Aphasia is a disorder that results from damage to portions of the brain that are responsible for language.  For most people, these are areas on the left side (hemisphere) of the brain.  Aphasia usually occurs suddenly, often as the result of a stroke or head injury, but it may also develop slowly, as in the case of a brain tumor, an infection or dementia.  The disorder impairs the expression and understanding of language as well as reading and writing. As nurses, we need to take a full assessment of the disease process in caring for the patient with aphasia, particularly in learning ways to sharpen our communication skills to provide for their specific needs.   

          Anyone can acquire aphasia, including children, but most people who have aphasia are middle-aged or older.  Men and women are equally affected.  According to the National Aphasia Association, approximately 80,000 individuals acquire aphasia each year from strokes.  About one million people in the United States currently have aphasia.  Aphasia is caused by damage to one or more of the language areas of the brain.  Many times, the cause of the brain injury is a stroke. A stroke occurs when blood is unable to reach a part of the brain.  Brain cells die when they do not receive their normal supply of blood, which carries oxygen and important nutrients.  Other causes of brain injury are severe blows to the head, brain tumors, brain infections and other conditions that affect the brain.

          Common characteristics displayed by a person who has aphasia may include decreased attention, decreased memory, inability to recall specific words, poor auditory comprehension, lack of ability to use words or gestures to make needs known, and high levels of frustration.  Some areas will be affected greater than others.  The person with aphasia will most likely have weakness or paralysis of the right side of their body.  This is because the left hemisphere of the brain is usually where language is located and the left side of the brain controls the right side of the body.  Although it is rare, a person may have aphasia resulting from a stroke in the right hemisphere of their brain.  In this case, the person would experience weakness or paralysis on the left side of their body.

          A nurse is normally the first person to see a patient just after admission to the floor.  There are several things we must do and not do as nurses caring for the patient with aphasia:  

Do talk simply and naturally and encourage the patient to respond in whatever way he/she can.

Do include him/her in the daily affairs. Consult the individual for their decisions in matters.

Do explain what has happened to the patient.  Reassurance may be provided by an intelligent, simple explanation.

Do encourage gestures and talking with hands.

Do tactfully change the subject when the patient is frustrated in trying to explain something.

Do keep any instructions and explanations simple.  Try to keep your conversation geared to the patient’s immediate needs or surrounding.

Do encourage the use of greetings and social exchanges such as “Hello” and “Thank You”.

Do utilize routine activities for speaking.  Let the patient ask for what is needed regarding dressing or mealtime issues.  If he/she is unable, say the word for them.

Do ask direct questions requiring a simple “yes” or “no” rather than those requiring complex answers.

Do educate family members on the tips for communicating at home.      

Do not speak as if he/she were a child, deaf or retarded. Treat the individual like an adult and simplify or rephrase your wording without shouting.

Do not discuss the patient’s emotional reactions and problems in his presence.

Do not give false optimism; reassure and be empathetic instead.

Do not confuse the patient with too much idle chatter or too many people/distractions in the room.

Do not answer for the patient if they are capable of speaking. 

          The effects of a patient dealing with aphasia can be devastating for everyone related to an individual who suffers from the disorder. From the onset of a stroke, or any type of brain injury, many families have questions about the rehabilitation process and how to deal with the communication impairments that are left behind.  Hopefully these tips will help the nurse in caring for the patient with aphasia. 



  1. I just had a patient at methadone clinic last week with significant expressive aphasia. It was certainly a learning experience. Being patient, not offering too many ‘suggestions’ as to what he was trying to say, and acknowledging that I knew he was struggling to communicate with me, all helped.

    I did offer him a pen to write his thoughts because that part of his abilities might have been preserved, but he declined. It took a little longer than usual but we got through it quite well I think.

    There was one moment where I got to say “I do understand that you are asking me for suchandsuch medication, but I am not going to give it to you because it would be unsafe…” He had a smile for me, knowing he wasn’t allowed that medication per his treatment plan.

  2. Found this on anoither website.

    HEAR ‘ME’….

    I have a type of aphasia so please:

    • Speak slowly yet not as if you’re talking to a child. Don’t raise your voice or yell at me.
    I need time to process the information to respond. Demanding a response confuses me.
    • Exaggerate expression and gestures and stop frequently. Write instructions down for me.
    I need patience and understanding. Stress causes me anxiety and confuses my thoughts.
    • Use clear, simple words and short, active sentences. Know: I ‘know’ I forget things.
    I am not incompetent or stupid. I simply process and do things differently now. Respect that.
    • If you don’t understand me, tell me. Do not pressure me for quick responses. Encourage me.
    I do forget , especially rapid fire demands & multi task demands. Repetition is needed & important.
    • Ask questions that allow two options only. Explain things slowly in an even tone. Don’t try to control me.
    Don’t put me in a box and assume you know my thoughts, my wants and needs. Ask me. Give me time.
    • Above all, be patient. I need to do my things my way. I am capable of making choices for now.
    Respect my decisions even when you disagree. I need my autonomy, for now. HEAR ‘ME’

  3. Excellent guidelines. My elderly mother-in-law is having increasing difficulties. Last time we found out it was both her B-12 and thyroid levels. Don’t forget to have these checked.

  4. my father is an aphasia patient in a nursing home for almost 2 years now.his mind is totally in tact,his memory and all.his only problem is he cannot speak intelligibly and has to be fed via a feeding tube through the stomach.he has made it clear that he hates the nursing home,wants to come home and misses his family life of being able to play his cd’s and watch tv and continue life as it was before his stroke.due to his mind being so in tact,my mother and I have decided we want him home finally and will even learn how to care for him and how to use the feeding tube,etc..we understand that we’ll have to dress and undress him,change his diaper about 2 times a day.we also realize we’ll have to connect his tube at nights.he spends the days in his wheelchair and uses his walker and can use the restroom by himself when awake,although he might need some help with getting off the toilet once he’s seated.we understand this and my mother and I are willing to care for him.the doctors and nurses however are doing their best to scare my mother and I by telling us that we’re ‘risking’ his life if we let him come mother and I feel that since he’s mentally in tact and is lonely and wants to return home ,that we owe it to him and we want him back into our life.he’s 95 years old and in really great shape considering his age.before his stroke he was the perfect image of health and the stroke was caused via a fall in the restroom at 3am one night after getting up to use the restroom..we believe he tripped on a rug,gashed his head which caused the,the stroke wasn’t caused by ill health or bad heart,etc..he was 94 years old at the time and had the health of a man 20 years his this time we want him home and we feel that he’ll probably even live longer once at home as he’ll be MUCH happier..the doctor is attempting to scare us constantly with worst case father has written notes to my mother and I claiming that the only physical tasks to perform daily are his dressing and undressing(which will be done by my mother or myself),bathing(which will be done by a nurse that will come in daily for 3 hours thanx to medicaid) and the connection and disconnection of the feeding tube and changing of his diaper twice daily// he claims his entire day is spent in his wheelchair and walking with his walker and he takes a nap for a while each day..this does NOT sound too impossible a task to my mother or to myself.why is the nurse and doctor attempting to make worst case scenarios sound so severe as though we’re taking the man’s life!!also,why would we leave him there when his mind is in tact and he wants so desperately to come home? I don’t believe my mother and I are in the ‘wrong’ in this case and like my mother says..they only have a few more years to be together at their ages anyway..she feels like they should be enjoying together at home in their last stages of life./are we wrong to bring him home?

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