Aphasia: A Care Staff Guide to Communication Support

Aphasia is a language disorder that affects a person's ability to speak, understand, read and write. It is most often caused by stroke, but it can also follow a head injury, a brain tumour or progressive neurological illness. Importantly, aphasia is not a problem with intelligence, and it is not the same as confusion or dementia. A person with aphasia usually knows what they want to say and may understand more than they can show. For staff in care homes, hospitals and community teams, the way we communicate can make the difference between a person being included in decisions and being ignored. This guide sets out practical techniques and the legal duties that sit alongside them. It is general information, not clinical advice.

How aphasia affects people

Aphasia varies a great deal between individuals. Some people have difficulty finding words, speaking in short fragments or using the wrong word. Others speak fluently but the words do not make sense, or find it hard to follow conversation, especially when it is fast or in a group. Reading, writing and understanding numbers can also be affected. Frustration, low mood and withdrawal are common, so how staff respond matters for wellbeing as well as for communication. Aphasia is different from dysarthria, where speech is slurred because of muscle weakness, though the two can occur together, and from the cognitive changes described in our guide to post-stroke cognitive impairment screening.

New aphasia is an emergency

Sudden difficulty speaking or understanding is a classic sign of stroke. If a person who previously communicated without difficulty suddenly cannot find words or follow what you say, call 999. Our guide to the FAST stroke test explains what to look for and what to tell the emergency team.

Supported conversation: what NHS guidance recommends

NHS Lothian's guidance on supported conversations for people with aphasia sets out simple techniques that staff can use straight away. To support understanding, it recommends staff take their time, repeat or rephrase key words or phrases, use simple meaningful gestures, write key words to clarify and offer choices, use simple clear drawings alongside speech, and use maps, photos, calendars, communication books and alphabet boards. To support expression, it advises giving the person time, encouraging them to think of another word or describe it instead, using yes/no questions to confirm understanding, responding to gesture, mime and pointing, and supporting with writing and drawing if the person is able.

In everyday practice, that translates into habits like these:

• Reduce noise and distraction. Turn off the television, find a quiet space and face the person at eye level.
• Use short, clear sentences. Speak at a natural pace and tone, not louder or slower in a way that sounds patronising.
• Ask one question at a time. Where possible, offer two clear choices rather than open questions.
• Check understanding. Summarise what you think they have said, and ask them to confirm.
• Allow silence. Do not finish the person's sentences unless they ask you to.
• Treat the person as an adult. Avoid talking over them to a relative or colleague.

Capacity, consent and best interests

Difficulty communicating does not mean that someone lacks capacity. Under the Mental Capacity Act 2005, a person must be given all practicable help to make a decision before anyone concludes they cannot, and communication support is a core part of that help. That might include pictures, written choices, simplified information, extra time, or involving a speech and language therapist in the assessment. Decisions made when a person cannot take part in the conversation should be recorded carefully, following the principles in our guide to Mental Capacity Act and DoLS training.

Working with speech and language therapy

Speech and language therapists assess communication, set goals and teach staff and families strategies that suit each person. Care staff can help by asking for an assessment where aphasia is suspected or has changed, following any communication passport or care plan, and recording what works. Practising everyday conversations, using familiar objects and photographs, and keeping a consistent approach between shifts all help therapy carry over into daily life.

Making information accessible

People with aphasia often struggle with letters, consent forms and complaints procedures that are written in dense text. Provide key information in short sentences with large print and pictures, give people time to read, and check understanding before asking them to sign anything. Make sure the person can ask for help, call for staff and tell you if they are in pain. Consider whether noticeboards, menus and care plans can be made aphasia-friendly.

Frequently asked questions

Will aphasia get better?

Many people improve, particularly in the first months after a stroke, and therapy can help, but progress varies and some difficulties persist. Staff should avoid predicting outcomes.

Should I speak for the person?

Only when they ask you to or cannot take part in any other way. Use supported conversation first so that they remain the decision-maker wherever possible.

What training can help?

Communication skills, stroke awareness and capacity training are all relevant. Browse the Learnsignal CPD hub for healthcare compliance courses.

Source: NHS Lothian, Supported conversations: aphasia. This article is general information, not clinical advice.