Aphasia is the name given to difficulties with spoken language, understanding, reading and writing.
It occurs when the communication centres of the brain are damaged, most commonly after a brain injury, stroke or if there has been a lack of oxygen to the brain.
Common features include difficulties with:
- Knowing what you want to say, but being unable to say it
- Finding the correct words
- Naming people, places and things
- Using the wrong word or making up words
- Putting the words in the right order in a sentence
- Some people mask their difficulties very well so that they appear to understand. They may, however, be picking up clues like body language, and tone of voice, and not always understanding what the other person is saying
- Writing words or sentences
Is everyone the same?
No. Some people have difficulties with just one aspect of language, e.g. expressing themselves. Others have a combination of difficulties. Each person will react differently.
What will the Speech and Language Therapist do?
The Speech and Language Therapist will assess all aspects of communication and determine the type and extent of any problems the person with aphasia has with their communication
Possible goals of treatment:
- Restoring language abilities as much as possible
- Improving communication by using remaining strengths
- Compensating for language problems by using other methods of communication, e.g. writing, gesturing, communication boards, picture charts, etc.
- Learning strategies to make communication easier
- Teaching caregivers and family members strategies to improve communication with the person with aphasia
It is said that a communication problem cannot occur in isolation as it is always a two-way process.
Therefore, the listener's patience and positive encouragement are crucial to reduce frustration and achieve communicative success.
How to help with understanding:
- Ensure your surroundings are quiet and free of distractions
- Ensure you have the person's full attention
- Simplify your language by using short, uncomplicated sentences
- Present one idea at a time
- Don't change topic suddenly or without warning
- Be prepared to repeat what you have said or rephrase it more simply
- Use gesture, pointing and facial expression to get your meaning across
- Write down key words
- Use pictures and photos to illustrate what you mean
- Allow extra time to process what you have said
- Speak naturally
- Don't pretend to understand. Let the speaker know if you haven't understood what they have said
- Involve the person with aphasia in conversations
- Don't be discouraged - keep talking!
How to help with expression:
- Allow the speaker plenty of time to formulate what they want to say
- Encourage any means of communication to convey the message, e.g. gesturing, pointing, facial expression, drawing, writing, vocalisation, thumbs up, head nod/shake
- Compile communication books with pictures, photos, a few written words (e.g. family names) which can be pointed to
- Ask questions which can be answered with 'yes/no'
- If you can predict the word sought, offer the initial sound or a 'run-up' clue e.g. chair - 'you sit on a ch…'
- Give them choices - 'do you mean...?' e.g. orange or banana?
- Write down key words
- If you understand part of the sentence, repeat it back to act as a prompt e.g. 'I want to go to…'
- Encourage the person to give you as much information about the word they are thinking of. It may be useful to ask specific questions to help the person tell you more:
- What do you use it for?
- Where do you find it?
- What does it look like?
- What does it feel like?
- Conversations about the 'here and now' are easier than long descriptions or abstract ideas
- Give positive feedback if you have understood what is being communicated e.g. 'I can see by the look on your face that you don't like that!'; 'That smile tells me all I need to know!'
- Accept alternative words or descriptions to keep a conversation going. Try not to keep correcting if you know what is meant
- Check your understanding - 'You were saying that the doctor came today … is that right?'
- Be tactfully honest if you have not understood.
Not all techniques will work for everybody.
Be cautious not to try too many techniques at once as this may lead to an overload of information.
Alternatives to Conversation:
It is important to maintain social contact when communication is difficult. Opportunities for conversation and the motivation to interact can quickly reduce. Remember that communication is tiring and concentration may be affected, so keep activities short and enjoyable.
- Listen to the radio, music, audio books, or watch television - then encourage comments and opinions
- Try simple turn-taking games that do not rely on language skills, e.g. Connect 4, Ludo, Draughts, Dominoes, simple card games, noughts and crosses
- Find jigsaws with an adult theme but few pieces to complete together
- Offer to read to them - a newspaper, a letter from a friend, a chapter in a book
- Find adult-orientated art activities such as painting-by-numbers or sketch books
- If spelling is difficult, try unscrambling anagrams of Scrabble tiles/plates, doing word-searches, simple cross-words or hang-man
- Find books, magazines or websites that are mostly pictures to enjoy looking at together rather than reading. Try gardening catalogues, sports photo books, 'Hello' or 'OK' magazines, holiday brochures, natural history information and social media
- If possible, go outside or to the hospital cafe and discuss the people, places and things that you see
- Do not be afraid of simply spending time together e.g. watching TV, holding hands or watching the world go by