How to communicate with someone with aphasia after a stroke

By James editorial team, Golan Europe S.L. · Published 1 November 2026 · 8 min read

Aphasia is a language problem caused by damage to the brain, most often a stroke. It affects words, not intelligence. To communicate well, use short, clear sentences and ask questions that can be answered with yes or no. Give plenty of time. Use writing, drawing, gestures and pictures as well as speech, and check that you have been understood. Speech and language therapy exists, and it usually involves the family too.

What aphasia is, and what it is not

Aphasia makes it hard to speak, understand, read or write. It happens when the parts of the brain that handle language are damaged. Stroke is the most common cause^[1].

It looks different in different people. The NHS lists signs such as not finding the right word, speaking slowly or in short, broken sentences, mixing up words or making up words, and struggling to understand others^[1]. MedlinePlus describes main types^[2]:

• Expressive aphasia: the person knows what they want to say but cannot get it out.
• Receptive aphasia: they hear the words but struggle to make sense of them.
• Anomic aphasia: they mostly get stuck on names of people, places and things.
• Global aphasia: almost all language is affected.

What aphasia is not:

• It is not a loss of intelligence. The person still has their memories, opinions and sense of humour.
• It is not the same as confusion or dementia, though they can happen together.
• It is not deafness. Shouting does not help.

Treat the person as the adult they are. Include them in talk about plans, money and their own care.

Do not assume they understand everything

Many families believe their loved one "understands everything, but just can't speak". Sometimes that is true. Often it is not.

In a study of 30 people with aphasia after a stroke, doctors, nurses and relatives all overestimated how much the person understood^[3]. Relatives were just as off when they felt sure as when they felt unsure. Nodding and smiling can be politeness, not understanding.

So check, gently:

• Ask the person to point to something you mentioned, or to choose between two written words.
• For anything important, such as a hospital date, write it down and go through it together.
• Watch their face and actions. Do they do what was agreed?

Checking is not a test. Make it part of the chat: "So we're going on Tuesday, yes?" while pointing at Tuesday on the calendar.

Make your words easier to follow

Small changes in how you speak can help a lot.

• One idea per sentence. "Lunch is ready." Pause. "It's soup."
• Use common words and the person's own names for things.
• Stress the key word, and write it down if needed.
• Cut background noise. Turn off the TV. Talk one person at a time.
• Face them so they can see your mouth and hands.
• Tell them when you change topic. "Now, about Sunday..."

Should you talk slowly? Research suggests speed alone is not the answer. In a study of people with aphasia, slowing speech helped understanding mainly when pauses were added between the parts of a sentence, and only for some types of aphasia^[4]. So instead of dragging every word, break your sentence into short chunks with a little pause between them.

Use a normal adult tone, not a voice for children. And do not talk about the person as if they were not there.

Ask questions they can answer

Open questions such as "What do you want to do today?" can be very hard. The person has to find many words at once. Make it easier:

• Yes/no questions. "Do you want tea?"
• Either/or choices. "Tea or coffee?" Hold up both, or write both.
• One question at a time. Wait for the answer before asking the next.
• Written options. Write three choices on paper and let them point.

Be aware that some people with aphasia mix up yes and no. If an answer seems odd, check another way: "So, no tea?" with a shake of the head, or write YES and NO for them to point to.

Give time, and help the word come out

Finding a word can take a long time. Waiting feels awkward, but rushing makes it harder.

• Wait. Count slowly to ten in your head before you help.
• Do not finish their sentence, unless they want you to. Ask: "Would you like me to guess?"
• Offer a guess as a question. "Is it about the garden?"
• Ask for another route. "Can you show me?" or "Can you write the first letter?"
• Do not correct every wrong word. If you know what they mean, carry on. The message matters more than the grammar.
• Be honest if you do not understand. Pretending causes more problems later. Say "I'm not getting it. Let's try another way" and stay calm.

Use more than words

Speech is only one way to communicate. The NHS says speech and language therapy can include practising ways to communicate without words, like drawing, body language, gestures and facial expressions, and using technology such as photos on a phone^[1].

At home, try:

• Paper and a thick pen always within reach, for both of you.
• Drawing. A quick sketch of a car or a house can unlock a whole story.
• Gestures and pointing. Show "drink", "phone", "outside".
• Real objects. Hold up the coat to ask about going out.
• Photos and maps. Family photos help with names. A map helps with places.
• A simple communication book of common words, people and needs. A speech and language therapist can help you make one.
• A calendar to point to days and plans.

Written information should be adapted too. NICE says appointment letters, timetables and even menus should be made aphasia-friendly for stroke survivors^[5]. The Stroke Association has communication tools and advice for families in the UK^[6].

When frustration, tears or tiredness take over

Aphasia is exhausting and frustrating, for the person and for you. The NHS notes it can lead to anxiety, low mood, loneliness and strain on relationships^[1].

Some changes after a stroke are worth knowing about:

• Sudden crying or laughing. A review found this kind of emotional change affects about 1 in 5 stroke survivors in the first months, and about 1 in 8 after six months^[7]. Crying is more common than laughing. It is not a sign of weakness.
• Low mood. A review found depression affected about 29% of stroke survivors, and it could last for years^[8].
• Tiredness. A review estimated that about half of stroke survivors have fatigue^[9]. Talking takes a lot of energy, so short chats are often better than long ones.

What helps: keep calm, take a break when either of you is getting tense, and come back later. Acknowledge the feeling: "This is really frustrating, isn't it?" If low mood, tears or withdrawal last, tell the GP or stroke team. Talking therapies and support exist after a stroke, and a professional decides what fits.

Looking after someone with aphasia is hard work. Our guide to caregiver burnout has ideas for protecting your own health.

Speech and language therapy, and training for you

Aphasia is treated with speech and language therapy. A therapist assesses the person and works on speaking, reading, writing and other ways to communicate. It usually involves family and friends too^[1]. MedlinePlus notes that language can keep improving for many years^[2]. The NHS says most people improve with treatment after a stroke, especially in the first few months, and some recover fully^[1].

Families can learn skills as well. Two reviews of "communication partner training" found it improves how trained partners support conversation. It probably also helps people with long-term aphasia take part in conversation with those partners^[10][11]. In one trial, volunteers trained in supported conversation got better at helping people with aphasia show what they knew, and the people with aphasia also communicated better^[12]. NICE says people who talk regularly with someone with aphasia after a stroke should be offered this kind of training^[5]. Ask the stroke team or speech and language therapist about it.

Some speech problems are an emergency. If someone suddenly has new trouble speaking or finding words, or a drooping face or a weak arm, it may be a stroke. Call the emergency number at once: 999 or 112 in the UK, 112 in Ireland, 911 in the US, 000 in Australia^[1].

When the family tells James, an AI companion, about a stroke with aphasia, he gives time to answer, asks yes-or-no questions and checks instead of guessing. He treats sudden changes in face, arm or speech as an emergency. You can read how James adapts after a stroke. If your family also lives with Parkinson's, see how to talk with someone who has a soft Parkinson's voice.

James is an AI, not a doctor. For medicines and treatment ask your doctor or pharmacist.

This article in other languages: EspañolРусскийDeutschFrançais