Patients with Receptive Aphasia: They Really Don't Understand
Author(s): Madeline J. Fox
Source: The American Journal of Nursing, Vol. 76, No. 10 (Oct., 1976), pp. 1596-1598
Published by: Lippincott Williams & Wilkins
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Patients with
Receptive Aphasia:
They Really Don't
Understand
had no impairment in their abilityprestroke
to reading abilities may be af-
Overestimating what the understand. fected. making it difficult for him to
aphasic patient understands Yet often, the aphasic patient's re- understand and remember what he
can frustrate him and even sponses are a result of practice rather reads although he can say the words
place him in danger. than a comprehension of what is going aloud. He may be able to copy letters
on. Because he has had a stroke. his and words but not be able to write out
ability to comprehend spoken and his thoughts.
MADELINE J. FOX Aphasia almost always involves a
written words is impaired. This is the
patient with receptive aphasia. decrease in the patient's ability to un-
Many patients with aphasia look alert. Aphasia is one of the most con- derstand and remember what is said
smile. nod. and even laugh and be- fusing and complex communication to him.
come angry appropriately. Many func- disorders encountered by hospital per-When aphasia involves difficulty
tion in social situations as though they sonnel. It is confusing because it using
in- words or speaking, it is called
volves the patient and all thoseexpressive
he aphasia. This patient is easy
MADELINE J. FOX. M.S.. r.C.C.. is an instructor in
to identify. But the patient with recep-
talks with. And it is complex because
speech pathology. Division of Otolarvngology.
Dept. of Surgery. University of Maryland School it may involve several modes of com- tive aphasia has language problems
of Medicine. Baltimore. which
munication. For example, the patient's are not easily detected, and. for
1596 OCTOBER 1976 AMERICAN JOURNAL OF NURSING
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this reason, I will concentrate on him. Other patients with receptive apha- another. Avoid asking the patient to
I have seen several hundred aphasic sia have a general idea of what isidentify said his own body parts as this is a
patients during the past six years, but they cannot grasp the specific difficult
in- task for some patients and
some during their acute hospi- formation contained in the spoken failure is not always an indication of
talizations and others after their hospi- message. A patient with this kind of
impaired understanding.
tal discharge. The majority of these aphasia may understand that she is Here go- are some tasks you can present
patients were referred with a descrip- ing home for the weekend and seem to determine what your aphasic
tion of having expressive language pleased, but she may not understand patient understands and remembers.
problems and normal or near normal that the purpose of her leave is to dis- 1. Ask the patient to identify parts
receptive language skills. pose of her possessions in preparation of the room or familiar objects placed
Most people associated with the for her transfer to a nursing home. before him. You can ask him to point
patients believed that the patients un- Because all aphasic patients have to the ceiling, the window, or the bed.
derstood what was said to them. Fam- some degree of receptive language Orin-place a comb, glass, and tissue box
ily members frequently rationalized volvement,
a an evaluation of all lan- on his tray, name one item, and ask
patient's inability to respond appro- guage skills should be obtained. A lan- the patient to point to the item named.
priately by stating that the patient was guage evaluation provides an accurate If the patient has difficulty pointing to
depressed or stubborn. Yet when a
indication of an aphasic patient's ex- the item named, he will probably be
language evaluation was done, it pressive and receptive language skills. unable to understand the specific con-
nearly always indicated that the It should also indicate a prognosis for tent of most conversations.
patient had difficulty understanding the return of functional languageTo provide additional clues, you
and remembering. skills. The names of certified speech can describe and name the item and
Overestimating the patient's ability pathologists in various areas can bethen ask the patient to point to the ob-
to understand is a common mistake obtained from the American Speech ject or part of the room. For example,
and easy to do. Some aphasic patients and Hearing Association (ASHA), you might say, "You drink water from
manage to conceal their poor memory 9030 Old Georgetown Road. Wash- a glass. Show me a glass." Or "You
successfully while others obtain ington, D.C. If the services of an sleep in a bed. Show me the bed." If
enough information from gestures, ASHA-certified
fa- speech pathologist arethe patient is able to identify these
cial expressions, and situational not cluesavailable, you can screen the pa- items with the additional clues, you
to make it appear that they under- tient's language skills to get a general can conclude that he may understand
stand everything being said. For ideaex-
of his understanding and memory. general ideas conveyed during short
ample, if you are discussing a patient's However, before attempting to spans of conversational speech but not
test results with him and have reports screen receptive language skills, moni- understand the specific information
in your hand and are smiling,tor theyour own behavior carefully so conveyed. For this patient, keep your
patient may realize that you that haveyou do not provide unintended messages short and concise. Do not
good news and act appropriately. nonverbal clues. You want to test what confuse him with unrelated verbal
Sometimes a patient responds to patient understands and not howmessages when you have specific in-
thedi-
rections only because he has done well
the he uses visual clues. For example,formation to give. Do not discuss the
task so often. For instance, when you want a patient to identify ob-weather or his day when instructing
if you
enter his room with bath supplies jects in the room, do not look or leanhim about his medication. Give him
about the same time each day, he in the direction of the object as you the directions, allow time for him to
may
begin to undress. He may be respond- name it. If you want the patient to respond, and then spend some time
ing to what you are doing and not identify
to articles of clothing, do notvisiting with him.
what you have said. Thus, if on straighten your that piece of clothing before 2. Test comprehension skills of
way to bathe another patient younaming stop it. the less impaired aphasic patient
in the aphasic patient's room to dis- Avoid asking the patient to identify by using a short paragraph from a
cuss a change in his routine, hetwo maysuch related items as table and magazine or a newspaper. Read a
rely on his visual cues and begin to chair
re-or comb and brush. Related paragraph to the patient, trying not to
move his clothing. words frequently serve as clues for select a controversial or familiar topic.
one
VOLUME 76, NUMBER 10 OCTOBER 1976 1597
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RECEPTIVE APHASIA
Here are some basic differences between receptive and expressive
aphasia. Patients may have both and the problems in each area
vary in severity in different situations and in different patients.
Then ask specific questions concerning
its contents. Be sure to avoid questions
having yes or no answers. If the RECEPTIVE APHASIA EXPRESSIVE APHASIA
patient is unable to talk. have simple
pictures or drawings representing the
answers and alternative responses. Ask Oj Reduction in the ability to under-
O Difficulty in thinking of words
the patient to point to the picture rep- stand what is said. needed to speak effectively, although
resenting his answer. If he can answer the patient knows what he wants to
these questions, then he is likely to un- say. In one situation, the patient may be
derstand most instances of brief con- able to describe an item but be unable
O Reduction in the ability to remember
what is said. to name it. At other times, he may be
versational speech.
unable to communicate effectively.
To determine the aphasic patient's
memory of spoken language, try some
E] Considerable reduction in the ability
of the following activities.
1. Place several items on the
to understand and remember lengthy,
complex, or unfamiliar spoken messages.
patient's tray and name them in a ran-
dom order. The patient must then
point to the items in the exactE order
Tendency to confuse associated n- Difficulty using words and concepts
named. Begin with two or three words
items,and concepts. For example,frequently
the associated. The patient may
and if the patient is successful, in- may be told that his wife is tell
patient hereyou that he is hungry when he
crease the number of items to six or to visit and believe that he was told wants a drink. At another time, he may
seven. that his mother had come. ask you to call his mother when he
2. If the patient is able, have him re- really wants his wife to be called.
peat random numbers you recite. The
series can range from three to six or
seven digits. O] Tendency to confuse opposites. ThisE] Difficulty in using opposites. This
patient may be told that it is all right to
patient may say yes and mean no or tell
Remember, the patient must point
do something particular and then heyou that he is hot when he is cold.
to or repeat items or numbers in the
may not respond, thinking that per-
exact order presented. If the patient mission has been denied.
cannot identify three items in se-
quence or repeat three digits, he prob-
ably will be unable to follow a two- n Difficulty in using abstractions. The
[3 Difficulty understanding abstractions.
part command such as, "Lock your This patient may be told that his coffee
patient's speech frequently is concrete.
wheelchair and stand up." He will is "boiling hot" and refuse to drink it
stand up immediately, forgetting the for fear of burning himself.
first part of the direction. For this [- Difficulty constructing grammatically
aphasic patient, it is important that correct and/or appropriate sentences.
multipart directions be avoided. This patient sometimes speaks in single
Present one part of the direction and words or phrases. For some patients,
allow the patient to respond before speech attempts contain nouns while
other patients use only adjectives or ad-
you present additional information.
verbs, making communication by this
The patient who can correctly iden-
latter group very difficult to understand.
tify five or six items in sequence or re-
peat a five digit span in order should
be able to follow the command, "Lock
[- Tendency to use automatic responses
[E Tendency to use automatic responses
your chair, stand up, and walk over to to mask communication difficulties. to mask communication difficulties.
the window." An aphasic patient who
can repeat six or seven digits in order
or who can point to six or seven items 1" Inappropriate behavior and responsesE] Inappropriate behavior and responses
in order will probably have little diffi- as a result of problems understandingas a result of problems in expression.
culty following simple commands and language.
simple conversation about a familiar
topic or in a familiar situation.
1598 OCTOBER 1976 AMERICAN JOURNAL OF NURSING
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