Tag Archives: supportive communication

How to Communicate With Someone Who Has No Language

4 Dec

When I tell people that Chuck’s stroke left him without language, the first question is usually, “Can he read?” Is reading language? Yes? Then the answer is, “No, he cannot read. Or write, or speak.” Furthermore, his comprehension of spoken language is poor.

Chuck has aphasia, a condition that can result from a stroke or other head injury and results in a loss of language; and apraxia, the ability to manipulate the musculature of the mouth in order to produce sound. (Which is beside the point in his case, sense he has no verbal capacity.) So how do we communicate? One way is through supportive communication. I’ll explain it as it was to me, then reveal which techniques worked best for us; you may find some of these suggestions helpful.

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How to Engage in Supportive Communication

1. Choose a time when Chuck is fresh and a place with few or no distractions. People who suffer from the affects of a stroke or head injury tire easily and are easily distracted by extraneous noise or activity.

2. Make sure Chuck has his dry-erase board and marker, picture dictionary, photos and photo albums.

  • Dry-erase and marker. The dry-erase board and marker were absolutely brilliant assistive tools and were suggested not by a speech therapist but by my niece Anna, who is a counselor and an artist. Chuck, himself a skilled artist, is able to sketch representative, descriptive, often comical drawings to indicate ideas and needs.
  • Picture dictionary. Chuck was provided a picture dictionary while at the speech therapy “camp,” but found it troublesome to use. Too much was going on in the illustrations, say a market full of people, food, items and activities. To identify a single item—let’s say an apple (to indicate he wanted one for a snack)—took too much effort. His vision deficit probably contributed: he has a right field cut, meaning he lacks vision on the inside of his left eye and the outside of his right eye, a result of the stroke.
  • Photos and photo albums. Photos and albums worked well for Chuck because he recognized himself and others and had positive associations and memories connected to the people and events in the pictures. They also prompted name retrieval. Part of Chuck’s cognitive deficits include not being able to visualize whom I’m referring when I say the person’s name; he has to actually see the person or a photo thereof.

3. Ask him if he has a topic he would like to discuss, using one or all of the tools above.

4. When he points to or draws something, ask him to say it. Give him time to formulate the word, and ask if he would like you to write the word. If he continues to struggle after about 20 seconds, or if he asks for help, prompt him. If he cannot get it by himself, say the word and have him repeat it. Be patient. Give Chuck time to process, prepare, and articulate. This process will be fluid, so continue using the technique described as the conversation moves from topic to topic.

5. Spend the same amount of time telling him about yourself or something of interest to you or how your day is going. Speak slowly, repeat frequently, and use the dry-erase board to write key words and illustrate concepts in order to increase his comprehension. Newspapers and magazines are a good source of topics. Be patient. Give him time to understand your message. Repeat the message as needed.

6. After about a half-hour, progress to an exercise or game.

Other Things to Remember

If you are talking to Chuck, look directly at him. I have noticed that since Chuck is unable to contribute to a conversation, people tend to ignore him because, I suppose, he cannot contribute. Ignoring him is not only rude but also can intensify the isolation and loneliness frequently experienced by people who have aphasia.

Keep it short and simple. Chuck gets frustrated when someone talks to him and he doesn’t understand, or when he tries to express an idea but cannot make himself understood. Yes/no questions are best. Don’t talk too much; it’s okay to just share space with him.

I’ve been told that a hallmark of aphasia can include a disinterest in the lives of others (as well as other personality changes). I’m not sure if this is organic/structural or the result of being the center of attention during a long period of rehab. Chuck definitely has become detached since his stroke, his emotional repertoire drastically reduced. Luckily, he is usually in a pleasant mood, which is not always the case with stroke survivors.

I hope someone finds these ideas helpful and applicable to their particular situation. If you would like to read more about our experience with stroke, recovery and caretaking, please read my book, Stroke Happens.

Best, Laura Ann Garren

 

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