Aphasia is an acquired communication disorder that impairs a person’s ability to process language, but does not affect intelligence. Aphasia impairs the ability to speak and understand others, and most people with aphasia experience difficulty reading and writing. The diagnosis of aphasia does NOT imply a person has a mental illness or impairment in intelligence.
The most common cause of aphasia is stroke (about 25-40% of stroke survivors acquire aphasia). It can also result from head injury, brain tumor or other neurological causes.
The impact of aphasia on relationships may be profound, or only slight. No two people with aphasia are alike with respect to severity, former speech and language skills, or personality. But in all cases it is essential for the person to communicate as successfully as possible from the very beginning of the recovery process.
Below are some suggestions to help communicate with a person with aphasia.
Make sure you have the person’s attention before you start.
Minimize or eliminate background noise (TV, radio, other people).
Keep your own voice at a normal level, unless the person has indicated otherwise.
Keep communication simple, but adult. Simplify your own sentence structure and reduce your rate of speech. Emphasize key words. Don’t “talk down” to the person with aphasia.
Give them time to speak. Resist the urge to finish sentences or offer words.
Communicate with drawings, gestures, writing and facial expressions in addition to speech.
Confirm that you are communicating successfully with “yes” and “no” questions.
Praise all attempts to speak and downplay any errors. Avoid insisting that that each word be produced perfectly.
Engage in normal activities whenever possible. Do not shield people with aphasia from family or ignore them in a group conversation. Rather, try to involve them in family decision-making as much as possible. Keep them informed of events but avoid burdening them with day to day details.
Encourage independence and avoid being overprotective.
There are more ways you as an individual can help such as:
Pause and Listen
Conversations with someone with aphasia may take more time. It helps to go into the conversation knowing that you need to be patient, utilize pauses, and wait. The more you clearly convey that the other person should take their time, the better they’ll be able to communicate. Stress increases communication difficulties, so make sure you are sending clear signals with your body language that you are patient.
Keep it Quiet
We all hear best when people speak to us at a normal volume rather than shouting, and when we hold conversations with minimal distractions. This fact is even more important when it comes to aphasia-friendly communication. Whenever possible, go somewhere quiet to speak, where you can see each other face-to-face.
Keep it Simple
Keeping it simple doesn’t mean infantilizing the person. It means thinking through what you need to say, removing the unnecessary parts of the story or questions, and getting to the heart of the matter. Keeping sentences brief provides more moments to pause and ensure that both people are following the conversation.
Verify
You verify understanding in conversations without thinking, but aphasia-friendly communication asks that you do this consciously. Make sure that you understand what the other person is saying by repeating it or letting them know what you heard. Additionally, ask the person with aphasia to repeat back and verify they understood what you were saying. This “double-check” system makes for clear communication.
Don’t Pretend
You would never nod at your boss and pretend to understand the task she was asking you to do if your job was on the line. Approach aphasia-friendly communication in the same way. Do not pretend that you understand what the other person is saying if you really don’t. Help the person by conveying that you want to understand, you have time to wait as they work on the message, and you have the flexibility to get creative with communication. It is much more rewarding for both people if everyone walks away from the conversation understanding each other.
Speak Directly to the Person
We instinctively know that we should always go to the source of the information when we have a question, but we sometimes forget that when a person has aphasia. Loop people with aphasia into the conversation by speaking to them directly instead of setting up moments where someone is speaking for them.
Ask If They Want Help
Adults with aphasia are adults, first and foremost. They have thoughts they want to convey and opinions they want to express. There will be times when they are having difficulty remembering or saying a word, and your first instinct may be to jump in and help. But it’s more helpful to wait to see if they can do it without aid and to ask if they want help if you sense frustration.
Ask Yes/No Questions
When we’re in a hurry, we instinctively start to phrase questions so people can give “yes” or “no” (as opposed to open-ended answers). For example, we’re more likely to ask: “Can you complete this by noon?” instead of “When can you complete this?” Again, take this communication method that you already do and apply it when possible to make questions aphasia-friendly. While some questions require a longer response, others allow the person to give a head nod or thumbs up motion in order to make their feelings known.
Take Breaks
When you see someone yawn, you know that it’s time to wrap up the conversation. Take this communication tip you already do and remember that people with aphasia often experience fatigue. It can be exhausting to have conversations when you have a communication disorder. Provide rest periods, and try to hold more complicated conversations while the person has energy.
Use This Acrostic
Aphasia-friendly communication can be summed up with this acrostic for the word aphasia:
A: ask simple, direct questions
P: provide multiple communication options
H: help communicate if asked
A: acknowledge frustration
S: speak slowly and clearly
I: if you don’t understand, say so
A: allow extra time
This is definitely the key area for me and I deal with it daily.
There is a lot more on Aphasia at the National Aphasia Association which is located at https://www.aphasia.org/aphasia-definitions/ if you care to learn more.
Next I will talk about horses and the effect they can have with someone who has had a stroke.