How would the nurse communicate with the patient who has aphasia after suffering from a stroke

Medically Reviewed by James Beckerman, MD, FACC on August 06, 2021

Imagine you wake up one day, and suddenly everyone around you speaks a language you don’t know. Or you understand what they say, but when you try to talk, the wrong words come out. Or you can’t speak at all.

That’s what it can be like for someone who’s had a stroke. If you’re caring for a loved one in recovery, communication problems can feel like a wall between you. Even if they can think clearly, you may struggle to connect with them.

Communication problems after a stroke tend to get better with time and treatment. And there are many ways you can help your loved one regain the skills they lost.

About 1 in 3 people who’ve had a stroke have some trouble with language -- like talking, understanding speech, reading, or writing. The specific effects depend on where the stroke happened in the brain. There are two basic types of issues.

Language Problems: Aphasia

Aphasia has to do with how people process language -- spoken or written -- in their brains. A person is just as smart as they were before the stroke, and they can think clearly. But they struggle to use or understand language. There are many types of aphasia with different symptoms.

Some people with aphasia can understand language, but can’t speak. Others can talk, but they don’t make sense -- their sentences are jumbles of random or made-up words. Aphasia can also make it hard or impossible to read or write.

Speech Problems: Dysarthria and Apraxia

People with speech issues understand language. They also know what they want to say and how to say it. But their bodies won’t cooperate. The muscles in their tongue, lips, and other parts may be too weak for speech. Or their brains can’t send the right messages to get those muscles to work in sync. Examples of speech problems are:

  • Dysarthria. A person can’t speak clearly and slurs their words. They may have trouble talking with a normal tone. They might also talk too softly or slowly.
  • Apraxia of speech. They may struggle to say words correctly, because they can’t get their tongue or lips to work quite right. They may speak slowly, with long pauses, and struggle with longer words and certain sounds.

Other problems after a stroke can affect communication, too. For example, your loved one may struggle to pick up on social or emotional cues during a conversation. Or they may have mood or memory problems that make it harder for them to express themselves.

It’s best to start rehab as quickly as possible after a stroke. Speech and language therapists can help with many types of communication problems. They can:

  • Help people relearn skills, like recognizing and sounding out letters
  • Teach people and their families how to use communication tools, like charts, electronic devices, and more
  • Teach exercises to build strength in the mouth or tongue muscles (for people with dysarthria)

Other treatments for communication problems after a stroke include:

  • Melodic intonation therapy, where people learn to sing words they can’t say
  • Art therapy
  • Group therapy and support groups

Scientists are studying whether some types of medications could treat language problems, too.

Practice. It takes a lot of work for someone to relearn how to communicate. Your loved one will need to practice skills and exercises. Set aside time to help, and try to be patient and positive. They’ll probably make mistakes, but encourage them not to give up.

Make it easier to focus. When you want to talk to them, turn off the TV. Stay out of noisy areas. Face them when you’re speaking so they can see you.

Be clear. Introduce the topic you want to talk about and ask yes-or-no questions. During a conversation, sum up what you’ve discussed or agreed on.

Speak in a normal way. You don’t need to talk louder or use baby talk. Assume that they can hear and understand what you’re saying, unless you know otherwise.

Be open to different ways of communicating. Writing pads, cue cards, pictures, gestures, and computer programs can help you connect. See what works.

You can’t predict how a person will recover from a stroke. But usually, communication problems improve naturally over weeks and months. The brain can often adapt and pick up new skills to make up for some of what it lost.

However, some people do have lasting communication problems. So you may need to learn new ways to connect with your loved one. When you work together and try different techniques, you can continue to improve how you communicate, and find a common language you can share.

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En Español, Consejos para comunicarse con personas con afasia

How would the nurse communicate with the patient who has aphasia after suffering from a stroke

Communication Strategies: Some Dos and Don’ts

The impact of aphasia on relationships may be profound, or only slight. No two people with aphasia are alike with respect to severity, former speech and language skills, or personality. But in all cases it is essential for the person to communicate as successfully as possible from the very beginning of the recovery process. Below are some suggestions to help communicate with a person with aphasia. You can also check out our Communication Poster, which is easy to print and share.

  1. Make sure you have the person’s attention before you start.
  2. Minimize or eliminate background noise (TV, radio, other people).
  3. Keep your own voice at a normal level, unless the person has indicated otherwise.
  4. Keep communication simple, but adult. Simplify your own sentence structure and reduce your rate of speech. Emphasize key words. Don’t “talk down” to the person with aphasia.
  5. Give them time to speak. Resist the urge to finish sentences or offer words.
  6. Communicate with drawings, gestures, writing and facial expressions in addition to speech.
  7. Confirm that you are communicating successfully with “yes” and “no” questions.
  8. Praise all attempts to speak and downplay any errors. Avoid insisting that that each word be produced perfectly.
  9. Engage in normal activities whenever possible. Do not shield people with aphasia from family or ignore them in a group conversation. Rather, try to involve them in family decision-making as much as possible. Keep them informed of events but avoid burdening them with day to day details.
  10. Encourage independence and avoid being overprotective.

For more aphasia resources check out our Helpful Materials

“Patience, Listening and Communicating with Aphasia Patients” – An interesting and helpful video by the RVA Aphasia Group in Richmond, VA

From our Blog:

Quick Tips for Aphasia-Friendly Communication (part 1)

Quick Tips for Aphasia-Friendly Communication (part 2)

Image Credit: Pixabay

Dobkin BH. Rehabilitation and recovery of the patient with stroke. In: Grotta JC, Albers GW, Broderick JP, et al, eds. Stroke: Pathophysiology, Diagnosis, and Management. 7th ed. Philadelphia, PA: Elsevier; 2022:chap 60.

Kirschner HS, Wilson SM. Aphasia and aphasic syndromes. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice. 8th ed. Philadelphia, PA: Elsevier; 2022:chap 13.

National Institute on Deafness and Other Communication Disorders website. Aphasia. Updated March 6, 2017. Accessed August 1, 2022.

Communication credit card

Stroke survivors can use this free, wallet-sized card to inform people that they have had a stroke and may need help to communicate.

They can be ordered from our shop.

If you find spoken language difficult, a communication aid helps you express your needs without speech. 

You can buy a communication aid from our online shop. It includes:

  • Ordinary and qwerty alphabets
  • Numbers
  • Days and months
  • A clock with moveable hands. 

There are also illustrated sections covering basic needs.

The Medical Passport enables you to discuss your medical needs with your doctor without the need for speech. It contains 34 pages of icons, pictures and words relating to health matters. 

Fast Talk is a booklet featuring words and pictures to help people with aphasia express themselves in everyday situations. The booklet is ringbound at the top and can easily be used with one hand. Alphabet and number pages are also included. 

You can order the Fast Talk booklet from our shop.

In April 2015, national aphasia charity, Speakability joined forces with the Stroke Association. 

Individual needs are displayed in this one-page summary which can be placed in visible places such as the front of a care plan or on the fridge, so carers and professionals know how to support the individual. This can also be taken into the hospital and kept with the person's notes or by the bed.

Download Communication Licence. 

Like a communication board, a picture dictionary can be a valuable tool if you have communication problems. 

The ICOON wordless picture dictionary was created as a communication aid for people travelling to countries where they're unable to speak the native language. It works well for people with aphasia, who often describe the condition as like being in a foreign country where they can't speak the language and where no one understands them. 

You can download the ICOON wordless dictionary on the iTunes app store.

Other picture-based resources:

Smartphones and tablets as communication tools

Smartphones and tablets can be great communication tools for people with aphasia.

There are a number of apps – both free or paid – that could help you with communication.

In addition to apps, a lot of smartphones and tablets have built-in features that could be useful communication tools such as:

  • The camera, to record information visually
  • Notes, to write down reminders
  • Maps, to show people where you've been or to find your way somewhere.

The Aphasia Software Finder can help you find the right app for you. When considering software or Apps, the advice of a suitably experienced Speech and Language Therapist is recommended. 

Going online can keep you informed. It can help you stay in touch and help you communicate. It can also help you gain independence and it can be fun. This guide to getting online has information to help you get online and use technology. 

You can use a computer, tablet or smartphone to make a video call. People with aphasia often find video calling better than a phone call.

These guides for people with aphasia will help you use Skype, Zoom and WhatsApp. 

Other communication tools

  • Total Communication - Total communication uses a variety of methods such as gesture, sign, drawing, facial expression and mime. It's based on the idea that any means of communication is valuable as long as it works.

  • Activities that do not rely on speech - If your relative or friend has difficulty speaking, they're likely to find conversation tiring. It may be helpful to spend some time doing things together that don't require much speech.

Angus Igwe won a Life After Stroke Award for art after he lost most of his words following a stroke: