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Effective workplace communication with employees with acquired brain injury


Talking about the job

Giving instructions that have meaning and relevance is a critical skill when you are supporting employees with ABI.

Giving instructions that have meaning and relevance is a critical skill when you are supporting employees with ABI. They may have difficulty following instructions or completing tasks because of:

Supported employees with ABI (like all workers) need to know what they are required to do. They need to know and understand:

Employees with ABI need to be given this information in specific and individual ways, depending on their cognitive needs.

This may include being shown as well as told what to do, needing very concrete information (bend your knees when you pick up the box), not abstract statements (remember the manual handling rules) or being left with ongoing reminders like a sample to copy (this box has the toys in it in the order you have to put them in).

You need to be aware of the person's receptive language skills (their level of understanding of what you say), and their visual-spatial skills (recognition of and ability to analyse and remember visual information).

Very often, people with ABI seem to understand more than they actually do. You need to test their understanding frequently, particularly in relation to any new task they are learning.

To check that your message about the work has been received, ask the supported employee to feed back what they have heard. This can be verbal or, particularly for people with limited verbal skills, a demonstration of the task.

The ability of an employee with ABI to use verbal or written skills to express themselves may appear unaffected but there can often be subtle and hidden problems that cause them difficulty on the job. These can include:


Annika, aged 53, had a stroke four years ago. Her speech and physical function are unaffected, and she lives independently in her own home. Annika is a widow with two adult children. She started work at Merrinvale a couple of years ago, wanting something to fill her day and to provide company. Her supervisors consider her one of the most competent employees and she fulfils a very important role in the Frame Up workshop, ensuring orders for steel shelving components are correctly selected and packed ready for shipping.

There have always been difficulties with this task in Frame Up. A significant number of orders are returned by customers because the wrong components have been supplied, and the business has suffered because of this. Although Annika seems to be the 'best' person to do the orders, in fact her stroke has left her with sensory and perceptual problems which mean she makes many errors. Annika has visual-spatial deficits which cause her severe problems drawing or copying objects, recognising them, telling left from right, and organising most visual information.

The order filling task is a minefield for someone with Annika's problems because it depends so much on being able to analyse and recognise objects.

From Paul's notebook

I had to go out to Beeson's again today. They were fuming because they said the shelving order was completely messed up again. I went right through it and, sure enough, I found there were too many 300mm shelves and no 200s. And no left hand brackets had been packed. I can't understand it. Annika is in charge of the packing and she checks each part as it goes onto the pallet. She really knows what she's doing and is the only employee who can read the orders correctly, and get things organised so they're out on time. Any of us can go up to her at any time of day and she can tell you exactly what's going on. She's really smart.

I had to grovel quite a bit to Reg Beeson, and we'll lose another half day redoing the order for them at our cost. I just can't figure it out.


  1. Present task instructions step by step. Check that the employee understands each instruction by getting them to demonstrate what is required. Provide lots of opportunities for practising the task steps.
  2. Make sure any written or visual information is in the language and of the font and point size that best suits the employee's needs.
  3. Use additional support services when they are needed. For example, employees for whom English is a second language may remember the name of an object or follow instructions more easily if they are given in their first language. Use interpreter services or community members to provide information.
  4. Organise the job environment so that the employee has less need to rely on their memory. Try things like:
  1. Acknowledge the employee's difficulty with expressive language and be supportive of it.

I can see you're finding it hard to say what you want; we'll take it slowly.

  1. Use simple workplace checks to work out how well a task will match a particular employee's ability and needs, particularly if they have any perceptual problems. For example:
  1. Prompt the employee to evaluate their own performance on the task.
  2. Avoid being judgemental.
  3. Use active listening:

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