January 26, 2026. By Tanner Perschau.

People with aphasia make up at least one-third of the estimated 795,000 stroke

survivors in America each year, although it is underdiagnosed in acute settings. Aphasia is an

acquired language impairment that can affect one’s ability to express and understand spoken or

written language. It is not a loss of intellect. People with aphasia are not only at higher risk of

poorer psychosocial and health outcomes but are also vulnerable in healthcare as a whole.

They have a higher risk of depression, longer lengths of stay in hospitals, and worse

rehabilitation outcomes than stroke survivors without aphasia. They face significant challenges

in typical encounters with health care professionals and are at greater risk of experiencing

preventable adverse events within our healthcare system.

Communication is central to person-centered care, and while it is widely regarded as the

gold standard of healthcare delivery, the literature highlights that communicative access within

healthcare is diminished for people with aphasia. While physical accommodations or

adaptations have improved in our care systems for other disability groups, communicative

access has not been implemented in the same way. It is more likely for emphasis to be placed

on technologies for the hearing-impaired than on addressing broader language barriers, like a

person with aphasia’s ability to contribute meaningfully in conversation with their providers and

make informed decisions for their plan of care. People with aphasia are not the only individuals

who feel the healthcare system is too overburdened to address their needs. But without

communicative access, they are not protected from harm, uncertainty, or unforeseen

complications.

Communication barriers between people with aphasia and healthcare professionals

arise largely because many providers lack the skills to communicate effectively with them. This

breakdown limits access to shared decision-making, increases the risk of preventable safety

events such as medication errors, and reduces the effectiveness of health promotion and

preventive care. It is a common misconception that people with aphasia have lost intellect rather

than language, and this misunderstanding often strips them of autonomy. They are routinely

excluded from care decision-making despite facing the same stream of information and choices

as any other patient. Whether placing their lunch order, consenting to a major surgery, or

discussing end-of-life plans, many individuals with aphasia report that healthcare professionals

bypass them entirely and speak directly to their loved ones instead. These communication

breakdowns undermine patient education and counseling, raising the likelihood of preventable

errors. If a woman with aphasia misunderstands her doctor’s instructions on dosing frequency,

she may slip back into atrial fibrillation, suffer another stroke, and land right back in the hospital.

This communication gap is a direct threat to prevention and long-term health stability.

Health care professionals also report frustration, discomfort, and insecurity when

communication attempts fail, making it more challenging for them to connect with people with

aphasia and to deliver usual care. Studies show that they acknowledge their responsibility to

have effective communication and value their patients’ autonomy, but they rarely feel competent

in using supportive communication techniques to speak directly to the person with aphasia.

While the literature supports the use of simple techniques, like multimodal communication

including gestures and drawing, and supportive conversation tools can have a positive impact,

healthcare professionals report a lack of resources and training as a significant barrier.

They believe training to increase knowledge of aphasia and communication partner skills would be

beneficial for their teams. Many shared that simply knowing where to access supportive

conversation tools would increase their motivation and willingness to learn, and expressed

interest in implementation and post-training support.

Literature supports a multiprong solution for improving communication access for people

with aphasia within our healthcare systems. Addressing the skills of communication partners is

only one part of the puzzle, and it would be naive to assume that this does not require

systemwide change. Providers’ skills in using communication strategies, and their feelings or

attitudes towards communicating with people with aphasia, are directly impacted by healthcare

leadership and the training and resources available. We may not be on the cusp of systematic

change, but perhaps this is a call for education systems to go beyond typical efforts surrounding

patient-provider communication. Students learn skills like motivational interviewing and

counseling families when receiving difficult news, but this is all assuming the patient does not

have aphasia. Can we start with small steps, like requiring future physicians and allied health

professional students to complete a free module providing an overview of basic concepts of

Supported Conversation for Adults with Aphasia (SCA™)? A course like this is free and

accessible on Aphasia Institute’s website.

Communication is a human right. People with aphasia deserve to belong to a healthcare

system that understands aphasia and how it affects communication, with providers who are

empowered with the skills to decrease language barriers and honor their right to high-quality

healthcare.

Tanner Perschau

UNC Speech-language Pathology Graduate Program, Class of 2026

2025-2026 NC Schweitzer Fellow

The views expressed are those of the author and do not reflect the official stance of the

Fellowship or University of North Carolina School of Medicine.