A stroke that damages the brain’s language centers often results in a communication disorder, most commonly aphasia, which affects the ability to speak, read, or write. It is important to recognize that aphasia is a language disorder, not a cognitive impairment; the person’s intellect and knowledge remain intact. For caregivers, establishing an effective system for two-way communication requires patience and specific techniques.
Adapting Your Communication Input
The way a message is delivered to a stroke survivor must be modified to ensure the information is processed clearly and efficiently. A foundational technique involves slowing the pace of your speech significantly, which gives the brain more time to decode the auditory information it receives. Speaking in a normal conversational volume, rather than shouting, is also important, as hearing ability is typically unaffected by aphasia.
Reducing the complexity of spoken language improves comprehension. This simplification means using short, grammatically direct sentences that convey only one idea at a time, avoiding complex clauses or compound sentences. It is helpful to limit environmental noise, such as turning off the television or radio, to focus the survivor’s attention and minimize sensory overload.
A major adaptation involves reframing questions to require the least effortful response possible from the survivor. Instead of asking open-ended questions like, “What would you like for dinner tonight?” offer a choice between two specific items, such as, “Would you like soup or a sandwich?” The most effective approach uses simple yes/no questions, which can often be answered with a head nod, shake, or a single word. This method reduces pressure and maximizes the chance of a successful exchange.
Utilizing Visual and Augmentative Aids
When verbal output is severely limited, introducing physical tools provides a necessary alternative pathway for expression. Communication boards are practical tools, often consisting of laminated sheets with organized images, words, or the alphabet. A survivor can point to a picture of a glass of water, for instance, to express a need without having to say the word.
More specialized boards can include the alphabet, allowing the person to point to letters to spell out words or names, even if the process is slow. Simple, low-tech writing surfaces, such as a small whiteboard or a notepad, can also be invaluable if the person retains the ability to write or draw. Even if the writing is messy or incomplete, it can often provide enough context to clarify a message.
Technological solutions fall under Augmentative and Alternative Communication (AAC) methods, including simple apps available on tablets and smartphones. These applications often feature customizable picture grids or text-to-speech functions, allowing the person to tap an icon or type a phrase for the device to speak aloud. Dedicated speech-generating devices can also be programmed with common phrases, enabling the survivor to communicate complex thoughts with a button press. These aids transform communication from a challenging verbal task into a more manageable visual or motor one.
Deciphering Responses and Validating Understanding
The final stage of the communication loop involves the caregiver’s ability to correctly interpret and confirm the message conveyed by the stroke survivor. Since spoken language is compromised, non-verbal cues must be given heightened attention, including gestures, pointing, and changes in facial expression. Observing eye movements is also important, as a survivor may use their eyes to indicate an object or a choice on a communication board. Physical gestures, such as a thumbs-up or a simple nod, become a reliable form of communication.
It is important to allow ample time for the stroke survivor to form their response, as the process of non-verbal encoding can be significantly slower due to neurological damage. Rushing or interrupting can lead to increased frustration and a breakdown in the communication attempt.
Once a message is interpreted, the caregiver must validate the understanding by repeating the message back to the survivor for confirmation. For example, if the person points to a food item and then nods, the caregiver should state, “You want the apple,” and wait for a confirmatory gesture. This validation step acknowledges the effort made and ensures accuracy, reinforcing the survivor’s attempts to communicate.