3.3: Communication

Gestures

Gestures may be the primary means a resident uses for communication. Gestures can also make it easier for the resident to understand what you are saying to them. Gestures should be encouraged when a resident is having difficulty with talking. Gestures are especially helpful when working with the hearing impaired, aphasic or cognitively impaired. Continue to speak words with gestures and use many facial expressions and body language.

A few common gestures to follow:

Figure \(\PageIndex{1}\): Gestures. Good bye: hand raised, palm facing out. Hello: hand raised and waving. Bathroom: hands held together low in front of the body. Angry: fists clenched at the sides, with an angry face.

Figure \(\PageIndex{2}\): Gestures (continued). Sick: bending forward with a hand over the mouth. Tired: head tilted onto the hand. No: shaking the head with a hand waving across. Walk: two fingers "walking" in the air. Thank you: hand moving forward from the chin. Yes: nodding with a fist moving up and down. Eat: fingertips brought to the mouth. Drink: hand tipping an imaginary cup to the mouth.

Left CVA

Right side of the body will be affected (right hemiplegia)

1. Resident may be aphasic, meaning a complete breakdown in any or all methods of communication (expression and understanding).
2. Resident may be dysphasic, meaning a partial breakdown in any or all methods of communication.
3. Resident may be anomic, meaning unable to name objects even though their usage is understood.
4. Resident may perseverate, meaning repetition of words, phrases, sentences, or actions inappropriately.
5. Resident may have a visual deficit, which may be full or partial field blindness to the right side.
6. Resident may speak in jargon, meaning incoherent speech or gibberish, but it may be spoken clearly.
7. Resident may have deficits in writing, reading, speech, comprehension, and math.
8. Resident may use “yes” and “no” inappropriately.
9. Resident may not be able to follow directions or repeat words or actions when demonstrated.

Special Communication Strategies

Some tips for speaking with aphasic residents (left CVA)

1. Get resident’s attention before starting to speak.
2. Speak slowly.
3. Watch resident as you speak to him/her.
4. Allow resident ample time to respond if you believe he/she can make a response, but don’t let him/her struggle.
5. Don’t use long, complex sentences. Break up long sentences into several short ones.
6. Use words that occur frequently in English usage and that are more familiar to resident.
7. Use gestures and facial expressions to accompany what you are saying.
8. Ask yes or no questions for quick response or if the only response a resident can give is yes or no.
9. Avoid requiring resident to communicate in large groups or noisy surroundings if he/she seems bothered by those situations.
10. Be aware that aphasic residents may not be able to attend to tasks for long periods of time.
11. Early during a conversation, provide the resident with a way to anticipate the content of a conversation.
12. Do not shout, however, it may be helpful to speak slightly louder than usual.
13. Don’t talk to the resident as if he/she was a child.
14. Be aware that aphasic residents often perform poorly right after attempting a task that is difficult.
15. Provide a reassuring and encouraging atmosphere for the resident.
16. Repeat or rephrase a sentence when the resident does not understand the sentence the first time.
17. Get confirmation as to whether or not resident is understanding what you say.
18. Remember that aphasic residents generally attend and understand better when the topic of conversation interests them.
19. Be willing to “give up” when it is clear that the resident is not able to understand you and when you are both becoming frustrated.
20. Get advice from the Speech-Language Pathologist about how to most effectively communicate with the aphasic resident.

Right CVA

Left side of the body will be affected (left hemiplegia)

1. Resident may be highly distractible with an extremely short attention span.
2. Resident may be disoriented and think he/she is someplace else.
3. Resident may show poor judgment.
4. Resident may misuse objects (e.g., use a comb for a toothbrush).
5. Resident may talk incessantly, repeating the same ideas over and over again.
6. Resident may deny there is anything wrong with him/her.
7. Resident may start to do something then stop as if confused about what he/she is doing.
8. Resident may be confused about time and space concepts (i.e., may not know time of day or year).
9. Resident may have perceptual motor problems such as eye-hand coordination and/or balance problems (i.e., over-reach mouth when eating).
10. Resident may have a left visual field loss and may neglect the left side of his/her body.

Special Communication Strategies

Suggestions for communicating with right CVA residents

1. Have the resident verbalize how to complete a task. Take precautions when he/she performs this task as residents often do not have insight into their deficits.
2. Orient the resident several times daily as you go about your routine by reminding him/her of the day, date, time of day, where he/she is, what plans he/she has that day, etc.
3. These residents may be confused by demonstration. Utilize verbal cues if this is the case.
4. Simplify the environment so there is less to deal with visually (decrease visual distractions).
5. Decrease noise levels.
6. Break tasks into small steps and help the resident sequence these steps if necessary.
7. Provide verbal cues for sequencing tasks as necessary.
8. Provide good lighting.
9. Provide verbal and tactile reminders to the neglected side.
10. Instruct resident from his right, or non-impaired side.
11. Cue resident to wait for all necessary instructions before beginning a task. Cue resident to complete tasks as necessary.
12. Ask short, clear, concrete questions and re-ask or restate the question if the resident gives a vague response.
13. Gently remind resident of the sequence of events he/she is anticipating if he/she gets confused (i.e., resident states, “My daughter will be here in one half hour.” RNA’s response might be, “No, your daughter will be here after lunch. It is just breakfast now.”)

Motor Speech Disorders

Motor speech disorders in communication commonly include dysarthria and apraxia.

Dysarthria (slurred speech) occurs when the muscles used to speak are impaired neurologically, as from a stroke or Parkinson disease.

Apraxia describes residents whose oral muscles are OK, but when they try to use them to speak, the message from the brain does not get through. They may not be able to form the sounds of words at all or they may mispronounce words.

Special Communication Strategies

Suggestions for communicating with residents who have motor speech disorders

	Dysarthria	Apraxia
1. Encourage the resident to repeat what was said. Sometimes a second attempt is clearer than the first.	x
2. Encourage the resident to speak slowly and as clearly as possible.	x
3. Let the resident know when you do not understand.	x
4. Ask the resident to speak one phrase at a time, in more severe cases, one word at a time.	x
5. Ask the resident to spell words you can’t understand.	x
6. Ask the resident to write key words.	x
7. Ask questions that can be answered with a “yes” or “no.”	x
8. Allow the resident plenty of time to speak.	x	x
9. Watch the resident’s mouth and face for helpful clues.	x	x
10. Use a communication board with the resident.		x

Communication Board

Communication boards are a helpful communication aid to be used with residents who cannot verbally express their needs. Communication boards are used by pointing at simple objects, pictures or words that are resident specific. The resident will point to the desired word or symbol to express functional needs.

At first, your resident may benefit more from actual pictures than printed words. It is less confusing if you limit the number of items on a page to the immediate or personal needs of the resident. You may also add printed words, including vocabulary specific to the resident and her/his situation.