language difficulties

I recently did an initial assessment on a patient who had had a recent head injury and was now getting rehab. This man was of Ethiopian descent but had lived in Australia for quite a few years. During my assessment I found it quite hard to get the patient to follow my commands. Even simple activites like shrugging the shoulders we difficult despite demonstration. At first I thought that there might be some problems with his understanding of english so therefore proceeded with alot of demonstration and simple instructions but there were still difficulties. This man also performed quitepoorly on pronation/supination testing which got me thinking that his issue may be more dyspraxia/dysphasia in nature. This was later backed up by his notes which said that he used to speak mostly english at home wih his family and was quite fluent. I have been continually treating this patient and have ad to be very careful with what I ask him to do, how I ask him and the time I give him to respond. This is the first patient I have had to treat with such high levels of cognitive disability and it has been qute a challenge. No matter how much you learn in uni, it is not until you actually come across a patient that you can truely learn how to deal with them. I feel that I have improved my communicaiton with him and can now get more effective treatments done. It is all about slowing down, having simple demonstrations as well as getting our hands on to guide them into the right postion more and trying different directions if the first way is not working. SOmetimes no matter how much you slow your talking, it just isnt going to get across to them, try another way.