Why Compensating for Lost Speech Isn't "Giving Up"


Laura Ramos Hegwer

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If your loved one has a speech impairment, your family may struggle with this question: If we “allow” him or her to communicate using gestures, books, or devices, does that mean there’s no hope that he or she will speak normally?

It’s a tough question that challenges families every day. After a loved one’s stroke, for example, family members may be wary of these methods—often called compensatory strategies—and hope that their loved one will improve with therapy alone. And that’s normal—we want to focus on our loved one’s recovery. For many of us, recovery means helping loved ones regain or improve their natural speech. And compensatory strategies might seem like they could prevent or delay a recovery of natural speech. But that's never been proven and, meanwhile, some strategies can be very helpful in allowing your loved one “compensate” for impaired speech.

Compensatory strategies focus on ways to work around temporary or permanent speech limitations. Perhaps most important, they allow people with impaired speech to remain socially connected with their loved ones. For example, communicating through writing, gesturing, or a speech generating device might help them feel less frustrated and more involved in their care. Nobody should have to wait for that!

In addition, using alternative strategies like picture books or boards helps people with speech problems practice communicating, which may motivate them during their recovery. For example, many people with traumatic brain injuries (TBIs) eventually regain some of their speech, but it can be a slow process. Using a compensatory method, such as a speech generating device, during their recovery can enhance the development of speech and language.

How Compensatory and Restorative Strategies Work Together

The goal of traditional restorative strategies is to correct the impairment. Such approaches might include organized retraining exercises that target specific aspects of speech, for example, learning to regain control of vocal and breathing systems that affect speech. Or they might focus on regaining swallowing control, if that is affected. The goal of these exercises is to restore or “cure” the speech problem.

However, recovering lost speech can take a long time. For some people, a solution that blends therapy to recover lost speech skills with compensatory strategies works best. For example, combining speech recovery and compensatory methods can help people with the brain disorder aphasia have more meaningful conversations with others. Often the compensatory strategy is one that we all use for communication already, but now must be relied on more often and in different situations. For example, two friends in class might pass notes to one another so they don’t disturb the teacher. Passing pre-written notes is a great compensatory strategy for someone with aphasia to use while he or she regains natural speech.

Support Your Loved One

Learning new ways to communicate can be stressful for you and your loved one. If your family member is adjusting to a compensatory strategy, here’s how to show your support:

  • Keep up an eager and confident attitude toward his or her recovery.

  • If your loved one is starting to use a communication board, tell the therapist about your loved one’s hobbies and preferences. That way, the board might include pictures or symbols he or she can “point to” to request favorite shows or foods.

  • Make time for your whole family to learn how to use the compensatory method.
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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 15, 2017

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Medical References

  1. Augmentative and Alternative Communication (AAC). American Speech-Language-Hearing Association. http://www.asha.org/public/speech/disorders/AAC.htm
  2. Augmentative and Alternative Communication Decisions. American Speech-Language-Hearing Association. http://www.asha.org/public/speech/disorders/CommunicationDecisions.htm
  3. Bahr E. Light Technology Augmentative Communication for Acute Care and Rehab Settings. Topics in Stroke Rehabilitation. 15(4):384-90. 
  4. Hustad KC. Augmentative and Alternative Communication for Preschool Children: Intervention Goals and Use of Technology. Seminars in Speech and Language. 29(2):83-91.
  5. Uliano D, et al. Augmentative and Alternative Communication in Adolescents with Severe Intellectual Disability: A Clinical Experience. European Journal of Physical and Rehabilitation Medicine. 46(2):147-52.
  6. Weissling K and Prentice C. The Timing of Remediation and Compensation Rehabilitation Programs for Individuals with Acquired Brain Injuries: Opening the Conversation. Perspectives on Augmentative and Alternative Communication. 19:87-96.

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