Communication barriers

1. Aphasia

Aphasia is a communication impairment that can affect an individual’s ability to speak, understand speech, read and write.

Some people describe aphasia as feeling like being in a foreign country where you don’t speak the language or can speak very little.

Here are some common barriers to goal setting conversations specifically related to Aphasia. All these difficulties can vary in severity and can co-exist:

Word finding and expressive difficulties (sometimes called expressive aphasia):

These difficulties are all highly frustrating for the person with Aphasia and can result in problems with expressing their goals, describing barriers and confidence in relation to their goals, formulating action plans and reflecting on their progress.

Expressive difficulties can make it difficult for people to participate in conversations and maintain relationships. These are often goals that people with Aphasia might want to work towards.

With expressive difficulties, the person may …

  • Be unable to the think of the word (tip of the tongue) or use the wrong word
  • Use the wrong sounds in a word e.g. “golf” > “folf”
  • Use a made up word e.g. “golf” > “dilimy”
  • Have difficulty forming sentences resulting in a “telegrammatic” way of speaking e.g. “go paper shop”
  • Say “yes” when they mean “no” and vice versa. This is because “yes” and “no” are closely linked in meaning and the person sometimes accesses the opposite word to the one they want to say

Apraxia of Speech (AoS)

AoS is a specific and less common speech difficulty relating to the motor programming of the muscles required for speech.

It rarely occurs in isolation and can be difficult to differentiate between other expressive difficulties.

A person with AoS will have a very effortful, distorted speech pattern and often speech intelligibility is significantly reduced.

Comprehension difficulties (sometimes called receptive aphasia)

Comprehension difficulties can affect a person’s ability to understand and process language. Understanding may break down in relation to:

> the length of the message
> the complexity of the language used.

For example, someone may be able to understand short, simple sentences but become lost when the conversation partner speaks too quickly, switches from one topic to another or uses complex language.

Comprehension difficulties can be a barrier to successful goal setting as the person may have difficulty understanding the concept of goal setting or related activities such as agreeing goals, considering barriers and assessing confidence.

Rehabilitation staff can feel very ‘stuck’ when communicating with a person who had significant comprehension difficulties.

Reading difficulties

Reading difficulties can vary from only understanding a few written words in isolation to having difficulty following the gist of a chapter of a book.

A person with Aphasia or cognitive-communication difficulties may find it difficult to attach meaning to the word they are reading, or may struggle with the amount and complexity of written information being presented.

Reading difficulties often have a significant impact on a person’s activity and participation and are often identified as goals, e.g., reading a text, newspaper article, chapter in a book.

A person with reading difficulties may have difficulty understanding G-AP documentation and any written action plans or instructions.

Writing difficulties

Writing difficulties relate not just to writing with pen/pencil but also to other tasks such as typing.

A person with Aphasia or cognitive-communication difficulties may have difficulties writing.

Typical difficulties with both written and typed output include: not being able to think of the word to type/write, typing/writing the wrong word, and spelling errors.

Similar to reading, written activities are often identified as goals e.g., sending a text or email, writing a shopping list.

A person with writing difficulties may have difficulty completing G-AP documentation.

Difficulty with numbers

Difficulty with numbers can be due to comprehension difficulties – understanding what the number means when it’s said, or it can be related to expressive difficulties in terms of retrieving and saying the correct number.



Reading difficulties can also have an impact as the person with aphasia may not recognise a number when it is written down. Similarly, a person with Aphasia may have difficulty writing or typing the correct written number form.

Cognitive difficulties such as reasoning, calculating and perception can also impact on dealing with numbers.

Numbers often impact on daily life e.g. understanding and conveying dates and amounts, inputting PIN numbers and phone numbers correctly, using a remote control, telling the time.

STARS Chest Heart and Stroke Scotland video (optional training)

Watch  this video to find out how aphasia has affected Lynsey’s life after stroke (12 mins)

Watch Video

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2. Dysarthria

Dysarthria is a communication difficulty that arises as a result of damage to the parts of the brain involved in the control of muscles used for speech as well as coordination of breathing.

Dysarthria can vary from slightly slurred speech to very limited speech intelligibility/clarity.

Depending on the severity of the dysarthria, goal setting conversations may be challenging across all stages of the process.

Acknowledging competence

Communication difficulties often mask an individual’s competence resulting in exclusion from conversations and decision making. This can happen when a person’s communication difficulty can be mistakenly associated with a cognitive difficulty.

It is important to acknowledge the person’s competence and include them in conversations and decision making. You can do this by:

  • Speaking clearly but naturally
  • Use supportive statements like “I know you have so much you want to tell me but because of the Aphasia that’s difficult”
  • Acknowledge breakdowns openly – share the frustration “I don’t think I got what you meant there…I know it feels frustrating… let’s try again”
  • Give the person plenty of time to think about things and respond “Take your time, there is no rush”

You can help to reveal competence by using communication ramps . Ramps can help with both understanding (getting the message in) and expression (getting the message out).

STARS Chest Heart and Stroke Scotland video (optional training)

Watch this video to find out how dysarthria and emotional liability have affected Peter’s life after stroke (3 minutes)

Watch Video

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