How to Communicate with Someone with Aphasia

Once I was asked to explain “in layman’s terms” how to best communicate with someone with aphasia.

I thought about it and said… ”It’s kind of like learning to dance… each person has a role and learning the steps makes for a beautiful exchange, and when one doesn’t know the steps, one or both may end up with sore toes… or feelings in this case!”

Steps in the Communication Dance!

Before we get started…

  • It takes two to tango; state the obvious “We’re in this together”; “We both know how to speak aphasia!”
  • Remember to take turns; slow yourself and your communicative partner down.
  • Do things collaboratively; share the communicative burden.
  • Be flexible; try a variety of ways to exchange info.
  • Don’t just use the techniques when communication breakdowns occur…use them habitually to help set the template and create a new way of communicating.
  • Remember that “key words” not only demonstrate the flow of the story/conversation, but they also provide a means of expression for the Person With Aphasia (PWA) and can be used during verification to be sure you are on the right track!
  • Rapport and sharing a sense of self, your humor, etc. are most important in a mutually satisfying conversation!


Step One: The setting…

  1. Know the situation…is this idle chit-chat, a sharing of stories or something more urgent?
  2. Do we need to modify the environment (turn TV off, etc.)?
  3. Do I need any tools (paper, props, etc.?)

Step Two: The supports…

  1. Start with what you know…narrate the situation (i.e. “You look excited/worried/upset”); use facial expression, situational cues to help you start the conversation.
  2. Encourage the PWA to communicate first…comment on any and all techniques they use / give specific feedback on what helped and what you still need to know.
  3. Listen (and Watch) for a general theme, …write down and ask about that general theme.
  4. Write key words throughout the exchange; cross out any words that you have determined were an incorrect path.
  5. Ask the PWA to gesture, or “show” you if the verbal attempts are unsuccessful; comment on what you see, and write it down to confirm accuracy.
  6. Ask the PWA to draw or write something (you can put those options out as cue cards if that helps); don’t read the message too literally!
  7. Ask the PWA general and BROAD questions, always avoid asking narrow (20-question type) questions.
  8. Try drawing concurrently and label (in questioning tone) any drawing that the PWA makes. Label yours also!
  9. Ask questions about the drawing or gesture, “Okay, is this a ___________?”; if you can’t figure out what the drawing is, ask the PWA to point out the most important part of the drawing.
  10. Provide choices to the PWA if you have narrowed your topic enough to do that (be sure you provide the choices in writing as key words!)
  11. Give the PWA a yes / no card or write it on the paper for determining accuracy of what you are saying and what they are saying too.
  12. Use visual scales, number sequences, props (newspaper, map, etc.) to strengthen the info going in and to provide an opportunity to help get the message out.
  13. Ask WH- questions (written and verbal) to focus your attention on the message. (i.e. “When did this happen?; “Who did that?”
  14. If the PWA has a communication book, encourage them to see if the information is in there.

Step Three: The rehearsal

  1. Verify, Verify, Verify!! Use statements like, “Let me tell you what I understand so far”; “Wait, Joe, Let me make sure I am on the right track”.
  2. Review the key words and flow of conversation; restate those that you crossed out, saying “and you told me it wasn’t _________”.
  3. Label pictures, clarify and ask for additional detail on anything that you aren’t sure of.
  4. Double check yes/no’s, relationship words (wife, brother, etc.) and man/woman. These are often incorrect and not realized.

Step Four: The encore…

  1. Give feedback at the end of the exchange/story on what helped you and what didn’t; Admit your mistakes and talk about breakdowns in communication for what they are…both listener and speaker errors.
  2. Emphasize the positive and demonstrate by review what was actually communicated (Many individuals with aphasia are unaware that they got that much across!)
  3. If you just can’t get the message exchanged, take a break, and come back to it.

Back to Understanding Aphasia page.