Communication Tools: Communicative Access & Supported Conversation for Adults With Aphasia (SCA™)

Supported Conversation for Adults With Aphasia (SCA™) is a communication method that uses a set of techniques to encourage conversation when working with someone with aphasia through:

  • Spoken and written keywords
  • Body language and gestures
  • Hand drawings
  • Detailed pictograph

SCA™ is designed to help people who “know more than they can say” express their opinions and feelings in a way that makes them feel valued and heard.  By using the SCA™ method, conversation partners (such as family members, doctors, nurses, or friends) can help break down the communication barriers and help people with aphasia re-join life’s conversations.

The goals of Supported Conversation for Adults With Aphasia (SCA™) are:

  1. Acknowledge the competence of the adult with aphasia.
  2. Help the adult with aphasia to reveal his or her competence.

People with aphasia need others to believe they are competent and have more understanding and social skills than may be apparent.

Acknowledging competence can be accomplished through using a tone of voice that is natural, choosing adult or complex topics for discussion, and integrating techniques into natural talk.  Helpful strategies include:

  • Saying “I know that you know” at appropriate times.
  • Attributing communication breakdowns to your limitations as a communicator, “You know I’m not good at explaining these things clearly!”
  • Dealing openly when you have to communicate with a partner to obtain or give information.

Despite your best efforts, there will be times when communication breaks down – it is valid and comforting to acknowledge the shared experience of being frustrated.

There are communication techniques that can help ease the exchange of information and feelings between the conversation partner and the person with aphasia.

Getting the message IN is a matter of modifying the way you converse to ensure you are being understood by the person with aphasia.  Some methods to try include:

  • Using short, simple sentences and an expressive voice.
  • Using gestures when conversing.
  • Writing down keywords or topics, so that you can both see them together – e.g., PAIN, in large, bold print.
  • Using pictures to illustrate an idea, and focusing on one picture at a time.
  • Eliminating distraction – noises, other people, or multiple visual materials.
  • Observing the person’s facial expression, eye gaze, body posture or gestures to determine their level of comprehension.

Getting the message OUT might be a bigger challenge for someone with aphasia.  To help them express their thoughts to you, try:

  • Asking yes or no questions.
  • Asking one question at a time.
  • Asking fixed choice questions such as, “Do you want water or coffee?”
  • Phrasing yes or no questions from general to specific.
  • Asking him/her to gesture, point to objects or pictures, or write key words, such as “Can you show me…”
  • Giving him/her sufficient time to respond.

Verifying the message is important to making the person with aphasia feel understood and valued.  Summarize slowly and clearly by saying, “So let me make sure I understand” and using the following methods:

  • Adding gestures or written key words.
  • Repeating the person’s message.
  • Expanding on what you think the person might be trying to say.
  • Recapping the conversation if it was a long one.

How to Use Communication Techniques

The fundamental thing to remember when working with someone with aphasia is to be natural.  Use communication techniques when breakdowns occur. Start with gesture and then gradually add more techniques, as needed.  Overusing communication techniques can also lead to reduced understanding if the person with aphasia feels you’re being patronizing.  Watch the cues from the person with aphasia closely and follow the path that seems to be getting the best response.  And remember – everyone experiences communication challenges from time to time, even the most skilled communication partners.

Those with severe aphasia will likely need more extensive support to absorb messages, both coming ‘in’ and going ‘out’, so use as many communication techniques as you need.

Helpful Materials

When communicating with a person with aphasia, keep some of the following materials on hand to help enable conversation and comprehension:

  • Blank paper – for writing key words and making functional drawings
  • Markers or pencils – use a medium black marker to write key words.
  • For those with aphasia, writing with a pencil is often easier.  Make sure to place the pencil and paper right in front of him/her.
  • Cut out window, created from construction paper – use this to frame one picture at a time.
  • Flashcards – whether letter-sized or smaller cards, flashcards can be used to write keywords (e.g., TOOTHBRUSH) or to introduce or change a topic.
  • Pictures or pictographic illustrations
example of SCA™ in action

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"Volunteering at the Aphasia Institute gives me the privilege of seeing people with aphasia take back their lives after stroke. I know I'm making a difference by volunteering at AI every week."
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