Adult with aphasia after a stroke, age 58
A person with aphasia after a stroke arrives at the emergency room following a fall. She is conscious, she understands every word the doctor says, but she can no longer answer. Without quick information, the doctor might treat her as disoriented, call in a psychiatrist, or prescribe an unsuitable treatment. The laminated card in her wallet, with the QR code on the back, gives her an indirect voice.
This case applies to adults with aphasia after a stroke, with stabilized after-effects (Broca's or severe global aphasia), independent in their movements with or without human assistance.
The moment as it happens
Emergency room, 9pm. A 58 year old man is brought in by firefighters after a fall in his garden. Conscious, a bruise on his forehead, no loss of consciousness. The emergency doctor asks him his name. He doesn't answer. He shows his wallet. The doctor sees an ID card, a health insurance card, and a blue laminated card with a QR code on the back and a message on the front: "I understand, I cannot speak. Scan the QR code."
The doctor scans it. In twenty seconds he reads: Bruno, 58 years old, severe Broca's aphasia since a left ischemic stroke 3 years ago, taking Kardegic 75, allergic to penicillin, wife's contact (number). He communicates by yes/no (nodding his head), by pointing at an alphabet board (in the left pocket of his jacket), and in writing with a pen he always carries.
The doctor gets out the alphabet board. Bruno points: "K-N-E-E-P-A-I-N". The doctor understands: "knee pain". He examines it. A fractured femoral neck, to be confirmed by X-ray. He calls the wife. He treats him. No confusion.
- You write it
- The QR is in place
- The reader scans
- Understood, without explaining again
Where to place the QR code for this case
A blue laminated card (a color chosen to stand out immediately in a wallet), business card size, slipped into the main compartment of the wallet right after the ID card and health insurance card. The front carries a short message in French and English ("I understand, I cannot speak, scan the QR code"), the back has the QR code alone.
Duplicate it in the phone card holder if the person with aphasia has one, in the medical bag next to the health record booklet, and at the entrance of the home (a card pinned inside the door for home emergency responders).
Avoid old-style medical alert bracelets: they are expensive, outdated, and young emergency doctors don't always think to look for them. Avoid necklaces, which are often hidden by clothing. Avoid cards buried at the bottom of a bag: emergency responders don't have time to search.
Worth considering: the card can have a printed arrow saying "see the left pocket of the jacket: alphabet board." Redundancy saves time.
Pre-written text templates
The three templates below are written by the supporting spouse, with the person's approval whenever possible (through yes/no answers). The medical vocabulary is precise and up to date, so the emergency doctor can start treatment without having to ask everything again.
For the "Overview" section
"Bruno, 58 years old. Severe Broca's aphasia since a left middle cerebral artery ischemic stroke in March 2023. Understands spoken and written language. Can nod yes/no. Writes a little, slowly. Uses an alphabet board in the left pocket of his jacket. Taking Kardegic 75. Allergic to penicillin. Wife's contact: Marie 06 XX XX XX XX."
For the "How to help" section
"You can: ask him closed yes/no questions, use his alphabet board for more complex questions, write down technical terms (he can read them), allow him 5 seconds to answer each question, call his wife for the medical history, call his speech therapist (number on the back of the wallet) if an assessment is needed."
For the "What to avoid" section
"What to avoid: talking to him as if he were a child (he understands everything), raising your voice (he isn't deaf), assuming he is disoriented, calling a psychiatrist for a communication issue (this isn't a psychiatric matter), giving him aspirin (he's already on an antiplatelet), prescribing penicillin (severe allergy)."
Conditions related to this case
This case is based on Broca's aphasia after a stroke. It also applies to Wernicke's aphasia (the person speaks a lot but incoherently), global aphasia, and primary progressive aphasias (semantic dementia, frontotemporal lobar degeneration).
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