Communication

Understanding communication changes after a stroke

Following a brain injury, it is common to lose the ability to remember the name of a person, place, or thing.

Sometimes the substituted word may be closely related to the correct one. For example, the person might say a chair is a table, or say your name is James when it is John. The substitution can also happen with numbers. The person may know, and possibly write, your correct age but say an incorrect number.

Unrelated word substitutions

Sometimes the substituted word may be unrelated to the correct one. For example, the person might say phone in place of car, or smoking for sweater. These word substitutions are confusions of words, not confusions of thoughts. The person does not need to relearn the word. Rather, they must learn to reconnect the idea and the word. For example, a person may say things like, “Pass the _______, you know, it goes with pepper.”

Speech and communication difficulties

In other forms of language problems, many words may be spoken simultaneously but the words are meaningless to the listener. Sounds may be produced and repeated many times. A person might make up their own words which have no meaning, or repeat a single utterance. This may represent the person’s total spoken communication.

Writing difficulties

Writing is another form of communication. The person may continue to be able to express thoughts, if only in a limited way, by writing. However, they may not remember how to write individual letters or may have difficulty forming legible letters. When trying to write words, they may misspell them or may omit or add letters. If attempting a sentence, words may be missing.

Impaired reading ability

Due to the brain injury, the person may also have an impaired ability to read. The degree of the problem will range from an inability to recognize individual letters or words, to confusion in reading and comprehending printed information.

They may look at a newspaper and recognize some letters or even a group of letters. However, often the words have no meaning, or there is a breakdown in comprehension. It would be like trying to read a foreign language. In addition, sometimes there is an ability to read something aloud but not understand the meaning of what is read.

Many individuals can give accurate information if the questions are kept short and simple. Sometimes it might be necessary to repeat or rephrase a question asked, especially if the patient appears not to understand, or makes a sound to show that they do not understand. Your speech-language pathologist will help develop a communication system that best suits the patient.

Here are some techniques that may be helpful when attempting to communicate.

Use yes/no questions. The therapists or family members may need to obtain information from the patient to complete certain tasks or to give the patient information or directions. A useful approach is to phrase questions that can be answered with a simple “yes” or “no” verbal or gestural reply. It’s important to establish the same form of the yes/no response for all persons who communicate with the patient. If the person cannot use words, they may respond to yes/no questions with a head nod or eye blink. However, do not confuse the person by asking for a head nod one time and an eye blink the next time.
Prevent the person from becoming isolated. Try to engage the person in some form of communication every day. A daily greeting such as
“Hello,” “Thank you” or “I’m fine” can be a pleasant exchange for a person with communication impairment.
Put yourself in a face-to-face position with the patient. Encourage the person to watch your face when you speak.
Speak in a normal tone of voice. Do not shout or raise your voice when speaking with the person. The patient hears you, unless there is a hearing impairment. Instead, the patient is having trouble understanding you, and the shouting will be an additional source of misunderstanding.
Talk with the person as you would with any other adult. Remember, do not talk down to the person.
Try non-speech types of communication. Some patients can write words they cannot say, or draw pictures representing their thoughts. Others can point to pictures or words in a communication chart or in a notebook, or point to things in the room. Gestures and facial expressions are a very common and effective way to communicate non-verbally.
Use short, simple sentences. All communication should be kept short and grammatically simple. “Would you like a sweater?” is easier to understand than the more complex statement, “The sweater is in the drawer in your room, and it is cold in here. Why don’t you put the sweater on to keep warm?”
Change the topic. If the person has outbursts during discussion, it is important to remain calm. It may also be helpful to change the subject to avoid confrontation and continued emotional outbursts.
Provide clear feedback. Both to the person about whether you understood or did not understand what was said.
Be patient. Give the person time to understand you, and time to form their thoughts.

Helping with language problems

Expressive language disorders: Consider using a communication board or alphabet board to communicate. Develop alternate communication systems with friends and family. Consider ways to let others know when your loved one is sick, needs to go to the restroom, is hungry or has pain. Educate friends and family that your loved one understands what is said, but has trouble getting their words out.
Receptive language disorders: Use gestures to communicate with the person if they are unable to understand the words. For example, point to things, wave hello, or give a thumbs-up for a job well done. Use pictures to communicate.

Be prepared for emergencies

Let your local authorities know of your situation. For example, if your loved one needed to call 911, they may not be able to get the words out right to help the situation. If authorities know ahead of time, they may have an arrangement to simply send someone out to check on them.
Consider having your loved one wear a medical alert bracelet that tells of the brain injury or language problem.
Consider having access to a medical alert system.
Consider creating a business card that explains the communication problem. This can be helpful when communicating with bus or cab drivers.

Apraxia of speech is a motor disorder that causes impairment in the ability to program the positioning of the muscles that produce speech. Apraxia of speech occurs with other language disorders.

Characteristics

Effortful speech with a trial and error approach to getting the speech articulators, such as the lips, tongue, and jaw, in the correct positions
Altered prosody, such as stress, intonation, rhythm
Slow rate of speech with inconsistent speech productions
Difficulty initiating utterances with pauses, restarts, and repetition of initial sounds
Often fully aware of errors

For example, when asked where they went to high school, the person may respond with “sock, crock, rrrrock…..rrrr…rocking [pause], Rockville High School.”

Therapy for apraxia of speech focuses on performing drills and structured exercises to relearn speech movements. The objective is to make communication effective, efficient, and natural-sounding.

Aphasia is a reduction or disruption in the ability to use words or other language symbols due to damage to the brain. The person’s spoken language is changed, as is their understanding of spoken language as well as their reading, writing, and math abilities.

When a person communicates thoughts by talking, writing, listening, or reading, language symbols are used. If a person has aphasia, they usually know what they want to say, but when they try to say it, the words do not come out correctly. The person can still think, but the ability to understand speech or to talk has been damaged.

The person might say, “Put the cigar on the chimney,” when they may really want to say, “Put the lunch on the table.” In this case, the person has the correct mental picture but uses the wrong words. An example like this is easy for the listener to interpret, because more than likely, the patient did not intend to say, “Put the cigar on the chimney.”
But what happens when the person is at dinner and asks for the sugar but really wants the cream? The words are meaningful and appropriate for the occasion, but they have not correctly expressed what they wanted to say. More than likely, both they and the listeners will be frustrated and confused by this type of inaccurate communication.

The amount of language loss can vary. The language loss can be severe in all areas of expression and comprehension, or it can be severe in some areas and less severe in other areas. For example, the person may not be able to say any meaningful words; instead, they may just repeat one word over and over. At the same time, they may listen to and understand most conversations and questions.

Following a brain injury, patients may not always understand what is being said to them. One man who experienced aphasia described his difficulty understanding what was spoken to him in this way: He knew that the nurse was talking to him because he could hear her voice, but all the words she said were meaningless. When she asked him if he was cold and wanted a sweater, he said it sounded like a foreign language. It did not make sense. When she used gestures and pointed to the snow outside the window and showed him a sweater, he knew immediately what she meant.