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What is aphasia?

An EMT’s personal story and tips on how to communicate with individuals with aphasia in an emergency situation

Human brain in body with highlighted supramarginal gyrus

Human brain in body with highlighted supramarginal gyrus, 3D illustration. It is involved in perception of language, space and limbs location, identifying postures and gestures of other people

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By Avi Golden, CCEMTP, IAFCCP; and Kaitlin Brooks, PhD, CCC-SLP

My name is Avi Golden. Sixteen years ago, I went in for surgery to repair a mitral valve prolapse and during the surgery, I had a stroke with resulting aphasia and right-sided weakness.

Before my stroke, I was an EMT for 20 years, and 7 of those years I was a critical care/flight paramedic. I was 33 years old and planning on starting medical school as my dream was always to become a doctor.

My stroke drastically changed the path of my life, from the new onset of one-sided weakness to the difficulty with communication – the aphasia was and still is the most difficult part.

Now that I was living with the condition, I started to research aphasia (as I, like many other first responders, did not truly understand what it was). In my paramedic textbook, aphasia was described in four simple words: “difficulty naming objects correctly.” As I was now living with the condition, I realized that aphasia was much more complex than this simple definition, and I identified the need to spread the word about aphasia to the public. For the past 14 years, I have traveled the world to educate first responders about aphasia along with a speech language pathologist.

What is aphasia?

Aphasia is an acquired communication disorder that impairs a person’s ability to speak and understand others, but does not affect their intelligence. Typically, aphasia impacts a person’s ability to read and write, as well. Often, the person knows what they want to say, but they cannot get the message out effectively. Aphasia makes it difficult to communicate, especially in emergency situations where the information needs to be provided quickly and efficiently.

I understand mostly everything that is said to me, but there are times when I may not be able to fully comprehend the message, or follow a direction, especially when there is a lot of background noise and/or visual distractions. My words do not come out fluently. I often get “stuck” on the words or may say the wrong word (e.g., “him” for “her”) or say a word that is similar to the word I was trying to say, but not what I wanted to say (e.g., “fork” for “knife”). As you can imagine, this leads to many communication breakdowns and can often make conversations frustrating for both myself and the listener.

Tips for communicating with a person with aphasia

What can first responder’s do to communicate with a person with aphasia in an emergency?

The first thing you can do is keep your communication simple, but still speak to the person at an adult level. You can do this by asking yes/no questions and confirming with a thumbs up/down or even a picture board with a smiley face/frown face. Try asking more direct, closed-ended questions, versus open-ended questions (e.g., “Do you live with a spouse?”, versus “Who do you live with?”).

The National Aphasia Association recommends the following communication strategies:

  • Ensure you have the person’s attention before you speak.
  • Minimize or eliminate background noise if possible (sirens, TV, radio and other people).
  • Speak at a normal volume.
  • Repeat statements or directions when necessary.
  • Give the person time to speak; try not to finish sentences or offer words, unless the person with aphasia prompts you to do so.
  • Try communicating using writing, drawings, gestures and facial expressions.

My colleague and friend, Dr. Kaitlin Brooks, who is a professor and speech-language pathologist, often speaks to first responders about aphasia. In our 90-minute class, Dr. Brooks and I educate others about what aphasia is, the different types of aphasia (with video examples), as well as communication strategies to be used in an emergency situation if you believe you have encountered an individual with aphasia. We also created a 15-minute video titled “Recognize Aphasia. If you or someone you know is interested in having us come to your department to speak on this topic, please feel free to reach out to us at the contact information listed below. The best way to really understand aphasia is to meet someone (or multiple people) with aphasia and I am happy to be on this journey to educate as many people as possible on this important topic.

Video: Cultivating patient rapport

Avi Golden is a practicing EMT, and former critical care and flight paramedic with North Shore LIJ (Northwell) EMS and NY Presbyterian EMS. Avi holds a Bachelor’s of Science in Biology and has extensive experience as a practicing paramedic both in the U.S. and with Magen Adom David in Israel. After experiencing a stroke in 2007 and experiencing resulting aphasia, Avi now educates the medical and lay community, and advocates for aphasia awareness.

Dr. Kaitlin Brooks is an assistant professor and clinical supervisor in the Department of Communication Sciences and Disorders at Molloy University in Rockville Centre, New York. Dr. Brooks is a licensed and certified speech-language pathologist with 15 years of experience working with adults with speech, language, cognitive and swallowing disorders. Dr. Brooks has published and presented on topics related to communication and swallowing disorders related to stroke as well as the importance of a multidisciplinary approach to the rehabilitation process. Dr. Brooks is passionate about improving awareness of aphasia and other communication disorders and educating allied health professionals on ways to improve communication with individuals with a communication disorder, especially in emergency situations.