Aphasia Treatment Strategies: Helping people with severe aphasia communicate.

Aphasia is a language disorder that occurs due to a stroke. It can affect the person’s ability to speak, to understand spoken language, to read and to write. It varies in severity. Some people may be able to speak in sentences but have word-finding difficulties. Others may be non-verbal and unable to speak in words and sentences at all.

A person who has a more severe expressive aphasia / limited spoken language can make significant progress over time and with speech therapy. However, there is no cure or quick fix for aphasia. Therefore, they will often need to use other means of communicating (in addition to speaking) to support them in getting their message across. These strategies may include writing, drawing, gesturing, using photos.

People with aphasia often benefit from support and reminders to use strategies. There are also many strategies that the person speaking to them can use to support their communication. Three useful strategies are listed and explained below.

Yes/No Questions - “Do you want coffee?”

What is a Yes/No question? Basically it is a question that requires a yes/no response. If you ask a person, “Do you want coffee?”, they will most likely respond “yes” or “no”. You could ask “What would you like to drink?”. This is a more open question. It’s more open because there are many things the other person could say in response. They might want a coffee, a latte, a cup of tea, a hot chocolate etc.

More open questions can be difficult for people with more limited spoken language. They may for example have difficulty retrieving words such as “coffee” and “tea”. Using the word 'or' in a sentence e.g. "Tea or coffee?" is also unhelpful if the person is unable to say one of the options.

So, if you know a person has limited spoken language, be sure to use yes/no questions. You can still ask some more open questions but quickly switch to a yes/no question instead if the person is having difficulty responding.

Some people with aphasia at times say “yes” when they mean “no” and vice versa. This is because “yes” and “no” are closely linked in meaning and the person sometimes accesses the opposite word to the one they want to say. Double-check that you have understood what the person wants e.g. “So you want coffee?”. Sometimes, using a yes/no chart or a simple thumbs up and thumbs down can help clarify things and avoid confusion.

Written Choice Communication - What would you like to drink?

One problem with yes/no questions is that you may have to ask many questions to find out the person’s answer. (“Do you want coffee? No … Do you want tea? No… Do you want hot chocolate? No … a cappuccino? Yes. Ok great, I’ll order you a cappuccino.” )

Written Choice Communication can be an effective way to support conversation in aphasia

This is why written choice communication can be helpful. Write the question at the top of a page and then write down some choices. Point to the question and each choice as you read aloud.

This strategy will work best for people with aphasia who have intact reading skills. However, if you point to each word and read aloud, this strategy can still work even if reading skills are impaired. Take your time and don’t rush through the choices.

Similarly, if there is a written menu available, you could also slowly talk the person with aphasia through what is on it and ask them to point to what they would like e.g. tea, coffee, hot chocolate. If the person is able to read quite well, they will likely be able to this without much prompting.

Picture Communication - “Point to the one you would like”.

Another strategy is to show the person with aphasia a range of pictures and ask them to indicate their response by pointing to a picture. If you are asking the question “What would you like to drink?”, a drinks menu with pictures would be ideal.

It is surprising how few hospitals have accessible menus for people with aphasia! Some restaurants and cafes do have picture menus but many do not. The picture above is an example of a drinks menu from a restaurant in Japan.

You could make a drinks chart or add the person’s favourite drinks to a customisable iPad communication aid app. Ask the person to show you what they would like on the drinks chart or in the iPad app.

Summary of Strategies

In summary, three strategies that you can use to help people with aphasia and limited spoken language are as follows:

• Ask yes/no questions

• Use written choice communication

• Show the person pictures and ask them to indicate their response

Remember you can use each of these strategies in a variety of communication situations, not just when ordering a tea or coffee.

We hope you have found our list of strategies useful. Please share it if you did. Be the first to receive more tips by signing up to our free monthly newsletter.