You’ve probably experienced this moment:
This situation is perplexing and could be even frightening. For most of us, it happens rarely. Imagine, though, if this experience was common for you. How would you feel if you lived with “tip of the tongue” events everyday? Some people do. This is called anomia, and is often one of the symptoms of aphasia, a type of speech disorder1.
More than 1 million Americans have been diagnosed with aphasia2 (pronounced uh-fey-zhu)3, a disorder that affects an individual’s ability to process and use language. Aphasia is caused by an injury to the brain1, with strokes being the most common cause. There are actually several types of aphasia. Expressive aphasia is when an individual struggles with saying words and speaking in complete sentences. Receptive aphasia is when an individual has difficulty in understanding what is said. Many people with aphasia have a combination of expressive and receptive challenges in their use of language1.
It’s important to remember that aphasia is not an intellectual deficit, but is linked to the ability to use the symbols of communication.
One way of appreciating the effects of aphasia is to think about it in terms of communicating in a country where you do not speak the language. When the person with aphasia is speaking, the words you hear may sound like nouns and verbs but you may not recognize them (similar to a foreign language). For the person with aphasia, it may seem like you are speaking in a foreign language. Although some words may make sense because of your use of tone and pitch or other communication cues, such as facial expressions, other words and parts of the message may be misinterpreted. This breakdown in communication may become frustrating to both you and the person with aphasia, as s/he is unable to communicate clearly or understand a message completely.
For a better understanding of aphasia, imagine that one of your older adult relatives had a stroke and has been diagnosed with aphasia. “Aunt Stella” exemplifies a highly independent older adult in all aspects of her life. You and your aunt have lived in the same community for many years and you've admired your aunt’s free spirit and desire to maintain her independence as she advanced in age.
Aunt Stella returned home after her stroke and has done exceptionally well. As the primary family member in the community, you “check in” with her each week to offer your assistance. Today, Aunt Stella is frustrated about newly prescribed medications and changes in other prescriptions since her stroke. She has questions about the drugs' purpose and dosage. She hopes you will accompany her to the pharmacist to clarify these issues. Here are some ways that Aunt Stella’s symptoms of aphasia (primarily the expressive type) may affect your interaction.
In conveying her gratitude for your help and concern about her medications, Aunt Stella's speech pattern is deliberate, slow and painstaking. She tends to telegraph the key words (e.g., “Thank you…help for me…pills and side effect…need to know it”).
Aunt Stella has trouble finding the right word and sometimes substitutes a wrong word when asking you to clarify her dosage from the information sheet. For example, instead of asking, “What are the side effects?” she said, “What is it… sight effect?” She struggles with trying to say words with difficult sound sequences ("prescription" and "blood pressure") and words with many syllables like "pharmacist" or "medication." Although Aunt Stella typically answers "yes" or "no" questions accurately, there are some misunderstandings as you discuss details (for example, she mistook dosing frequency with the number of pills she takes at each dosage).
Treatment for aphasia will differ, depending upon the type of aphasia, the severity, and the individual life situation of the person with aphasia.
A speech-language pathologist (SLP) would offer Aunt Stella and the family recommendations for treatment based upon her individual needs and personal goals1. For example, the SLP might encourage the use of gestures or external aids (such as a book with written words she can point to) to promote her verbal expression or as an alternate means to provide a way to express words that are difficult to say4. The SLP might also offer suggestions to family members and others in Aunt Stella’s social circle to facilitate communication5. All treatments are designed to increase Aunt Stella’s ability to function within the context of her lifestyle.
Showing respect and responding in encouraging ways is one way that you can help. Dr. Jane Mertz Garcia of Kansas State University, offers practical advice on how you might do this. Clarifying your message and promoting the expression of communication will help to create a welcoming and positive environment when you interact with Aunt Stella.
There are at least three basic ways that you can clarify your communication to help your family member with aphasia6.
First, you need to adapt your communication style. By changing how you say things, you can help increase understanding. Make sure that you actually have the time to effectively communicate. By slowing down and pausing between phrases, you are giving the person with aphasia more time to process words and intent. It’s also important to focus on one topic at a time. For example, you might begin your conversation by saying, “Let’s talk about your medications. I know your doctor prescribed a new one." When you do this, you are focusing your conversation, which gives Aunt Stella a chance to place the conversation in context. Then, when you are ready to move on to the next topic, such as finding a time to meet with the pharmacist, you need to alert Aunt Stella to this change. For example, you might say, "I understand your concerns about medications. Let’s find a time to go see your pharmacist. When do you want to go?" This gives your family member time to prepare for the next topic. All of these tips can increase your family member’s ability to understand what you want.
Second, you need to adjust what you say. Complex sentences during conversation may be very difficult to follow and understand for a person with aphasia. You should be direct and to the point with your language. This means speaking in succinct sentences. For example, avoid statements like, "It might be hard to see the pharmacist before we go to the post office," (a sentence that includes many components that must be reordered and quickly processed to understand). Instead, you might say, "Let’s go to the post office. Then, we’ll stop at the pharmacist."
Third, you need to make accommodations by communicating without language. In reality, much of your communication is non-verbal, so you can use some of these techniques to support Aunt Stella. When interacting with her, you should do so face-to-face, allowing observation of facial and bodily expressions to enhance the meaning of the message. You also can write things down as you talk and use props to enhance understanding. Visual aids can be a great tool to communicate without relying on words. For example, have the medications nearby when you are talking about them. It may be hard for Aunt Stella to read the label information, but the color and size of the medication might be easy to identify. Also, a calendar is a helpful aid when discussing events such as a date to visit the pharmacist. Writing it down also provides a means for Aunt Stella to share the information with others.
Clarifying communication is all about how you can support Aunt Stella's efforts to communicate. Here are some ideas to help her express herself6.
First, if the message is unclear, ask her to demonstrate what she is trying to say through physical communication. For example, Aunt Stella might be able to point to what she is unable to say such as identifying a specific pill bottle or pointing to a specific day on her calendar when she can speak to her pharmacist.
Second, you can become aware of how you use questions. Before asking a question, first identify the broad topic, so that Aunt Stella knows where the conversation is headed. Although it’s natural to ask open-ended questions, these might be difficult for the family member with aphasia to answer. Instead, ask questions that allow a person to answer with a yes or no response. This might take some extra time, but if you ask the right questions, you should be able to figure out the answer. For example, instead of asking "What kind of side effects do you have and when did they begin?" (an open-ended question), you might ask, "Is the medicine bothering you?...Are you having side effects?...Did they start recently...after the stroke?"
Sometimes the difficulty lies in how an individual understands communication, and sometimes it lies in how an individual is able to express herself. Sometimes a person may have difficulty with both understanding and expression. Important techniques for communicating with individuals with aphasia include knowing how to adapt your communication style, how to adjust what you say and how to make accommodations. You also know that there are ways to physically communicate and to ask questions that promote expression. Above all, you’ve learned that individuals with aphasia can continue to contribute to their communities, with support and acceptance from those around them.
A national resource is the American Speech Language, and Hearing Association:
2200 Research Boulevard
Rockville, Maryland 20850
Talk with your local speech-language pathologist. Ask your primary healthcare provider for a reference, or check the yellow pages under Speech. You might also inquire at your local hospital or rehabilitation center.