This is a recurring question, and the answer is one of the simplest in aphasia therapy.
Functional words and phrases are whatever that client says they are, at that time and setting.
There is no magic set of words/phrases that apply to every person with aphasia. Developing these words should be relatively easy if the family with aphasia participates.
So what does it mean that the client determines the functional words for aphasia therapy? For the client, it means that there are certain words and concepts that apply to them, but maybe not to someone else. Is it important to know the names of all of the fruits? Of every single possible piece of clothing? Does this person need to ask for socks or underwear? Do they need to know that a picture of a raccoon is a raccoon? Does it apply to them?
If they have a pet raccoon, then yes, they may want to say something about it.
Functional words and phrases are different for each person and may change in different settings and times in recovery. Functional therapy words and concepts should relate specifically to that person and not items that happen to be in the household. One person may need to talk about shaving, another may not.
Each person with aphasia has specific things they want to say, such as a child’s name. These are functional words. They may want to say “I love you”, “come here”, or “bye”.
There can be fine lines between learning functional and common items. For example, I rarely run across the need for a client to request a spoon. It happens occasionally, but in general, there’s always silverware on the table or accessible already. Saying the word “spoon” rarely comes up in everyday life. You may think that because it’s a common household object, it’s something they need to learn. I would argue that this may not be the case until later in the person’s recovery when more and more vocabulary is expected.
The time and setting need to be taken into consideration. When the client is still in the hospital, they may just need to understand “pain”, “doctor”, “wife/husband/partner”, “tired”, food concepts, etc. Simply saying “hi” or “thank you” or “shut up” can be a big thing.
Early on in the recovery process, the client may need words like “help”, “water”, “bathroom”, family names, “doctor”, etc. These are basic concepts that don’t even begin to help with the complex thoughts or ideas the client may have, but it can be a starting place to start speech or understanding. The idea is not to think up every conceivable thing the client may wish to talk about at that time. Keep it simple, practice it, use it in real life. “Good morning” or “how are you?” or “what?” may be useful phrases at this time.
In a nursing home setting, the environment and what the client needs may be more limited. There”s a thought that functionally, the client really doesn’t need much more than basic needs since they are largely confined. In this setting, the client’s functional words may be family names, “phone”, “tv”, “nurse”, “help”, “no”, etc.
Later in the recovery process, functional words may be family names and family concepts, things to do with work or hobbies, tv shows, social exchanges, restaurant ordering phrases, food concepts, etc. This is the time to keep adding other vocabulary as well. Does the person hate onions? Then it may be worthwhile to work on “no onions”. Is she an avid bird-watcher? Then maybe she wants to say certain bird names.
The main things to ask yourself when choosing functional words–is it relevant right now to this person? Keep the list on the smaller side so it’s not overwhelming. It can be frustrating for the person with aphasia to have a more limited set of practice phrases for the time being, but it can be more overwhelming and frustrating to have too many concepts to learn that aren’t necessary right now.