My father-in-law has COPD and for the past two years my wife and I have been living with him as his caretakers. One of the most valuable lessons that we've learned in helping him improve his communication ability is that therapists must speak clearly and involve the patient even when there's a family member there to assist. Multiple times after a therapist has departed, he's asked, "what did she say?" and we had to repeat as well as try and answer questions that he could have asked himself directly. Many patients either can't hear properly or mentally just aren't willing/able to ask questions so it is essential that before leaving a therapy session that you take the time to make sure they fully understand their own health situation.