What is a communication breakdown?

• That's what we call it when the conversation stalls or just plain falls apart!
• Maybe your loved one is trying to tell you that they want crawfish étouffée for dinner. But they can't find the phrase "crawfish étouffée," so instead they grab some paper and start drawing the shape of the pot you use to make it.
• This confuses you and the two of you never get to what your loved one was actually trying to say.
• That's a communication breakdown. 
• Breakdowns happen all the time, even with speech-language pathologists! It's the nature of aphasia. 
• But there are strategies we can use to limit them - or at least make them quicker.

It can be intimidating to learn how to support someone with a communication disorder.

• That's why we're here to help!
• We've compiled some of our tried and true strategies from people with aphasia, care partners, and speech-language pathologists. These should give you a good idea of how to help your loved one during a communication breakdown.
• We always recommend discussing support with your loved one. After a communication breakdown, it's okay to ask, "Was what I did helpful to you just now?" Talk it through and find other options if not. 
• Your speech therapist and mental health counselor can help with these discussions too!

Word-finding strategies

• GIVE LOTS OF TIME. Don't rush your loved one with aphasia - time pressure often makes things worse.
• Learn your loved one's cues for when they want you to jump in and help.
• Summarize what your loved one has already said to give some context and help jog their language system.
  • Example: Your loved one is telling you a story about therapy today but gets stuck.
    • Person with aphasia: Sarah closed door, sit down...and then ...... (stuck)
    • You: [slowly, after a lot of pause time] so Sarah closed the door, she sat down, and then...?
    • Person with aphasia: Dropped her pen. 
• Use "this or that" choices to help narrow down the options.
  • Example: Your loved one is trying to tell you what they want for lunch but gets stuck.
    • Person with aphasia: Not...not....ugh.
    • You: (slowly, after a lot of pause time): Is it chicken, ground beef, or something else? (You can also use writing to make these choices even clearer - then they can point!)
    • Person with aphasia: Beef.
    • You: Is it a hamburger, spaghetti, pizza, or something else?
    • Person with aphasia: Burger.
    • This can continue for as long as it needs to!
• Always have paper and a pencil on hand.
  • Some people with aphasia will draw a picture of the word they're getting stuck on.
  • Others will write the first letter, first few letters, or even the whole word. 
  • These are all clues that help us get at the person with aphasia's meaning.
• Follow the person with aphasia's lead - don't just say "it's okay."
  • Sometimes they're getting stuck on a minor detail and are fine to move on without resolving the breakdown.
  • Other times it's really important that we get it right! Try not to write it off before trying all these strategies to get at what they are trying to say.

Auditory comprehension (understanding) strategies

• Speak slowly! "Chunk" your sentences into short meaningful phrases.
  • This can take some practice to sound natural, but it helps people with aphasia so much.
  • This is the most important strategy you can use!
• Use lots of gestures to emphasize your words.
  • For example, if you're talking about a phone call you just had, you can hold your phone up to your ear.
  • This will help remind you to speak slower, too.
• Write "keywords" down on a piece of paper between you and your loved one during conversation.
  • Use a bold marker and write important words and phrases in larger print.
  • Try to only write down nouns that are immediately relevant to understanding the conversation.
  • For example, if you're having a conversation about an upcoming doctor's visit, you might write "Dr. Smith" and "next Thursday."
  • Only put a few words on a page at a time. Too much information can be confusing. If you keep it below 7-10 words or phrases on a page, it helps with distraction.
• Draw diagrams for more complex conversations.
  • For example, if you're telling your loved one about the errands you ran today, you can write down the name of each place and connect them with arrows as you talk. 
• Make sure your loved one is regularly tested for hearing loss.
  • Sometimes we think it's an auditory comprehension deficit, but really your loved one just can't hear anything.
  • In that case, a hearing aid will take care of most of the issue. 

Reading strategies

• Help your loved one with aphasia set up speech to text on their devices. 
• Use the Natural Reader app on iPhone and Android to help with longer texts.
  • You can upload whole documents to this app and it reads it out loud for you.
  • You can adjust speaking voice and speed.
• Limit the amount of text at one time.
  • Longer paragraphs are harder for people with aphasia to read.
  • Shorter sentences and phrases are easier.
  • Try to cut down your sentences to only include the most relevant information. Don't include a lot of fluff!
• Give a lot of space between paragraphs and sentences. Bullet points are ideal.
• Write in large letters - ideally 16 pt font on computers.
• Restaurant menus are often difficult for people with aphasia to read. Check out our list of free aphasia-friendly menus for restaurants around the area.

RESOURCES

It's okay to get frustrated during a communication breakdown.

• Your loved one with aphasia is frustrated, too! 
• Just remember when a true breakdown occurs, you're not frustrated with each other - you're frustrated with the aphasia.
• Let that unite you rather than divide you!