Video transcipt
Video link: Aphasia – Education and advice for family and friends
This video will provide information on aphasia and provide advice on how best to communicate with someone who has aphasia.
Aphasia is the medical term for a language disorder caused by damage to the language centers of the brain. It is most commonly caused by a stroke, but can also be caused by head injury, infection of the brain, and brain tumors.
The left side of the brain normally controls how we communicate. Aphasia can cause difficulties producing language and also understanding and processing what others are saying to you. It can affect your ability to read, spell, and use numbers. Often, all of these areas are affected to some extent, but some may be more impaired than others.
In order to understand aphasia, it may be helpful to think of some everyday examples. To have aphasia is similar to being dropped into a foreign country where you can’t speak or understand the language, or where your knowledge of the language is limited to some well-known phrases and words.
You’re able to pick up some clues of what people are saying to you from their tone of voice and facial expressions, but you’re struggling to process the actual language that they are using.
Another way of thinking of aphasia is that your brain is a complex system of roads, with different roads connecting your thoughts and ideas to words and the language to communicate them. Normally, the roads are well-traveled and familiar, and ideas know where to go with very little conscious effort. Then, without warning, these well-traveled streets and motorways that you normally use are under construction or completely gone, and the GPS system fails.
Your ideas are still there, but it’s hard to share them. It will take you longer, and your thoughts may sound very different when you speak or write. Another way of helping to understand aphasia is to imagine that your language storage center in your brain is like a filing cabinet.
Language is stored in the drawers, and the drawers are organized according to different meanings. For example, food vocabulary would be in one drawer and holiday vocabulary in another drawer. Vocabulary which you use more often being stored at the front and vocabulary used very rarely at the very back.
Each file is an individual piece of information about a word. For example, its meaning, its sound, and how it is spelt.
The index is a system that quickly locates the right file when you need it. When aphasia happens, it’s as if, in the worst-case scenario, the files have been thrown onto the floor and mixed up and the index has been shredded. Or it may be that the drawers are just a bit stiff and the information in the drawers have been slightly mixed up. This means that when you want to find a certain word, this is very difficult.
For example, you know you have the file for car, but you’re unable to quickly pull it out to say the word or a word with a related meaning.
For example, bus may come out instead. Or sometimes you may say a word with a similar sound, like tar.
It’s important to remember that aphasia is a problem with language, not intelligence. It can hide people’s thoughts, ideas, and personality.
People with aphasia still have ideas, but it’s hard for them to share their ideas. There are different types and severities of aphasia, as it affects everyone differently.
Receptive aphasia is when you hear the words, but you may not be able to fully process what they mean.
It will be easier to understand short, simple sentences and more difficult to understand long conversations or more unusual or less familiar language.
With non-fluent expressive aphasia, speech is often effortful and sounds very stilted. You are usually very aware of the speech difficulty, and it can lead to high levels of frustration. Fluent expressive aphasia is less common. In fluent aphasia, the person can produce words fluently with many words strung together using normal speech melody. However, the words they use aren’t correct for the intended meaning and may not even be real words. The person’s speech may be referred to as a word salad.
This is like putting a bunch of random phrases, words, or sounds from a dictionary into a bag and mixing them all up together.
Sometimes the person has difficulty self-monitoring what they are saying, and they usually have limited awareness that their speech is not making sense.
Global aphasia is the most severe form of aphasia, when a large area of the brain has been damaged and all aspects of language, such as speaking, understanding, reading, and writing, are all very difficult. Aphasia can cause changes in many areas of someone’s life. It may result in social anxiety, reduced ability to make decisions, changes in your job, and a loss of independence. Aphasia affects partners and family members, too. Roles can change in relationships, and it is normal to feel a range of emotions as a result of a loved one’s aphasia. Feelings of grief, sadness, depression, anger, loneliness, and helplessness are often experienced. We are now going to give some general guidance for helping you communicate with someone who has aphasia. It’s important to remember that aphasia is different for everyone. These tips are just a guide. With time and practice, you will work out what is the best way to communicate with your loved one. To help the person with aphasia understand you better, reduce background noise and any distractions. Face the person. Use a normal tone. Do not speak to them like they are a child. One-to-one conversations will be easier to follow than group conversations.
Use short sentences using simple and familiar vocabulary. Give one bit of information at a time. Avoid sudden changes of topic. When you do change the topic of conversation, make this clear. This could be by telling them that the topic is changing, writing a keyword down, or showing them by pointing to a photo or picture.
Provide additional clues as you talk. For example, use gesture and facial expression. Use props such as maps, photographs, and calendars.
Make sure the person with aphasia has their hearing aid and glasses if required. To help the person with aphasia express themselves, be patient and allow extra time for the person to get their message across. Watch the individual’s face and allow plenty of time for an answer.
Ask closed questions rather than open-ended questions. For example, “Do you want chicken or beef for dinner?” will be much easier than, “What do you want for dinner?” Ideally, support your question with a picture. You could ask them if they want to keep trying themselves or if they want you to help them. Offer your help, but don’t force it. If they want help, you could prompt them to describe the item. What is it used for?
What does it look like? Can they show you? Can they draw it? Avoid talking over the person and finishing their sentences for them.
Clarify and summarize what you have understood. Be honest if you’ve not understood everything. Acknowledge that it is difficult and frustrating.
There may be times when you will have to leave the conversation and agree to return to it later. After the person with aphasia has had some rest, it may be easier.
Someone with aphasia will experience significant fatigue, and they will find it harder to communicate whenever they are tired. In the Northern Trust, our speech and language therapists are based in the hospital and in the community. Your speech and language therapist will provide you with activities which will help to reorganize the filing cabinet in your brain.
They will also work on strategies to help you when you are stuck on a word, finding a different road to express your ideas.
They will also help you to communicate in alternative ways. This is referred to as total communication and encourages individuals with communication difficulties to communicate in the most accessible way for them. This could be using gesture, writing, drawing, using communication books, photos, or pictures. Please remember the seven golden rules for communicating with someone with aphasia. Ask simple questions. Provide choices.
Help communicate if asked. Acknowledge the frustration. Speak slowly and clearly. If you don’t understand, say so. Allow extra time.
We hope you now know more about aphasia and that you’ll be able to implement some of the tips, techniques, and strategies discussed to help communicate with your loved one. Remember, you can watch any of the videos again as a reminder whenever you need to. There are additional resources on the webpage where you accessed this video, including links to websites which will further inform you about aphasia. We would really appreciate it if you would take a few minutes to scan the QR code or click on the link where you accessed this video to complete our feedback questionnaire.
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