Stroke Language

One of the saddest mistakes that it is very easy to make is to think that an unresponsive patient cannot hear what is going on or cannot understand. Even someone apparently in a terminal coma can be more aware than anyone realises. I have had personal experiences of his.

The idea of "Stroke language" is a simple system of signs that everyone should know so that if they are ever in the situation of being paralysed or unable to communicate in the normal ways, they can still transmit messages by whatever movement remains possible to them.

One of the worst things about being a patient who cannot speak or write is the inability to communicate even urgent messages about their needs and wants, even though they still have the mental ability to think, learn, and remember. Sometimes in a hospital or emergency situation, people are faced with others who speak a completely different language. If there was a public system of signs, then in an emergency, communication could remain possible.

It could be designed by a medical and speech-therapy team in close collaboration with Stroke Associations and other representatives of patients and families, and copies could be available in Post Offices, Libraries, schools etc as well as in hospitals for patient-staff-visitor use.

There would be alternative means of communicating the major needs, based on the behavior that is most commonly remaining to paralysed and badly hurt people - eg communicating through the eyes, or gross motor movements of mouth or limb, or fine movements of one hand.

For example, suppose there was international agreement on eye movements, and everyone knew them - since eyemovements can be the only voluntary movement some stroke patients have left: -

  • Shut once in response to a question = No.
  • Open wide = yes

These may be all that a patient can remember or be shown - nodding and shaking the head may be impossible but recognisable when someone else does it, accompanied by the eye-signals, to try to teach them.

  • Moving round = don't know, not sure.
  • Blink quickly = food need
  • Turned to nearest wall = toilet need
  • Turned up = pain or discomfort.
  • Turned from side to side = need for company.
  • Blink slowly = need for sleep.
  • Screwed up =want TV, book, radio, or other entertainment.

Once the major need has been communicated, other people can find out the exact need by asking questions that can be answered yes or no.

Patients could be shown a large chart showing these signs and their meanings (in both print and symbol) so that they could use the sign they wished. Patients who could point in any way, eg finger, or stick between the teeth could also point to the message they wished to make.

Alternative means for the same messages could use tongue, fingers or toes, or head turning.

It is often too late to learn a 'Stroke language' after communication has been cut off. Better for everyone to have some idea of it beforehand.