notice that your family member does not make good eye contact or that his face is not as expressive as it once was. In other words, when he is angry, his facial expressions do not indicate that he is angry. You may also notice that he stands too close to people when he talks with them. This can make your family member's friends and co-workers uncomfortable.

The most complicated level of expression is the written word. Putting thoughts on paper may be much more difficult for him than it was before. His writing may have more errors and take much longer for him to complete.


The following are examples of expressive difficulties your family member may exhibit:

1. You may note that he never seems to get to the point in conversations. He may start a conversation about work and end up telling you about one of the kid' s problems at school. Not only is the conversation difficult to follow, but it puts you at a loss for information.

2. Your family member may have enjoyed lively arguments and discussions before the injury. Now, he is not able to keep up with you in conversations, hold his own in arguments, or give you a quick comeback for jokes.

3. Your family member never brought work home before the TBI. Now he brings his full briefcase home every night. When you ask him about it, he says he has a number of memos to write and then never gets them done.

4. You observe that your family member does not make eye contact when he speaks with you or others. He also has started an irritating nervous laugh that he resorts to during nearly every conversation.

Management Techniques

1. Set up a cuing system to let your family member know when he is getting off the topic. A hand signal or key word will help redirect him back to the subject. In private conversations, be direct and tell him when he has wandered off of the topic. You can also assist him by asking the wh questions to get him back on topic (who, what, when, where, why).

2. Discontinue your family discussions for a time. Your family member is no longer a match for you in verbal debates. The experience will only be frustrating for him.

3. Assist him in setting up a structure for his written memos. The wh questions are appropriate for memo writing (who, what, when, where, why). This could be set up in a computer format so your family member has only to fill in the blanks.

4. Direct instructions from you on eye contact and other communication skills will be most helpful. Privately discuss these issues with your family member so he can be aware of others' responses to his communications. If appropriate, set up a cuing system to help him monitor these responses.