What is Aphasia?
Aphasia is a term that Speech Language Pathologists know very well but among the wider population there is limited awareness of aphasia and what the term actually means. Specific parts of our brains contain language (typically the left half of the brain). Aphasia is a language/communication disorder that results from damage to the language parts of the brain. Aphasia can result in difficulties in one or more language areas/modalities : speaking, listening, reading and writing. Aphasia differs in type and severity (mild, moderate or severe). For example, one person with aphasia may have mild, occasional word-finding difficulties in conversation while a different person may have severe word-finding difficulties and very limited expressive language. Similarly, a person with aphasia could have severe comprehension difficulties while another person may still be able to understand spoken language perfectly well.
Comprehension difficulties due to aphasia
Imagine not being able to fully understand your own language. You are in your own country, not a foreign one and people are speaking a language you have spoken all your life yet you have difficulties understanding what you hear. Imagine how isolating that must feel. That is a harsh reality for many people with aphasia.
The breakdown of comprehension varies widely among individuals with aphasia. It may be at word level, phrase level, short sentence level, longer sentence level or above. Some people with aphasia may have severe difficulties understanding single words and one-stage commands e.g. “Pass me the salt”. Others may understand well in a one-to-one conversation yet have difficulty understanding when people speak fast, when a lot of spoken information is given e.g. (radio or television) or in the presence of background noise or group situations.
How can you tell if the person has reduced comprehension of spoken language?
A Speech Language Pathologist/Speech and Language Therapist will carry out a full language assessment and will be able to ascertain the level of comprehension of the individual. Finding out that a loved one has difficulty understanding spoken language is difficult and initially it can be hard to know how you can help.
You may find that you do not fully believe that the person’s comprehension is impaired and give examples of how they have demonstrated understanding in different situations. It is important to remember that in context a person with aphasia will likely understand much better as there are often lots of situational cues. One example of communication in context is when you are at a checkout desk in a supermarket and the cashier after scanning all the items asks “Would you like a bag?” Even if you did not understand the word ‘bag’ you could probably deduct what they were asking. Understanding language out of context and beyond the here and now is much harder and may be a challenge.
If the person with aphasia is able to verbally answer questions and their answers are not related to the question asked, then it will become apparent to you that they have not understood. However, if they have more limited expressive communication, they may simply smile and nod and you may assume that they have understood when they have not. Some individuals with aphasia are very good at masking that they have not fully understood while others may look puzzled, openly tell you “I don’t know what you are saying” or ask you to repeat. Furthermore, some individuals may not understand that they in fact have misunderstood.
Here are some ways that you can help support the comprehension of the person with aphasia:
1) Reduce background noise
When there is background noise, it can be much harder to hear and understand what is being said. Background noise can also be a distraction and makes it harder for the person with aphasia to process what is being said. While you may be able to filter out the background noise, this will likely be much harder for the person with aphasia.
2) Ensure you have the person’s attention
Level of attention is an important factor. If someone is not paying attention or is distracted, it is very unlikely that they will understand what you have said to them. Can you recall a time when someone was talking and your mind was elsewhere? Did you follow what they had been saying? You can get the person’s attention by saying their name and being face to face with them when you are talking.
3) Use simple language & speak slowly
When speaking to the person with aphasia, try to speak slowly and keep sentences short and to single thoughts. Add a short 1-2 second pause between sentences to allow the person additional time to process what you are saying. Always give the person time to respond.
4) Emphasise key words
We do not need to understand every single word in a sentence to get the gist/follow the message. Therefore, it can be really helpful to emphasise key words to further facilitate understanding. Here are some examples:
‘Yesterday I went to the cinema.’
‘The movie was really good’
You can emphasise key words by placing stress on them when you are talking. Always ensure that your tone of voice is not patronising when doing so.
5) Break instructions down into smaller steps
Remember that longer instructions may be more difficult for the person to follow so break any instructions down into small steps. Find out more about how to break instructions into smaller steps in this earlier blog post: “What is an information-carrying word?”.
6) Use gesture
Hand gestures can also facilitate understanding and may be particularly helpful when supporting a person with more severe comprehension deficits. However, it should be noted that gestures may not always be fully representative of the intended meaning/may be unclear to the other person. Here are some examples of gestures:
Acting out an action such as drinking, eating
Making a glasses shape with fingers and thumbs over eyes to indicate a pair of glasses
Moving a hand backwards 3 consecutive times over one shoulder to indicate a past event
Moving a hand forwards 3 consecutive times over one shoulder to indicate a future event
Pointing at objects can also be helpful as the person with aphasia will likely then understand that you are talking about a particular object.
7) Write down key word/sentences
If the person with aphasia can read/understand single written words or sentences, writing will likely be a very effective way of supporting their communication. Try writing down the key words or full sentence and point to each word as you say it or simply allow the person to take the time to read what you have written. You can also find out how you could use Written Choice Communication by clicking/pressing here.
8) Use photos to set the context
We live in the era of Instagram, Facebook and Google Photos. Many of us are partial to sharing our travels, days and nights out with others by posting photos on social media. Why not also share some photos with your loved one with aphasia? By showing them a photo of a place, event or people, you are setting the context for the conversation. The person with aphasia will know that any comment you make or any question you ask will in some way be related to that photo, thereby facilitating their understanding and perhaps also their expressive language skills.
9) Avoid sudden changes of topic
Try to stay on one topic at a time as otherwise the person with aphasia may not follow and may assume you are still talking about the first topic. If you do need to change the topic, explicitly state that you are going to talk about something else and consider using a photo or writing a key word to indicate that the topic has shifted/ introduce the new topic.
10) Conversation Partner Training
Different communication strategies may work better than others when supporting the comprehension of a person with aphasia. Should you wish to have training on how to be a more effective conversation partner, ask a Speech Language Pathologist/Speech and Language Therapist if you could have specific training and/or check out Better Conversations which is a free, online Conversation Partner Training resource.
Our next blog post will be on how you can support the expressive language skills of a person with aphasia. Stay tuned.