Every year 795,000 people in the US suffer a stroke. About 87% of all strokes are ischemic strokes in which blood flow to the brain is blocked. Stroke is a leading cause of long-term disability. For some this includes damage to the area of the brain responsible for speech, resulting in a condition called aphasia – a disorder that impairs language skills, reading and writing. This can pose a significant obstacle to the care of patients. After all, in most cases, the delivery of that care depends largely on the ability to communicate with them. What are you to do when treating an individual with aphasia?
Sooner or later you will be faced with treating a patient with aphasia, either in the emergency room or in a primary care setting. It’s estimated that about 1 million people in the US currently have aphasia, and nearly 180,000 Americans acquire it each year. The majority of cases are caused by stroke.
Signs and Symptoms of Aphasia
There are ways to communicate with an individual with aphasia and it helps to understand the disorder. There are two broad types of aphasia, called fluent and nonfluent. There are several types of aphasia within those groups but we will just describe these two broad categories to give you a general understanding of the disorder.
Fluent aphasia: The most common type of fluent aphasia is called Wernicke’s aphasia. People with this disorder can speak, and may do so, but in long sentences that have no meaning. Some may use nonsensical, made-up words. For example, a person with Wernicke’s aphasia may say, “ I”m going to that roundered stone to get cream and wind many as you want to go.” It can also be extremely frustrating for the person suffering from this type of aphasia because they are often unaware of the mistakes in their speech. They are trying to communicate, not understanding why they cannot be understood. Also, a person with Wernicke’s aphasia may have difficulty understanding another person’s speech.
Nonfluent aphasia: The most common type of nonfluent aphasia is called Broca’s aphasia. People with this type of aphasia may understand another person’s speech. However, when they try to communicate, they know what they want to say but their speech may be garbled – and they know it. They may work very hard to speak in short sentences and when they do, they may eliminate parts of speech like “is”, “the” or “and”. Instead of saying “I will walk the dog” they may say “walk dog”. Instead of saying “There are two books on the table”, they may say “book, book, two table”. People with this type of aphasia understand another person’s speech.
There is one more common type of aphasia that may present in your patients; global aphasia. It severely impairs communication. People with global aphasia may have extreme impairments in their ability to speak, or understand language in general. Some may be able to say a few words, others may repeat the same words over and over again.
Best Practice for Communicating with a Patient with Aphasia
Several studies have sought to answer this question by going directly to the source – people with aphasia. Here are two of the studies and their findings:
A study published in Disability Health video-recorded 25 clinical encounters with persons with aphasia. Their community physicians and a companion were present during the interview. After each encounter, the physicians completed a questionnaire. The person with aphasia and his or her companion completed a video interview. Those with aphasia and their companions recommended that physicians practice the following communication strategies to enhance patient/physician interactions:
- Use visual aids
- Write down keywords while speaking
- Use gestures while speaking
- Ask patients and their companions about their specific communication preferences and incorporate it in interactions with the patient
Another study published in the American Journal of Speech-Language Pathology reported on the experiences of patients with aphasia, their family members, and physicians when communicating during medical care. Face-to-face interviews were conducted with 18 participants—six patients with aphasia, six family members involved in patient care, and six practicing physicians. The patients and their family members reported positive experiences, along with frustrations and challenges in communication. There were four learnings from the study:
- Patients and family members work as a team
- Patients and family members want physicians to “just try” to communicate with the patient
- Physicians want to interact with patients but may not know how
- Over and under-accommodation to the patient’s communication needs is a common problem
The study concluded that changing how physicians communicate is essential to “help facilitate the patients’ increased understanding and ability to express themselves.”
When you encounter patients with aphasia, keep these suggestions in mind when communicating with them:
- Talk to them as adults, not as children.
- Do not pretend to understand them if you do not.
- Do not shout if the person does not understand you.
- Always make eye contact when talking to the patient.
- Ask “yes” or “no” questions.
- Use gestures and visual cues.
- When possible, offer choices for possible answers, but not too many choices. Processing them may be difficult.
- Give instructions in small, simple steps.
- Allow more time than you think is necessary for the person to understand and answer – sometimes a lot longer. Be patient.
- Assist communication by pointing, drawing, using a book with pictures or words about common medical issues, treatments and procedures.
- Check frequently during the conversation to see if the person understands.
- Always talk to the patient, not to their companion. However, make sure to give informational materials to the companion for support.
People with aphasia can continue to improve their speech, sometimes over the course of years. However, when you see patients with the disorder, they will be struggling with communication in some way. Show them understanding, patience and compassion. Treat them as an adult, help them move through communication obstacles and make sure their companions have the information they need to follow care instructions. You will be able to deliver quality care to patients with aphasia, it may just take longer and need to be communicated more creatively than you are accustomed to.