Physical therapy is easier to participate in with aphasia when instructions are shown as well as spoken, choices are confirmed, and the person has a reliable way to describe pain, fatigue and preferences. Aphasia may make it difficult to retrieve a word, follow a long spoken instruction or read a printed exercise sheet. It does not mean the person cannot make decisions about their body or treatment.
Prepare a communication plan before the first session
Call or message the clinic before the appointment and ask whether the therapist can allow extra time, demonstrate movements and provide a simple written summary. The person with aphasia should decide what assistance they want. A family member can help prepare information without becoming the person who answers every question.
A small card may say: “I have aphasia. Please speak to me directly. Show me one movement at a time. Give me time to answer. Check that you understood.” Include an emergency contact only with permission. The same principles are useful when preparing for a medical appointment with aphasia, although physical therapy adds the challenge of communicating while moving.
Agree on a way to describe pain or discomfort
Before exercises begin, establish a communication method for “stop,” “slower,” “too difficult,” “dizzy” and “I need a break.” It may be speech, a written card, pointing, gesture or an assistive communication device. Practice it while the person is comfortable. Do not wait until they are exhausted or distressed.
- Ask the therapist to indicate the area of the body on a simple diagram and let the person point to the location.
- Offer a small number of choices, such as “left knee” or “right knee,” rather than several questions at once.
- Check whether a yes/no response is dependable for this particular person; aphasia can sometimes affect verbal responses.
- Ask the therapist to repeat back the concern before continuing: “You mean your shoulder hurts during this movement?”
If the symptom is new, severe or unusual, it should be assessed by the treating clinician. Do not assume every grimace is normal exercise discomfort or that the absence of a spoken complaint means everything feels fine.
Understand one exercise at a time
Long instructions such as “Stand up, put your left foot back, shift your weight and repeat ten times” place several language and memory demands on the person at once. A therapist may instead demonstrate the movement, use a short phrase, ask the person to try it and only then introduce the next step. Written keywords or a picture can be placed next to the demonstration.
The goal is not to make the task childish or excessively simple. Use adult language and ask permission before hands-on guidance. Check understanding by watching a comfortable practice repetition rather than making the person pass a verbal test. When a movement cannot be performed safely, the clinician should adapt the exercise rather than press for compliance.
Keep the patient in charge of treatment choices
Difficulty finding words is not a reason to speak only to a companion. The therapist should explain the proposed exercise, why it is being used, foreseeable discomforts and available alternatives in a way the person can understand. Allow time to accept, refuse or ask for clarification. The principles in making informed medical decisions with aphasia also apply to hands-on assessments and home exercises.
For example, rather than asking a companion “Is she happy to do this?”, the therapist can address the patient directly: “Would you like to try the supported standing exercise today?” If the answer is uncertain, offer a picture or demonstration, confirm the response and revisit the choice. A companion’s presence should support the person’s voice, not replace it.
Design a home exercise sheet that can actually be followed
Ask for a short plan showing a photograph or simple drawing of the starting position, a clear action and the clinician’s prescribed number of repetitions. Separate each exercise onto its own section. Include any safety instructions and when to stop. For a person with reading difficulties, a short video demonstration may be more useful than a page of dense text, provided the therapist confirms that the exercise is suitable.
| Information | Accessible way to present it |
|---|---|
| What to do | One clear picture plus a brief action phrase |
| How many times | Large written number or visible tick boxes |
| When to practise | Calendar reminder or familiar daily routine |
| When to stop | Prominent STOP symbol and agreed warning signs |
| What to report | Short notes, body diagram or recorded question |
If several family members assist, keep one up-to-date copy. A written plan can prevent differences between “what the therapist prescribed” and “what someone remembers hearing.” Linking practice to an accessible calendar and reminder system can help without turning every conversation at home into a treatment reminder.
Plan for communication fatigue
Understanding speech, translating instructions into movement and searching for words may require significant effort. A therapy appointment can become tiring before the physical exercise does. Ask the therapist about quieter surroundings, scheduled pauses and whether complex explanations could take place at the start of the session when the person is fresher.
There is a difference between ordinary tiredness and a new symptom that needs medical assessment. The article on aphasia fatigue and planning conversations around energy explains why reducing communication load can make everyday activities more manageable. Rest breaks should never be interpreted as unwillingness to cooperate.
Example: confirming a home exercise safely
Imagine a therapist demonstrates a seated knee movement. The patient points to a drawing of the left leg, but the therapist intended the right. Instead of simply repeating the same instruction louder, the therapist points to both legs, shows the intended movement and asks the patient to indicate which leg they will use. The patient demonstrates one repetition. Only after the movement is understood does the therapist confirm the prescribed amount and add it to the home sheet.
This short exchange reveals a possible misunderstanding without embarrassing the patient. It also gives the clinician an opportunity to notice pain, balance difficulty or another reason the movement should be changed.
Questions patients and families often ask
Should the companion answer questions to save time?
Not routinely. The patient should be addressed first. A companion can clarify information, with permission, when the person wants assistance or the response remains unclear.
Can pictures replace verbal instructions?
Pictures can be very helpful but are not automatically understood by everyone. Demonstration, gesture, short written cues and a check of understanding may be needed in different combinations.
What if the person says “yes” but performs a different movement?
Do not treat it as disobedience. Recheck the instruction using demonstration or two clear choices. Some people with aphasia have difficulty processing or producing yes/no responses consistently.
Who decides whether an exercise is safe?
The treating physical therapist or relevant clinician assesses the exercise, taking account of the person’s medical condition and ability. Communication supports help that assessment; they do not replace it.
For general guidance on supported conversation, the National Aphasia Association explains the use of gestures, pictures, choices and confirmation. The central principle remains simple: make communication accessible so the person with aphasia can participate in every decision.