Transcript Communication

SECTION 3
Communication
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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
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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.
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Communication
Nonverbal communication
► Posture
► Movement
► Facial expression
► Tone of voice
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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.
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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.
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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).
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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.
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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.
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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.
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For partnership
For true communication to occur, the survivor
must:
► Understand what the care provider says
► Be able to express thoughts
► Be understood
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Key point
The stroke survivor deserves
respect.
This person’s values,
interests, concerns, opinions,
strengths, and weaknesses
reflect a lifetime of
experience.
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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
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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
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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.
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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).
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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.
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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.
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General problems that affect communication
► Limited
mobility and wheelchair use
► Impaired hearing
► Frozen facial expression
► Slowed responses
► Impaired vision
► Emotional lability
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Specific communication impairments
► Dysarthria
► Aphasia
► Inconsistent
or inappropriate speech
► Cognitive communication impairments
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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
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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
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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.
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Key point
Remember – people with aphasia are able
adults who know more than they can say.
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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.
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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.
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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.
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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.
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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.
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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.
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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
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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.
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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.
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Upon reflection
► Have
you ever communicated with a stroke
survivor who has aphasia?
► What were some strategies that worked?
► How did you feel?
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