Communication and Stroke

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Communication and Stroke
Presented by Alana MacIntyre, SLP Northeastern
Ontario Stroke Network www.neostrokestrategy.com
Adapted by Alana MacIntyre, SLP, from Holly
Sloans and Lisa Saccos presentation
Communication After Stroke
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Purpose

• Understand what communication is
• Identify communication impairments
• Apply strategies to become a better communication
  partner
• Become able to support survivors friends,
  families and caregivers in communication
  situations

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What is Communication?

• Must involve two people
• A message must be sent and received
• It involves at least one of the following
• Speaking
• Facial expression
• Gestures

• Tone of voice
• Body language
• Writing/drawing

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How do we communicate?

• Speech Tongue, lips, voice box and lungs move
  together to make words (talking)
• Language Symbol system we use to represent our
  thoughts (e.g., English, French)
• Cognition Thinking skills

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How does stroke affect communication?

• Difficulty
• Understanding
• Thinking of Words
• Getting Words Out
• Speaking Clearly
• Reading
• Writing

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• Communication difficulty depends on
• Where in the brain CVA occurred
• How much damage was done

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Dysarthria/Apraxia

• Speech Disorders Know what they want to say,
  but cannot say the words clearly, if at all
• Dysarthria
• Difficulty producing clear speech
• Weakness or reduced coordination of the muscles
  needed for speech (mouth, throat, chest, etc.)

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• Apraxia
• Difficulty planning the movements for speech
• There may be
• Groping for correct words
• Mixing up sounds (e.g., tat for cat)
• Limited speech

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What are cognitive-communication impairments?

• Breakdown in thinking skills
• May have difficulty
• Organizing thoughts
• Concentrating
• Remembering
• Understanding non-verbal communication or
  humour/sarcasm

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What is Aphasia?

• Breakdown in language Mild ? Severe
• Caused by damage to the left side of the brain
• Can affect
• Understanding
• Speaking
• Reading
• Writing

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Receptive Aphasia

• Difficulty understanding spoken language and/or
  written language
• Range from totally unable to understand speech,
  to only having difficulty if the spoken/written
  information is long and complex

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Expressive Aphasia

• Difficulty speaking and/or writing
• Can range from mild (some trouble finding words)
  to severe (not able to talk at all)

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Expressive Aphasia

• May have difficulty with
• Finding the word they want to say
• Saying the wrong word or
• nonsense words
• Putting their thoughts into sentences
• Using correct grammar in sentences

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Global Aphasia

• The worst of both receptive and expressive
  aphasia
• Unable to understand what people say to them and
  are unable to speak

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Something to RememberIntelligence is NOT
Affected!

• With any client who has one of these identified
  problems, it is important to remember that they
  DO have difficulty understanding and speaking
  language.

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BUT

• Often survivors with communication impairments
  can still
• Think, plan, decide, and reason
• Usually produce Some clear words
• Understand facial expressions and gestures

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Aphasia Waking up in a Foreign Country
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Intelligence vs. Cognition

• Cognition understanding and trying to make
  sense of the world
• Intelligence a property of the mind that
  encompasses many related mental abilities, such
  as the capacities to reason, plan, solve
  problems, think abstractly, comprehend ideas and
  language, and learn

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Become a Skilled Conversation Partner!

• Learn how to discover what the client wants,
  enjoys, feels
• Instead of trial and error, and guessing, use
  proven strategies to make things MUCH easier for
  both your client and yourself!

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How to get the message IN

• Use short sentences, simple grammar, common
  vocabulary
• Speak S-L-O-W-L-Y
• Use normal tone and loudness
• Repeat and/or rephrase

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How to get the message IN

• Give plenty of time to process what you have said
• Use facial expressions, gestures, and visual cues
• Ask if the client understands you
• Write down key words, draw pictures

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Writing Techniques

• Write down key words
• Make sure they can see it
• Glasses on
• Large print
• Place it on their unaffected/best side
• Talk naturally while you write
• Ask Where did you work?
• Write WORK?

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How to help get the message OUT

• Be patient!! Give them lots of time to answer
• Ask them to gesture/draw/write
• Give them choices (verbal, written and/or with
  gestures)
• Ask yes/no questions
• Ask closed ended questions (i.e. orange or
  apple juice?)

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Asking Questions

• Open Ended Questions
• Where did you work?
• What would you like to drink?
• Who are you going to vote for in the election?
• These questions are Very Difficult to understand
  and answer

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• Types of Questions to Use

• Yes/No Questions
• Do you work at IBM?
• Would you like a coffee?
• Do you like Harper?
• Closed Ended Questions
• Do you work at IBM or Compaq?
• Would you like coffee or tea?
• Do you like Harper or Martin?

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• Types of Questions to Use
• These questions are much easier to understand
  and answer, especially when combined with words
  and/or pictures!

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Other Helpful Tools

• Tell the person when you do not understand
• Repeat what you thought the person said
• Ask the person to write down what they said

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Other Helpful Tools Cont.

• Have conversations in quiet places (No TV, close
  the door, etc.)
• Maintain eye contact
• Assist client if they give you wrong or missing
  information

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The CommuniKit

• The CommuniKit is a collection of communication
  boards put together and organized in a single
  folder
• The purpose of the CommuniKit is to assist health
  care professionals/caregivers to communicate
  effectively with their clients
• The CommuniKit is available in many organizations
  (contact NEOSN for more information)

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How Does This Help You?

• With Improved Communication You Can
• Reduce client and staff frustration
• Increase your ability to help your clients and
  better meet their needs
• Improve the quality of the relationships with
  clients and their families

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With Improved Communication You Can Also

• Create a supportive environment in which the
  client and staff work together to improve
  communication and lessen frustrations
• Improve client safety and independence
• Become more satisfied with your job!