Now, again, I told you, this would be the
worst for me and it broke my heart
to see my dad deal with this.
But remember, the left hemisphere is
usually dominant for language skills
if you're right handed, and even
in most left-handed people,
so don't rush over that.
Usually, the left hemisphere is dominant
for language skills in right-handed people,
and in most of the left-handed
people that you work with.
So, if they have a stroke on the left side,
they're probably going to have
some language problems.
So we've got aphasia. Now, aphasia
occurs when a stroke
damages the dominant
hemisphere of the brain.
For most people, when it comes to language,
that's going to be the left side,
but there'll always be people
that are a little different,
but you've got just kind of a general
rule for the general population.
Now we talk about language disorders,
they're going to have difficulty with
expression and understanding
written and spoken words,
so they may give me some pretty
bizarre looks and faces.
My dad always had these super bushy
eyebrows, we had to cut them.
So we would always get that weird face
from him when we would say something
and it wasn't processing in his brain.
So aphasia, dysphasia, and dysarthria
are terms that you'll hear when we talk
about problems with communication.
Now, let's first take a look at aphasia.
There's different types of aphasia.
Receptive aphasia means
the patient will have
difficulty in understanding written
and spoken language.
Yeah, this one's a lot of fun.
Sometimes, it will feel like
speaking to someone who doesn't
speak the same language as you,
and you have zero in common.
Again, you know what we need to do. Remain
professional, remain therapeutic,
and just be patient, and keep reassuring the
patient in a calm and professional tone,
"We'll get this. I know this
is frustrating for you.
I'm sorry that I'm not
understanding right now,
but I'm going to stick with you until we do."
So, receptive aphasia means
when they receive things,
they have a hard time understanding it,
whether it's written or spoken.
Now, expressive aphasia.
They may know exactly what they want to say
in their mind, but they can't get it out.
That's why my dad would say -- when
he couldn't find the word.
So, they've lost the ability to produce
spoken or written language, even.
It's very difficult.
So, global aphasia, this is horrific.
I hate it when a patient has this for them,
because it's a severe form of both receptive
and expressive language skills.
So they cannot receive what you're
saying to them very well,
and they can't communicate back to you.
To me, this would be a horrible
fate to have to deal with that.
So think about stroke patients,
communication is a huge factor.
You want to be aware, is
it receptive aphasia,
is it expressive aphasia,
or is it global aphasia?
And think about how you would interact
with each one of these
patients a little differently.
Okay. So, let's talk about some strategies.
You want to make sure
you have the patient's attention
before you start.
So we're talking about these
different types of aphasias.
Never start a conversation with a
patient with your back to them.
If you're not making eye contact, don't
start the conversation, okay?
That is good for hearing problems,
vision problems, stroke patients,
and it's just professional.
So you want to make sure that you
have eye contact with your patient,
and you start an unhurried conversation.
You want to make sure there's not a lot
of background noise. A lot of times,
patients and families have TV and
radio and lots of people,
but if I'm going to go talk to a patient,
I would just walk in,
I'd make eye contact and I'd say,
"Good morning, Mr. Johnson.
My name is Rhonda. I'm going to
be taking care of you today.
Hey, I'm having a little bit hard
time hearing in here.
Would you mind if I turn
down the television?"
Always ask permission, okay? I always
say, "I'm having a hard time.
Would you mind if I turn the television
down?" Because you need to think
of the patient's room as their home.
So I don't just open the door and
come in. If the door is closed,
I'll gently knock on the door and
wait for someone to respond.
If he's globally aphasic, like the patient's
not going to be able to respond, I get it.
But it's still etiquette
to let them know that you're
physical boundary before
you come in a room.
You want to keep your voice
at a normal level,
unless the patient tells you, "I have
a severe hearing problem."
Now, my dad was almost deaf in both ears,
so even if he had hearing aides, you
had to speak very clearly and directly.
Once health caregivers knew that, they would
always make sure they made eye contact,
he lip-read a lot, and they
would speak in short,
but pretty loud sentences for him.
And he always told me the people that
were careful and took the time to do that,
how much it meant to him that they did that.
So keep the communication simple, but adult.
You should not sound like a Sesame
Street episode, right?
You want to be simple, short, but adult.
So use your senses that are simplified.
Use a simplified structure,
reduce your rate of speech, and
emphasize key words.
Do not talk down to the
patient with aphasia.
You want to assume,
"Yes, they're understanding what I'm
saying." That's the kind of
speed and rhythm you want to your
speech, but you want it slow,
and you want to articulate and you always
want to be looking at them.
Don't be at the computer --typing things
in and asking them questions.
That will communicate value to your patient,
plus, it's going to be less
frustrating for both you
and the patient when you recognize
that communication with the patient
is your priority in the moment, and you
do that with your full attention.
No multitasking when you're
trying to communicate.
So give them plenty of time to speak.
Resist the urge to finish
their sentences, okay?
Resist the urge to finish their sentences.
Resist the urge to finish their sentences
or offer words, okay?
That is really difficult for a patient.
Once you have a strong,
and you maybe know some key sounds
with them, that's a little different.
But it can come across as condescending to
a patient when you try and fill in the blank.
Plus, you frustrate them because
the more words you offer,
then they have to process that word and
see if it is and try to explain it.
Don't do it. Just wait. Be patient.
Communicate with drawings and gestures
and writing and facial expressions is okay.
If you want to use a facial expression,
If you want to write something
down or draw a picture
or point to a part of their body,
that's also helpful to them.
So, make sure that you're communicating
successfully with "yes" and "no" answers.
We always teach you to use therapeutic
communication, which is open-ended questions.
Not with a patient with aphasia.
You want to ask them
After they've communicated to you, ask
them, "Is this what you were asking?
Would you like a glass of water?"
They can say "yes" or "no."
"Would you like me to rub some
lotion on your feet?"
"Yes" or "no."
Not the open-ended therapeutic one
when it comes to figuring out
what they're trying to say and communicating
with someone who has aphasia.
So encourage them.
Everyone likes to be validated. We all
like to act like we don't need it,
but everyone likes to be validated.
They're very frustrated.
Most of them are worried about taking up
your time and being slow and feeling stupid.
You should just praise them. Encourage
them, "You're doing really good."
If they make an error, you down
play it, "No big deal."
Always use those words or your own
way of saying that, but let them know,
"Ah, it's no big deal. We'll fix it. We'll move
forward, we've got it, not a problem."
And don't ask them to make sure every
word is produced perfectly.
If you can glean the meaning, keep moving.
Okay. So, help them with normal activities
whenever possible. Remember,
we want them to be as independent
as possible, so don't speak for them.
Don't shield them from family or ignore
them in a conversation. Include them.
Remember, you're the role model.
So, we want them to be involved in
decision making as much as possible.
We want them to know about events, but
we want to avoid burdening them
with day-to-day stuff they don't need to know,
but don't make them feel like they don't
belong anymore, or they're not included.
You can also role model that for
the family so they know that,
"Yeah, it's okay to talk to him about
things," like you normally would.
Encourage them to be independent
and don't be a smother mother.
Like, you know, a helicopter -- helicopter
moms, you know they are?
They can't let their kids go for anything.
Don't treat them as if they're fragile.
Encourage them to be independent,
to do as much as they can, and to try
things. They're not going to grow,
they're not going to get stronger unless we
encourage them to be more independent.