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The Communication
Toolbox:
Practical strategies for facilitating
communication
Susan Howey
Speech-Language Pathologist
Stan Cassidy Centre for Rehabilitation
Aphasia
Difficulty in formulating, expressing, or
understanding language
Impairment in using a symbol system
(language) to communicate
?
?
Key Objectives
What is my role in communicating with a
person with aphasia?
What are the 2 key questions that I need to
answer when facilitating communication?
What are 7 of the most important strategies
I can use to facilitate communication?
ACCESS
ACCESS
Communication access
??
ACCESS
You
(conversation partner)
Experiences of aphasia
Question #1
Am I being understood?
How to get your message in
1) Control the flow of
information:
Take your time
Simplify: Use short,
uncomplicated sentences
How to get your message in
Control the flow of
information: (cont’d)
Keep your message focused:
One idea at a time
Make it clear that you are
changing the subject
How to get your message in
2) Supplement speech
with visual cues:
natural gestures, pointing,
and visual aids
How to get your message in
Have a pen and paper
handy:
Write down key words
Dr. Jones
TODAY
10:30
How to get your message in
3) Check to see if you were
understood
EXAMPLE
“Mr. Smith, I want to tell you about an
upcoming event” (bring pen, paper,
calendar)
“On Tuesday,…” (point to calendar, write
down Tuesday)
“…the Kent Brothers’ Band is coming to
play” (write down Kent Brothers’ Band)
EXAMPLE (cont’d)
“They’ll be playing downstairs in the
auditorium.” (point in direction of location)
“Would you like to go?” (Point to person,
write down question)
“Great. So on Tuesday, you’ll be going to the
concert.”
Question # 2
Does the person have a
way to respond?
How to help get their message out
Successful communication
is the goal – regardless of
how the message is
communicated
How to help get their message out
1) Encourage multimodal communication
Speaking
Pointing – objects or pictures
Gesturing
Showing you what they are talking about
Writing down a word or part word
Drawing
Intonation/ facial expression
Communication myth
A “communication board” will
ensure that we are addressing
communication needs
How to help get their message out
2) Closed-Ended Questions
Yes/No
Choice
How to help get their message out
Yes/No questions – response modes
Verbal
 Head nod/shake
 Pointing to the words
 Gesture (e.g., thumbs up/down)

Communication myth
Using yes/no questions is
usually the best way to
help the person with
aphasia express what they
would like to say
ROOM
REST??
How to help get their message out
Choice questions: options
Provide verbal choices
Write choices down
Give a choice of objects
Give a choice of pictures
How to help get their message out
Closed-ended questions
Attempt to identify the general
topic first, then narrow your
questioning
Broad  Detailed
How to help get their message out
3) Verify that you understood the message
correctly - by rephrasing or paraphrasing
their idea, then watching/ listening for
confirmation
Include other cues as needed:



Write down key words
Use visual aids
Draw
Acknowledge Competence
E.g., “I know that you know”; “I know you have
something specific to say – I’m just not quite
getting it yet”
Give the person time to get their ideas across
Avoid speaking about the person with aphasia
as if they are not in the room
If you need to direct questions to another
person, ask for permission first
EXAMPLE
“Hi Mrs. Smith. You seem upset.”
Multi-modal: “Can you show me what’s wrong?”
If this does not help her to get her point across,
use closed-ended questions to elicit information
– begin with general topics
(use her facial expression, gesture, pointing to
help you make an initial guess)
EXAMPLE
Write down key words – cross off inaccurate
guesses; circle correct information
ROOM
THERAPY
SOCIAL WORK
REC
OT
PT
SPEECH
Something Else
EXAMPLE
When you feel you understand,
summarize (speak, write, draw, gesture)
and look for confirmation
THERAPY
SCHEDULE
LOST
In a tough spot…
If you get stuck, be honest – “I know
you’re trying to say something specific,
and I just can’t figure it out yet.”
Then summarize what you know so far,
and let the person know that you can
come back to it later.
“Toolbox”
Black marker
Blank paper
“Toolbox”
The strategies you use as
a conversation partner
Message in
Message out
Review
Your role
To enhance communication
access by becoming a skilled
communication partner
2 Key questions
Am I being understood?
Does the person have a way
to respond?
7 important
communication strategies
1)
Acknowledge competence
Message in:
2)
3)
4)
Control the flow of information
Supplement speech with visual cues
Check to see if you were understood
Message out:
5)
6)
7)
Encourage multi-modal communication
Use closed-ended questions
Check to make sure you understood the message
Thank you!