How to communicate with someone who has aphasia

Aphasia takes away words, not intelligence. Conversation gets much easier when the people around the person change how they talk:

• Slow down and use short sentences, one idea at a time.
• Wait for an answer longer than feels natural.
• Ask yes/no or either/or questions.
• Add writing, gestures, and pictures to what you say.
• Check you have understood before moving on.

• Get attention first. Face the person, make eye contact, and turn off the television or radio.
• Short, plain sentences. “Your sister is coming at three” rather than a long sentence with several ideas.
• Write key words as you say them. A name, a time, or a place written in large letters on a notepad can make the difference.
• Use gestures and objects. Point to the calendar, hold up the coat, show the photo.
• Keep an adult tone. Simplify the language, not the content or your voice.

• Give time. Count to ten silently before offering help.
• Offer choices. Written options (“tea / coffee / water”) let the person point.
• Encourage any way of communicating: pointing, gesturing, drawing, writing a first letter, or showing a picture on a phone. The goal is communication, not perfect speech.
• Narrow it down. If you do not understand, ask questions that narrow down the topic: “Is it about today? Is it about a person? Is it someone in the family?”
• Confirm. Summarize what you think was said (“So you want to call Mary tonight?”) and wait for a yes or no.
• Be honest when you do not understand. Pretending to understand is quickly noticed and erodes trust. Say so, and try again later or another way.

These techniques are the basis of an approach called Supported Conversation for Adults with Aphasia, developed at the Aphasia Institute in Toronto. Its central idea is that a skilled conversation partner can reveal the competence of a person with aphasia, and that the partner’s skills can be taught. Many speech-language pathologists train family members in it; ask whether yours does.

Caring for someone with aphasia is tiring, and communication breakdowns are frustrating on both sides. Aphasia support groups and caregiver groups help both the person with aphasia and the family. Ask the stroke team or a local speech-language pathologist what is available nearby or online.

For an overview of therapy and what to expect, see speech therapy after a stroke.

Does aphasia affect intelligence?

No. Aphasia affects language, not intelligence. People with aphasia generally know what they want to say and understand much more than they can express. Talking to them as competent adults matters.

Should I finish sentences for someone with aphasia?

Usually not straight away. Give time first. If the person is clearly stuck and wants help, offer a guess and check it (“Do you mean the doctor?”). Ask them what they prefer: some people welcome help sooner than others.

What is the best way to ask questions?

Questions that can be answered with yes or no, or by choosing between two options, are easiest: “Do you want tea or coffee?” rather than “What would you like to drink?”

Should I speak louder?

Not unless the person also has a hearing loss. Aphasia is a language problem, not a hearing problem. Speaking more slowly and in shorter sentences helps; speaking louder does not.