How to Help A Person with Aphasia Express Themselvesby Barbara B. Shadden

The many different forms of aphasia are most apparent when we listen to what the person says.  Meet three different stroke survivors - each with aphasia.  All three are trying to ask a family member to take them to the mall for shopping.

Nancy: “What I’d like is for you to take me to…the…to the….you know…the place with areas you can go into and buy stuff.” 

Roberto:  “It would be good if you could do it so we could go to the minda for some potting.” 

Craig: ”Uh…uh…car…uh…store?

Nancy has word-finding problems (anomia). Most people with aphasia experience this. It happens to all of us occasionally (e.g., when someone’s name is on the tip of your tongue), but word-finding problems in aphasia interfere with everyday conversations. Anomia can be mild, like in Nancy’s case. You sometimes see someone talking around the word (called circumlocution) as a way to get the meaning across. Anomia can also be so severe that the individual cannot find most of the content words they need to communicate their thoughts.

Roberto has what is called fluent aphasia.  For people with fluent aphasias, the words come out easily with seemingly normal intonation and grammar. However, the speech is sometimes described as being “empty.”  Roberto’s use of the word “it” as a replacement for a content word is a good example of this.  We also find people with fluent aphasia seem to be using words that don’t make sense in the middle of their sentences (“minda” and “potting” above are examples of these paraphasias). When fluent aphasia is severe, expressive language is sometimes described as jargon - it sounds like it should be making sense, but it doesn’t.

Craig has nonfluent aphasia. He really has to struggle to talk, and his speech is slow and lacking in normal intonation.  Often, the “little” words of our language -“of,” “the,” “at” -- seem to elude the person with nonfluent aphasia. They can produce core content words but that isn’t always enough to get the message across. Their language is sometimes described as “telegraphic” referring to the absence of little connecting words.

Clearly, different strategies are needed to help different people with aphasia express themselves better. Always remember to ask first what works best. Don’t forget: the person may also have trouble understanding you, which can limit the effectiveness of some communication techniques. In Roberto’s case, he thinks he is making sense, so asking him to repeat won’t necessarily help.

The following do’s and don’ts capture some of the more universal strategies used to help individuals with aphasia express themselves.

Do give people time to express themselves. Many persons with aphasia communicate slower than “normal” speakers.

• Don’t anticipate what the person may be about to say and finish it for them or jump in with a response.  While this may happen in typical everyday conversations, it can be very stressful to some people with aphasia.

 Do ask if the person with aphasia wants your help when having trouble finding a word. If he or she does, you can:

• Fill in the word if you know it or provide a choice of words if you aren’t sure 
• Ask some questions designed to either elicit the word or to understand the intended meaning
• Suggest they write (or even draw) 
• Don’t ignore their efforts 
• Don’t suggest moving on to another topic right away 
• Don’t turn immediately to another person present for help 
• Don’t fill in several possible suggested words without knowing whether they want this type of help 

Do indicate if you did not understand what the person said. Asking someone to repeat is fine or you can…

• Repeat what you did understand and then pause when you get to the part you didn’t understand (e.g.,”OK, you said you were going out to dinner at…….) or
• Repeat or rephrase what you believe they were trying to communicate -- for confirmation or
• If you still don’t understand, indicate that you both can return to topic later and try again
• Don’t pretend to understand when you don’t
• Don’t ignore what they said because you didn’t understand

Do encourage a person to make use of any type of communication support available. This might be a notebook or an electronic communication device. If you aren’t sure how to use these supports, ask.

• Don’t ignore available tools for communication but also…
• Don’t force individuals to use such tools if they don’t want to

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

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