Understanding and Working with Aphasia

Presented By: Justin [...]]]> A few weeks ago I put together some materials for an in-service training on aphasia.  I wanted to share it for those who are looking for an in-service to perform, or for those who would like to learn a little more about it.

Understanding and Working with Aphasia

Presented By: Justin Zarb

Aphasia: Quick Fact Sheet

Who Gets Aphasia and What Causes It?

• By far the most common cause of aphasia is stroke.  However, any disease or injury that damages brain tissue can cause aphasia (head injury, aneurysm, brain tumors).  It is estimated that about 20% of individuals who suffer a stroke will also incur a serious loss of speech and language.

What is Aphasia?

• Aphasia is a total or partial loss of the ability to communicate whether through listening and understanding, speaking, gesturing, reading, or writing.

When Does Aphasia Onset?  When Does Aphasia Get Treated?

• Within hours of recovering from a stroke, aphasia will usually become evident if there has been sufficient brain damage.  Sometimes the aphasia will be hard to detect if it is a non-oral form such as reading, writing, or gesturing.  A trained speech pathologist should perform an evaluation for the stroke victim.
• Treatment for aphasia can begin immediately with speech therapy.  If therapy is available, almost all aphasic patients will improve their use of language.  Some individuals who are very impaired in the first few days can go on to a full (of almost full) recovery within a few months.  Typically, therapy only produces results within the first 12 months after the onset of aphasia.

Where In the Brain Does the Damage Occur?

• Each individual’s stroke or incident will affect different parts of the brain, and therefore affect different parts of one’s communication.  For instance, the left frontal lobe of the brain controls one’s ability to form complete sentences.  More often than not, many parts of one’s brain are affected by a stroke and there is a mixture of their abilities that are affected.  Additionally, multiple strokes over a period of time can cause new aphasic symptoms for an individual.

Why Is Aphasia Important to Learn About?

• Imagine trying to help an individual walk if you didn’t understand how their prosthetic leg functioned.  The better you understand the tools and abilities the individual has to work with, along with the limitations facing them, the better you will be in helping them communicate and you communicate with them.

A Guide for Communicating with an Aphasic Person

• Respect: Treat the person as a mature, responsible adult.  Do not make the mistake of equating speech ability to one’s intelligence.  Giving someone respect will improve their confidence in their abilities.
• Normalize: Talk in your natural voice, this will also help the person feel dignified.  Only use a low-tone voice or other adaptation if you know the person also has a hearing loss.
• Be Patient: Give the aphasic person time to respond.  Remember, they are re-learning a complex system of communication and will only improve if given the opportunity to practice.
• Observe: Look for any cues that the person understands what you said, or knows what they are trying to say.  If the person seems to not understand, try repeating and then rephrasing your request.
• Adapt: If the person is having difficulty verbalizing, try using a pencil and paper. Communication boards may also work well for some individuals.  Don’t forget that gesturing can also be a great communication tool for you and for them!
• Control the Environment: Try conversing in a quiet setting, turn down or off any radios, televisions, fans, or air conditioners that make talking more difficult.
• Be Honest: If you did not understand the person, do not pretend that you did. Simply tell the person you are not sure what they are saying.  If there is not time to keep trying, tell the person you’ll try again later.
• Have a Good Attitude: Enjoy the exchange with the person, inject humor into the situation if appropriate to keep things light-hearted.  This can help the person feel that they are not solely responsible for the failure in communication, but that it is a mutual discussion where both parties are learning one another.
• Ask for Help!: It is okay to ask the person what method of communication works best.  Paper?  Gestures?  Yes/No questioning?
• Be a Guide: Establish a topic at the beginning of a conversation.  Stay on one topic at a time.  Give the person fair warning if you need to change the topic.    If in a group, try to make sure only one person is speaking at a time.
• Set Them Up For Success: Simplify long, complex directions.  Avoid abstract questions in favor of Yes/No questions.  (Are you having a good day?  Instead of, How are you doing today?)  Pick topics that you know the person is likely to respond well too.
• Look and Listen: Make eye contact to let them know you are engaged in communication with them.  Listen to all the words and try to piece together what they are trying to say.  Ask follow-up questions to clarify their meaning, and let them know when you do understand!

Pop-Quiz!

Here are a few questions to clarify your understanding of aphasia.  Some of the material was already covered, some will be new to this presentation.  Make your best guess if you are unsure!

A person with severe aphasia from a stroke can make a full recovery within one year.

True                 False

Persons with aphasia all have the same basic symptoms.

True                  False

Aphasia can affect one’s ability to speak, gesture, listen and understand, read, or write.

True                 False

An aphasic person who has difficulty finding words and making complete sentences may still be able to sing an entire song from memory.

True                 False

An aphasic person with comprehension problems can still detect the melody of a sentence – realizing if someone is asking a question or expressing anger.

True                 False

A person with aphasia may have great difficulty understanding a particular word or words, while completely understanding others.

True                 False

A person with aphasia is not as smart as they used to be before they had aphasia.

True                 False

A person with aphasia understands that they are being spoken to, although they may not understand what is being said to them.

True                  False

It is recommended that you should try to finish an aphasic person’s sentences for them.

True                 False

You are trying to help someone with receptive aphasia sit down for lunch.  You ask, “Here’s your lunch!” but the person still has not sat down.  What else can you try to do to help them sit?

You need to use the restroom, but you cannot say the words restroom, bathroom, potty (etc.). How would you tell someone to take you to the restroom?

You do not like green peas.  At all.  You never ate green peas your whole life.  Today, you were served green peas with lunch and someone told you, “Finish your peas.”  You cannot formulate any word that someone else can comprehend.  What would you do?  What would you like to help you in this situation?

Echolalia is a term used to describe an aphasic individual who has the tendency to repeat, without modification, an utterance addressed to him by another speaker.  This may be a complete sentence or the final phrase or word of the sentence.  Who in our program exhibits this type of aphasia?

Sometimes, the aphasic person speaks what is known as jargon, an incomprehensible profusion of utterances.  Does the aphasic person know that their speech is not understood?  Who in our program exhibits this type of aphasia.

Automatic speech is an inappropriate word or phrase produced without voluntary control.  This may include a set of numbers, days of the week, and various accessory expressions.  Have you ever cared for someone with Automatic Speech?

Aphasia Pop-Quiz Answer Key

1. T
2. F
3. T
4. T
5. T
6. T
7. F
8. T
9. F

14. The aphasic person may or may not know they are speaking jargon.  Sometimes they are aware, and are frustrated.  Others seem to not be aware that their speech is jargon at all, and enjoyed conversing with you.

Further Discussion Questions:

1. Who at our program/facility experiences aphasia?
2. How successful have you been in communicating with our aphasic members/residents?
3. Do you think you can apply what was learned today and have more success in communicating with persons with aphasia in the future?
4. What was one thing you did not know about aphasia that you learned today?
5. Have you ever had a fun or humorous experience when working with someone with aphasia?

- Justin Zarb

Image by: DerrickT (flickr)