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Issues Related to the Communication Environment

As is true for many people with functional limitations, a survivor with limited stamina or fatigue may need extra time or multiple means of communication. Exhaustion can diminish concentration. Duplicating information and allowing extra time can minimize limitations.

Survivors with limited stamina may have difficulty keeping appointments. Unable to anticipate fluctuations in energy levels from day to day, it becomes difficult to plan future events with any conviction that they will complete the plan. Flexibility and accommodations in scheduling may be necessary.

Likewise, survivors may not be able to sustain themselves through a lengthy meeting and may require scheduling of additional times.

Examples of Problems

  • A provider shows impatience when it takes a survivor a long time to explain her situation. It also takes her a long time to react to the questions asked of her. 
  • A provider talks quickly and when the survivor is quiet between statements, the provider prematurely jumps in. The survivor doesn’t feel she can ask for more time. She processes information slowly in order to adapt to the fatigue she often experiences.

Suggested Solutions


  • Listening and providing reassurance will help the survivor to recognize the validity of her own experiences. Trusting her to know and express her limitations can be of enormous value to a person who knows that others may not understand the struggle she has simply trying to think.
  • If a person has persistent fatigue, accessing aspects of her memory becomes difficult. If trying to figure out the order of events is difficult, Jane Doe, Inc. recommends using cues to help determine the order of events – find out her daily routines, sunlight patterns, TV patterns, internet habits, cooking patterns, that have times of day associated with them. These may trigger her memory for when certain things occurred.
  • To prevent working memory overload when giving verbal instructions, ensure that the survivor has a quiet location to receive them.  Below are some suggestions for providing verbal instructions:
  1. Provide one instruction at a time. Do not move on until it is clear that the instruction is learned and understood.
  2. If the instruction is something that can be demonstrated, then demonstrate and have the survivor demonstrate back to you her understanding. Confirm that she understands.
  3. If the instruction is something that cannot be demonstrated, then both speak it and write it. If it is already written, have the survivor tell you what she understands has to be done. Writing it herself may help her to remember it. Confirm that she understands.
  4. Allow someone to take a break to deal with frustration.
  5. Allow a person more time, even additional meeting time on another day, if necessary.
  6. Use rehearsal or role-play strategies.
  7. Mnemonics or rhymes or images might be used to create associations with an instruction to assist memory.
  8. Consider tape recording important instructions, so that the survivor can play back and review them.