Communicating With a Loved One Who Has Aphasia: How Can Families Support Conversation After Stroke
Written by Mariya Kika, M.H.Sc., Reg. CASLPO, Speech-Language Pathologist
Table of Contents
How does aphasia change conversation at home?
Aphasia changes how a person communicates. It does not change who they are.
After a stroke, families often notice that everyday conversations take more time and effort. A quick question at breakfast or a phone call with a grandchild now take more time. They may involve long pauses, filling in the blanks, repetition, and frustration for everyone involved.
Frustration is natural. What was once simple and easy has now become incredibly challenging. It's important to remember that aphasia is a language disorder, not a loss of intelligence. The person with aphasia often knows exactly what they want to say. The challenge is in the connection between thought and word.
Communication can be broken down into two main skills:
Expression: Getting a message out
Comprehension: Getting a message in
Some individuals mainly have trouble understanding what others say. Others understand well but have difficulty finding or saying words. Many experience a mix of both.
Because aphasia looks different in everyone, the strategies that help will also differ. The sections below provide guidance along these two skills: helping a message get in, and helping a message get out.
To learn more about how aphasia affects speaking, understanding, reading, and writing, see Speech Therapy for Aphasia: How Can Adults Rebuild Communication After Stroke.
How can families help a message get in?
Helping a message get in means making it easier for the individual with aphasia to understand what is being said.
Family members can:
Ensure they have the individual’s attention before speaking
Turn off or reduce background noise like the TV or social media streams
Use short, clear sentences with one idea at a time
Pause between ideas to allow time to process
Write down key words while speaking
Use gestures, facial expressions, or photos to support the message
Identify when the topic is changing
It's important to keep an adult tone. Simplifying language is not the same as speaking to a child. The goal is to make the message clearer, not smaller.
How can families help a message get out?
Helping a message get out means giving the individual with aphasia more ways to express themselves.
Family members can:
Ask them if they’d like help before jumping in
Allow extra time to respond, and resist the urge to fill the silence
Ask yes/no or choice questions when an open question is too difficult
Offer written choices so the person can point to an answer
Encourage any way of communicating, including gesturing, pointing, drawing, or writing
Keep a pen, paper, and a few photos or a key word list within reach
Summarize what the message as it was understood, don’t make assumptions
For example, an open question like "What would you like to do this weekend?" may be difficult for some individuals with aphasia. The same topic can be facilitated with three choices, either spoken or written: "Visit family," "Stay home," or "Go for a drive." The person can pick one, and the conversation can build from there.
In other words, the goal is not perfect words. It is getting the message across, on the person's own terms.
What should families avoid in conversations?
Many common reactions or initial strategies come from a good place. But, they can make conversation more difficult or frustrate the individual with aphasia.
This can include:
Speaking louder. Aphasia is not a hearing problem.
Finishing sentences without asking. Some individuals welcome help with a word; others would rather take their time. Ask which they prefer.
Correcting every word. Turning conversation into practice can make it feel like a test.
Speaking for the person. Avoid speaking for them, over them, or about them like they are not there.
Pretending to understand. It's more respectful to say, "I didn't quite get that. Let's try another way."
Changing the subject. Don’t rush through a difficult topic or conversation because of discomfort or because you believe the individual with aphasia cannot participate.
If communication breaks down, it's okay to pause and come back to it later. Fatigue, noise, and stress can all affect communication, and some days will be easier than others.
How can families keep a loved one included at gatherings?
Holiday dinners, birthdays, and family events can be some of the most challenging settings for someone with aphasia. Emotionally, they may still be adjusting to the changes in their life. Physically, they may still be having difficulties.
But, when it comes to family events, they can feel overwhelmed or embarrassed. It is important to note that quick topic changes, multiple speakers, background noise, and other things often found at events can lead to a build up of communication fatigue. This leads to individuals withdrawing or feeling left out.
Family members can:
Seat the person where they can see faces clearly, away from the kitchen or music
Encourage one person to speak at a time
Create a smaller conversation of two or three people
With the person's permission, share a few strategies with guests ahead of time
Plan breaks, since conversation after a stroke can be tiring
Choose video calls over phone calls for relatives who live far away, so gestures, written words, and facial expressions can be seen
Staying involved in family life matters. And the success of this depends on the use of strategies and meeting the individual where they are.
What is communication partner training?
Communication partner training teaches the people closest to someone with aphasia how to support conversation. It focuses on the partner, not on the person with aphasia.
One well-known approach is Supported Conversation for Adults with Aphasia (SCA™), developed by the Aphasia Institute in Toronto. It is built on the idea that the person with aphasia is competent and knows more than they can say. Clinicians teach participants how to effectively use practical techniques such as writing key words, using yes/no questions to check understanding, and summarizing what was said.
Training for family members and communication partners can be part of speech therapy for aphasia. It can be facilitated in both in-person and virtual treatment sessions. It is an important aspect of supporting individuals with aphasia because it targets those in their immediate environment.
When should families reach out to a speech therapist?
Families do not need to wait for a referral or a formal diagnosis to seek speech therapy for a loved one. Speech therapy can be initiated by anyone at any time, including caregivers and family members.
It may be worth reaching out if:
Conversations at home often end in frustration on either side
The person with aphasia is pulling back from phone calls, outings, or family events
Hospital or outpatient therapy has ended, but communication goals remain
The person is planning a return to work, volunteering, or other activities
Family members are unsure which strategies to use, or when
A free consultation is a chance to ask questions and talk through what support and treatment could look like. The individual with aphasia is included in every decision about their care.
About the author
Mariya Kika is a registered speech-language pathologist and the founder of Cognicare Speech Therapy, operating virtually across Ontario. She holds a Master of Health Science from the University of Toronto. She previously worked as the sole speech-language pathologist at Altum Health, part of Toronto's University Health Network, providing outpatient neurorehabilitation that centered return-to-work care. She is a member of the Canadian Concussion Network, Ontario Brain Injury Association, Toronto Brain Injury Association, and Canadian Telerehab Community of Practice.
For more on aphasia, see Stroke & Aphasia, Speech Disorders and this blog post Speech Therapy for Aphasia: How Can Adults Rebuild Communication After Stroke.