Effective Communication Strategies For Post-Stroke Aphasia

A stroke occurs when the supply of oxygen-rich blood to the brain is interrupted. When brain cells are deprived of oxygen, they start to sustain damage, and swift treatment is required to preserve brain tissue. Speech and communication problems are common after a stroke, with about one in three survivors experiencing difficulties. A stroke survivor may have trouble producing or comprehending language, a condition known as aphasia. They may also experience dysarthria, a motor speech disorder that causes difficulty controlling the muscles used for speech, resulting in slurred or slow speech. Another possible disorder is apraxia, which causes difficulty coordinating the oral muscles to form words, leading to inconsistent and unpredictable errors in speech.

While communication problems after a stroke can be challenging, there are strategies that can help. Here are some tips for communicating with a stroke survivor who is experiencing speech difficulties:

1. Use alternative communication methods such as writing pads, cue cards, pictures, or gestures, or communication boards with symbols and images.

2. Speak clearly and slowly, and avoid shouting as it may cause confusion or come across as condescending.

3. Minimize distractions and try to have conversations in a quiet place without background noise.

4. Ask yes or no questions based on their likes, dislikes, and preferences to help determine their needs and preferences.

5. Pay attention to facial expressions and eye movements, as they can provide clues about how the person is feeling or what they are trying to express.

6. Be patient and supportive, as the recovery process can be frustrating and exhausting for the survivor.

Use a communication board with symbols and pictures

Communication boards are a simple yet effective tool to help stroke patients communicate with others, especially during the early stages of recovery. These boards display symbols and images that the stroke survivor can point to in order to express their needs, feelings, or answer simple questions.

Communication boards typically feature basic answers such as "yes" and "no", as well as images of daily activities, conversational phrases, and expressions related to pain or discomfort. For instance, the Vidatak EZ Board, a highly-rated patient communication board on Amazon, features a range of options that the user can point to. This board has proven to be extremely useful in healthcare facilities and for patients in the hospital or rehabilitation centres.

You can also create your own communication board with symbols and pictures. Start by assessing the patient's needs and the topics they are likely to want to discuss. For example, you may include pictures or symbols related to daily routines, favourite activities, food and drink preferences, common locations, and a range of emotions. It is important to keep the board simple and organised, avoiding clutter, to ensure the patient can easily find what they need.

In addition to the communication board, you can also utilise picture dictionaries, which serve as visual dictionaries with icons and photos to complete essential phrases. "Pointing Pictures" is a reference book designed for individuals with communication disorders, recommended by the National Aphasia Association. Similarly, the ICOON wordless picture dictionary is another valuable resource, initially created to aid travellers in foreign countries. These picture dictionaries can be extremely helpful for individuals with aphasia, allowing them to communicate their needs effectively.

Ask yes/no questions

Asking yes/no questions is a great way to communicate with a stroke victim who can't speak. Here are some tips to keep in mind when using this method:

• Base your questions on what you know about the person's likes, dislikes, and personal preferences. For example, if you know they usually watch a particular show at a certain time, ask, "Do you want me to put the TV on now?"
• Use yes/no questions to find out their preferences for meals, if they are in pain, or if something in the environment is bothering them. For instance, if there's too much sunlight in the room, ask, "Do you want the curtains closed?"
• If the person is unable to speak verbally, they may still be able to respond using non-verbal cues. Pay attention to their facial expressions and eye movements, which can provide clues about how they're feeling or what they're trying to express.
• Minimize distractions when asking yes/no questions to create a calm and focused environment for communication.
• Be patient and don't rush the person. Communication after a stroke can be exhausting, so give them time to respond and take breaks if needed.
• Combine yes/no questions with other communication tools, such as communication boards or gesture systems, to enhance their expressive abilities.
• Remember that the person's intelligence remains intact even if they can't verbalize their thoughts. Avoid "dumbing down" your conversations and continue to engage them in meaningful and stimulating topics.
• Speak clearly and at a normal volume. Avoid shouting or using baby talk, as this can be condescending.

Minimise distractions

Minimising distractions is key to communicating with a stroke victim who can't speak. This is because attempting to communicate non-verbally can be frustrating for a stroke survivor if there are too many distractions, such as a loud TV, in the immediate environment.

To reduce distractions, you can:

• Turn off the TV or radio.
• Stay out of noisy areas.
• Choose a quiet place to talk.
• Ensure only one person speaks at a time.
• Avoid speaking loudly, as this may cause confusion or come off as condescending.

By minimising distractions, you can create a calm and focused environment that facilitates non-verbal communication and helps reduce frustration for the stroke survivor.

Pay attention to facial expressions

Paying Attention to Facial Expressions

If your loved one doesn't have facial paralysis due to the stroke, watch their expressions as you speak to them. Some stroke survivors can move their mouths in response to what they're hearing. Their eyes can also give clues about how they're feeling or what they're trying to express.

The ability to observe and interpret facial expressions is a powerful tool for communicating with a stroke victim who has lost their ability to speak. By paying close attention to their facial movements and eye gestures, you can gain valuable insights into their thoughts and emotions. This becomes especially important when the stroke survivor is unable to communicate verbally or through writing.

• Be observant: Focus on the stroke survivor's face during your interactions. Look for any subtle movements or changes in their facial muscles and eyes. These can be indicators of their emotional state or attempts to convey a message.
• Ask open-ended questions: Encourage the stroke survivor to respond through facial expressions by asking open-ended questions. For example, you could ask, "How are you feeling today?" or "Are you comfortable?" Their facial expressions may provide clues about their well-being or any discomfort they might be experiencing.
• Use facial expressions yourself: Utilize your own facial expressions to convey emotions and sentiments. For instance, a smile and a nod can indicate agreement or encouragement, while a concerned look can show empathy and a willingness to listen.
• Pay attention to eye movements: The eyes can be incredibly expressive, even when the stroke survivor's ability to move their mouth is limited. Observe their gaze, eye contact, and any changes in their eye movements, as these can provide important non-verbal cues.
• Be patient and attentive: Communicating through facial expressions can be tiring for the stroke survivor. Give them time to respond and be patient if their expressions are subtle. Maintain a calm and attentive demeanor to ensure you don't miss any important non-verbal signals.
• Combine with other communication methods: Facial expressions are just one aspect of non-verbal communication. Combine your observation of facial expressions with other methods, such as yes/no questions, gestures, or the use of communication boards, to create a more comprehensive means of interaction.

By incorporating these strategies, you can enhance your ability to understand and connect with a stroke victim who cannot speak. Remember that every individual is unique, so adapt your approach based on their specific needs and the progress they make during their recovery journey.

Use speech-generating devices

Speech-generating devices (SGDs) are medical devices designed to improve the quality of life for individuals with severe speech impairments. SGDs are often tablet-like units, but they are distinct from mobile apps in that they are tailored to meet the unique needs of stroke victims and individuals with communication disorders. These devices enable users to communicate their thoughts through electronic voice generation.

SGDs can be highly beneficial for stroke survivors with aphasia, enabling them to socialise and interact with caregivers. They can be particularly useful when an individual has lost the ability to project their voice, as they can be adjusted to the desired volume, eliminating the need for the patient to shout.

When selecting an SGD, it is important to consider the specific needs and preferences of the user. Dedicated SGD machines, such as those offered by Tobii DynaVox or Lingraphica, tend to be more expensive than tablet-based solutions. Apple iPads, for instance, offer a range of features, including a ten-hour battery life, portability, and Wi-Fi capability, at a price point just over $500. Android-based devices are also widely available and offer similar functionality.

It is worth noting that while technology can be a valuable tool for stroke survivors with aphasia, it should be used alongside other communication strategies and therapies. Speech and language therapists can provide guidance on the most appropriate tools and techniques to support the individual's rehabilitation and communication journey.

Frequently asked questions