Common Communication Barriers

By Lisa M. Petsche

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.

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