Communicating with someone with aphasia

People who have aphasia have language problems. They may have trouble saying and/or writing words correctly. This type of aphasia is called expressive aphasia. People who have it may understand what another person is saying. If they do not understand what is being said, or if they cannot understand written words, they have what is called receptive aphasia. Some people have a combination of both types of aphasia.

Expressive aphasia may be non-fluent, in which case a person has trouble:

• Finding the right words
• Saying more than 1 word or phrase at a time
• Speaking overall

Another kind of expressive aphasia is fluent aphasia. People who have fluent aphasia may be able to put many words together. But what they say does not make sense. They are often unaware that they are not making sense.

People who have aphasia may become frustrated:

• When they realize others cannot understand them
• When they cannot understand others
• When they cannot find the right words

Speech and language therapists can work with people who have aphasia and their family or caregivers to improve their ability to communicate.

The most common cause of aphasia is stroke. Recovery may take up to 2 years, though not everyone fully recovers. Aphasia may also be due to the brain losing function, such as with Alzheimer disease. In such cases, aphasia will not get better.

There are many ways to help people with aphasia.

Keep distractions and noise down.

• Turn off the radio and TV.
• Move to a quieter room.

Talk to people who have aphasia in adult language. Do not make them feel as if they are children. Do not pretend to understand them if you do not.

If a person with aphasia cannot understand you, do not shout. Unless the person also has a hearing problem, shouting will not help. Make eye contact when talking to the person.

When you ask questions:

• Ask questions so they can answer you with yes or no.
• When possible, give clear choices for possible answers. But do not give them too many choices.
• Visual cues are also helpful when you can give them.

When you give instructions:

• Break down instructions into small and simple steps.
• Allow time for the person to understand. Sometimes this can be a lot longer than you expect.
• If the person becomes frustrated, consider changing to another activity.

You can encourage the person with aphasia to use other ways to communicate, such as:

• Pointing
• Hand gestures
• Drawings
• Writing out what they want to say
• Signing out what they want to say

It may help a person with aphasia, as well as their caregivers, to have a book with pictures or words about common topics or people so that communication is easier.

Always try to keep people with aphasia involved in conversations. Check with them to make sure they understand. But do not push too hard for them to understand, since this may cause more frustration.

Do not try to correct people with aphasia if they remember something incorrectly.

Begin to take people with aphasia out more, as they become more confident. This will allow them to practice communicating and understanding in real-life situations.

When leaving someone with speech problems alone, make sure the person has an ID card that:

• Has information on how to contact family members or caregivers
• Explains the person's speech problem and how best to communicate

Consider joining support groups for people with aphasia and their families.

Stroke - aphasia; Speech and language disorder - aphasia

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. www.nidcd.nih.gov/health/aphasia. Updated March 6, 2017. Accessed July 4, 2024.

Updated by: Joseph V. Campellone, MD, Department of Neurology, Cooper Medical School at Rowan University, Camden, NJ. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.