Communication with dysphasia

At the moment, I am doing clinical placement at Neuro outpatient. Many of patients there had CVA. One of my patient has L sided stroke. He has R sided weakness, more so in the upper limb, altered sensation of the R side, and so on.

The most significant problem affecting the progress of his rehabilitation is severe allodynia of the right side. He has minimal pain at rest; however has pain with tactile input including light touch, with passive and active movement.

He also has expressive dysphasia, which making communication with him difficult. Generally he is only able to say “yes, no and alright”. He has no apparent problem with understanding instructions. From the notes written by previous student, I grasped that the main strategy to communicate with him is to ask yes and no questions.

His pain is medically managed by gabapellin, however from his medical notes of last appointment, on the pain chart, he pointed to no pain. As a result, his pain medication prescription has not been updated for about 1 month.


As part of his treatment, he received stretches to his R side, especially his wrist and finger flexors, as well as PIP, DIP and MCP joint mobs and exercises for achieving lumbrical grip. Due to his allodynia, I am quite cautious with his stretches, ask if it’s causing him pain frequently and watching his facial expression quite closely. However, sometimes I accidentally ask open ended questions and he would struggle quite a bit to try to say something, but often ended with just a yes. And I have to guess the words he’s trying to say, which is quite difficult.
I am also doing sensory stimulation prior to his lumbrical grip exercises, according to the notes, his allodynia has improved as he can tolerate touching and stretching better.

As an outpatient department it’s more difficult to liaise with other health professional. It would be a good idea if I would attend his speech treatment if he is having one or even just ask for some suggestions from a speech pathologist. I’ll try follow this up.

Just wondering if anyone have any experience with patient with allodynia or dysphasia? Or has any suggestions to improve communication with patients with dysphasia?