Communicating with someone who cannot talk or hear well

After a brain injury or stroke, people can find it hard to talk. Speech problems can also be caused by a progressive neurological condition.

The problems can be a combination of 3 disorders:

• Aphasia — they struggle with expression and comprehension.
• Apraxia of speech — the muscles they use to speak lack coordination.
• Dysarthria — their speech is weak, slurred, or unclear.

When you are communicating with someone who has difficulty talking, you will have to look for other clues to understand what they are trying to say. These clues include body language. They will also be watching your body language to try to understand you.

Useful nonverbal clues

Facial expressions

We show our feelings on our faces. The person you are communicating with may smile when you smile. They know that this means you are happy.

Gestures

Gestures can include pointing to objects you are talking about or using your hands to mime an action. This could mean lifting your hand to your mouth as if you are holding a cup as you ask, 'Do you want a drink?'

Tone of voice

Changes in the rise and fall of our voice give clues about what we are saying.

Examples include:

• when asking a question, our voices rise at the end of the sentence
• when we are angry, our voices are usually louder
• when we are reassuring someone, our voices are usually softer.

We can also stress words that are important in a sentence, such as by stressing the words 'coffee' and 'tea' when asking, 'Do you want coffee or tea?'

Practical tips for communicating

• Make the environment as quiet and free from distractions as possible when you want to communicate. For example, switch off the TV.
• Always make eye contact. You can also let the person know you are talking to them by touching them gently or saying their name.
• Think about how much nonverbal information you are giving. This includes gestures (pointing) and voice clues (changing the tone of your voice, saying the word at the same time as you do the action). It also includes visual clues (can the person see your face clearly?).
• Use short sentences and repeat them with extra clues if you need to.
• Ask questions that just need a "yes" or "no" answer.
• Use a "forced alternative", which is a choice between two options. For example, "Do you want coffee or tea?" This is instead of an open question like "What do you want?" The aim is to give more clues to help the person communicate what they want.
• It may help if you or the person draws a picture or writes things down.
• Try to use the same gesture or mime for the same word every time. Do not expect the person to respond verbally. Encourage them to gesture as well. They may talk spontaneously if they do not feel under pressure.
• Make up a book (a small photo album is good) with photos of family members, pets, friends and so on. You can use this to point to when discussing someone you both know.
• Use New Zealand Sign Language (NZSL).

Learn NZSL — Deaf Aotearoaexternal link

The strategies below can help you communicate with someone who is either hard of hearing or deaf.

• Do not start talking until you are in front of the person, close to them and have their attention.
• Make sure they see you coming, otherwise you may startle them.
• Face them directly and try to be on the same level as them.
• Do not eat, chew or smoke while you are talking to someone who is hearing impaired. It will make it harder for them to understand you.
• Keep your hands away from your face while you are talking.
• Make sure they are ready to communicate. Hearing-impaired people find it harder to communicate when they are tired or not feeling well.
• Try to make sure there is no, or very little, background noise, such as a TV or music.
• Speak normally and do not shout.
• Make sure the light is not shining in the person's eyes. This may make it harder for them to read your cues.
• If the person you are talking to finds it difficult to understand, try to find a different way of saying the same thing.
• Use simple, short sentences.
• Write things down if you need to.
• Allow enough time to communicate without rushing. Being in a rush will add to everyone's stress and make it hard to communicate well.
• If the person you are communicating with has a hearing aid but still cannot hear you properly, check to see if their hearing aid is in their ear. Check that it is turned on and has a working battery. If all these things are okay, find out when the person last had their hearing checked. It may be time to get it checked again.
• Use as many other methods of communication as possible, including body language, facial expressions and New Zealand Sign Language (NZSL).

Learn NZSL — Deaf Aotearoaexternal link