Why aphasia changes the board
Aphasia is a change in language after an injury to the brain, such as a stroke. It can affect four things: saying words, understanding what others say, reading and writing. Each one can be affected a little or a lot, and the mix is different for every person. Aphasia itself does not affect intelligence.
That mix is why a plain word list or an alphabet chart often isn't enough. A word list leans on reading. An alphabet chart leans on spelling. Either one may be the very thing that is hard. Our guide to communication boards for adults covers the basics of any board; this page is about what changes with aphasia.
| Aphasia can make it hard to | What's on the board | What you do |
|---|---|---|
| Find or say a word | A picture and a word in every square, to point to | Wait, then say aloud the word they pointed to |
| Follow what is said | The same pictures, for you to point to | Say one idea at a time and point to the key picture |
| Read | One large printed word or short phrase per square | Read it aloud as you point |
| Write or spell | Words already printed, plus blank space for choices | Write two or three answers to choose from |
| Say "yes" and "no" the way they mean it | Yes, No and "I don't know" squares in the top row | Check the answer a second way |
Which rows apply to one person, and how much, is a question for their speech-language pathologist. For the hospital and the first weeks at home, see our guide to communication boards after a stroke.
What should the squares look like?
- Large, plain print. The Aphasia Alliance's tips for written material ask for type of 14 point or larger, a plain sans serif font, and no words in all capitals.
- One page on the table at a time. The Aphasia Institute's tips include focusing on one picture at a time and clearing away other visual material.
- A way out. A square that says "It's something else" tells you the right word isn't on the page, so you keep looking.
- Repair phrases. "Say it again, please." "Write it down, please." "Wait, please." These let the person steer the conversation.
How do you check yes and no?
Some people with aphasia can say "yes" and "no", but the word that comes out is not always the one they mean. Our stroke guide covers the first check at the bedside. At home, keep checking.
- Offer a third answer. "I don't know" and "It's something else" mean nobody is pushed into a yes or a no.
- Go from general to specific. "Is it about food?" Then "Is it lunch?" Then "Is it soup?"
- Ask a second way. Point to the Yes and No squares and let them point. A thumbs up or thumbs down works too.
- Say it back before you act. "You want to call Anna. Is that right?"
If answers often don't match, mention it to the person's speech-language pathologist.
Write key words and offer written choices
Keep a pen and plain paper with the board. Page 2 of our free file is a written choices page for this.
- Write the key word as you say it. One or two words, large, in lower case. "Doctor. Tuesday."
- Leave it where you can both see it. Either of you can point back to it later.
- Offer written choices. For a question the board can't answer, write two or three possible answers in a list and let the person point. "Who called? Anna. Mike."
- Add "something else" as the last choice, the same way the board has a way out.
- Keep the sheet. Words that come up again and again belong on the board.
Reading single words can be hard too. If written choices aren't landing, say each one aloud as you point to it, or draw it.
How do you let the person choose the topic?
A board with only needs on it can ask for water. It can't say "tell me about the game." Tips for families from the National Institutes of Health include keeping the person in the conversation and asking for their opinion. That takes topic words.
A topic page starts with "I want to talk about..." and a grid of subjects. The person points to one. You narrow it down with yes or no questions and written choices.
12 topics to start an "I want to talk about..." page
- My family
- Friends
- Work
- Home
- Sports
- Music
- TV and news
- Pets
- Garden
- Food and cooking
- Faith
- The weather
Swap in the person's own subjects: the team, the grandkids, the old job. For each one, gather something to point at, such as photos, a calendar or a map.
When you move to a new subject, say so, and point to the new square before you go on.
Habits of a good conversation partner
The board is half of it. The other half is what you do. The Aphasia Institute in Toronto teaches a set of habits called Supported Conversation for Adults with Aphasia, and other aphasia organizations give families similar lists (see Sources). SCA has three parts.
| Part | What you do | With the board |
|---|---|---|
| Getting your message in | Short sentences, one idea at a time, your normal adult voice | Point to one picture as you say the key word, and write it down |
| Getting their message out | One question at a time: yes or no, or a choice of two ("water or coffee?"). Then wait | Put the board within reach. Watch their face and hands as well as their finger |
| Checking | "So let me make sure I understand," then say it back slowly | Point to their answer as you say it |
Three more habits from the same lists:
- Give plenty of time, and don't correct how a word came out.
- Own the mix-ups. "I'm not explaining this well. Let me try another way."
- Say "I know that you know" when the word won't come.
Page 3 of our free file puts the main habits on one page, so you can hand it to visitors.
One page, a book, and a card for going out
When one page can't hold it all, families add topic pages and keep them together in a binder or a small book: one subject per page, with a tab on the edge to flip to. MedlinePlus, from the National Library of Medicine, describes a book with pictures or words about common topics or people.
For going out, a wallet card tells a stranger in a few words that the person has aphasia and asks for time. Our aphasia wallet card page has a free one to print.
Frequently asked questions
What should be on a communication board for someone with aphasia?
A picture and a word in every square. Yes, No and "I don't know" in the top row. Then everyday needs, people by name and photo, feelings, repair phrases such as "say it again, please", and a topic page for conversation.
What if someone with aphasia says yes but means no?
It happens. Give a second way to answer, such as pointing to the Yes and No squares or a thumbs up and thumbs down. Then say back what you understood before you act on it.
How do you communicate with someone with aphasia?
Find a quiet place. Use short sentences, one idea at a time, in your normal adult voice. Point to pictures and write key words as you speak. Ask one question at a time, give plenty of time to answer, and check that you understood.
Can you have a conversation with a communication board, or only ask for things?
A board with topic squares is made for conversation. The person points to a subject on an "I want to talk about..." page. You fill in with yes or no questions, written choices, photos and a calendar or map.
Where can I get a free printable aphasia communication board?
Doctor Carissa's free talking together pages are a 12-square board for talking, a written choices page and a guide for visitors, as a PDF in US Letter and A4. The Aphasia Handbook from the Stroke Foundation and the Australian Aphasia Association also has picture pages to point to.
Sources
We opened and checked every link on October 4, 2026.
- Aphasia, American Speech-Language-Hearing Association (ASHA), Practice Portal. Aphasia affects spoken expression, written expression, understanding speech and reading to varying degrees; low-tech supports include photos and communication books; partners offer written or visual choices.
- Aphasia, NIDCD (National Institutes of Health). Tips for family: write down key words, keep a natural adult manner, include the person in conversations, ask for their opinion, don't correct their speech, allow plenty of time.
- Communication Tools: Communicative Access and Supported Conversation for Adults With Aphasia (SCA), Aphasia Institute (Toronto). Getting the message in, getting the message out, and verifying; one question at a time; fixed choices; one picture at a time; "I know that you know".
- Aphasia Handbook (PDF), Stroke Foundation and Australian Aphasia Association. Aphasia does not affect intelligence and is different for everyone; say one thing at a time; write down key words; pictures or key words to point to.
- Communicating with someone with aphasia, MedlinePlus (National Library of Medicine). Adult language; yes or no questions; clear choices, not too many; a book with pictures or words about common topics or people.
- Conversations With People With Aphasia, Aphasia Alliance. One piece of information at a time; signal a change of topic; write down key words; use maps, calendars and photos.
- Written Communication, Aphasia Alliance. Font size 14 or larger, a sans serif font, no block capitals.
- Aphasia (difficulty using language), The Dudley Group NHS Foundation Trust. "Yes" and "no" may or may not be used correctly; offer a choice of two; thumbs up and down; pen and paper alongside speech.
An educational support tool. Not a substitute for evaluation or treatment by a licensed speech-language pathologist or physician. Read the full disclaimer.