"Common Communication Barriers"

By Lisa M. Petsche

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Spending time with someone who has an acquired communication disorder--such as speech impairment from a stroke or mental impairment due to Alzheimer's disease--can be challenging. It's natural to feel awkward when you can't relate to someone in the usual ways. However, there are many ways to overcome obstacles in order to have a positive interaction.

Following are tips for successfully dealing with some of the most common communication difficulties.

Setting the stage - some general advice

• Limit the number of participants to three or four. One-to-one conversations are ideal.
• Choose a quiet area to minimize distractions.
• Ensure you have the person's full attention before initiating conversation. Sit close by, facing the individual.
• Show interest by maintaining eye contact and leaning forward. Be conscious of your facial expression and other body language.
• Be prepared for multiple forms of communication, such as gesturing, pointing to an alphabet, word or picture board, drawing and writing.

Hearing impairment

• Pick a location with good acoustics. Rooms with carpeting and curtains are better than those with lots of hard surfaces.
• Sit with your face to the light and be careful not to cover it with your hands.
• Ask if one ear is better than the other, and speak to that side. Lean in when it's your turn to speak.
• Use a loud voice but avoid shouting. Speak slowly and clearly, but don't exaggerate.
• Keep your voice low-pitched.
• Be succinct about expressing yourself, and use short sentences.
• Read the person's non-verbal expressions, since some hearing impaired people are hesitant to ask others to repeat themselves. If it looks like they didn't pick up what you said, rephrase it.

Speech impairment

• Choose subjects of special interest to motivate the person in case he or she is self-conscious about engaging in conversation.
• Encourage the individual to slow down if necessary, in order to pronounce each syllable.
• Be patient and remain calm, allowing extra time for the person to get his or her words out. Don't interrupt or try to finish sentences unless they become really frustrated.
• Be attuned to non-verbal language that can give clues to the factual or emotional content of the message.
• Summarize the message to check if you heard it right.
• Ask the person to repeat the message if you cannot make it out. Don't pretend that you understood.
• Ask questions that require a yes or no answer.
• Don't correct every error.
• If the person is able to write, have a notepad and pen handy as a backup.

Mental impairment (dementia)

• Approach slowly, establish eye contact, and then address the person by name.
• Always identify yourself by name and, if necessary, indicate your relationship - for example, "Hi, Joe, it's your sister-in-law, Anne."
• Keep your voice low-pitched, to convey calmness and reassurance.
• Use simple words and short sentences, speaking slowly and distinctly.
• Keep questions to a minimum and avoid open-ended ones, especially those that begin with Why or How. Offer limited choices - for instance, "Would you like coffee or juice?" rather than "What would you like to drink?"
• Allow plenty of time for response to a question before repeating it or changing the subject.
• Nod your head and smile, if appropriate, to indicate understanding.
• Avoid debating facts. Focus instead on feelings or use distraction if the person becomes argumentative.
• Respond to the person's mood when his or her words don't make sense. For example, "It sounds like you're feeling sad."
• Stick to topics with which the person is familiar. Avoid complex or abstract subjects.
• Be direct. Avoid clichés and limit the use of pronouns such as it, she and they.
• Try using different words when your message is not getting across.
• When giving instructions, break down a task into simple steps and communicate them one at a time. Demonstration may help.

Final thoughts

• Encourage participation and independence, but watch for signs of frustration or fatigue that signal you should bring the conversation to a close.
• Remind yourself that with repeated contact your comfort level will increase. And don't forget that humor is a valuable tool which can help reduce awkwardness and frustration.
• Keep in mind, too, that you don't have to fill every minute together with conversation. For example, you can listen to music, watch a movie or share a meal.
• Above all, persist with your efforts to regularly communicate with your friend or relative. Your continued involvement will help that person feel important and confident.

Lisa M. Petsche is a medical social worker and a freelance writer specializing in health and elder care issues.