I was working recently with a client, not long retired from the music production industry, who has an aphasia following a significant stroke. The title of the song, Bridge Over Troubled Waters, written by Simon and Garfunkel seemed highly appropriate in the context of the challenges he and his wife were facing, when their communication broke down. They were hitting troubled water on a regular basis.
These situations are all too common for people with speech and language problems such as aphasia , apraxia of speech or severe dysarthria, as well as for the people with whom they communicate. How to best find a ‘bridge’ when a disruption in the normally smooth flowing conversation is encountered? These disturbances to the naturally occurring turn-taking patterns of communication can be caused for many reasons: a misunderstanding, a word finding difficulty, use of jargon that leaves a listener confused or maybe speech that is distorted to the point it becomes unintelligible.
What type or style of bridge to build will depend on each person’s abilities. However, broadly speaking, when working with clients my work as a Speech and Language Therapist will focus on two areas:
- therapy to support the client in building their ‘own bridges’ when they notice or experience trouble understanding someone or conveying their message and/or
- training the people who interact regularly with the person, often termed in research literature as their ‘communication or conversation partners’.
Where a client builds their own bridge or crossing, strategies might include the use of gesture, writing key words, drawing or where possible talking around the area of trouble to convey meaning in another way. These strategies sound so simple but may require encouragement to adopt unfamiliar approaches to participate within conversation.
Communication partners also enter new territory when coping with the aftermath of a diagnosis such as Stroke. It takes time, knowledge and practice to find ways to best to support their family member or friend. Putting in the scaffolding to ensure the bridge is steady and creating bridges, when needed, can have such a positive impact on holding conversations and bring relief to all involved.
These bridges might include:
- understanding the nature of the communication difficulties and so adjusting expectations
- the communication partner might need to modify how they speak, in terms of the complexity of their language and rate of speech
- adopting alternative communication practices by using materials such as pictures, photos or writing key words, to ensure their message is delivered and understood
- negotiating or being aware of when to allow more time and when to offer a suggestion
- eliminating environmental barriers such as background noise
- being empathetic and supportive to help foster a positive communication environment.
So whether people find ways around the troubled water, build stepping stones across or create beautiful bridges, the outcome will enable the person with the communication difficulty to participate more fully and enable conversations to flow again.
