An audiologist evaluating the hearing of a person with aphasia joins a team that will influence a person's daily communication and can greatly affect that person's treatment for—and recovery from—aphasia.
But providing audiology treatment to people with aphasia presents some unique challenges, due to patients' difficulties with expressive and receptive communication. Clinicians should try to balance their communication accommodations with recognition of and respect for the client's retained cognitive skills and general autonomy (Kagan, 1995; Stein & Brady Wagner, 2006).
Surprisingly, there is little supportive evidence to develop best practices for providing audiology services to this population. But the available research, combined with clinical experience, reveals some basic strategies for improving communication for many people with aphasia. Using these strategies will help audiologists get the best possible outcomes in evaluating and providing services to patients with aphasia and other communication difficulties.
1. Provide Information Early
Provide written information, such as brochures or contracts, before an appointment. Pre-appointment information gives the person with aphasia a chance to read materials or fill out forms at a slower pace—and with help from others, if needed.
2. Slow Down
Adding pauses between phrases and sentences gives people extra time to understand what you're saying. Giving extra time to read written materials can serve the same purpose. In fact, keeping the pace of the whole session slow and unhurried—and perhaps even scheduling a longer appointment to allow extra time—can be very helpful, because people with aphasia generally have more trouble communicating if they feel rushed and flustered.
Simplify communication interactions and the clinical environment. Make short statements in plain speech, using common words instead of jargon. To change topics, make a point of saying you're moving on to another subject. Ask questions the client is able to answer, such as yes/no questions, by facilitating single-word responses instead of long narratives. Simplify printed materials with summary sheets or rewrite them in simpler language and an uncluttered format (see illustration [PDF]; Alelighay, Worrall, & Rose, 2008; and The ASHA Leader's series of articles on health literacy). Closing the office door—or choosing to meet in a room away from a busy hallway—can reduce distractions and simplify the communication environment.
Communication involves more than speech. People with aphasia often use alternative strategies, such as drawing, writing, gesturing, or using electronic or manual communication devices. Encourage clients to bring their systems or devices to the appointment, and provide paper and pencils for the client's use, as well as your own. For instance, you can provide concrete gestures, draw simple pictures, write key words as you speak, or provide demonstrations and practice opportunities as you explain testing tasks.
5. Modify Tasks
Adapt assessment tasks, interviews, or treatment planning discussions to make them more accessible to people with aphasia. For example, writing, gesturing, or multiple-choice pointing—to words, pictures, or objects, depending on client strengths—may be more successful than asking for verbal responses. If task modifications are not effective for assessment, a good option may be to replace standard behavioral assessment tasks with physiological measures or simpler behavioral tasks (Rosner, Kandzia, Oswald, & Janssen, 2011).
It can be hard to tell if a person with aphasia has truly understood what you are saying because they often nod and indicate agreement even if they haven't. To verify comprehension, ask direct questions or ask the client to demonstrate his or her understanding in concrete ways, such as showing a particular task response or skill.
It is also important to verify what you think the client has told you, because aphasia can cause someone to speak unintended words. The clinician can verify the message by repeating it—orally, in writing, by gesture, or through drawing—and then asking the client to confirm.
7. Involve Others
Invite a family member, close friend, or skilled caregiver to attend appointments. The additional person can be helpful every step of the way. Engage the client's speech-language pathologist for assistance with pre-training assessment tasks, helping the client review and understand documents, facilitating interviews, and interpreting assessment results in light of language abilities.
Providing audiology services to individuals with aphasia can be difficult at times, but adding these basic principles to your treatment—as appropriate—can help. With creativity, patience, teamwork, and sensitivity to individual strengths and challenges, we can meet the needs of people with aphasia. The audiologist's challenge is ensuring that hearing loss is adequately diagnosed and treated, and does not contribute an additional, unnecessary burden to the existing communication difficulties of aphasia.