Communication board for stroke survivors

Why a stroke can make talking hard

More than 795,000 people in the United States have a stroke each year, and about 2 million Americans live with aphasia. A stroke can affect communication in more than one way, and the same person can have more than one. The care team names which ones apply; knowing the words helps you set up the board to match.

Our guide to aphasia communication boards covers talking at home over the longer term: written choices, topic pages and conversation habits.

What to put on a board after a stroke

Start with one page. Add more once the first one is in daily use. The basics of any board are in our guide to communication boards for adults.

First, check yes and no. After a stroke, some people say or point to "yes" when they mean "no". Before relying on the board, ask a few questions you know the answer to ("Is your name John?", "Is this a cup?") and watch whether the answers are consistent. If they aren't, double check important answers another way (a gesture, writing or a picture) and let the care team know.

1. First: yes, no, I don't know, wait. Put them at the top of every board.
2. Needs: drink, food, toilet, pain, tired, rest, too hot, too cold.
3. Things within reach: glasses, phone, TV, blanket, hearing aid, dentures.
4. People: "my family" plus photos labeled with real names.
5. Feelings: frustrated, scared, sad, okay. Frustration is common and worth having a square for.
6. Repair phrases: "Say it again, please", "Write it down, please", "Slower, please", "It's something else".
7. A pain page: a body outline to point to and a 0 to 10 number row.
8. An alphabet page, if the person could spell before. Some people can point to the first letter of a word even when they can't say it. Aphasia can affect spelling too, so if letters aren't working, lean on pictures.

Keep every square to one picture and a short word or phrase. Use adult pictures and plain, large print.

Setting up a board in the hospital

Hospital rooms are busy, and staff change every shift. A few small steps make the board get used.

1. Laminate it or put it in a sheet protector so it can be wiped clean.
2. Clip it where the hand already is: the bed rail on the working side, or the over-bed table.
3. Tape a sign above the bed: "Please use my board. Ask yes or no questions. Give me time to answer." Our hospital and basic needs board includes an "about me" sign for this.
4. Show each nurse and aide the board at shift change if you're there. Leave a copy that stays in the room when you go home.
5. Keep a pen and pad beside it for key words.

Taking it home

1. Print a copy for each room the person spends time in: bedside, kitchen table, favorite chair.
2. Add personal words: the dog, the grandkids, the TV channel, the team, the neighbor who drives.
3. Make a small version for the car, a walker pouch or appointments (half a sheet, laminated).
4. Show every visitor how it works. A 30-second demo at the door helps.
5. Review it weekly. Take away squares nobody uses. Add the words you keep guessing.

How to use the board together

1. Turn off the TV and talk in a quiet room, one person at a time.
2. Point while you talk. "Are you in pain?" as you touch "pain".
3. Ask one yes or no question at a time, then wait. Count to ten silently.
4. Check back before you act. "Water? Yes? I'll ask the nurse." Point to their answer as you say it.
5. Don't pretend you understood. "I didn't get that. Let's try the board" is kinder than guessing.
6. Write key words in large print as you speak.
7. Take breaks. Pointing is work, especially in the first weeks. Try again after a rest.
8. Talk to them as the adult they are. No baby talk, and don't talk about them as if they aren't there.

If they can't point

Some people can't point clearly because of weakness or tiredness. A common workaround is partner-assisted scanning: you point to each row slowly, the person signals "yes" (a nod, a blink, a thumbs up, a hand squeeze) at the right row, then you go square by square in that row. Agree on the "yes" signal first. Check the signal with a few easy questions first, some with a yes answer and some with a no ("Is your name Bob?", "Is it nighttime?").

Scanning is slow work for both of you. Say each square aloud as you point, keep the squares used most in the first rows, and stop for a rest when signals get harder to read.

Frequently asked questions

What should be on a communication board for a stroke survivor?

Yes, no and "I don't know" on the top row; needs like drink, toilet, pain and tired; people's names and photos; feelings; and repair phrases like "write it down, please". Add an alphabet page for someone who can spell.

Can someone with aphasia read a communication board?

Reading can be affected too, which is why each square has a picture and a word. When you point and say the word aloud, the person gets it three ways: picture, print and speech.

Pictures or an alphabet board?

Many people use both. Pictures are faster for everyday needs; the alphabet lets someone who can spell say anything. Start with pictures and add the alphabet page.

Where can I get a free printable stroke communication board?

Doctor Carissa has a free 12-square everyday needs board and a fuller free basic needs board for hospital stays. The UK Stroke Association has a free Communication Picture Book, and the University of North Carolina shares a free bedside board in English and Spanish.

Should we use a board or wait to see if speech comes back?

A board is for today's needs: saying "I'm in pain" now shouldn't wait. What happens with speech over time is a question for the person's care team, not for a printable.

Who can help choose the right board?

The speech-language pathologist on the care team can suggest words, layout and access for that specific person. Bring your board to the visit.