Assisting a family member
To communicateVerbal language and non-verbal language
- Verbal language and non-verbal language
- Aphasia: strategies for communicating
Communicating is a very important activity in people's lives and correct communication allows you to express yourself at any time.
The need to exchange information with one's fellow human beings has led man to create ever more complex forms of language over the centuries and from simple pictograms we have arrived at modern writing.
Without communication it becomes almost impossible to live in society and without a codified language one could not satisfy the needs, from the simplest to the most complex.
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Verbal language and non-verbal language
Communication can be defined as an exchange of information that takes place between two or more individuals with the aim of emitting and receiving signals in a dynamic process between the subjects involved.
Through communication, moods are also expressed (fear, joy, anger, etc.), as well as conveying the intentions of the message with particular transmission models: persuasive, emotional, poetic, informative.
The two main subjects of the communication content exchange are: the issuer and the receiver.
The issuer is the one who creates the transmission of information by choosing the content of the message, using its vocabulary and the meanings it can attribute to the data.
The recipient, on the other hand, is the one who interprets the data of the issuer attributing a subjective interpretation and a judgment on the contents. Without a doubt it can be said that man uses the word as the main means of communication.
In addition to the subjects of communication (issuer and recipient), there are also many other aspects that must be taken into consideration in a communication process, especially when the issuer is a patient who has difficulty expressing their content. Communication is made much more effective when there is a good ability to understand each other based on human warmth, expressiveness and belonging to the same group, which all represent fundamental aspects in a communicative relationship; all these elements are called empathy.
Empathy is the ability to listen with lively interest to what is said without immediately expressing judgments for or against the contents expressed; it is an attitude of openness. Empathy is very useful in the therapeutic process.
Another very important aspect of communication is represented by the way it is carried out: many people interpret language by giving different meanings to a speech (subjective content), while others perceive from the language nuances that are not always codifiable, a kind of "skin" sensation; this reading is the result of a series of messages that are provided to the recipient without using words, that is, conveyed through non-verbal language.
Verbal and non-verbal language are part of the communicative system of the human being.
Non-verbal language is much more effective and "honest" than verbal and cannot be easily changed because it is regulated by very "ancient" brain centers; this means that real contents cannot be masked with words. Non-verbal language expresses an individual's interiority, makes emotions unfold without filters, is difficult to control rationally, contributes to the presentation of oneself and strengthens verbal communication.
Non-verbal communication includes gestures and facial expressions, two very important elements in the communication process. The way of moving the face during a speech is internalized as an element of belonging to a given culture, while gestures express and emphasize the deep, instinctual contents.
The whole process of communication is also affected by the tone and tone of the voice, the gaze and the movements of the eyes.
As already mentioned, non-verbal language implies less effort in the communication process, it is more effective and more true. When talking to or listening to a person, it is not difficult to grasp the emotional contents, which are able to express more than words.
To understand well what non-verbal language is, it is enough to see a newborn struggling with the world: he does not speak but communicates in a very effective way the moods and the deep contents emerge strongly (tears, despair, joy). Only insertion into social life and development will tend to remove the emotional charge of non-verbal language, without however succeeding completely.
All types of language serve to put the human being in relationship with the world: illness, sorrows and mental disorders can lead people towards isolation and increasingly impoverish the ability to build relationships with one's fellowmen.
Communicating is an activity that never stops, it communicates in various ways from when one is born and continues unceasingly until death. Any gesture or position of the body, even if not supported by words, still constitute a model of communication and it is however impossible not to communicate regardless of the strategies put in place to avoid the exchange of information with other people.
In relationships, even distance is a form of communication, in fact the distances that exist between transmitter and receiver express the type of communication quality: the more distant you are from people, the more detached the relationship becomes. Clearly, much depends on the context in which we speak, but "shortening distances" expresses the will to change the intentions towards the interlocutor.
Some things are impossible to express ten meters away and it is enough to think about how distances make people uncomfortable in particular situations. It will have happened to everyone to "shorten the distances" in an elevator, overcoming the limit between personal and intimate space, and to immediately feel an unpleasant sensation. Therefore, even distance is a very powerful communication tool, together with posture that can express a choleric, perplexed, indifferent, shy, relaxed attitude and so on.
When you have a patient close to you, whatever the pathology that afflicts him, the posture he generally assumes or in the bed, is precise, uncontrollable communication. If the patient lies in bed in a fetal position (knees close to the chest), for example, he is communicating that he is probably in difficulty as well as when he takes particular positions to defend himself from pain (analgesic positions).
Silence is also communication: having a fixed gaze or looking out of a window when other individuals are at home means communicating the desire not to speak to anyone.
Being close to a patient to help and follow him over time necessarily implies that a relationship is established between the various subjects involved in the care. Those who take care of care must favor personal resources and the possibility of freely expressing their emotions and contents, for this reason it is said that the relationship becomes helpful.
The helping relationship is animated by actors like any other communication activity, but the content necessarily varies: one person is in difficulty and has specific resources (sometimes limited) or does not possess them at all, the other must instead be able to stimulate the potential of the person in difficulty and, in general, to listen.
There are specific components of the help report that have been well described by many authors.
Effective communication presupposes sincerity from the outset, which must be the fundamental prerequisite of the relationship since nothing is built with lies. Sincerity should be bilateral, there cannot be a sincere subject and a liar, or better, such a situation can exist, but then we cannot speak of a helping relationship. At the home of the sick, we frequently witness completely superficial and false relational modalities, especially in the event that there are people at the end of their life, and it is good to know that these dynamics often become a defense mechanism to bear the pain associated with the disease. .
The aforementioned empathy must also serve to establish a good helping relationship. Experiencing the sick world can be difficult when operators are not emotionally involved in situations. All the more reason for family members, on the other hand, it becomes extremely difficult to maintain an empathic approach with a patient because, when the emotional component is heavily involved, it is almost impossible to "stay out" of the situation. On the other hand, when an external operator is assisting, his behavior should be close to the inner world of the patient, without however being incorporated into his own pain, otherwise the benefit that the suffering subject would derive would be useless.
Empathy can be used to grasp particular emotional states related for example to some delicate procedures such as intimate hygiene, during which embarrassment can create deep resistance, or to be able to accept all the bad things that are "vomited" on in a only an instant in case of choleric crisis. This attitude requires the ability to know how to reset all judgments, a very difficult attitude for anyone, since our way of life pushes us to catalog, analyze, understand and always control everything.
Another important aspect of the helping relationship is the ability to listen, because without listening there is neither empathy nor trust. Listening requires the ability to grasp the information that comes from another individual, and for the patient it can also become a time-consuming activity: speaking and manifesting one's own points of view, feelings, more or less clear emotional contents is already a therapeutic activity and must always be fed.
Listening is favored by decreasing distances: as already mentioned, the more the "centimeters" that separate us from people decrease, the more the willingness to come into contact with the universe of the other is shown. In this regard, it is emphasized that touching the patient with a simple gesture such as a caress or holding his hand is of great help, especially for people with difficulty communicating.
When listening to the patient, it is good to reduce all the variables that can hinder this activity (radio, television, background noise in general) and always remember that listening occurs through the ears, but also the gaze and attitude of the patient. body play an important role.
Hearing and vision disorders, neurological diseases, communication disorders that result from particular diseases, memory disorders and attention disorders can make communication difficult and create difficulties ranging from mild to total incapacity to communicate.
A person who has difficulty communicating, due to age or specific diseases, must be put in a position to improve his residual abilities with the help of various methods, from the simplest to the most sophisticated. Technology provides many aids to make communication less difficult but, before resorting to more complex tools, it is always good to start with the simplest ones such as, for example, glasses and hearing aids for the correction of visual or auditory deficits.
Among the main methods to promote communication we find simple systems for the transmission of messages, aids to facilitate writing, systems to facilitate reading, systems to enlarge images and letters, call systems, systems that require the use of computers and so on.
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Aphasia: strategies for communicating
Aphasia is a speech disorder caused by brain injuries resulting from various types of accidents: vascular, traumatic, neoplastic, infectious; many times it is associated with other neurological disorders such as difficulty in articulating words (dysarthria). The aphasic frequently maintains cognitive abilities unchanged but is unable to respond or understand what he is told. In principle, lesions that affect the brain and that result in a loss of language are located in specific areas (Broca, Wernicke).
The manifestation of aphasia occurs in different ways: by replacing one word with another similar one, articulating a word that has the same sound but a different meaning, inserting words that have no logical connection with speech.
In Broca's (motor) aphasia there is an alteration of language while the ability to understand remains unchanged; this awareness produces enormous frustration in the patient.
In Wernicke's aphasia, however, there is difficulty in understanding speech and in language: the patient who is affected speaks by coining new words (neologisms), but does not realize that his communication is incomprehensible, therefore he tends to get angry.
This very short and not exhaustive description makes clear the serious loss of autonomy that affects the aphasic subject.
A person who cannot speak certainly communicates enormous discomfort and detachment from reality.
All the people who gravitate around the patient must be duly informed of the problem and what are the difficulties encountered by the assisted person, in order to avoid unnecessary conflicts and frustrations. In fact, it is good to know that often those who cannot communicate are attacked by feelings of all kinds (fear, anxiety, aggression) and that communicating with subjects who have difficulty expressing or understanding requires a lot of availability. When speaking or trying to communicate, it is necessary to repeat the sentence several times without being discouraged; appearing impatient increases the distance and lowers the possibility of speaking. Many times the patient tends to communicate through gestures, which must be interpreted. Strategies can also be adopted which aim to simplify the instructions to be given, for example short sentences, symbols, signs, images. Attendants are recommended to maintain a positive reinforcement attitude after each result. Any form of acoustic or auditory distraction must be eliminated and, if possible, the following questions should be avoided: one indication at a time is more than enough.
The speech therapist can perform an important rehabilitation activity and for this reason it is strongly recommended to request assistance: the patients who are followed in the rehabilitation process, in fact, are more likely to improve their disorder, also in consideration of the fact that they are stimulated and feel less abandoned.
To facilitate communication, you can try to use simple methods for the transmission of messages such as, for example, panels with images, situations or letters that the patient can indicate if he has the capacity. It is also possible to build these aids at home using cardboard, Plexiglas, adhesive letters and the like.
More sophisticated devices are available on the market that facilitate the communication of patients who knew how to read and write before the event that triggered aphasia; these include:
- alphabetic communication systems, that is electronic devices that reproduce the words typed on a small screen or convert them into sounds, also allow to memorize sentences already made to make communication easier;
- symbolic communication systems (symbolic communicators), that is simple instruments made up of one or more large keys to which to associate a recorded voice message; whenever the patient has a specific need he can press it. For example, by recording the phrase "I am thirsty", every time the button depicting the image associated with the need to drink is pressed, the phrase already made will be listened to. Figures with their meaning are affixed to the keys.
The prices of this kind of aids vary from a few hundred euros to a few thousand. Before buying expensive instruments, it is recommended to get advice from the neurologist because in some cases they can be completely useless!
Among the systems that favor writing, and that can be used when motor skills are almost intact and the person is able to write or draw, there are ergonomic handles and straps. Maintaining the ability to draw or write, even if the contents are not consistent, is very important for a continuous stimulation of cognitive skills.
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