You need two new pairs of shoes, so you go to your favorite store and ask the salesperson to show you outdoor running shoes and warm, waterproof snow boots. No problem.

No problem, that is, unless you have aphasia. As a result of a stroke that occurred on the left side of your brain, you have difficulty speaking. You are right-handed, so writing also is difficult and you often are unable to retrieve and/or spell words that you want to write. Reading and comprehending sentences is nearly impossible for you. And even though you are thinking "white," your attempt to name the color may come out as "green."

If you live in Baltimore, Maryland, however, you can visit seven businesses, including a shoe store, that offer custom-made picture boards and other support materials to help people with aphasia—and those with other speech-language disorders or limited English—to communicate. These businesses have been certified as "aphasia-friendly" by the Snyder Center for Aphasia Life Enhancement (SCALE).

Life Participation Approach

The aphasia-friendly business campaign extends the philosophy of the center, which emphasizes the life participation approach to aphasia treatment, according to speech-language pathologist Denise McCall, SCALE program director. SCALE's mission is to create a community for individuals with aphasia and their families. The center provides a place for individuals with aphasia to connect, offering interactive activities to support and empower members as they re-engage in the community. It also provides training and support for family members, and spearheads local community outreach and advocacy projects to raise public awareness and understanding.

Under the federal Americans With Disabilities Act (ADA), almost all businesses that serve the public must take steps to communicate effectively with customers with disabilities. Because the nature of communications differs among businesses, the ADA allows flexibility in carrying out that mandate. SCALE's outreach efforts helped local businesses find effective communication solutions specific to each.

Neighborhood Outreach

As part of its outreach effort, SCALE staffers contacted several businesses located near the center of the section of north Baltimore known as Belvedere. They asked a simple question: Would the business be willing to receive free tools and training to help its employees serve people with aphasia?

"It's a no-brainer," McCall said. Based on prevalence data, SCALE estimates that 23,000 people in Maryland and 3,000 in Baltimore have aphasia. "We explain to businesses that if they aren't aphasia-friendly, all those people and their family and friends aren't likely to shop in their stores. Why would they say no?"

Seven businesses ultimately participated in the launch of the program in early 2011. Armed with clipboards with icon-based checklists, teams of SCALE clients (known as "members") visited the businesses to conduct evaluations of the environment, customer services, bathrooms, and written materials.

"Did the business have clear signage with icons? Are bathrooms accessible—do they have grab bars on both sides of the stalls? Are the faucets on the sinks easy to use with one hand? Are employees patient and knowledgeable about communicating with people who have aphasia? The evaluations were truly eye-opening for the employees at these businesses," McCall said.

Each business then sent a representative to SCALE for training conducted by SCALE members on how aphasia affects language and communication, how the effects are different for each person, and most important, how aphasia does not impair memory or cognitive skills. Several members shared their personal struggles and successes.

The members' message was clear, McCall said: "We are consumers with opinions who want service, and if you can't accommodate us we will go elsewhere."

SCALE members, volunteers, and staff then developed aphasia-friendly communication tools unique to each business: a picture-based menu for a restaurant, a list of banking options with icons accompanying each word or phrase (e.g., "open an account," "withdraw money"), an extensive picture board for the shoe store displaying sizes, colors, styles, and types of shoes.

Finally, members invited the business representatives to a June 2011 award luncheon, co-sponsored by the National Aphasia Association (NAA). SCALE members presented the businesses with the individualized communication materials, the "Aphasia-Friendly Business" award suitable for display, and an "aphasia-friendly business" decal for their front doors.

The message on the decal could not be simpler or clearer: "Awareness + Communication Tools = Aphasia Friendliness."

Program Expansion

Since then, other businesses have approached SCALE and asked to participate in the program. Unfortunately, funding is an issue, McCall said. In an effort to build on the program, SCALE shared its program and materials with the NAA, which is seeking grants to expand the concept nationally. According to Ellayne Ganzfried, executive director, NAA is adapting the materials for a larger audience and has assembled a committee that will pilot the program in various locations in 2012.

For now, at least, SCALE members have less difficulty eating at restaurants (Swallow at the Hollow and Zen West Café), banking (M&T Bank), purchasing prescriptions and other medical supplies (Northern Pharmacy & Northern Pharmacy Medical Equipment), buying shoes (Van Dyke & Bacon Shoes), and accessing architectural services (Penza+Bailey Architects).

And even more important than the business-specific communication tools, McCall said, is the business employees' understanding of what aphasia is and how to interact with people with aphasia. "It's all about good customer service," McCall said, "and that includes recognizing the competence and dignity of customers with aphasia and offering a patient, respectful approach."