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Supporting Mr. Hamilton, Part 1: Communicating With Clients With Expressive Dysphasia 

Joshua Hamilton, 57, survived a cerebral vascular accident several months ago. In addition to a few other health challenges, he has expressive aphasia. Marta, his support worker, has been assigned to Mr. Hamilton to assist him with his basic care at home.

Mr. Hamilton frequently asks Marta questions that she does not understand. Here is an example of a recent conversation:

Mr. Hamilton: Wuld ples git bassen eaten?

Marta: Could you please repeat that, Mr. Hamilton?

Mr. Hamilton: (raises his voice) Plasin get eatin puck.

Marta: Would you like something to eat?

Mr. Hamilton: (looks puzzled and upset) Dat stan woo.

Marta: (pretends to eat) Would you like a snack?

Mr. Hamilton: (shakes his head but says nothing)

Marta: (pretends to drink) Something to drink?

Mr. Hamilton: (nods his head and looks relieved)

Marta: (gets a glass and cup)

Mr. Hamilton: (gestures toward the cup)

Marta: (gets a tea bag) Would you like a cup of tea?

Mr. Hamilton: (nods)

In this situation, Marta was not sure what exactly Mr. Hamilton wanted. She thought the words eaten and eatin suggested that Mr. Hamilton wanted something to eat. He was, in fact, trying to say “tea.” Marta did not know this, but she knew from reading his care plan and speaking to his family that Mr. Hamilton liked tea. Using body language and symbols, Marta discovered what Mr. Hamilton wanted, and by being patient and persistent, she was able to meet Mr. Hamilton’s needs.

 

Supporting Mr. Hamilton, Part 2: Communicating With Clients With Expressive Dysphasia 

Marta has noticed that Mr. Hamilton sometimes repeatedly says unrelated words, such as “bun … bun … bun … bun” instead of using the correct words. According to Mr. Hamilton’s care plan, this impediment (obstacle) is a result of his global aphasia and occurs most frequently when he is tired, hungry, overstimulated, or in need of toileting. Occasionally, he will repeat a word over and over again and seems to get into a pattern of repeating himself, even though he has used the words correctly since his stroke.

Following the suggestions in his care plan, Marta reminded Mr. Hamilton to use another word the next time he repeats the same word or phrase. Here is an example of how she did this during a meal:

Mr. Hamilton: (gestures toward his food) Gum … gum … gum … gum …

Marta: (pointing at one of the foods on his plate with the spoon) Not “gum” (spoken gently). Potatoes?

Mr. Hamilton: (shaking his head)

Marta: (pointing at another food on his plate) Meat?

Mr. Hamilton: (nodding his head) Gum … gum …

Marta: (putting the meat on his spoon) Not “gum” (spoken gently). Meat.

Marta made sure to speak clearly and gently, used short sentences, and faced Mr. Hamilton. She also remembered to smile so she would not appear annoyed or angry in any way, knowing that Mr. Hamilton may be very sensitive to signs of impatience or frustration in others.

Mr. Hamilton: (nodding his head) Meat.

Marta then proceeded to assist Mr. Hamilton with his food.

 

1.  Remembering DIPPS—the five principles of support work—describe in details how Marta, his support worker, can assist Mr. Hamilton with his basic care?
2.  How would you describe Expressive Aphasia? What communication techniques that Martha had used to communicate effectively with Mr. Hamilton
3.  After reading both scenarios, what other communication techniques you could use to communicate with Mr. Hamilton? 

SCIENCE
HEALTH SCIENCE
NURSING
Institutional and Ho MISC