
Communicating with someone who cannot talk
Te whakawhiti kōrero ki te tangata tē taea te kōrero
After a brain injury or stroke, people can find it hard to talk. Speech problems can also be caused by a progressive neurological condition.
The problems can be 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 to understand what they are trying to say. These clues include body language. 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 are communicating with may smile when you smile. They know that this means you are happy.
Gestures
This can include pointing to objects you are talking about or using your hands to mime an action. For example, lifting your hand to your mouth as if you are 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 are saying. For example, our voice rises at the end of a sentence if we are asking a question. If we are angry, our voice is usually louder. If we are 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. You can also let the person know you are talking to them by touching them gently or saying their name.
- Think about how much nonverbal information you are giving. This includes gestures (pointing) and voice clues (changing the tone of your voice, saying the word at the same time as you do the action). It also includes 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 need a "yes" or "no" answer.
- Use a "forced alternative", which is a choice between two options. For example, "Do you want coffee or tea?" This is instead of an open question like "What do you want?" 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. Do not expect the person to respond verbally. Encourage them to gesture as well. They may talk spontaneously if they do not 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
Written by speech-language therapists, Te Whatu Ora – Health New Zealand Waitaha Canterbury. Adapted by HealthInfo clinical advisers. Last reviewed July 2023.
Sources
The information in this section comes from the following sources, some of which may be clinically complex or not available to the general public
Green et al. (1997) Mild traumatic brain injury: a therapy and resource manual. Singular, San Diego.
Koller, K. (2002) Handout: Ranworth Healthcare speech language therapy visual information processing strategies.
McKay Moore Sohlberg (1994) Communication Skill Builders: Understanding Attention Impairments.
Image and embedded video sources
Image of a man focusing no sanding a model airplane from Shutterstock (image ID 1791375929). November 2023.
Image of a man talking on the phone from Shutterstock (image ID 387504061). November 2023.
Image of an elderly couple sitting in a garden from Shutterstock. August 2014.
Image of people in a meeting from Shutterstock (image ID 176023793). November 2020.
Image of 2 Asian people greeting each other face to face from Shutterstock (image ID 180093542). August 2014.
Image of 2 businessmen having a meeting from Ambro at FreeDigitalPhotos. August 2014.
Image of 2 men sitting outside and talking from Shutterstock (image ID 748930963). November 2023.
Image of 2 men talking with hand gestures from Shutterstock (image ID 248077960). November 2023.
Page reference: 121515
Review key: HISCD-79694