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SECTION 3 Communication 2 Communication ► Defining communication and communication partnerships ► How stroke affects communication ► Developing communication partnerships with stroke survivors ► General post-stroke problems that affect communication ► Specific communication impairments 3 Communication Defining communication: ► The exchange of ideas through speech, language, gestures or writing. ► It helps people stay connected to each other. ► Clear communication is also central to getting needs met. 4 Communication Nonverbal communication ► Posture ► Movement ► Facial expression ► Tone of voice 5 Communication partnerships Partners in communication ► Every conversation or interaction involves at least 2 equal communication partners. ► Both partners send and receive messages. ► Both have to understand the message the other one sends. 6 Key point Stroke survivors may be less able to take an equal role in a communication partnership than other adults. When communicating with a stroke survivor, you may need to take more responsibility for the conversation than you would with other adults. 7 How stroke affects communication Stroke often impairs a person’s ability to communicate and connect with others. It can: ► be hard to determine what the survivor understands. ► cause specific impairments such as slurred speech (dysarthria), loss of language, (aphasia),and cognitive communication impairment (problems understanding and forming thoughts). 8 How stroke affects communication ► Makes muscle weak that may alter facial expression or prevent the survivor from turning to face the person speaking. ► The survivor’s voice may be weak and hard to hear. ► Physical impairments can stop the survivor from walking down the hall to speak with someone or picking up a phone to call a friend. 9 How stroke affects communication Attitudes of others: ► People may assume a survivor is not intelligent because he or she cannot communicate effectively. This can frustrate survivors even more. ► People often treat individuals with impairments as though they cannot think or speak for themselves. ► Being ignored can erode confidence. It can make the survivor avoid socializing. 10 How stroke affects the survivor Being unable to communicate can: ► frustrate stroke survivors. ► make them withdraw from social situations. People might think that the stroke survivor cannot or does not want to communicate. When this happens, the stroke survivor may not have a chance to connect to another person – something we all need. 11 For partnership For true communication to occur, the survivor must: ► Understand what the care provider says ► Be able to express thoughts ► Be understood 12 Key point The stroke survivor deserves respect. This person’s values, interests, concerns, opinions, strengths, and weaknesses reflect a lifetime of experience. 13 Developing a communication partnership ► Provide time and opportunity to communicate ► Be clear about the message you are sending ► Show that you want to understand the other person’s message ► Respect the message the other person sends ► Trust that the other person wants to understand the message you are sending ► Show your understanding of the other person’s situation 14 When communication is challenging ► Be hopeful. What needs to be said will eventually be understood ► Be patient and persistent ► Be creative. There is more than one way to get your message across. Try drawing, printing words, or using different words ► Tell the other person that you do not understand something ► Admit you are frustrated 15 When communication is challenging (cont’d) ► Address the problem. Ignoring the problem sends a message that you do not respect the other person. ► Don’t pretend to understand. ► Don’t change the topic to avoid fixing the problem. 16 Useful tips Assess: carefully observe the survivor to assess what he actually understands. Set the stage:Make sure there are few distractions. Get the survivor’s attention: Approach the stroke survivor slowly and from the front. If needed, gently touch a hand or arm to help get their attention. Make eye contact: Face the stroke survivor if you can. Keep eye contact (if culturally fitting). 17 Useful tips (cont’d) ► Deal with private matters privately: Get permission before raising a private matter with family or friends. The survivor may share information with you that they are not ready to share with family. Always include the stroke survivor in a conversation. ► Give one message at a time: Keep the conversation simple. Too many thoughts, ideas and questions at one time can be confusing. 18 Useful tips (cont’d) Pay attention: The person’s reaction can help you know if you are being understood. Repeat important information: If you are not sure that your message was understood, repeat it using the same words. Take time: Give the person time to respond. Interrupting can discourage further communication. Stay patient and calm: Do not expect communication to be fast, even if the topic is simple. 19 General problems that affect communication ► Limited mobility and wheelchair use ► Impaired hearing ► Frozen facial expression ► Slowed responses ► Impaired vision ► Emotional lability 20 Specific communication impairments ► Dysarthria ► Aphasia ► Inconsistent or inappropriate speech ► Cognitive communication impairments 21 Dysarthria ►A motor problem. ► Caused by weakness and/or lack of coordination of muscles of the mouth, throat, and chest. ► Those who have dysarthria have trouble making the sounds of speech clearly 22 Dysarthria – how you can help ► Choose a quiet place when survivor is rested. ► Ask survivor to speak more slowly and loudly. ► Repeat what you have understood. ► Make notes • Try paper and pen, white board, or computer. • Use a picture or alphabet board 23 Aphasia ► Aphasia is the loss of language, or being unable to use language. Language includes sounds, meanings, and rules for combining words into sentences. ► Aphasia may affect a survivor’s ability to talk, read, write or understand language. ► Many people link communication skills with mental ability. They may misjudge the mental abilities of the survivor with aphasia. 24 Key point Remember – people with aphasia are able adults who know more than they can say. 25 Aphasia – how you can help ► Set the stage. ► Be patient. ► Provide specific choices ► Break down longer questions into yes or no questions. ► Use pictures and objects. ► Always include survivors in the conversation. 26 Inconsistent or inappropriate speech Survivors may use words they don’t intend to use. These words may be related to the word that they wanted to say. How you can help ► If you are unsure what the survivor said or meant, explain you have not got the message yet. 27 Inconsistent or inappropriate speech How you can help (cont’d) ► Ask the survivor to repeat what was said. ► You can also ask the survivor if it is alright to ask questions to help you understand. ► Do not pretend to understand. 28 Inconsistent or inappropriate speech Yes or no? Survivors may say yes when they mean no. How you can help ► Work with the survivor to develop a non-verbal Yes/No ► Listen closely to the intonation. 29 Inconsistent or inappropriate speech Emotional words Some survivors may swear and use angry-sounding phrases when frustrated How you can help: ► Acknowledge the frustration, and ignore the out-of-place language. 30 Inconsistent or inappropriate speech Fluent aphasia - Survivors with fluent aphasias may talk constantly without making much sense. ► It can contain made-up words or phrases with no real content. ► These survivors are usually unaware of the fact that their speech is incomprehensible. 31 Inconsistent or inappropriate speech How you can help: ► Take the time to tell them that you are having trouble understanding them. ► Look for and use non-verbal signs ► Listen for messages & emotions in the words 32 Cognitive communication impairments A severe stroke, multiple strokes, or a right hemisphere stroke may cause difficulty with organizing, thoughts, concentration, memory, and knowledge of non-verbal communication. This leaves the survivors with a reduced ability to understand and communicate clearly. 33 Cognitive communication impairments How you can help: ► Maintain the focus of the conversation. ► Stay on the right. ► Communicate directly. ► Help the survivor remember. ► Deal with what you see as rudeness. 34 Upon reflection ► Have you ever communicated with a stroke survivor who has aphasia? ► What were some strategies that worked? ► How did you feel? 35