Receptive Communication (Aphasia)
Altered receptive communication as evidenced by difficulty understanding, hearing and/or reading due to stroke.
Chapter 6, Section 6.1Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) / Resident’s receptivecommunication will improvefrom ___ to ____as measured on thecommunication outcomes scale / Conduct communication assessment using validated tool. Review hearing and vision status.
Position yourself where you will be easily heard. Confirm with the resident that they can hear you.
Verify that resident is wearing working hearing aid and glasses as needed.
Speak in a normal tone/volume or your speech may be distorted and can overload hearing aids, which can be painful.
Provide opportunities for the resident to communicate.
Allow the resident time and opportunity to respond.
Be patient and persistent in communication. Do not change the topic too quickly.
Try drawing or printing,use objects, pictures or use different words to support conversation with the resident.
Use maps, calendars, schedules and clocks when talking about times and places.
Ask family members for photos or other materials that can be used as starting points for conversation.
Be sure you position yourself and place communication materials so that the resident can see you.
Be supportive. Tell the resident that you understand that they know what they want to say.
Make sure there are few distractions. Talk to the resident face-to-face in a quiet room.
Approach the resident slowly and from the front. If needed, gently touch a hand or arm to help get their attention.
Introduce yourself. Make sure name tag is visible. Address resident bytheir preferred name and follow other interventions as recommended by OT/PT.
Make eye contact at level of resident when possible.
Always include the resident in a conversation.
Introduce topics clearly. Give one message at a time. Ask one question at a time.
Keep printed information short and direct and use large, clear print.
Repeat important information using the same words if you are not sure that your message was understood.
Speak slowly in a normal voice.
Repeat what you have understood. Ask the resident to explain anything you have not understood
Communicate about important issues when the resident is rested.
Ask questions to verify that your message have been heard accurately.
Educate family members on interventions to improve communication. / Speech Language Pathologist/Registered Staff
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
Registered Staff/PSW/HCA/recreation Staff
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with
resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
Registered Staff/PSW/HCA/Recreation Staff
Expressive Communication (Aphasia)
Altered expressive communication as evidenced by (specify) slurring of speech, difficulty with word finding, problems producing words and sentences, difficulty writing, problems forming thoughts, physical impairments (inability to access communication devices such as picture themeboard, phone, computer, paper & pen) due to stroke.
Chapter 6, Section 6.1Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) / Resident’s expressive communication will improve from ___ to ____as measured on the communication outcomes scale. / Conduct communication assessment using validated tool. Assess resident’s need for augmentative or alternative communication (AAC) aids. Provide resident with AAC aids if warranted (specify).
Provide time and opportunity for the resident to speak and to respond.
Communicate in a quiet place.
Ask resident to speak slowly and loudly if the communication impairment has resulted in a weak, soft or slurred voice.
Speak to the resident slowly. Use a normal voice level.
Keep choices limited and use ‘yes’ or ‘no’ questions if resident has trouble expressing preferences. / Speech Language Pathologist/Registered Staff
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
Repeat what you have understood. Ask the resident to explain anything you have not understood.
Place communication aids within easy reach and on unaffected side.
Use an alphabet board/communication board /computer/tablet
Provide resident with paper and pen or white board and marker so they can write their message.
Make notes to keep track of conversation.
Communicate about important issues when the resident is rested.
Give the resident time to respond. Supply the word if the resident seems to be getting frustrated.
Position yourself where you will be heard easily and ask if the resident can hear you.
Ask questions to verify that your messages have been heard accurately.
Develop non-verbal codes (e.g. thumbs-up, thumbs-down) if resident tends to say “yes” when they mean “no” and vice versa.
Check if resident is wearing glasses, if they are needed.
Ensure resident is wearing dentures if required to support verbal communication.
Educate family members on interventions to improve communication. / All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
PSW/HCA/Registered Staff/SLP
PSW/HCA
All staff interacting with resident.
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Visual Impairment/Neglect Affecting Communication
Resident has other impairments (specify)(e.g., blurred vision, double vision, right/left sided neglect) related to stroke as evidenced by difficulty communicating.
Chapter 6, Section 6.1Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) / Resident will be able to compensate for a vision impairment by using appropriate strategies (specify)
. / Follow interventions for visual neglect as recommended by OT
Cue resident to scan environment right to left orleft to right.
For a visual field loss, move yourself and any materials so they are easily seen in the remaining visual field.
Ensure resident has assistive visual device(s) in place.
Educate family members on interventions related to vision impairment. / All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
PSW/HCA/Registered Staff/SLP
Inability to Change Facial Expression Affecting Communication
Impaired communication related to stroke as evidenced by inability to change facial expression.
Chapter 6, Section 6.1Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) / Resident will be aware of and be able to compensate for lack of expression when communicating with others by using appropriate strategies (specify). / Verify that resident’s facial expression is reflecting their emotion by asking the resident. (e.g., you look happy, you look sad)
Educate family members on interventions to verify that facial expression is reflecting emotion. / All staff interacting with resident.
PSW/HCA/Registered Staff/SLP
Inappropriate Emotional Reactions Affecting Communication
Altered communication as evidenced by inability to respond with appropriate emotional reactiondue to stroke
Chapter 6, Section 6.1Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) / Resident will experience decreased number of inappropriate emotional responses (specify). / Identify and record triggers for inappropriate emotional responses and avoid triggers where possible.
Remember that the resident is not being rude on purpose.
Help the resident recognize and change responses that appear rude by telling them how you feel about this behaviour and what would work better.
Educate family members on interventions to adjust emotional responses. / All staff interacting with resident.
All staff interacting with resident.
All staff interacting with resident.
PSW/HCA/Registered Staff/SLP
Alignment with Best Practice
- BP Blogger Newsletter - June 2007 Best Practice in LTC Initiative – Volume 5 Issue 1 Jan/Feb 2010
- Aphasia Institute
- Quality-Based Procedures: Clinical Handbook for Stroke (Acute and Postacute) 2015, Module 9, Community Treatment – QBP Stroke
- Canadian Best Practice Recommendations for Stroke Care – Communication
January 2016Page 1 of 8
Developed by the Ontario Stroke System in collaboration with Long Term Care Stakeholders and based on the best practice resource:
Taking Action for Optimal Community and Long Term Stroke Care, A Resource for Healthcare Providers (2015) - Heart and Stroke Foundation.