Communicating to a patient with stroke

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Approximately one-third of people who have a stroke experience aphasia.

Left sided stroke can result in aphasia, agraphia and alexia.

Right sided stroke can result in impaired sense of humour.

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In 90% of subjects left hemisphere is responsible for language skills.

Challenge for a nurse

React with anger and frustration Refuse to speak Withdrawn Family members may refrain from

communication to avoid frustration Can’t make the patient to co-operate

with treatments and procedures. 3

Communication problems Aphasia and dysarthria Aphasia

Total loss of comprehension and use of language Dysphasia- is due to partial disruption or loss

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Non fluent/ Broca’s / Motor/ Expressive aphasia Site of injury is the

Broca’s area in the motor cortex

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Difficulty in expressing thoughts verbally or in writing

Ability to understand written and spoken words remain intact

Rote speech and automatic speech are intact

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Fluent/ Wernicke’s / Sensory/ Receptive aphasia Site of injury is Wernicke’s area-

temperoparietal lobe

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Comprehension is impaired. Hears sounds but cannot understand

meaning. They talk a lot. Neologisms are

common Recite poetry, biblical verses Troubling to the family members

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Global aphasia Massive stroke Combination of receptive and

expressive aphasia Poor prognosis

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Dysarthria Disturbance in the muscular control of

speech Results in problems in pronunciation,

articulation and phonation

Combination of aphasia and dysarthria is seen

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Assessment by Speech Language Pathologist Flow Choice of words Completion of phrases or sentences Speech quality Articulation problems Comprehension Written- Read and do the command

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Assessment- Language Screening test

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Nursing measures

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General considerations Never assume that the patient can’t understand. Be sensitive, respect privacy. Tell what is happening around him. Treat him as an adult. Offer liberal praise and reinforcement for efforts. Practice when he is rested.

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Dysarthria May need physiotherapy

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Create a good setting

Communicate in a quiet room. Limit the number of people in the conversation. Stand at the eyesight in the opposite side of the

affected side. Face and hands should be seen by the patient. Establish unhurried atmosphere.

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Allow body contact - clasping and touching.

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Expressive aphasia- when you are a listener

Stimulate conversation. Practice naming of objects for routine self care.

Be patient. No pressurising. Ask questions with yes/ no

answer. Ask open ended question at intervals.

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Allow adequate time to respond- 30 seconds.

Relax your face while waiting.

Disregard the choice of incorrect words- no correction, no filling.

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Anticipate patient’s needs when appropriate and verify your interpretation of patient’s meaning. Let him know when you do not understand.

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Let him try 2-3 times. Stop, wait and then retry.

Offer initial sound or syllable of the word if the patient is frustrated and you know it.

Tell the patient that speech skills can be relearned given time.

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Let the patient find the right words by using questions as What would you do with it? How is it used? Where would I find it? What colour is it? Can you take me to it?

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Encourage your patient to use other ways to communicate

Write it first and read aloud. Gesture the meaning or what someone would do

with it. Describe it in other words. Describe the category or other words like it.

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Give a sentence to complete You said you want a drink of_____ If nothing works ask the patient to skip it

and come back to it later.

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Accept self expression by alternative means- pantomime, pointing- picture board

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Draw a picture

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Point to the picture

Point to Communicate booklets are a compact, user friendly communication aid.

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Picture board

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E-tran frame- gaze

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Communication passports Record to communicate with health and

social care providers

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Symbol sets Sets of picture symbols represent a

range of vocabulary and subject matter.

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Voice Output Communication Aids (VOCAs)

Computer-generated voice to play messages aloud.

One finger to select pre-recorded messages.

Keyboard - typed text can be converted into speech.

Can still write or type.

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Computers

Touch-screens, sip-and-puff switches Trackballs, joysticks, touch-pads,

specially designed mice, and other pointing devices

Mobile Apps Box of words DAF Droidspeaker Communication helper Mobile 112 My voice

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Receptive aphasia- when you are a speaker

Face the patient and speak slowly and distinctly. Normal speaking voice. Short simple sentences, no long speeches.

Repeat or rephrase. Mention place and date. Avoid pronouns- name of people, things. Use

photos and visual aids. Break instructions into component parts.

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Use simple hand gestures and demonstrations as needed.

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Watch for signs that they have understood what you are saying- nodding and smiling

FAMILY IS IMPORTANT

Involve the family in planning and implementing all strategies.

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What the caregivers can do at home?

Set up a routine at home. Encourage independence and enjoy the patient’s

favorite activities. Don’t let others ignore the patient. Let him share the decisions that affect his life. Get him back to social situations slowly.

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Keep a diary to point out progress that others have noticed.

Family – active part of the rehabilitation team.

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Conclusion

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Research areas Identifying communication strategies for

nursing staff and its effectiveness gestures verbal communication written communication Touch Nonverbal, proxemics , kinesics and

tacesics communication42

Conversational analysis: nurse–patient interaction in communication disability after stroke.

Social effects of stroke Barriers to patient centered

communication

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