HealthInfo Canterbury
Communicating with someone who can't talk
People who find it hard to talk after a brain injury or stroke, or because of a progressive neurological condition, can have a combination of three disorders:
- Dysarthria – their speech is weak, slurred, or unclear.
- Apraxia of speech – the muscles they use to speak lack coordination.
- Aphasia – they struggle with expression and comprehension.
When you are communicating with someone who has difficulty talking, you will have to look for other clues, such as body language, to understand what they are trying to say. They will also be watching your body language to try to understand you.
Useful nonverbal clues
Facial expressions
We show our feelings on our face. For example, the person you're communicating with may smile when you smile – they know that this means you are happy.
Gestures
This can include pointing to objects you're talking about, or using your hands to mime an action, for example lifting your hand to your mouth as if you're holding a cup as you ask "Do you want a drink?"
Tone of voice
Changes in the rise and fall of our voice give clues about what we're saying. For example our voice rises at the end of a sentence if we're asking a question; if we're angry our voice is usually louder; if we're reassuring someone our voice is usually softer. We can also stress words that are important in a sentence, for example, "Do you want coffee or tea?"
Practical tips for communicating
- Make the environment as quiet and free from distractions as possible when you want to communicate. For example, switch off the TV.
- Always make eye contact and let the person know you're talking to them by touching them gently or saying their name.
- Think about how much nonverbal information you are giving – gestures (pointing), voice clues (changing the tone of your voice, saying the word at the same time as you do the action), and visual clues (can the person see your face clearly?)
- Use short sentences and repeat them with extra clues if you need to.
- Ask questions that just require an "yes" or "no" answer.
- Use "forced alternatives" – a choice between two options – rather than open questions like "What do you want?" Ask "Do you want coffee or tea?" The aim is to give more clues to help the person communicate what they want.
- It may help if you or the person draws a picture or writes things down.
- Try to use the same gesture or mime for the same word every time. Don't expect the person to respond verbally – encourage them to gesture as well. They may talk spontaneously if they don't feel under pressure.
- Make up a book (a small photo album is good) with photos of family members, pets, friends and so on. You can use this to point to when discussing someone you both know.
You might also find this dictionary of sign language useful.
HealthInfo recommends the following pages
- Alzheimer's New Zealand – Supporting a person who has dementia
This PDF has information about communicating with someone who has dementia.
Written by community speech-language therapists, Canterbury DHB. Adapted by HealthInfo clinical advisers. Last reviewed November 2020.
SourcesReview key: HISCD-79694
