How To: Supported Conversation For Adults With Aphasia

Supported Conversation for Adults with Aphasia (SCA™) teaches communication partners how to support a loved one with aphasia during conversation. 

This approach was developed by Aura Kagan and the Aphasia Institute, which offers SCA training and materials.

In this article, you’ll learn:

• Why SCA works
• How to teach SCA to communication partners
• What an example session looks like

Let’s get started!

See the Aphasia Workbook for worksheets, handouts, and treatment guides made for speech-language pathologists who treat aphasia.

What Is Supported Conversation for Adults with Aphasia?

The goal of Supported Conversation for Adults with Aphasia is to help patients re-engage in everyday life.

SCA posits that people with aphasia are competent (losing language doesn’t mean losing intelligence). And that with the right training, communication partners can help them communicate in ways that reflect how capable they are, despite their language disorder.

This can improve patient safety, confidence, and quality of life.

Communication partners do this by:

1. Acknowledging the competence of the person with aphasia
2. Helping them reveal their competence

While there are many structured therapies for aphasia, SCA isn’t one of them! Rather, it’s a loose conversation treatment that focuses on helping patients socialize and communicate their daily needs.

Who Is SCA For?

Any patient with aphasia can benefit from SCA!

It’s appropriate for mild to severe impairments and receptive or expressive aphasia.

SCA can be taught to family, friends, healthcare providers, and anyone else who communicates with people with aphasia.

Having a patient and their communication partner work together is one of the best ways to improve communication success.

More Popular Articles

• Complete Guide to Aphasia Treatment Approaches
• 55 Expressive & Receptive Aphasia Treatment Activities

What Are The 3 Principles of SCA?

There are 3 underlying principles of SCA (Kagan, 2007):

1. Multi-modal communication. Use gestures, writing, speaking, drawing, facial expressions, and AAC. Since communication is dynamic, the tools for the person with aphasia should also be dynamic.
2. Partner training. Teach strategies to communication partners to improve functional communication
3. Opportunities for social interaction. Emphasize social interactions and communicating information and ideas. Talk about their everyday life or practice with Picture Cards or interview questions.

How To Do Supported Conversation for Adults With Aphasia

SCA focuses on training the communication partner. You’ll teach them how to acknowledge and reveal the competence of the person with aphasia. 

Use SCA during everyday conversation. Or practice starting communication exchanges with Picture Cards and conversation prompts.

The Aphasia Institute offers SCA training courses, including a free introduction to SCA with video examples.

Below are instructions to share with the communication partner.

How to Acknowledge Competence

Treat the person with aphasia like an intelligent adult.

• Speak naturally and talk directly to the person with aphasia
• Use an adult tone of voice, words, and speech volume
• “I know that you know.” Acknowledge and emphasize that you know that the person with aphasia knows more than they can currently communicate
• Attribute communication breakdowns to your own limitations as a communicator
• Be open when you have to turn to someone else to get information

How to Reveal Competence

1. Make sure they understand what you say

Is the topic of conversation clear to the person with aphasia?

• Use short, simple sentences
• Use a slow-normal speech rate
• Include visuals, like gestures, written keywords, and simple drawings
• Reduce distractions (close the door, remove clutter, turn off the TV)
• Observe the patient’s non-verbal social cues (nodding, blank stare, etc.) to understand their level of comprehension

2. Make sure they can express themselves

Does the person with aphasia have a way to answer your questions and ask their own questions?

• Ask yes/no questions
• Ask one question at a time
• Ask specific questions. For example, “For lunch, I can make a sandwich or soup. Which one do you want?” (versus, “What do you want for lunch?” which is too open-ended)
• Request more information by asking the patient to gesture, point on a communication AAC board (Yes, No, Don’t know), write, etc.
• Give the patient plenty of time to respond

3. Verify that you understand each other

Do you understand each other?

• “Let me make sure I understand.” Summarize what you believe the message is and ask for clarification
• Repeat the message
• Add gestures or write down keywords
• Expand what you think they were trying to say
• Summarize a longer conversation

Example SCA Conversation

Topic of conversation: What is your favorite season and why?

To help reveal competence, the communication partner will ensure a quiet room with minimal distractions. They will ask one question at a time and give the client time to think.

They will acknowledge competence by using a calm, adult tone of voice throughout.

1. Communication partner asks: “What is your favorite season?”
2. Client says: “I don’t know.”
3. Communication partner acknowledges competence by saying, “I believe you have a preference, let me rephrase my question.” 
4. Communication partner will reveal competence by asking a more specific question: “Do you like it when it’s cold like winter? Or hot like summer?”
5. Client says, “I think maybe…like a….I don’t know.”
6. Communication partner reveals competence by providing pictures for the client to point or gesture to. She uses a whiteboard and draws a sun with a red thermometer for ‘hot’ and a snowflake for cold.
7. Communication partner says, “Hot like summer (points to the thermometer and sun) or cold like winter (points to the snowflake)? Point to the one you like.”
8. Client points to the sun. “I love the hot one…summer.”
9. Communication partner will reveal competence by repeating and summarizing what the client says, while adding it into the conversation.
10. Communication partner says: “You said you like summer (points to the sun and thermometer). You like it when the weather is hot. I also like it when the weather is warm and sunny.”      

More Aphasia Conversation Prompts

• How to take a new medication
• What to watch on Netflix
• Favorite book genre
• Where to meet for a get-together
• What to bring to the potluck

See the Aphasia Workbook for more conversation prompts and activity guides designed for people with aphasia. 

More Aphasia Treatment Approaches

If SCA isn’t the right fit for your patient, here are other evidence-based aphasia treatment approaches to look into:

• Semantic feature analysis
• Naming therapy
• Cueing (using Naming therapy)
• Response elaboration training
• Phonological components analysis
• Melodic intonation therapy
• Treatment of underlying forms
• Verb network strengthening treatment
• Script training

Read 55 Aphasia Treatments for more treatment ideas.

The Aphasia Workbook

References

• Aphasia Institute. (n.d.). Communication Tools: Communicative Access & Supported Conversation for Adults With Aphasia (SCA™) – Aphasia Institute. Aphasia Institute. Retrieved Dec 19, 2024, from https://www.aphasia.ca/communication-tools-communicative-access-sca/
• Kagan, A. (2007). Supported conversation for adults with aphasia: Methods and resources for training conversation partners. Aphasiology, 12(9), 816–830. https://doi.org/10.1080/02687039808249575
• Simmons-Mackie, N., Raymer, A., & Cherney, L. R. (2016). Communication Partner Training in Aphasia: An Updated Systematic Review. Archives of physical medicine and rehabilitation, 97(12), 2202–2221.e8. https://doi.org/10.1016/j.apmr.2016.03.023
• Kagan, A., Black, S. E., Duchan, J. F., Simmons-Mackie, N., & Square, P. (2001). Training Volunteers as Conversation Partners Using “Supported Conversation for Adults With Aphasia” (SCA). https://doi.org/10924388004400030624