How to talk to someone with aphasia: what helps at home

The short answer to how to talk to someone with aphasia is to make it easier for words to get in and out. Find a quiet spot, face them, and use short sentences at a normal volume. Ask questions they can answer with yes, no or a choice. Write key words down, point and gesture, and give them time to answer before you help. Above all, talk to them as an adult. Aphasia affects language, not intelligence.

The Stroke Association, a UK stroke charity, puts that last point plainly. You're talking to an adult who has problems with communication, not with their intelligence. Every tip below follows from it.

Set up the room before you start

Background noise makes everything harder. The Stroke Association lists noise and several people talking at once among the main problems for people who have trouble understanding.

• Turn off the TV and radio, or move to a quieter room.
• Sit close, face to face, at eye level, and make eye contact before you start.
• Glasses on and hearing aids in, if they use them.
• Keep a pen and a pad of paper on the table. A small whiteboard works too.
• Pick a time when they have some energy. Fatigue is common after a stroke, and the Stroke Association notes it can be worse in the afternoon.

The National Aphasia Association suggests getting their attention before the first word, with their name, a light touch on the arm, or a photo of what you're about to talk about.

How to talk to someone with aphasia: say less, more plainly

Short and plain beats slow and loud. MedlinePlus is direct about shouting: unless the person also has a hearing problem, it won't help.

• Use short, simple sentences at a normal volume.
• Speak a little slower, with a clear pause between ideas.
• One idea per sentence, one question at a time.
• Use an adult tone and adult topics. MedlinePlus warns against making the person feel like a child.
• Break instructions into small steps.

The National Aphasia Association gives a good before-and-after. Instead of a long sentence about a doctor's visit, an errand and lunch, say "Joe, at 10, we will go to see Dr. Baker," and point to your watch.

Ask questions they can answer

Open questions like "What do you want for lunch?" ask a lot of someone who struggles to find words. Turn them into questions with a short answer.

• Yes or no: "Do you want soup?"
• Either-or: "Soup or a sandwich?" Write both words down so they can point.
• Keep choices few. MedlinePlus says to give clear choices, but not too many.

Check that their yes and no are reliable before you trust them for anything that matters, like pain or medicines. The Stroke Association notes that people with aphasia sometimes say yes or no when they mean the opposite. It suggests checking with a thumbs up or thumbs down, or a tick and a cross on paper to point at. The National Aphasia Association adds that some people repeat the last choice they heard instead of the one they want, so swap the order and ask again.

Write it, draw it, point to it

Words on paper often get through when spoken words don't. The Stroke Association notes that many people can still recognize single written words even if they can't read well. Write the key word in big letters as you say it: DOCTOR, 10:00, AMY.

• Point to the thing you're talking about.
• Use gestures, like a thumb over your shoulder for "yesterday" or a hand at your mouth for "eat."
• Draw a quick sketch, a map or a clock face.
• Show a photo on your phone.
• Use a calendar for dates and plans.

Encourage them to do the same. The NIDCD says to welcome any kind of communication, whether it's speech, gestures, pointing or drawing. MedlinePlus suggests a small book of pictures or words about common topics and people, which both of you can point to. If a word is stuck, the Stroke Association suggests they try spelling it, writing it, drawing it, pointing to the first letter on an alphabet chart or describing it.

Wait, then check you understood

Silence feels long when someone is struggling. They need it. The National Aphasia Association suggests counting to five before you ask if you can help, and waiting for the person to finish without completing their thoughts for them. MedlinePlus says the time they need can be a lot longer than you expect.

When they've said something, repeat back what you understood and let them confirm it. Don't correct a word if you got the meaning. The NIDCD advises against correcting their speech, and the Stroke Association calls it "a conversation, not a test."

Take Linda, whose husband would get halfway through a sentence before she jumped in with her best guess. Usually she guessed wrong, and he'd give up. Now she waits, then writes down two possible words for him to point at. It takes longer, and he finishes far more of what he starts.

Expressive, receptive and global aphasia

Many people don't fit neatly into one type, so watch what actually helps. These patterns are a starting point.

Expressive aphasia

They understand most of what you say but struggle to get words out, often in short, effortful phrases. The NIDCD says people with this kind (Broca's aphasia) are usually aware of their difficulty and can get frustrated easily. Give extra time, offer written choices, and don't finish their sentences.

Receptive aphasia

Speech may come easily but not make sense, and understanding you is hard. The NIDCD says people with this pattern (Wernicke's aphasia) are often unaware of their spoken mistakes, so skip correcting their words. Lean on writing, pictures and gestures for what you say, keep sentences very short, and use choices they can point to.

Global aphasia

Speaking and understanding are both badly affected. Use yes-or-no questions with a thumbs up or down, real objects, photos and pointing. Talk to them as normal anyway. The NIDCD and the National Aphasia Association both stress keeping the person in the conversation.

Groups, visits and phone calls

Group conversations move fast and overlap, which is hard to follow. The Stroke Association suggests someone act as a "chairperson" so that one person speaks at a time.

• Tell visitors the basics before they arrive: one person at a time, short sentences, wait for answers.
• Ask for their opinion, especially on family matters, as the NIDCD recommends. Don't answer for them.
• Sit them where they can see everyone's face.
• Keep visits short if they tire.

Phone calls take away facial expressions and gestures, and the Stroke Association notes they can be hard to follow. Video helps because they can see your face. On a voice call, use more yes-or-no questions, slow down, keep it short, and say what each call is about up front: "Hi, it's Sam. Quick call about Saturday."

A small communication card

MedlinePlus suggests that when someone with speech problems is out alone, they carry an ID card with contact details for family, a note about their speech problem, and how best to talk with them. The Stroke Association offers a free wallet-sized card for the same purpose. You can make your own on an index card:

Questions families ask

What should you not say to someone with aphasia?

Skip "Just spit it out," "You know this," and questions you already know the answer to. Don't finish their sentences or say "Never mind" when you can't follow. Say "Let's come back to it," and do.

How do you communicate with someone with aphasia who can't speak?

Use yes-or-no questions answered by nodding, a thumbs up or pointing at YES and NO on a card. Write choices down, use photos and real objects, and ask their speech-language pathologist about a communication board or app.

Does talking with them help recovery?

The Stroke Association says having conversations and communicating as much as possible helps recovery, and these habits make that easier. For structured practice, see aphasia exercises at home. For what to expect over time, see does aphasia go away.