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Promoting A Supportive Communication Environment

Globally, Quality of life (QOL) has been used to determine the impact of diseases from the perspective of the patient. This includes behaviors and attitudes toward people with disabilities that can either help or hinder functionality 1. There is growing interest in using well-being as a QOL measure to effectively reflect client outcomes and service provision in the field of healthcare and health interventions2 . A change in the stroke survivor’s social roles has an impact on his or her QOL because they rely on others for daily activities3.

This, however, highlights the importance of self-help groups in assisting people with aphasia in establishing new identities in which their own disability is recognized4. It would be preferable to target socially relevant therapy and raise public and professional awareness to reduce communication barriers in the community in order to better understand the social activity of people with aphasia 5. The causes of aphasia are more complicated than just a language disorder. To improve the quality of life of family members and individuals with aphasia, it is necessary to understand functional communication limitations in order to develop effective rehabilitation programs 5. This entails assisting individuals and families in developing a positive post-stroke identity6.

Modifying the communication environment

The social approach to intervention in the lives of people with aphasia focuses on the ability of people with aphasia to communicate effectively in their environment6 . These approaches are distinguished by increased life participation and higher QOL 7. This focuses on how communication partners in the aphasic individual’s environment modify their communication in order to successfully transmit thoughts8. This is accomplished by paying attention to the “nature of the place,” taking into account the message’s content, and ensuring that they are communicatively accessible 8 .

Communication partners are people in the environment with whom people with aphasia interact with. This includes family members as well as healthcare providers, volunteers, and friends. These partners exhibit some characteristics, such as an increase in the use of effective strategies to reveal people with aphasia’s communicative competence 9. Healthcare providers are critical in creating an enabling environment for meaningful interaction in hospital rehabilitation. This entails providing information and emotional support to the patient in order to help them cope with their stroke 10.

Family members, who are considered stakeholders in providing insight into living successfully with aphasia, express their need for information on aphasia, to develop effective communication methods with the individual with aphasia, and to establish better relationships with their family 11. As a result, if family members are not given instructions on how to facilitate communication, they tend to create their own communication materials to encourage communication with the aphasic individual 12. These strategies can be positive, such as when the spouse or relative uses a gesture to accompany his or her speech, or negative, such as when the spouse or relative ‘pretends’ to understand the individual with aphasia, resulting in a breakdown in communication 13.

They have difficulties facilitating communication with people with aphasia, which can be distressing due to their constant interaction with the individual with aphasia. Without the use of these strategies, there is often a disruption in communication, which can be traumatic for people who frequently communicate with people who have aphasia 13. In light of this, family members advocated for their inclusion as key members of the rehabilitation process, emphasizing the importance of prioritizing their need to communicate, as people with aphasia can establish better relationships 11.

Communication interventions in the lives of people with aphasia after stroke necessitate an expansion of research and management efforts to include the communicative skills of people with aphasia’s communication partners 14. This entails providing formal information or educational interventions that may successfully improve patients’ and caregivers’ knowledge of stroke and communication 6. People with aphasia reveal that using communication strategies is an important part of living with aphasia. They believe that having access to visual information, such as pictures and verbal information, helps them communicate 15.

They emphasized the importance of gestures in compensating for verbal deficits and facilitating word production in people with aphasia. People with aphasia emphasize that raising awareness of aphasia creates opportunities for participation in society16. In this regard, the communication partner is expected to maintain the communication exchange by listening, paying attention to what the person with aphasia is saying, and ensuring that others speak to the person with aphasia despite his/her withdrawal from communication 17.

Healthcare professionals and people with aphasia

Healthcare professionals may not know, and frequently do not know, how to communicate effectively with people who have a communication disability. As a result, people with communication disabilities are more likely than others to have compromised healthcare and poor long-term outcomes. People with communication disabilities, on the other hand, describe the knowledge and skills nurses use during interactions that aid in communication success 18. Positive interactions between caregivers and residents in long-term care facilities have been shown to not only improve residents’ QOL and psychological and social well-being, but also to contribute to increased life expectancy 9.

O’Halloran, Hickson, and Worrall (2008) investigated the environmental factors influencing communication between healthcare providers and people with aphasia. They investigated the barriers to or attitudes toward communication between healthcare providers and people with aphasia. Frustration when communication failed and a lack of knowledge of other alternative communication systems were among the obstacles encountered. Certain attitudes and behaviors, such as kindness, patience, and a willingness to try again when communication was unsuccessful, facilitated more successful communication. Adopting the incorporation of written information in easily understandable ways was also beneficial in assisting communication for people with aphasia. Thus, the ultimate goal for people with aphasia and the professionals who work with them is to remove the barriers that frustrate and disable people4 .


  1. Mattevi BS, Bredemeier J, Fam C, Fleck MP. Quality of care, quality of life, and attitudes toward disabilities: perspectives from a qualitative focus group study in Porto Alegre, Brazil. Rev Panam Salud Pública. 2012;31(3):188-196. doi:10.1590/S1020- 49892012000300002
  2. Cruice M, Worrall L, Hickson L. Reporting on psychological well-being of older adults with chronic aphasia in the context of unaffected peers. Disabil Rehabil. 2011;33(3):219-228. doi:10.3109/09638288.2010.503835
  3. Lynch EB, Butt Z, Heinemann A, et al. A qualitative study of quality of life after stroke: The importance of social relationships. J Rehabil Med. 2008;40(7):518-523. doi:10.2340/16501977-0203
  4. Code C, Eales C, Pearl G, Conan M, Cowin K, Hickin J. Supported Self-Help Groups for Aphasic People. In: The Sciences of Aphasia. Elsevier; 2003:187-200. doi:10.1016/B978- 008044073-6/50014-6
  5. Code C. The quantity of life for people with chronic aphasia. Neuropsychol Rehabil. 2003;13(3):379-390. doi:10.1080/09602010244000255
  6. Anderson S, Marlett NJ. Communication in stroke: The overlooked rehabilitation tool. Age Ageing. 2004;33(5):440-443. doi:10.1093/ageing/afh163
  7. Simmons-mackie N, Raymer A, Armstrong E, et al. Communication Partner Training in Aphasia : YAPMR. 2010;91(12):1814-1837. doi:10.1016/j.apmr.2010.08.026
  8. Paul NA, Sanders GF. Strategies used by communication partners of aphasic speakers. Act Adapt Aging. 2009;33(3):161-178. doi:10.1080/01924780903148185
  9. Simmons-Mackie N, Raymer A, Cherney LR. Communication Partner Training in Aphasia: An Updated Systematic Review. Arch Phys Med Rehabil. 2016;97(12):2202-2221.e8. doi:10.1016/j.apmr.2016.03.023
  10. Gordon C, Ellis-Hill C, Ashburn A. The use of conversational analysis: Nurse-patient interaction in communication disability after stroke. J Adv Nurs. 2009;65(3):544-553. doi:10.1111/j.1365-2648.2008.04917.x
  11. Brown K, Worrall L, Davidson B, Howe T. Living Successfully with Aphasia: Family Members Share Their Views. Top Stroke Rehabil. 2011;18(5):536-548. doi:10.1310/tsr1805-536
  12. Howe T, Davidson B, Worrall L, et al. “You needed to rehab … families as well”: Family members’ own goals for aphasia rehabilitation. Inernational Journal of Language and Commununication Disorders. 2012;47(5):511-521. doi:10.1111/j.1460-6984.2012.00159.x
  13. Murray LL, Chapey R. Assessment of language disorders in adults. In: R.Chapey (Ed), ed. Language Intervetion Strategies in Aphasia and Related Neurogenic Communication Disorders. 4th ed. Lippincott,Williams &Wilkins; 2001:55-126. Accessed June 24, 2018.
  1. Simmons-Mackie N. Social Approaches to Aphasia Intervention. Lang Interv Strateg Adult Aphasia. 2008;(March):290-317.
  2. Brown K, Worrall L, Davidson B, Howe T. Snapshots of success: An insider perspective on living successfully with aphasia. Aphasiology. 2010;24(10):1267-1295. doi:10.1080/02687031003755429
  3. Howe TJ, Worrall LE, Hickson LMH. Interviews with people with aphasia : Environmental factors that influence their community participation. 2008;22(10):1092-1120. doi:10.1080/02687030701640941
  4. Le Dorze G, Brassard C. A description of the consequences of aphasia on aphasic persons and their relatives and friends, based on the WHO model of chronic diseases. Aphasiology. 1995;9(3):239-255. doi:10.1080/02687039508248198
  5. O’Halloran R, Hickson L, Worrall L. Environmental factors that influence communication between people with communication disability and their healthcare providers in hospital: A review of the literature within the International Classification of Functioning, Disability and Health (ICF) fram. International Journal of Language and Communication Disorders. 2008;43(6):601-631. doi:10.1080/13682820701861832

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