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Simple ways to cue someone who is struggling to find their words
Do you know someone who has anomic aphasia? Did you leave an interaction and wonder how you could have supported their journey in communication recovery? Here you’ll find some suggestions from a neuro Speech Pathologist in how you can support the person with anomic aphasia and how to keep the conversation going.
Anomia is a type of aphasia
What is anomic aphasia? Anomia is a type of expressive aphasia that affects one’s ability to recall words. I assure my clients that they still have their vocabulary, the words are simply harder to access. Anomia can occur independently or in conjunction with other milder forms of aphasia. Generally with anomia, speech is fluent and grammatically correct but there may be hang ups when they can’t find the right word to complete the thought. Maybe the conversation comes to a halt and there’s an uncomfortable, long pause. Maybe it only lasts for a few seconds, but it can feel like an eternity to the person with aphasia. It can be frustrating and embarrassing.
As the communication partner, we can help keep the conversation flowing and alleviate some of the frustration for our friend with anomia. Here are some strategies that facilitate communication in any scenario but is especially helpful for those who struggle with anomia.
Start with minimizing distractions and background noise.
Position yourself so you are face-to-face to capture all the nonverbal communication (facial expressions, gestures, etc.) that supplements language.
Give extra time for word finding.
Avoid speaking for the person with anomia or finishing their sentences. Instead try the cueing methods outlined below.
Finding the right level of cueing that does not contribute to frustration but is still challenging enough to help the person with aphasia in their recovery, is difficult. I recommend consulting their Speech Pathologist. Cueing is hierarchical and you’ll need to know where in their recovery the person is, in order to best support their progress. Too much help means the target word is handed to them and the brain doesn’t have to work. If the brain is not challenged to rewire pathways to where vocabulary is stored, there is little recovery happening. Too little help, can mean too great of a jump between the person’s current level and the target word. This can be frustrating for everyone and can detract from the conversation. In the best case scenario, a supportive cue is brief and helps the person with aphasia feel encouraged to continue talking.
In most of the cueing strategies described, it helps to have an idea of what the word is that you are trying to help your communication partner find. This is the "target word."
Phonemic Cues
In this method of cueing you give the fist sound or few sounds of the target word. For example, the conversation is hung up because they are trying to remember the word for the place where they ran errands that afternoon. You happen to know they went out for groceries, so you give the first sound for grocery store, which is “gr” and wait. Did this help? Sometimes I give it twice if I think it is on the tip of their tongue. If I think they need more help, I give away more sounds in the word “gro-“ or even the first couple of syllables, “grocer…”
Of course, the more natural this is to conversation the easier it will be for them to identify the target word and the easier it is to accept the help. Try to embed your phonemic cue in a sentence that makes sense to the situation. For example, rather than offering "gro-" and waiting, try "Were you at the gro...?" Leave a pause and see if they can finish the word and sentence.
Writing (Orthographic) Cues
Is writing a strength? Sometimes after developing aphasia, writing can be more preserved than speech. If so, this can be a great way to support word finding. If you’re at home and there’s a whiteboard or paper handy, you can simply write down the first letter or two to help with word finding. Without a pen, try using your finger to draw out the first letter in the air, or place your fingers in the shape of the letter, such as “L” or “W.” This may take a couple of tries to see if it works for you and your communication partner. But one advantage of using writing or drawing letters in the air is it preserves silence. The person with aphasia is allowed to concentrate in silence with a visual tip. They may feel a little more empowered that no one had to verbally interject for the conversation to continue.
"As human beings, the ability to communicate is the core of our existence...." – Val Kilmer
Semantic Cues
A semantic cue is a hint based on the meaning of the word. Usually, you’ll need to know the target word for this to be effective. But sometimes it can be used to keep the conversation going as you throw out ideas by giving descriptions and they can confirm or not if you are on the right track. It can also help the person with aphasia cue themselves because sometimes when they begin to describe it, they arrive at the target word on their own.
Example:
"Oh I think I know what you're talking about. It's that place where you go to buy supplies for home repair, right?"
"No, not there." "Is it the place where you buy food? Stock up on groceries?"
"Yes, that's it. We were at the grocery store."
Multiple Choice Cues
The benefit of multiple choice is it can be used even if you’re not sure of what the target word is. You simply give 2-3 options for what you think they might be trying to say. Or if you know what the word is they are trying to recall, you can add a couple of decoys in your list to help them with their vocabulary but in a very natural way.
Example:
“We wanted to buy…..at the grocery store. We were going to make a soup, but they didn’t have….”
How to cue: “Were they out of noodles or chicken or broth?”
“They were out of noodles! Egg noodles!”
Modeling
Sometimes no amount of cueing is going to help or maybe it’s a moment when its more important to keep the conversation going, so we just say the intended word. Giving the target word is modeling. But for the optimal benefit of modeling, the person with anomia should then use the target word in their own sentence. This strengthens their access to that word in future efforts. So be sure to leave time and space for the person with aphasia to then use the word you just modeled in their own way.
Balancing Encouragement and Support
As a communication partner of someone who has aphasia, it is our goal to foster independence in communication. Sometimes when someone struggles to communicate, they may say less and allow someone else to speak for them more than they would have before developing aphasia. We can support them by honoring their fatigue and energy levels and giving breaks when they ask for them. And the rest of the time we can work on supporting their communication efforts with the cues described above. Like everything else, its a balance.
Have questions? Sign up for a free consultation with a Speech Language Pathologist with expertise in aphasia recovery. Amplify Speech Therapy is here to support communication partners, as well as persons with aphasia.