Disclaimer: this resource is intended for speech and language therapists and students of this profession. If you require therapy for aphasia please contact a speech and language therapist.
Creating Aphasia-Friendly Environments
Summary: An approach that seeks to optimise the environment of individuals with aphasia for effective communication. This could include modification to the physical environment (e.g. lighting, background noise), tailoring of written information to maximise comprehension and educating the wider population on how to support those with aphasia (Parr et al., 1997; Worrall et al., 2006).
Example:
The following are examples of changes that could create a more aphasia-friendly environment. See below for a discussion of the texts and studies that inform this list.
The following are examples of changes that could create a more aphasia-friendly environment. See below for a discussion of the texts and studies that inform this list.
- Reduce background noise (Darley, 1976; Parr et al., 1997; Smith, 2001)
- Ensure the area is very well lit (Harrison et al, 2003)
- Increase accessibility to written materials for clients with aphasia, e.g. one sentence per page, use short sentences, keep Flesch-Kincaid grade level 5 or below, highlight keywords, supplement with relevant photos or line drawings (see below & The Stroke Association, 2012, for details)
- Make conversation partners aware of the need to reduce the complexity and rate or their speech (see entry on Supported Conversation for adults with Aphasia for more details on conversation partner training)
- Deliver aphasia-awareness training to local businesses and have them display a shop sign to indicate their preparedness to cater for customers with aphasia (Holland cited in Jordan & Kaiser, 1996)
Evidence Base: There is limited research into how to most effectively create aphasia-friendly environments (Howe et al., 2004). In a qualitative study of individuals with aphasia in a range of day-to-day situations, Howe et al. (2007) found that factors such as confusingly organised information (e.g. bus timetables and forms) were a barrier to participation.
Several studies have explored the effectiveness of aphasia-friendly written information for individuals with aphasia. Rose et al. (2003) found that aphasia-friendly formatting resulted in an 11.3% increase in comprehension of written information, although not all participants with aphasia preferred this type of formatting. Similarly, Brennan et al. (2005) found that aphasia-friendly formatting resulted in significantly improved reading comprehension for participants with aphasia - although noted that images, in particular ClipArt images, may be distracting. Egan et al.’s study (2004) indicated that an aphasia-friendly written training manual could help individuals with aphasia learn to use the internet.
In a study investigating the effect of background noise on a grammaticality judgement task, Smith (2011) found that a participant with aphasia made proportionally more errors than controls when performing the task against background noise. Similarly, Darley (1976) carried out a review of studies into the effects of background noise on participants with aphasia, concluding that background noise appears to reduce performance in language tasks. Interestingly, Harrison et al. (2003) found that bright light improved the speech detection of participants with aphasia in a dichotic listening task.
Several studies have explored the effectiveness of aphasia-friendly written information for individuals with aphasia. Rose et al. (2003) found that aphasia-friendly formatting resulted in an 11.3% increase in comprehension of written information, although not all participants with aphasia preferred this type of formatting. Similarly, Brennan et al. (2005) found that aphasia-friendly formatting resulted in significantly improved reading comprehension for participants with aphasia - although noted that images, in particular ClipArt images, may be distracting. Egan et al.’s study (2004) indicated that an aphasia-friendly written training manual could help individuals with aphasia learn to use the internet.
In a study investigating the effect of background noise on a grammaticality judgement task, Smith (2011) found that a participant with aphasia made proportionally more errors than controls when performing the task against background noise. Similarly, Darley (1976) carried out a review of studies into the effects of background noise on participants with aphasia, concluding that background noise appears to reduce performance in language tasks. Interestingly, Harrison et al. (2003) found that bright light improved the speech detection of participants with aphasia in a dichotic listening task.
References
Brennan, A.D., Worrall, L.E., & McKenna, K.T., 2005. The relationship between specific features of aphasia-friendly written material and comprehension of written material for people with aphasia: An exploratory study. Aphasiology, 19, 693–711
Darley, F.L., 1976. Maximizing input to the aphasic patient. In: Brookshire, R.H. ed. Clinical aphasiology: Conference proceedings. Minneapolis, MN: BRK Publishers
Egan, J., Worrall, L., & Oxenham, D., 2004. Accessible Internet training package helps people with aphasia cross the digital divide. Aphasiology, 18(3), 265-280
Harrison, D.W., Beck, A.L., Vendemia, J.M., & Walters R.P., 2003. Ambient sensory conditions: modification of receptive speech deficits in left-side stroke patients using bright light. Perceptual and Motor Skills, 96, 623–624
Howe, T.J., Worrall, L.E., & Hickson L.M.H., 2004. Review: What is an aphasia-friendly environment? Aphasiology, 18, 1015–1037
Howe, T., Worrall, L., & Hickson, L.M., 2007. Observing people with aphasia: environmental factors that influence their community participation. Aphasiology, 22, 6, 618–643
Jordan, L., & Kaiser, W., 1996. Aphasia: A social approach. Cheltenham: Stanley Thornes
Parr, S., Byng, S., Gilpin, C., & Ireland C. 1997. Talking about aphasia: Living with loss of language after stroke. Buckingham: Open University Press
Rose, T., Worrall, L., & McKenna, K., 2003. The effectiveness of aphasia‐friendly principles for printed health education materials for people with aphasia following stroke. Aphasiology, 17(10), 947-963
Smith, P.A., 2011. Impact of distraction and memory on grammaticality judgment in a patient with aphasia. In: Clinical Aphasiology Conference, Fort Lauderdale, FL. [online] Available at: <http://aphasiology.pitt.edu/archive/00002255/01/58-75-1-RV-Smith.pdf> [Accessed 04/02/2016]
The Stroke Association, 2012. Accessible information guidelines: Making information accessible for people with aphasia. [online] Available at: <https://www.stroke.org.uk/sites/default/files/Accessible%20Information%20Guidelines.pdf(1).pdf> [Accessed 02/02/2016]
Worrall, L., Brown, K., McGahan, L., Alkhaledi, M., & Denise, S., 2006. Environmental factors that influence the community participation of adults with aphasia: The perspective of service industry workers. In Clinical Aphasiology Conference: Clinical Aphasiology Conference (Ghent, Belgium) [online] Available at: <http://aphasiology.pitt.edu/archive/00001762/01/185.pdf> [Accessed 04/02/2016]
Brennan, A.D., Worrall, L.E., & McKenna, K.T., 2005. The relationship between specific features of aphasia-friendly written material and comprehension of written material for people with aphasia: An exploratory study. Aphasiology, 19, 693–711
Darley, F.L., 1976. Maximizing input to the aphasic patient. In: Brookshire, R.H. ed. Clinical aphasiology: Conference proceedings. Minneapolis, MN: BRK Publishers
Egan, J., Worrall, L., & Oxenham, D., 2004. Accessible Internet training package helps people with aphasia cross the digital divide. Aphasiology, 18(3), 265-280
Harrison, D.W., Beck, A.L., Vendemia, J.M., & Walters R.P., 2003. Ambient sensory conditions: modification of receptive speech deficits in left-side stroke patients using bright light. Perceptual and Motor Skills, 96, 623–624
Howe, T.J., Worrall, L.E., & Hickson L.M.H., 2004. Review: What is an aphasia-friendly environment? Aphasiology, 18, 1015–1037
Howe, T., Worrall, L., & Hickson, L.M., 2007. Observing people with aphasia: environmental factors that influence their community participation. Aphasiology, 22, 6, 618–643
Jordan, L., & Kaiser, W., 1996. Aphasia: A social approach. Cheltenham: Stanley Thornes
Parr, S., Byng, S., Gilpin, C., & Ireland C. 1997. Talking about aphasia: Living with loss of language after stroke. Buckingham: Open University Press
Rose, T., Worrall, L., & McKenna, K., 2003. The effectiveness of aphasia‐friendly principles for printed health education materials for people with aphasia following stroke. Aphasiology, 17(10), 947-963
Smith, P.A., 2011. Impact of distraction and memory on grammaticality judgment in a patient with aphasia. In: Clinical Aphasiology Conference, Fort Lauderdale, FL. [online] Available at: <http://aphasiology.pitt.edu/archive/00002255/01/58-75-1-RV-Smith.pdf> [Accessed 04/02/2016]
The Stroke Association, 2012. Accessible information guidelines: Making information accessible for people with aphasia. [online] Available at: <https://www.stroke.org.uk/sites/default/files/Accessible%20Information%20Guidelines.pdf(1).pdf> [Accessed 02/02/2016]
Worrall, L., Brown, K., McGahan, L., Alkhaledi, M., & Denise, S., 2006. Environmental factors that influence the community participation of adults with aphasia: The perspective of service industry workers. In Clinical Aphasiology Conference: Clinical Aphasiology Conference (Ghent, Belgium) [online] Available at: <http://aphasiology.pitt.edu/archive/00001762/01/185.pdf> [Accessed 04/02/2016]
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