The environment has a strong influence on communication (Howe et al. 2008). This includes both the physical environment with its space and acoustics, and the social environment. The social environment refers to the opportunity to communicate prior to, during and following exercise sessions. The expectations, beliefs and values of both the exercise professional and the stroke survivor will influence the social environment. Good communication is therefore important to facilitate a shared understanding of the potential benefits and barriers of engaging in the exercise programme, and to agree with the stroke survivor the goals, content and processes of the exercise programme.

The purpose of this chapter is to increase awareness of the factors influencing communication, to describe some of the more common communication disorders experienced after stroke and to introduce the principles underpinning good communication that will assist in creating the right social environment for both exercise professionals and stroke survivors.

Demonstrating Effective Communication Skills

What is Communication?

Communication could simply be described as a process of giving and receiving information. It is a shared activity involving two or more people covering a range of activities such as engaging in social greetings, giving instructions, negotiating agreements, expressing opinions and discussing world events. The information exchange occurs in different contexts, informal and formal, and where the balance of power and control may be shared equally or held by one or more of the participants. However, this description fails to recognise the complexities of how and why we communicate with each other and does not take into account that people are individuals who see things differently.

How do we Communicate?

Communication can be both verbal and non-verbal. The expressions ‘It’s not what she said, it’s the way she said it’ or ‘Actions speak louder than words’ demonstrate this. The term non-verbal communication could be interpreted as any form of communication not involving spoken or written words; however, this is not strictly true as non-verbal messages often accompany verbal expression (Hargie and Dickson 2004).

Non-verbal communication can serve several purposes; it can:

• Completely replace speech, e.g. where the chosen method to communicate is sign language or a simple signal or gesture across a busy room.

• Complement speech by emphasising some aspects of the message, e.g. showing emotion and pointing and gesturing to clarify points.

• Contradict the spoken word, e.g. body language that suggests another message. These non-verbal behaviours can be deliberate such as when using sarcasm or humour. However, behaviours can also be outwith personal control, e.g. blushing or tensing, and therefore revealing the true message.

• Control the initiation and turn taking in conversation, e.g. eye contact acts as a signal for when to listen and when to talk.

Utilising all the available modes of communication (Fig. 7.1) and being aware of one’s own non-verbal communication is important when establishing effective working relationships with stroke survivors.