Using symbol support with adults with acquired communication difficulties

The aftermath of an acquired medical conditions can lead to some serious communication difficulties for those with established verbal communication. Adults who suffered a stroke or other head trauma can be left with some long term difficulties communicating in the same way they have been their entire life. This life changing event can effect not only their communication, but also their self esteem. According to R., Tamblyn, R., et al. (2008) “If we can provide a means of enhancing communication, many of those adverse outcomes can be avoided.” The first few days at the hospital or at home can be challenging when health care professionals and family members struggle to communicate and interact with the patient.

These difficulties can range from inability to read or write, difficulty finding the specific word they are looking for to communicate, all the way to the complete inability to communicate verbally. In the United States and many developed countries, a speech-language-pathologist is called in to assess the patient and determine the best course of action. A speech-language-pathologist or an AAC specialist can assess and recommend an alternative way for the patient to communicate with others. This alternative way to communicate can range from high-tech devices such as an app on the iPad to low tech communication strategies such as writing.

There are times when family members and hospital staff must establish an efficient way to communicate with the patient before, during or after the visit of the speech-pathologist. The use of picture symbols can be an effective and easy strategy to implement in order to facilitate communication. Picture Symbols such as Smarty Symbols are a set of images that represent wants and needs, the user can point to the images to communicate. These communication boards can be as simple or as complex as needed.

The Smarty Symbols library contains over thirty thousand picture symbols designed specifically to represent words and short phrases used in communication. Unlike regular photographs, these images were created by illustrators under the guidance of a speech pathologist to make sure representation of the words were as clear as possible. One problem with picture symbols is that for decades, these illustrations were always designed having children in mind which made these images not as appropriate to be used by adults with acquired communication disorders such as aphasia. That’s why the Smarty Symbols library now includes adults and elderly characters.

We have created a few communication boards that you can download and print to make available at a hospital or other acute setting facilities to serve as a basic communication strategy. These boards can also be printed by family members to use with their loved ones at home.

You can also create custom boards such as this one by using words or phrases that are specifically needed by the individual. For example, if you have someone who uses dentures, glasses, or other personal devices those can be included on the communication boards provided.


  1. Bartlett, G., Blais, R., Tamblyn, R., et al. (2008) Impact of patient communication problems on the risk of preventable adverse events in acute care settings. Canadian Medical Association Journal, 178 (2).
  2. Koehler (2011). AAC in Acute Care. From:

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