Being kind to our neighbors with neurological communication disorders
Broken limbs get all the glory. I know this, I had my humerus broken in half in a horse wreck in my early 30s. Broken limbs are visible; relatable; and they typically have a finite healing timeline. Now move along the spectrum to someone with a neurological physical impairment, such as a hemiparesis - when one half of the body has weakness or paralysis. It’s still visible but gets to be harder to relate. When you have a broken limb, it’s a temporary need to adapt to not using that limb. Conversely, many neurological physical injuries are long-term and have lasting effects on a person’s everyday activities and opportunities. Now move along to the more invisible conditions: neurological injuries affecting speech, language, cognition, visual processing, and so on. Living with these conditions becomes much harder to relate to and understand. Cue the assumptions and the isolation that comes with these.
Consider the following scenarios: Details are de-identified but they are all real situations.
A young stroke survivor with damage to the speech planning centers was left with imprecise speech. There are no other deficits from the stroke. As they have gradually increased their courage to expand their circle of who they will expose their speech pattern to (such as those unfamiliar with their medical situation), they find that it is common that other impairments are assumed and people speak to them like a small child. Or, hearing impairment is assumed and others speak extremely loudly. These negative experiences reinforce avoiding communication, and increase sense of loss.
The same person above was at a restaurant with their family and tried to order a beer. They were denied in a very rude manner, because it was assumed they were intoxicated.
A person with progressive loss of speech and language due to a brain disease was previously in a high-powered, illustrious career, where their success and impact defined them. They have already self-restricted during gatherings and out in the community because of how demoralizing the disease has been. On the occasions that they do join in conversation or initiate communicating, others try to finish their sentences and thoughts (often incorrectly) or inadvertently leave them out because the person’s obvious struggle makes others uncomfortable. They report that the speech therapist is the only person in their life who gives them enough time to express themselves and they feel tremendously isolated.
A high-profile person in the community who exposes themselves in public speaking situations is ridiculed on public forums for sounding stoned or without credibility. The person is extremely competent but suffered neurological injury that affected the melody and rate of speech.
A professional with a doctoral degree returns to work after receiving chemotherapy with neurotoxic side effects, impacting subtle aspects of cognitive-language functioning. They are still able to process high-density information in meetings but need the opportunity to use accommodations to keep up with the pace. They are afraid to use some of these because of the cutthroat culture in the “subtext” and risking damage to their professional reputation during recovery.
A young adult recovering from a mild traumatic brain injury looks OK, is back at work, and adulting without help from others. However, the cost of keeping everything together is extremely taxing, requires everything that used to be automatic to now be conscious, and they are experiencing despair about their life ever feeling normal again. Others, even those close to them, can’t relate and say things like “but you seem fine”. Others don’t understand the lack of bandwidth and there is subtle dismissal of their experience. The person begins to doubt their own experience and wonder if they are being dramatic or weak.
The examples could go on and on. In almost all of the examples, no one intends to be hurtful or ignorant. I would say that they are all situations where there is a mismatch between intention and impact. However, there are ways that we can maximize responsibility for our impact. Neurological injury or disease can strike anyone at any time; wouldn’t it be beautiful if we knew that if we ourselves were dealt these cards, that the community would make it easier, not harder, to live with invisible but very real losses of speech, language, or cognition?
Assumptions are so problematic in any arena, but hugely impactful in the case of neurological disability. In the above examples, there are factual assumptions about what someone can do: Conclusions about someone’s capabilities based upon a single observation(speech patterns, using accommodations, pausing, the person’s appearance). More concerningly, there are also assumptions embedded in society about what abilities make someone worthy. Neurological communication disorders affect people differently; sometimes speech, sometimes language, sometimes cognition, or a combination of these. But that does not change the fact that worth and dignity are not graded on any of these abilities. I suspect this is why we all fear losing an ability - that we will be constantly subject to the silent judging of our worthiness, based on the loss of an ability we cannot control. When respect is tied to an ability, a system is created where someone’s belonging is conditional. How much easier would it be to live with the cards life deals to us if we had unshakeable belief that respect and dignity were unconditional in one another’s hearts and in societal messaging?
This principle holds even when neurological change affects personality or judgment in visible ways. In some neurological diseases, such as frontotemporal dementia and certain subtypes of Alzheimer’s disease, frontal lobe involvement may impact social behavior, decision-making, and emotional regulation. These changes are extremely hard on family members. Even amidst them, moments of connection still break through: a person may light up on the dance floor when familiar music plays, or express care through small acts that have always mattered in their relationships. The disease may profoundly change how someone interacts with the world, but it does not erase their humanity or need for connection. Loss of ability does not negate a person’s right to dignity, compassion, and participation. Many of us will love someone who goes through changes like these, or experience them ourselves.
What can we do to be truly kind to our neighbors living with neurological communication disorders? This list isn’t exhaustive, but a few places to start:
Never assume competence based on how someone sounds.
Speech clarity, word-finding, or processing speed are not measures of intelligence, character, or worth. If you’re unsure what someone meant, ask for clarification.
Give time, not rescue.
Silence in conversation can feel uncomfortable, but rushing to finish someone’s sentence usually serves our discomfort, not their needs. A few extra seconds of patience can preserve a person’s autonomy and dignity. One of the greatest gifts we can give someone is space to communicate, as well as welcoming their communication just the way it is.
Follow their lead.
If someone uses a strategy (writing, typing, gestures, notes), treat it as normal. Adapt with them rather than spotlighting the difference.
Respond to the message, not the delivery.
Focus on what the person is trying to say. Communication is a shared responsibility; the burden is not just on the speaker or the listener.
When in doubt, ask respectfully.
A simple “How can I make this conversation easier?” can open the door to collaboration instead of guesswork. Convey warmth and interest through body language.
Never assume that what you’re hearing or seeing tells you who someone is. Neurological communication differences change the surface of interaction, not the depth of the person underneath.
Most of us will interact with someone with a neurological communication disorder at some point in our lives. Some of us will become that person. The culture we build around communication today is the culture we may one day rely on ourselves. We don’t need to know everything about someone’s medical situation or be an expert in communication disorders. We need small, meaningful acts of patience and curiosity: They make conversations kinder, public spaces safer, and communities more humane. 🧠🫶🏻