It is now widely acknowledged that the communication difficulties experienced following a traumatic brain injury (TBI) are fundamentally different to those associated with aphasic syndromes and consequently require different types of assessment and interventions (Holland, 1982). Milton and Wertz (1986) highlighted these differences suggesting that ‘Individuals with Aphasia usually communicate better than they talk and TBI patients frequently talk better than they communicate’ (p. 223). The most common injury aetiology of clients attending the Oliver Zangwill Centre for Neuropsychological Rehabilitation is TBI and therefore clients more commonly present with this latter type of cognitive communication impairment, rather than the more specific aphasic syndromes. Working with these clients requires awareness of the interplay between impairments in psycholinguistic processing and other cognitive domains in relation to communication.

The cognitive communication disorders observed in clients at the Oliver Zangwill Centre are typified by:

• Difficulties in language processing – in particular with inferential or metaphorical language.

• Difficulties with discourse – e.g. over inclusion of information, tangential output, irrelevant responses, inability to maintain a topic, difficulty turn taking, increased self-disclosure, reduced initiation.

• Pragmatic difficulties – i.e. adapting language to different environments, and different people, reduced flexibility in adapting language.

• Naming difficulties.

It is common for clients to present as socially isolated, with difficulties in relating to others and maintaining good work or social relationships. This is thought to significantly reduce life satisfaction (Dahlberg et al., 2006).