How to Communicate With Someone With Aphasia: The EASE Check

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You ask him a simple question. He stares, gets frustrated, and walks away. Some nights you replay it for hours and wonder what you did wrong. Other nights, you're as frustrated as he is.

Learning how to communicate with someone with aphasia starts before the first word. It starts with a four-point check that takes about thirty seconds.

Set the conversation up for success before you start it. Aphasia makes language harder to process. Noise, fatigue, long sentences, and strong emotion all add to the challenge. Check for them before you say a word. Genevieve Richardson, a speech-language pathologist with 32 years of clinical experience, teaches a four-point check called EASE: Environment, Attention, Simplify, and Emotion. Run it before any conversation that matters, and you set it up to work.

Genevieve walks through the full framework in Episode #206 of LIFE Beyond Aphasia. Watch it below, or listen wherever you get your podcasts.

Four things decide whether a conversation works: where you are, when you talk, how much you say at once, and how both of you feel. Noise in the room competes for the language he has available. Late in the day, fatigue drains it. Long sentences overload it. Strong emotion shuts it down. When one of those four is off, the conversation breaks. It feels personal, but this is a brain problem. His intelligence and who he is are still there.

EASE turns those four into aphasia communication strategies you can use at home. When a conversation goes wrong, you can find where it broke and fix it. You become the detective instead of the target.

E is for Environment: set the room first

Look around before you speak. Is the TV on? Is the dog running through the house? Is the neighbor mowing his lawn? Every sound pulls from the language he has to work with.

Clear what you can. Turn off the TV. Let the dog out. Move to a quieter room if you need to. Then get face to face, at his level, so the only thing competing for his attention is you.

A is for Attention: get it, then pick your window

Say his name or touch his shoulder. Then wait two or three seconds. Eyes on you and a brain ready to listen arrive at different times. Once he is present with you, ask your question.

Timing matters too. Most people with aphasia communicate best early in the day. By late afternoon, talking, thinking, and walking all take more effort. Put the conversations that matter in his best window. Breakfast is a good place to start.

S is for Simplify: one idea, then wait

Say one thing. Pause. Then say the next thing.

"I talked to Sally today." Pause. "She wants us to come for lunch." Pause. "Do you want to go tomorrow?" Then wait for his answer.

Show him what you mean when you can. Hold up the cup when you ask about water. Keep something to write on nearby so you can jot down the key word. 

Tip: Keep a small dry-erase board [Like This One] nearby for writing key words during conversation. 

E is for Emotion: check both temperatures

Check yours first. When you are exhausted, you rush, pile on words, and react faster. Then check his. If he is already frustrated or worn out, the conversation can wait. Write it down and come back to it in the morning. 

Reassure him that you are trying. Then ask, "Can you show me?" He might point to the remote, a cup, or a room. That gives you context.

Then tell him, "I'm going to ask you some yes and no questions." Start narrowing it down. A little context first makes the yes and no questions work.

Or ask him to write it down on a dry erase board [Like This One] or look it up online if he can.

Conversations that work are how you find each other again. EASE takes practice, and it gets easier each time. Pick one conversation a day this week and run the check first. Give yourself grace while you learn it.

Keep the check where you'll see it. Download the printable EASE check and put it on your fridge or wherever you talk most.

How long does the EASE check take?

A few seconds once you know it. At first, you will think through each letter. With practice, you scan the room, get his attention, simplify, and check the temperature almost automatically.

What is the best time of day to talk with someone with aphasia?

Usually the morning. Most people with aphasia process language best early in the day, and it gets harder by late afternoon. Watch for his most alert window and plan important conversations there.

What do I do when I can't understand what he's trying to say?

Ask him to show you. Pointing to an object or a room gives you context. Then switch to yes and no questions to narrow it down. Keep pen and paper nearby to write the words you did catch.

Is his frustration about me?

It is about his brain. Aphasia makes it hard to get words out, and the frustration has to go somewhere. Understanding what is behind it lets you respond to the moment instead of taking it on.

EASE sets up one conversation. Download the printable EASE copy here.