By Maureen A. Will, Captain, Brookfield Police Department, Brookfield, Connecticut, and Joan F. Peters, Esq., Executive Director, National Aphasia Association
A police officer is working the scene of a construction job on a busy roadway. Suddenly car horns are blaring and people are yelling: “Move it! Move it!” He sees a young woman driver, car stopped, clutching her steering wheel and staring at the traffic pattern. The officer walks toward the driver and signals the route through the construction site, but the driver still doesn’t move. The officer tells her how to move her car through the pattern. The car sits, so the officer points the side of the road. This time, the driver goes to where officer is pointing. With the car safely parked, the officer approaches the driver and asks her to produce her license and registration. She fumbles to remove the license from her purse. When the officer asks why she was stopped in the middle of traffic, her answer sounds like gibberish. Her words are not slurred, but they are not coming out right, either. When the officer asks her where she has been or whether she has been drinking or is on any medication, the driver becomes frustrated. But her words aren’t making sense. The officer does not smell any odors of an alcoholic beverage emitting from her person, but that doesn’t rule out the influence of drugs. But she’s not on drugs; she has aphasia.
lthough aphasia is little known, it is fairly common. Officers are more likely to come into contact with people with aphasia than with people with Parkinson’s disease, cerebral palsy, multiple sclerosis, autism, or muscular dystrophy. Aphasia affects about one out of every 275 people. One of the reasons that aphasia is not better known is that people with aphasia are among the disability groups least able to advocate for themselves. They have trouble communicating.
Aphasia is an acquired communication disorder that impairs a person’s ability to process language, but it does not affect their intelligence. People with aphasia describe it as a short circuit in the brain between the ability to think and the ability to use words. In addition to affecting the person’s ability to speak and to understand others, aphasia may also impair their ability to read, write, and do calculations.
Aphasia is the result of damage to the brain. The most common cause of aphasia is stroke. Approximately 25-40 percent of stroke survivors acquire aphasia. About one-third of stroke survivors are under age 65. Young adults and even children have strokes. About one-third of severely head-injured persons also have aphasia. More than 80,000 people acquire aphasia each year. Some recover quickly, but for others it is a lifelong condition.
Although every case of aphasia is different, aphasia cases tend to fall into one of several types. One of the more common types is called nonfluent aphasia (or sometimes Broca’s aphasia). The speech of persons afflicted with nonfluent aphasia is labored and purposeful, but their comprehension is generally good. He or she will likely limit speech output to short utterances of less than four words, have a limited vocabulary, clumsily form sounds, and speak in a halting effort. The person may understand speech and be able to read but have limited writing ability.
A second type is called fluent aphasia (or sometimes Wernicke’s aphasia). Speakers who have fluent aphasia can talk fluently, but what they say may not make sense. Their receptive skills are usually impaired and they may not be able to understand simple questions. This type of aphasia can be confused with other disorders, such as mental illness. With mixed nonfluent aphasia, both receptive and expressive components of speech are impaired. Those who have it do not read or write beyond an elementary level.
Persons who have a third type, known as global aphasia, are almost incapable of communicating at all. This is the most severe form of aphasia and they are able to produce only a few recognizable words. They will understand little or no spoken speech and can neither read nor write.
Many aphasia sufferers do not know that their disorder is called aphasia. Particularly in rural areas or in smaller hospitals, physicians do not always diagnose aphasia. As aphasia is usually the result of some other injury to the brain such as a stroke, traumatic brain injury (TBI), or brain tumor, many do not know about the underlying condition.
The important thing to remember with respect to aphasia, as well as other communication disorders such as cerebral palsy, is that communication impairments do not always signify an intellectual impairment or mental illness. Generally, it is the access to ideas and thoughts that is disrupted, not the ideas and thoughts themselves.
Identifying the Person Who Has Aphasia
Law enforcement contact with a person who has aphasia could develop in a number of situations, from normal interaction with citizens to traffic stops and crime scene encounters. For 911 operators, the person who has aphasia presents a challenge. In these contacts, the person with aphasia will only become exacerbated if people can’t fully understand each other. The person with aphasia often will have no physical disabilities, so the officer will need to use indicators to determine if the person has aphasia.
Language is a key identifier in recognizing a person who has aphasia. The person who has aphasia will have difficulty speaking or understanding others or both. The speech may be halting or the person may be making an effort to speak. Words may come out wrong or in reverse order, or the person may just not be able to find the appropriate word to fit the situation. Speech may not be fluid or may not seem normal. Some people with aphasia use what’s known as automatic speech. This speech, which is out of the person’s conscious control, may include swearing, singing, or reciting familiar sequences like the ABCs or the days of the week. Alternately, they may be unable to grasp what it is the officer is saying. Even if they are speaking fluently, the officer should make sure that the person is supplying qualifying answers to the questions asked and that the person understands.
The officer may need to ask questions and look for clues about the person’s condition. Ideally, someone who has aphasia is wearing the blue aphasia button or carrying an aphasia wallet card indicating they have aphasia. A visual sign on the person’s vehicle such as the aphasia window sticker or an aphasia visor card are other indicators. At home there should be a sticker by the doors telling responding emergency personnel that a person who has aphasia lives at the address. Once it becomes apparent that the person is having difficulty understanding words and communicating, officers need to take their time and be patient, and to use whatever tools, including writing questions, that they have available to communicate.
Officers can take steps to make encounters with persons who have aphasia less stressful and more productive. During an encounter with police, a person with aphasia may become frustrated. Officers should remember that the frustration is not directed at them and should not take offense.
Persons who have aphasia most commonly have multiple aspects of communications impaired while some channels remain accessible for a limited exchange of information. The police professional will need to access the available communication channels when interacting with a person who has aphasia. Basic guidelines for communicating with persons who have aphasia include the following:
- Obtain the person’s attention before beginning to speak.
- Keep communication simple but adult, and repeat statements when necessary.
- Simplify sentence structure and reduce the rate of speech.
- Keep voice level normal and emphasize key words.
- Augment speech with gesture and visual aids when possible.
- Give the person with aphasia time to talk and respond. It may take the person with aphasia some time to get through the sentence.
- Avoid finishing the person’s sentences.
- Use all types of communication, such as gesturing, writing, or drawing, and try to use yes-or-no responses for questions that do not need comprehensive answers.
- Be mindful that the person may have comprehension difficulties; as such, it is necessary to confirm the answers to questions.
- When possible, turn off competing sounds such as radios or televisions.
Many people with aphasia have difficulty filtering out background noise or following a group conversation. To offset this try to minimize or eliminate background noise as a distraction.
Most aphasia sufferers carry contact information for someone who can help. If necessary, call the contact.
Common Contact Situations
Many people with aphasia are living regular lives within the communities. Although some do not venture out of their homes often because of depression, frustration, and communication difficulties, others do go out with friends or family or by themselves. Officers will encounter citizens who have aphasia and should be prepared to respond appropriately.
911 Calls: Making routine telephone calls is often an effort for people with aphasia; a 911 caller is almost always under stress, and calling in an emergency creates more stress for persons who have aphasia. A person with aphasia may invert numbers or be unable to give specific information, so they should be kept on the line until the emergency service has been dispatched. Where manpower allows, police officers should always be sent to the residence of the caller to check on the welfare of the party calling.
If the person indicates he or she has aphasia, make a note in the 911 computer system to indicate that a person with aphasia lives at the address. This will assist future operators should other calls come in. Operators should also use their computer-aided dispatch units to their fullest potential by adding in narrative comments or an address advisory for people with aphasia.
Traffic Encounters: Persons with aphasia have the right to operate motor vehicles, as long as they can understand traffic signs and comply with the motor vehicle laws in their state. For example, some states require stroke survivors to retake their license exam. Some people have seizures as a result of their brain injury. They may be prohibited from driving until they have been seizure-free for a time. Therefore, officers need to be aware that the person may be on some type of seizure medication, and if the medication has not been taken or the situation is stressful, seizures can result.
If the vehicle operator or a passenger seems confused, look at the vehicle for the aphasia window sticker or an aphasia visor card. Most persons with aphasia will present their aphasia identity card; nevertheless, it is always considerate to ask the person having difficulty in communicating whether he or she has aphasia and whether he or she is carrying a card. Avoid extraneous background noises as much as possible. At a highway construction site, the driver may be confused by the signs or the officer’s hand signals. The officer may have to write the directions.
Emergency Situations: In an emergency situation such as an evacuation or a fire, if there is no obvious indication that the person has aphasia, there may not be time to make the determination. There is a potential for the person with aphasia to become upset or agitated and experience difficulty in understanding directions. The officer should be firm in his or her directions and must get the job done to get the person to safety.
Police and Community Education
The universal symbol for aphasia that is on visor cards and stickers is part of a national campaign by the National Aphasia Association (NAA). The NAA’s goal is to help police and other emergency responders identify someone with aphasia. The sticker can be placed in the rear window of a vehicle on the left (passenger) side or a visor card placed on the dashboard. In homes, it can be placed at the front, side, or rear entrances to the residence. The NAA has also distributed a large blue button that reads, “Ask me about aphasia.” This button may be displayed on a purse or backpack or attached to the rearview mirror. As the officer approaches a home or vehicle, he or she should look for these identifiers. The NAA will gladly supply the police department with windshield stickers and dashboard visors that can be distributed to persons who have aphasia.
Encourage your community to let the department know that a community member has aphasia so the information can be placed in the department’s CAD and E-911 systems. The department should have officers visit aphasia support and information groups in their area to introduce themselves and the department and encourage them to use aphasia visor cards or stickers in their vehicles. (Visit the NAA’s Web site at www.aphasia.org , or call the Response Center at 800-922-4622 for a list of groups in your area.) Officers can also work with the local social services department so the case workers can make their clients with aphasia know that the law enforcement community understands the needs of people with aphasia and has resources available to help them in the time of crisis.
Learn more about aphasia by visiting the National Aphasia Association’s Web site at www.aphasia.org or by calling the Response Center at 800-922-4622.