Language difficulties

Hello all,

Last week I had to go and visit a patient who had just been discharged from hospital after a short stay following urine retention. The patient is 5 years post left-sided stroke (right hemi). On the RITH referral form, the treating physio from the hospital (who happened to be a fellow student- not from this group) had written down that an interpreter would probably be required with this patient, because Yugoslavian is his first language and he knows very little English.

For our first visit, we did not take an interpreter with us because our main aim was just to assess the home environment and determine whether or not the patient was safe in his home. We also wanted to first assess just how difficult communication would be before taking up the time of an interpreter, in case it wasn't necessary.

Upon talking to the patient, he was having great difficulty producing words/communicating what he wanted to say, and was hesitating/stuttering a lot. It seemed though, that the patient was understanding pretty much everything we said to him. I became immediately suspicious that perhaps the communication difficulties were caused by expressive dysphasia post stroke, as opposed to a language issue. His wife was home and spoke fairly good English (she was also Yugoslavian), so I asked the wife in private whether or not the patient understood/spoke English well and she informed me straight away that he understands English quite well, but that since his stroke he had been having great difficulty producing the desired words whether he be attempting English OR Yugoslavian (expressive dysphasia).

It therefore became apparent that we would be wasting our time bringing in an interpreter- as the patient in the most part, was just producing random sounds or the very beginning of words. This scenario made me wonder whether the previous physio had even spoken to the wife about the client's language before assuming it was a problem with understanding English. While in some situations it may be quite rude to direct questions about the patient to their family members, in other situations it is entirely appropriate.

As long as you speak to the patient's family in private and ensure you are not coming across as not believing the patient or ignoring what the patient has to say- often in scenarios like the one above, a lot can be gained by having a quick word to the family about what the patient was like previously. After all, they have known the patient a lot longer than we have- what we might assume to be a personality change following stroke for example, may well just be how the patient was all along.

Good luck with final assessments everyone!