How to communicate with someone who has aphasia: a practical guide for families

The first weeks after aphasia arrives are full of small failures that feel enormous. A question hangs in the air. A word comes out wrong. Someone you have talked with every day for decades looks at you with frustration you have never seen before. Almost every family goes through this, and almost every family gets better at it. Communication with aphasia is a skill the whole household learns, and it can be learned.

This guide collects the habits that speech-language pathologists and families rely on most. None of it replaces the speech-language pathologist who knows your person. It is the everyday part: what to do at the kitchen table, in the car and at the hospital bedside.

What aphasia changes, and what it doesn't

Aphasia is a language disorder caused by damage to the parts of the brain that handle language. Stroke is the leading cause, and the National Institute on Deafness and Other Communication Disorders notes that approximately one third of stroke survivors have aphasia. It can also follow a brain injury or a brain tumor. It can affect speaking, understanding, reading and writing in different amounts.

What it does not take is intelligence. The person's memories, opinions and sense of humor are still there. The problem sits between the thought and the word. If you remember one thing from this page, remember that: you are talking with an adult who knows what they want to say. Our longer explainer, What aphasia is, and what it isn't, goes deeper.

Set up the conversation before you start

• Turn off the TV and the radio. Background noise makes language much harder to process.
• Face the person, at eye level, in good light, so they can see your face and your hands.
• Pick the time of day. Many people with aphasia communicate best when they are rested, and worst when they are tired or in pain.
• Keep a pad and a thick marker within reach, and the tablet or phone they use to communicate charged and close.
• One conversation at a time. At a family dinner, agree that one person talks at a time.

While you talk: short, clear and adult

The NIDCD's advice for families is simple and worth following exactly: simplify language by using short, uncomplicated sentences; repeat words or write down key words when needed; keep a natural conversational manner appropriate for an adult; minimize distractions; allow plenty of time to talk; and avoid correcting the person's speech.

In practice that means one idea per sentence. “Do you want to go outside?” rather than “Should we go out to the garden before lunch, or wait until your sister calls?” Slower is kinder than louder: raising your voice does not help, and it can feel like a scolding. And never talk about the person as if they are not in the room. They are, and they are following more than you think.

Give time, then more time

When someone is reaching for a word, silence is not a gap for you to fill. It is the space where the word arrives. Count to ten in your head before you help. If they are still stuck, try “Take your time, I'm not going anywhere.” Ask them, once, whether they would like you to guess or to wait when they are stuck, and honor the answer. Our article on supporting someone who can't find the words covers this in detail.

Check what got through

Guessing games are exhausting for both of you. Instead, confirm out loud: “You're asking about Saturday, right?” Yes-or-no questions help narrow things down when an open question stalls, as long as they are a bridge back to real conversation and not a quiz. Write the key word as you say it, so the person can see it as well as hear it. When you are not sure you understood, say so kindly rather than pretending.

Open every channel

Communication is bigger than speech. Pointing, gestures, facial expressions, drawing, writing the first letter of a word, showing a photo: all of these count. Treat them as real communication, because they are. Many families also add a communication app, so that the words the person cannot say out loud can be chosen on a screen and spoken.

In ExpressAgain, one tap on a phrase says it out loud. The Communicate page adds Build a message, which puts a sentence together from starters like I am, What about and Let's; Type, where a family member types anything and has it spoken; and Letters, an alphabet board for spelling a word letter by letter. A 3 at a time switch shows fewer choices on harder days, and there is no timer. Tap any phrase to speak it explains each tab.

Talk about what matters, not only what is needed

It is easy for every conversation to become logistics: pills, meals, appointments. People with aphasia often say the thing they miss most is being included. Share the small news. Ask their opinion on the family decision and wait for it. Show them the grandchild's drawing. The family feed in ExpressAgain exists for exactly this: relatives post photos, voice clips and video, and the patient answers with big reactions and quick spoken replies.

My People helps with the other direction. Each person has Call, FaceTime and Text buttons and a Speak button that says a line like Please call my daughter, so reaching out does not depend on finding the words. My People shows how it works.

When a conversation breaks down

Some conversations will not work, however well you do everything. That is normal. Name it gently, take the pressure off and come back later: “Let's come back to this. It's not going anywhere.” Watch for fatigue, because the same person who chatted easily in the morning may struggle by evening. A bad afternoon is not a sign that anything has gone wrong.

Look after the people doing the listening

Communication partners get tired and discouraged too. Ask the speech-language pathologist whether a family member can sit in on part of a session to learn supported conversation. Short lessons in the app's Learn section, including why words get stuck and ways to communicate, give family members the plain education version. And share the load: when the whole circle knows these habits, no one person carries every conversation.