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Helping a Person with Aphasia Understand Your Words

Fred is red in the face and clearly upset with the waitress. “Listen,” he says with great effort. ”Talk slow. I am stroke…aphasia.” The waitress laughs. “I know, honey. Everyone says I talk too fast. Can’t seem to change it.” And she keeps talking rapidly, asking several questions as once. Fred’s anger increases and his wife steps in. “He’ll have the BLT with fries.” He looks away, angry with everyone, and feeling left out as usual.

Fred’s experience is an everyday occurrence for people with aphasia. Strangers, friends, even family struggle to bridge the communication barriers caused by aphasia. Communication is critical to almost everything we do.  It is used for social interactions, which give us emotional support and validation. Even everyday small talk—comments over the newspaper at breakfast, shared memories—is a way of connecting. Communication is also be used for transactions: making appointments, buying something at the drugstore, talking with a doctor. When a stroke leaves an in individual with aphasia or other communication problems, the losses can be devastating.

Aphasia is an impairment of the ability to understand and/or express language in its many forms. (Read more on aphasia here.) The good news is: there are a number of helpful do’s and don’ts for communicating with someone with aphasia. Here we will discuss ways of helping a person understand better. For information on helping a person with aphasia express themselves, click here.

First, it is important to remember the following key points:

Struggling with communication does not mean the person cannot think or understand the world around them. As one spouse explains, “Mike didn’t get stupid. He just has aphasia.”  Sadly, many people mistake a person’s inability to participate fully in conversations as a sign that they are somehow less of a person. People with aphasia and their closest family can become isolated as friends and others disappear because they are uncomfortable and uninformed.  For everyone in the social network, with appropriate communication techniques, the underlying competence of the individual with aphasia can be revealed

Just as each stroke is different, so is each person’s aphasia. Different parts of the brain govern different skills used in communication, so the area damaged shapes the aphasia.  This fact leads to the first tip for conversation partners.

Begin by simply asking: “What can I do to help? What works for you?” This step is often left out and the best efforts of conversational partners can fail because this question wasn’t asked. Sometimes the person with aphasia can explain, like Fred tried to do in the example at the start of this article. Other times, a family member can best answer these questions best. But always try to start by asking directly what the conversation partner can do.

Do’s and Don’ts for Improving Comprehension

For someone with comprehension problems, the following suggestions about what to do and not do can be helpful.

Do speak slowly. Even if you typically talk rapidly, slow yourself down. It can be done if you focus on how you are talking.

  • Don’t speak louder if the person doesn’t understand. Unless there is a known hearing loss, speaking louder just makes people feel incompetent and unwilling to try.

Do talk more simply and use frequent pauses. Use shorter sentences with simple grammar if needed. Emphasize key words and use more common words. For example, ask “Do you think the dinner will go well?” instead of “Do you anticipate any trouble with the evening event?”

  • Don’t lapse into “baby talk.” (This is particularly common when the stroke survivor is older.) Signs of baby talk include things like: exaggerated intonation patterns, use of cutesty words like “dearie”, frequent repetitions without pausing, and excessive simplification of language.  Baby talk makes the person feel incompetent, and we want to reveal competence.

Do give the person time to process. Sometimes extra time is all that is required to help the person understand and respond.

  • Don’t keep talking if you see a look of confusion on the person’s face. Wait to see what the person (or anyone with the person with aphasia) indicates what is needed next.

Do be willing to repeat what you have said if the person seems to have trouble understanding or asks for a repeat. If you do repeat, you may need to modify your wording or break up what you said into smaller units.

  • Don’t repeat immediately if the person doesn’t respond quickly.  That will simply frustrate and confuse the person trying to process what you said.

Do be sensitive to the environment and the number of speakers. People with aphasia have more trouble understanding when:

  • There is a great deal of background noise
  • There is poor lighting so faces are harder to see (and facial expressions are less obvious)

Don’t ignore the environment or dismiss the needs of the person with aphasia. It is way too easy to think that that one difficult situation won’t hurt anyone.  The problem is, as the stroke survivor is exposed to more and more of these situations, they are likely to withdraw from communication or choose not to be involved at all.

  • Try to find a quieter space or even avoid places with lots of noise
  • Position the person with aphasia so that he or she can see the faces of others well.

Do be sensitive to the communication needs of persons with aphasia in a group with a number of speakers.  Remind everyone how to modify their communication and to avoid overlapping comments. This can be hard but failure to address these needs in group contexts can isolate the person with aphasia

  • Don’t ignore the needs of the person with aphasia because it is easier on others in the group.

Do use a variety of communication supports such as: gestures, writing key words on paper or offering choice of words in print (including printed versions of Yes and No with image like “thumbs up” and “thumbs down”.

  • Don’t assume that there is no way to help the person who has trouble understanding.

By: Barbara B. Shadden, Ph.D., CCC-SLP, BC-ANCDS, University Professor Emeritus, Program in Communication Disorders, University of Arkansas

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"Struggling with communication does not mean the person cannot think or understand the world around them."

More on Aphasia

For more information on understanding an managing aphasia, explore the articles in Stroke-Network.com's Speech & Communication section.

Understanding Aphasia

Everything a stroke survivors needs to know to understand the different types of aphasia, diagnoses and initial treatment strategies. Read more here.

The High Price of Aphasia

For stroke survivors coping with aphasia, the costs can be personal, professional, and financial. Read more here.

Tools for Improving Communication

Four easy tools that help stroke survivors improve communication and comprehension. Read the complete article here.

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