Communication tips

The most important part of learning to communicate with someone with aphasia is to stay patient. It’s also sometimes the hardest thing to do!

The first step is to acknowledge and accept that communication has changed – not just for the person with aphasia, but for you and other communication partners. It will take time to learn a new way to communicate, and it may be frustrating at times. Even when you can communicate successfully, it may be slower and look different than it used to.

Even when communication is hard, being patient also means being persistent. One method to try is the PURE method:

P: Positive Intent (“I know you’re trying to tell me something, and I really want to know what it is”).
U: Unsuccessful (“I’m having trouble understanding you right now.”)
R: Reasonable Alternative (“Can you point to it? Can you show me a picture? Would you like me to guess?”)
E: Example (“We got it! Next time, you can point to the kitchen to let me know we’re talking about dinner.”)

This method can be helpful when there is communication difficulty. It keeps the interaction positive and moving toward a solution, rather than giving up or simply getting frustrated. Although you might not be successful every single time, it demonstrates patience and persistence. Sometimes the best thing you can do is let the person with aphasia know that you care about what they have to say.

One strategy that can be simple and very helpful when communicating with someone with aphasia is eliminating distractions. Creating the best possible communication environment can make communication much more successful.

A quick survey of your area can go a long way. Before starting a conversation, check out your surroundings and see how you can help set the stage for a successful conversation.

sing yes or no questions can be a very easy way to help you communicate with a person with aphasia. These questions are often easier for the person to understand. They also don’t require the person to produce a new word to answer.

You can use yes or no questions in many situations:

• Offering options: “Do you want to watch TV?”
• Confirming understanding: “I think you mean you want to go outside. Is that right?”
• Clarifying intent: “I heard you say Sarah. Do you want me to call Sarah?”

This can seem easy, but there are a few things to remember:

• Stick to one thought per question. In everyday speech, we often ask things like, “Do you want to go to the movies, or should we eat lunch first?” This combination of questions can be confusing to the person with aphasia. Their answer can also be confusing to you. If they answer “yes,” you still aren’t sure which option they prefer.
• Use visual aids. Some people with aphasia can have difficulty with yes/no . Although they know which response they mean, the wrong word might come out. It can help to use a gesture or picture to accompany the response. This can include a thumbs up/down, a head nod, or an image of a happy/sad face.
• Don’t rely only on yes/no questions. These questions can be very helpful to confirm information and gain understanding, but it is also a very limited way to communicate. Encourage the person with aphasia to engage in more communication than just yes/no to have more meaningful interactions.

Gestures are a great strategy to support communication with a person with aphasia. They don’t require any special equipment or training, they are free, and they are always available.

Both the person with aphasia and the caregiver or communication partner can use them to improve communication. Best of all, there are many common gestures that you already know – no need to learn a special system! This means that other communication partners and community members will also be able to use these common gestures.

• Mimicking common actions – think of this as playing charades. This can be used for many actions! Common actions that are easy to act out include eating, drinking, making a phone call, sleeping, driving, and brushing teeth, among many others.
• An extended, flat hand to mean “stop” – this can be used by the either the person with aphasia or the communication partner. This can mean they are not understanding something that the other is saying, or they want patience.

These examples are just a starting point. You can use additional gestures that are familiar, as well as create new ones if needed. You can continue to speak verbally while you use gestures to help the person with aphasia pair the gesture with its meaning.

Visual aids can be a helpful tool for people with aphasia to communicate. People with aphasia can have a hard time reading and writing as well as speaking. Because of this, written text doesn’t always help. However, most people with aphasia can recognize and use pictures or other visual aids.

Even if your loved one with aphasia can speak and understand spoken language, visual aids can help reinforce a message. It can also be a resource when the person has a hard time finding words. When the communication partner is speaking, a picture or other visual aid can help the person with aphasia understand. It also helps the brain connect the picture with the spoken words.

For people who have more severe impairments, pictures and other visual aids can take the place of speech when needed. Relying on visual aids can reduce the pressure to speak. As the communication partner, you can still provide the word for the picture once the person with aphasia has selected it.

Thanks to technology, it’s never been easier to use pictures and other visual aids. If you have a smartphone, then you always have access to many visuals that will be helpful. At any time, you can do a web search to find an image that will support communication. If you prefer, you can also print commonly used pictures and visuals. These can be kept at home, in the car, in a purse/backpack, or in a “communication book” that can be brought into the community.

Here are some tips for using visual aids to communicate with someone who has aphasia:

• Personally relevant is always best. If you can, use a picture of the person’s actual belongings rather than general images found on the internet.
• Use visuals and speech together. Say the name of each picture as you point to it. The combination of verbal speech and an image help the brain to connect the words to the image. For instance, visual aids can be useful when presenting choices. You can say, “Do you want to go play golf (point to picture of golfing) or watch football (point to a picture of a football game)?”
• Use visuals to represent key points or topics. For instance, you might have just gotten some news about your niece’s upcoming wedding that you want to share with your loved one with aphasia. Be prepared with a picture of your niece and a wedding scene in order to establish a context and keep the conversation on track.

Visual aids can be helpful for people with any type of aphasia, from mild to severe. Because images are easy to find and use, they are a convenient tool to incorporate into your conversations.

Drawing can be a very helpful tool for both the person with aphasia and their communication partner. Someone with aphasia is often able to draw an idea or item even when they cannot think of the word. At the same time, drawings can be easier for a person with aphasia to understand than speech or written language.

• Don’t be shy. Many of us feel like we are not artists, but even simple stick figures and line drawings will be helpful. It’s okay to laugh at your drawings as well – have fun!
• Be prepared to suggest drawing. If they are trying to communicate something verbally but you aren’t understanding them, it’s okay to say, “Will you try drawing it?”
• Use verbal speech to go with your drawings. For instance, draw a picture of a football and hold it up while saying, “We are going to the football game today.”

Drawing is a quick and easy way for both someone with aphasia and their communication partners to improve communication. Don’t be afraid to have fun while using this technique!

As technology advances, people with aphasia and their loved ones have more options than ever to help them communicate. One resource that many people find helpful are apps. There are a variety of aphasia apps that can be helpful. Some are created specifically for people with aphasia. Others are more general apps that just happen to be useful for people with aphasia.

Some apps may be too complex for someone with aphasia. It’s always best to see if there is a demo or “lite” version of an app before deciding to purchase it.

Here are some apps and technologies that help people with aphasia communicate:

• Text-to-speech apps: For people who are better able to write than speak, a text-to-speech app can help in many social and community situations. Enter the text, and the app will speak it aloud for you. Many apps also offer word prediction, making typing easier. Some will also read any text aloud. This includes short messages or entire webpages. Many apps are available for $5 and under.
• Speech-to-text apps: For people who have some intact verbal speech but have a hard time with written language. These apps can convert spoken language into written words, which can be very helpful for sending texts and e-mails. Many smartphones can already do this.
• Communication apps: There is a wide range of apps designed to help people with aphasia and other communication impairments. They range from free to very expensive. Consider using one of Lingraphica’s free apps, SmallTalk. This family of apps has pictures and vocabulary related to different themes. The person with aphasia just needs to touch a picture, and the app will speak a word or phrase out loud. Great for casual conversation, communicating with medical professionals, and day-to-day community activities.
• Whiteboard apps: There are many apps available that will turn your smartphone or tablet screen into a whiteboard. This allows the person with aphasia and their communication partners to easily draw or write key words as part of a conversation. An easy way to improve communication that you can always have in your pocket!
• Texting and e-mailing: Be sure to use plenty of emojis and pictures when communicating via text or e-mail. With all the emojis currently available, you can often create a whole message with emojis! If the person with aphasia understands spoken language but has trouble reading, you can send voice recordings or videos.
• Social media: Because many people use pictures on social media, it can be a great way for people with aphasia to connect with family and friends. Apps like Instagram focus on pictures as communication, which is ideal for many people with aphasia. In addition to keeping in touch, social media has many resources for people with aphasia.

If there is a gap between what someone wants to say and what they are able to say, an augmentative and alternative communication (AAC) device might be helpful.

An AAC device, also known as a speech-generating device (SGD) is a tablet or computer that helps people communicate. They use a combination of pictures, written words, and spoken language. Most are customizable to focus on what is most important for the person using the device.

If someone you know uses an AAC device, here are some tips for communicating with them:

• Be patient! Allow them plenty of time to create a message. It can take a long time to find the appropriate icon or icons.
• Ask for information. If you’re not sure if they are trying to communicate something, ask. It’s okay to say, “Are you working on a message?”
• Check in frequently. In group conversations, it can be helpful to ask the AAC user if they have anything to add before changing topics. It can be very frustrating for the AAC user when they have something to say, but the topic changes before they have a chance to add their message.
• Handle the little things with the device. As a communication partner, you can help the AAC user with things like charging the device, turning it on, and adjusting the volume. This helps ensure that the device is ready to be used.
• It’s okay to ask if the user needs assistance. If they have been looking at their device for a while, you can ask, “Do you need help finding something?” Many times, the communication partner can help navigate to an appropriate page that will allow the AAC user to make a selection.

When communicating with someone with aphasia, sometimes what you don’t do is just as important as what you do. Despite good intentions, sometimes our first attempts are not always the best. Even though we want to improve our communication, it can be hard to know where to start.

Here are some things not to do when communicating with a person with aphasia:

• Don’t repeat yourself in a louder voice. It’s important to speak clearly, but if the person with aphasia did not understand you, saying it again louder will not help. Try rephrasing, using visuals, and making your language simpler.
• Don’t discount the person’s intelligence. Remember that aphasia is a language impairment, not a cognitive impairment. People with aphasia can think logically and make decisions.
• Don’t talk for or over the person with aphasia. It might be tempting to finish their sentences, but that can be frustrating for the person with aphasia. Instead, be patient and allow plenty of time for them to speak. Encourage others (such as family members, doctors, community members) to speak directly to the person with aphasia. Don’t speak on their behalf unless they ask you to. If you sense that the person might be getting frustrated and need help, you can ask “Do you want me to talk to the doctor?” Get their permission before you communicate for them.
• Don’t lose sight of who they are. Aphasia is a big life change, but they are still the same person underneath the new struggle. Focus on communicating about hobbies, family jokes, and things that show their personality.
• Don’t give up on communication. When communication is difficult, it can be tempting for both the person with aphasia and the communication partner to say “forget it.” It’s important to be persistent and let the person with aphasia know that you care about what they have to say. Tell them you want to keep working to figure it out.

Conversational coaching for aphasia is a partner approach to aphasia treatment. Partner approaches require an involved family member or other communication partner. The person with aphasia and communication partner work together to improve communication. It is both people’s responsibility to use the techniques. Conversational coaching is a great tool for people who want to support their loved ones with aphasia.

In conversational coaching, the speech-language pathologist (SLP) acts as a coach. The SLP teaches the person with aphasia and their communication partner strategies to improve communication.

The SLP, person with aphasia, and communication partner work together to select the strategies that work best for them. They then practice these strategies in conversation. While they communicate, the SLP observes and provides guidance and feedback. The SLP might give a specific task, like sharing information about a video clip.

Conversational coaching can be used for people with many types of aphasia. It is also appropriate for people with aphasia at any severity level. Conversational coaching is a functional tool that can be incorporated into everyday conversation. Once the strategies are learned, it can become habit.

Multiple communication partners can be trained in the strategies. The more people that support the person with aphasia, the more their communication can improve. To be successful, this technique requires at least one committed communication partner.