by Shaylee Hoffman, M.S., CCC-SLP
Changes in the ability to communicate can be one of the most frightening and frustrating after-effects of a stroke or brain injury. There are many ways communication can be affected when injury to the brain occurs, and just one of these is called “aphasia.” Aphasia is a broad term that refers to a loss of ability to understand or express language. There are many types of aphasia and it varies in severity based on many factors, including the location and size of the injury in the brain.
Aphasia can affect a person’s ability to express language, understand language, or both. It can vary in intensity from being as severe as being able to speak and understand little to no language, to a more mild form, where the person has difficulty retrieving just certain words.
I became a speech-language pathologist in 2010. Since that time, I have had the privilege to work with hundreds of clients with all different types of aphasia. If I have learned anything from my time working with these folks, it’s that each person’s aphasia is as different as the patterns of their fingerprints. Once they are able to tell me, I always find it so fascinating to get a glimpse of what is going on in their brain as they navigate the struggle of trying to communicate with aphasia. “It feels like I am trying to pull the words through cotton” or “I can see the word spelled-out in my mind’s eye, but I just can’t say it” or “I know what I want to say, but I can’t put the words in the right order.”
For most of the us, the process of verbalizing our thoughts or understanding what others are saying to us, is done with seemingly little effort on our part. Think about those times that you are trying to think of that one actor’s name or those times when you can’t think of that one right word that exactly fits what you are trying to say. Now take that little bit of frustration you feel during those times and multiply it by the thousands of times we need to speak in a day. That is just a tiny glimpse into the frustration someone with expressive aphasia feels. Or imagine that you are having a conversation with someone and they keep saying things to you that make absolutely no sense, like “Remember when the snoodle went and linkered the blight?” You tell them they aren’t making sense and they just keep repeating the same nonsense. All they while, your brain doesn’t realize it is processing the words incorrectly. This makes communication nothing less than exhausting.
In learning to communicate with aphasia, it is important to remember that verbal communication is not the only means of communication. If the ability to communicate verbally has been impacted, you may need to rely more heavily on other, nonverbal means of communication to help reduce frustration.
Here are some tips to use nonverbal communication to your advantage:
Maximize the communication environment. (Go somewhere quiet to speak. Eliminate background noise. Speak at a normal volume.)
Use facial expression and gestures. (Pointing. Pantomiming, i.e. putting hand to face to form a “telephone” gesture, etc. Sign language—this can be an “official” form of sign language or coming up with your own signs that make sense to you and your communication partner.)
Writing (Some people find writing out what they want to say easier than saying it aloud. Sometimes the word may not be spelled correctly or the sentence perfect, but at least the communication partner can get the ‘gist’ of what you are wanting to say.)
Drawing (Make simple sketches or stick drawing of the main point or idea.)
Augmentative and Alternative Communication (AAC) devices. (These are devices that aid in communication. They can be as simple as a page with “YES” and “NO” printed on it, so that you can touch the intended answer when someone asks you a question, to as technical as a computer-generated speech device that has pre-programmed messages that will speak for you. There are now also many apps for smartphones that are free or low-priced and have simple pre-programmed messages that you can use to help communicate “in a pinch.” Just search “AAC” in your app store.)
In speech therapy, people will often tell me that they feel that using these non-verbal forms of communication is like giving up on speaking. In reality, just the opposite is true. No one communicates in just one way. We all use different combinations of these forms of communication all the time. In fact, because the neurons of the brain work in a network, using these can actually help stimulate spoken language.
Often, because aphasia makes communication so frustrating and exhausting, the person with aphasia will want to pull-back from and avoid social situations. While this is understandable, it is important to continue to stay social, even with aphasia. The recovering brain needs the input and stimulation of varied conversation and communicative situations. Doing things like reaching out to family and friends, going to support groups, and volunteering are great ways to stay social and are so important for recovery!
Speech Therapy is also a great option for those with aphasia and speech-language pathologists are great at finding the way that you communicate best and helping you maximize your communication. They can tailor their therapies to the goals and wishes of each client.
However, sometimes, for various reasons—location, insurance coverage, transportation, etc., speech therapy is not always an option. If you are in this boat, here are some options to help make speech therapy work for you:
Many speech-language pathologists do tele-practice—that is, online therapy through an application such as Skype.
If you live near a university, check to see if they have a speech pathology program. University clinics often provide therapy for a nominal fee.
There are also companies who have created therapy software for use on your home computer. An internet search for “aphasia therapy software” will bring up many different options.
If speech therapy is just not an option for you, you can still do things to help stimulate language! If you are able, read, play word games, such as Scrabble, word search, or crossword puzzles; journal, write down words, or just letters, if you are able. Most importantly, find any way to keep communicating that works for you! It may not look or sound like it used to, but the message is just as important as ever!
Thank you so much for reading!
Shaylee Hoffman, M.S., CCC-SLP
Speech-Language Pathologist at EntireCare Rehab & Sports Medicine Expert