I've heard from many a frustrated family member something like the following: "The therapist just comes in and sets up her bag of items. Every single time. She puts out a plate, a fork, and a cup and just says 'show me the cup'. He can't ever get it. This is all she does. How is this helping"?
The short answer is that it’s not helping. It’s a testing situation versus a learning situation. In a testing type of therapy, which is what almost all therapy looks like in rehab, the therapist is presenting a stimulus (like a photo or object) and asking for a response. The patient’s response is either correct or incorrect and the therapist takes data this way. This eventually leads to a “plateau” because the patient with aphasia doesn't spontaneously improve their responses. They’ve learned nothing because they’ve been taught nothing.
In the learning situation, however, the patient isn’t constantly tested, but taught the information using a variety of approaches. Way before correct/incorrect answers are tallied, what’s important is what type of help the patient needs to correctly respond and how much of that help they need.
Tips to improve comprehension in aphasia include:
- Understanding is best in context. This means that while you are in the kitchen and you are talking about dinner, you may ask them to get the plates, speaking more slowly and pointing to the cabinet. Context, using gestures, and speaking more slowly will help them understand.
- Use more than one way to communicate. Comprehension is a continuum. This means that you have different levels of support to reach more independent skills. For example, point to items as you discussed them. "Can you hand me the scissors?" while pointing to the scissors. You may write the word "scissors" or you may use your fingers in a cutting gesture.
- Saying only a single word is actually harder to understand than if you say a short sentence = context helps. For example, saying the word ‘shoes’ may not mean anything by itself. It can sound like ‘dues’, ‘shows’, ‘bows’, etc. But saying “put on your shoes” while pointing to your shoes or to their shoes connects that word to the object/action in context. Think about what your typical speech-to-text app does when you say a single word–it may or may not match it with the correct written word. But when you say a sentence, the app can go back and correct a word given more context.
- Slow down your rate of speaking and emphasize key words. For example, “Mark (getting his attention), do you want something to drink? (gesturing a drink or holding up two object choices)”
Comprehension can and does improve over time using these techniques. While it’s difficult to return to more complex understanding similar to before the stroke, enabling even moderate understanding will have a huge impact on speech, strategy use, reading, technology use and writing skills. These tips and more are available for free in Spanish and English on our Aphasia Communication Tip Cards at https://theaphasiacenter.com/aphasia-communication-tips/.
