Communicating post-stroke: Tools for coping with aphasia

I recently returned from the Canadian Stroke Congress in Vancouver.

The congress was a four-day event all on stroke; from prevention to treating stroke in hospital to long-term recovery in the community. There were representatives from all over the country sharing research, programs and ideas. One of the workshops I attended was on aphasia.

Are you scratching your head and asking yourself, “Aphasia – what’s that?”

Don’t worry, you aren’t alone! It’s surprising how many people haven’t come across the word.

I was first introduced to aphasia in my early 20s as a student doing my undergraduate degree in physical health and education. During my practicum at Baycrest Centre for Geriatric Care in their rehabilitation program, I came face to face with many individuals who had difficulty speaking due to a stroke or other head trauma.

Aphasia is a problem of language and communication that makes it difficult to understand or produce speech. It can also affect reading and writing ability.

Aphasia is due to an acquired brain injury including stroke, tumours and head trauma. It can be so severe that communication is almost impossible or it can be very mild, like it was with my father. It can affect one single part of language such as retrieving the names of objects or the ability to read or write.

More often than not, aphasia impairs many parts of language and communication. Thirty per cent of stroke survivors are usually affected by aphasia.

People with aphasia can retain cognitive and social skills they had prior to their injury; they are simply hidden by their challenges. However, they may appear less competent and as a result are often treated with less competency. This can lead to decreased participation in social and community life, and have devastating effects on self-esteem and quality of life.

Aphasia has a major impact on a person’s identity, self-esteem, relationships and roles.

For my dad, he lost the ability to practice law. It was a major blow to his identity. A man of eloquence and a strong debater, he had to work hard at being understood by others. Although his aphasia was considered mild, his speech was slurred and slow, and he had difficulty reading.

The InteRACT (Intensive Residential Aphasia Communication Therapy) out of Dalhousie University has some great communication tips and tools for supporting someone with aphasia:

Try to put yourself in the other person’s shoes: If you are feeling uncomfortable or unsure, try to imagine how the individual with aphasia is feeling.

• Do not be quick to judge: Challenges with speech or language do not reflect intelligence.
• Communicate in the best environment possible: Try to communicate in quiet places with adequate lighting.
• Observe the individual’s non-verbal messages: Oftentimes an individual with aphasia may be able to use gestures to communicate. Try to encourage and interpret gestures.
• Use age appropriate intonation and vocabulary: Remember that you are communicating with an adult: avoid baby talk, or a patronizing tone.
• Maintain eye contact and remain in close proximity (arm’s length away).
• Prepare yourself to communicate: Do not have anything in your mouth like candy or gum, and do not cover your mouth while talking.
• Give the person time to communicate.
• Confirm that you understand the person’s message or that the individual with aphasia understands your message.

Wendy Johnstone is a gerontologist and is the founder of Keystone Eldercare Planning. Her column runs in the Comox Valley Record every second Friday.