Using Visual Supports and Alternative Formats to Improve Communication in ABI

December 23, 2025

Visual supports and alternative communication formats are often essential for people with acquired brain injury who experience processing, memory, attention or language difficulties. When information is delivered verbally alone, key messages can be missed, forgotten or misunderstood. Commissioners and inspectors increasingly expect ABI services to adapt communication using accessible, multi-modal approaches that support understanding, participation and informed choice.

This article focuses on the use of visual and alternative communication supports in ABI services. It should be read alongside Communication, Neuro-Accessibility & Support Strategies and Person-Centred Planning & Strengths-Based Support. It also connects to the wider Acquired Brain Injury Services Knowledge Hub, where rehabilitation, safeguarding, community support and workforce practice all depend on communication that is accessible, consistent and person-centred.

After brain injury, people may struggle to process spoken information quickly, retain key details, follow long explanations or understand abstract language. Visual and alternative formats reduce these demands by making information more concrete, structured and easier to revisit. Strong ABI services therefore treat accessible communication as a core quality and safety requirement rather than an optional enhancement.

Why visual supports are effective in ABI

Visual information reduces reliance on memory, processing speed and verbal comprehension, allowing individuals to absorb information at their own pace. Unlike spoken communication, visual prompts can remain available after the conversation has ended, helping the person revisit information when needed.

Visual supports may help with:

Understanding routines and expectations
Reducing anxiety around change
Supporting sequencing and task completion
Improving memory retention
Supporting consent and decision-making
Reducing overload during complex conversations
Increasing independence in daily tasks
Strengthening participation in rehabilitation

Effective use of visual support depends heavily on staff competence and consistency. Providers should therefore connect this work to training staff in neuro-accessible communication for acquired brain injury services, ensuring staff understand how and when visual communication should be used.

Common visual and alternative formats

There is no single “correct” visual support. The most effective format depends on the person’s cognition, literacy, vision, sensory profile, rehabilitation goals and communication preferences.

Common formats include:

Pictorial schedules and planners
Step-by-step task guides
Photographs of people, places or routines
Symbols and icons
Written keywords or bullet points
Colour-coded prompts
Visual choice boards
Memory books or orientation folders
Digital reminders and phone prompts
Simple diagrams explaining processes or risks

The key is clarity and usability. Overly detailed or visually cluttered materials may increase cognitive load rather than reduce it.

Why verbal communication alone may not be enough

Many ABI services unintentionally rely too heavily on spoken communication. Staff may explain something clearly once and assume the person has understood and retained it. However, ABI-related processing difficulties can mean the information is lost almost immediately after the conversation ends.

Verbal-only communication can become particularly unsafe where discussions involve:

Medication changes
Risk management
Appointments and rehabilitation schedules
Financial decisions
Consent and capacity
Safeguarding concerns
Community safety plans

Accessible visual reinforcement helps ensure the person can revisit and process information in their own time rather than relying entirely on immediate memory.

Commissioner and inspector expectations

Expectation 1: Accessible information. Inspectors expect information to be provided in formats people can understand. Providers should evidence that communication adjustments are personalised rather than generic.

Expectation 2: Consistent use. Commissioners expect visual supports to be embedded into daily practice, not used occasionally or only during reviews.

Expectation 3: Dynamic communication support. Communication formats should adapt to fatigue, overload and fluctuating presentation. This links closely to adapting communication for fatigue, sensory overload and fluctuating capacity in ABI, because visual support may become more important during periods of cognitive fatigue.

Operational example 1: Visual daily routines

Context: A person with ABI becomes anxious during transitions between activities and frequently forgets planned appointments, leading to distress and missed rehabilitation sessions.

Support approach: The provider introduces a pictorial daily schedule to improve predictability and reduce reliance on verbal reminders alone.

Day-to-day delivery detail: Staff create a visual planner using photographs, symbols and short written prompts showing the day’s routine. The schedule is reviewed with the person each morning and updated when plans change. Staff use the same visual format consistently across shifts so the information remains familiar and easy to follow.

How effectiveness is evidenced: Missed appointments reduce, anxiety during transitions decreases and the person becomes more independent in preparing for activities. Daily records show fewer repeated reassurance requests and improved engagement.

Supporting processing time and memory retention

Visual communication is particularly valuable where processing speed and memory are affected. Written prompts, diagrams and step-by-step guides allow the person to revisit information after the conversation rather than trying to remember everything immediately.

Visual reinforcement may include:

Appointment reminder cards
Medication charts with symbols
Safety prompts near exits or kitchens
Visual sequencing for personal care routines
Weekly planners using colour coding
Simple rehabilitation goal trackers

These approaches complement supporting processing time and information retention in ABI communication, because visual information reduces pressure on short-term memory and allows slower information processing.

Supporting consent and decision-making

Visual aids can clarify choices, risks and consequences. This is especially important where the person struggles with abstract concepts, long explanations or emotionally charged discussions.

Accessible decision-making support may include:

Pictures showing available options
Simple diagrams explaining treatment choices
Visual comparisons of risks and benefits
Step-by-step explanations of procedures
Written summaries after meetings
Visual prompts showing who to contact for support

The goal is not to oversimplify or direct the decision. The goal is to make information understandable enough for meaningful participation.

Operational example 2: Visual consent tools

Context: A person becomes distressed during discussions about a planned medical procedure because verbal explanations feel confusing and overwhelming.

Support approach: Staff introduce visual consent tools to explain the process more clearly and reduce anxiety.

Day-to-day delivery detail: The provider uses simple diagrams, photographs of the clinic environment and step-by-step images showing what will happen before, during and after the procedure. Staff review the materials slowly over several conversations rather than expecting immediate understanding.

How effectiveness is evidenced: The person asks more informed questions, distress reduces and records show clearer participation in the consent process. Staff can evidence that communication was adjusted to support understanding rather than relying on verbal explanation alone.

Reducing overload through structure and predictability

Visual supports are often most effective when combined with structured communication approaches. Predictable layouts, repeated formats and familiar symbols reduce cognitive demand because the person does not need to decode new communication patterns repeatedly.

Services can strengthen accessibility by linking visual support to structured communication approaches to reduce distress in ABI. For example, staff may use the same colour coding for appointments across planners, handovers and reminder cards, helping the person build familiarity and confidence.

Consistency is especially important where multiple staff or agencies are involved in support.

The role of environment in visual communication

Visual communication tools are less effective if the environment itself is overwhelming. Cluttered noticeboards, excessive signage, noisy spaces or poor lighting can make visual information difficult to process.

Providers should therefore consider how visual supports interact with the surrounding environment. This links closely to creating neuro-accessible environments to support communication in ABI, where environmental design helps reduce cognitive and sensory overload.

For example, a clear visual planner in a calm, uncluttered room may support understanding far better than the same planner placed among multiple competing visual stimuli.

Maintaining relevance over time

Visual supports must be reviewed as needs, goals and rehabilitation progress change. Materials that were helpful during early recovery may later feel restrictive, childish or no longer relevant.

Providers should regularly review:

Whether the person still finds the format useful
Whether information remains accurate
Whether complexity should increase or decrease
Whether goals and routines have changed
Whether sensory or visual needs have altered

Reviews should involve the person wherever possible so communication support remains collaborative rather than imposed.

Operational example 3: Regular review of materials

Context: A rehabilitation provider notices that a person has stopped using previously successful visual prompts. Staff initially assume the person is disengaging.

Support approach: The team reviews the communication materials and recognises that the person’s rehabilitation progress means the original format now feels repetitive and over-simplified.

Day-to-day delivery detail: Staff redesign the materials using shorter prompts, digital reminders and more independent planning tools. The person helps choose preferred colours, layout and wording. Old materials are removed gradually to avoid confusion.

How effectiveness is evidenced: The person re-engages with the communication tools, independence improves and support becomes less staff-led. The provider can evidence that communication adjustments evolve alongside rehabilitation progress.

Evidencing effective use

Providers should evidence:

Use of visual and alternative formats within care plans
Staff understanding of communication supports
Improved understanding and engagement
Reduced communication-related incidents
Visual materials reviewed and updated regularly
Consistency of communication across teams
Improved participation in rehabilitation and decision-making
Reduced anxiety linked to uncertainty or overload

The strongest evidence demonstrates how communication tools improved real outcomes, such as rehabilitation engagement, appointment attendance, emotional regulation, informed consent or increased independence.

Why visual accessibility matters

Accessible communication supports autonomy, safety and meaningful participation after acquired brain injury. Visual and alternative formats reduce reliance on memory, lower cognitive load and help people process information in ways that work for them.

For ABI providers, visual communication should not be viewed as an optional add-on. It is a core neuro-accessibility strategy that supports safer care, better rehabilitation engagement and more person-centred support. When services combine visual accessibility with structured communication, fatigue-aware practice, supportive environments and consistent staff training, communication becomes significantly more effective, predictable and empowering for people living with acquired brain injury.