Aphasia: What you need to know
Aphasia can happen as a result of brain damage linked to Alzheimer's disease or stroke. The challenges that the person will face depend on which parts of the brain are affected. Studies suggest that between 9 percent and 62 percent of people who have a stroke experience some degree of aphasia.
In the past, aphasia referred only to a complete impairment of the person's communication and language, while dysphasia was used to describe partial language impairment.
However, because there was confusion between dysphasia and dysphagia, a swallowing disorder, aphasia is now used for all degrees of impairment.
Types and symptoms
There are several kinds of aphasia.
Stroke can lead to aphasia, a loss of the ability to communicate.
Fluent aphasia or Wernicke's aphasia: The person finds it difficult to understand the meaning of spoken words, but they can produce connected speech. However, the speech may be incoherent, with irrelevant words intruding. Reading and writing may be difficult.
Non-Fluent aphasia, or Broca's aphasia: Speech production is often short, and described as halting and effortful. It is hard to access words, and formation of sounds may be difficult. Writing may be affected, but the ability to read and understand often remains intact.
Global aphasia: This affects all aspects of language. The person may be able to say a few recognizable, words but they cannot understand speech or read and write.
Anomic aphasia: The person may produce grammatically accurate language, but they have difficulty naming objects and words, so they may talk around the word as they try to explain themselves. Listening and reading may remain intact.
The person with aphasia will normally have noticeable difficulty with their use of speech and language. They may become frustrated at their inability to express themselves.
However, the type of difficulty will be different according to the type of aphasia they have.
Weakness or paralysis on one or both sides of the face or body can also make speech production or writing more difficult. The muscles used to breathe or swallow can be affected, and this has an impact on the production of sounds.
The part of the brain that controls speech and language recognition is referred to as the language center. These include Broca's area and Wernicke's area. Aphasia happens when there is damage to any of these parts of the brain or the neural pathways connecting them.
Damage from stroke or Alzheimer's can lead to aphasia.
Damage can result from:
The type of aphasia depends on which part of the brain is damaged.
Global aphasia happens when there is widespread damage right through the language center, fluent aphasia normally results from damage to the temporal lobe, or the side of brain, and non-fluent aphasia happens when there is damage to the frontal lobe, or the front of the brain.
As many people have aphasia after a stroke, a speech-language pathologist will conduct an evaluation to diagnosis aphasia soon after the event.
Some basic exercises that can help assess the patient's language skills include:
- Naming objects that begin with a certain letter
- Reading or writing
- Holding a conversation
- Understanding directions and commands
The Boston Diagnostic Aphasia Examination test incorporates exercises that extensively evaluate the patient's language skills.
A comprehensive diagnosis will also include a Computerized Tomography (CT) or Magnetic Resonance Imaging (MRI) scan to determine the location and degree of brain damage that has caused the aphasia.
Speech and language therapy is the only treatment for aphasia. Most people do not regain full use of their communication skills, but speech therapy can bring about a significant improvement, even with global aphasia.
Speech therapy aims to achieve:
- Better use of existing language abilities
- Improving language skills by relearning them
- Ability to communicate in a different way, making up for missing words in speech
As there are different levels of aphasia, and not everyone learns in the same way, speech and language therapy techniques will vary.
Melodic Intonation Therapy (MIT)
This is mostly used to treat non-fluent aphasia. It involves the use of humming or singing in rhythm, known as melodic intonation, while repeating phrases and words the patient has been struggling with. This process stimulates brain activity in the right hemisphere. It can help to increase the number of words the patient can say.
A small group of people with aphasia meet with a therapist and communicate. This gives the patients a chance to practice and improve their language skills by interacting with a group of people in a comfortable and helpful environment.
Promoting Aphasic's Communicative Effectiveness (PACE)
This is a kind of therapy that improves the patient's communication skills by engaging them in conversation. The patient is shown a picture or a drawing and asked to respond in any way that they can. The level of conversation starts simply, but in time it will become more complex.
Computerized Script Training (CST)
This involves a computer-delivered script based on day-to-day conversations. It gives the patient an opportunity to practice their communication skills using realistic situations.
How to help
A few tips that can help people to communicate with someone that has aphasia.
Having a friend to practice with can help someone with aphasia regain their speaking skills.
- Get the person's attention before starting to speak, and maintain eye contact
- Eliminate background noise
- Keep your voice at normal volume, but speak more slowly than usual
- Keep sentences short and simple and avoid questions that need a complicated answer
- Do not change the subject of conversation suddenly
- Minimize distracting background noises
- Don't pressure the person to answer, and give them time to speak
- Use Yes/No type questions
- Downplay errors and avoid correcting them, as they may find this frustrating
- Engage in normal activities where possible
- Remember that their disorder is affecting the way they communicate, their tone may not necessarily reflect their mood
- Try to keep a notepad or some paper and a pen to hand, as this may help to communicate
Remember that the person's ability to think is not necessarily impaired. Talk to them as intelligent adults, just as you would have done before they had aphasia.
Aphasia impacts many aspects of life, from personal relationships to economic wellbeing, as communication is fundamental to day-to-day living. It can leave the patient feeling frustrated and distressed, and their loved ones can become impatient. Together with other effects of the stroke, aphasia can lead to depression.
A person with aphasia is encouraged to go to support groups, and to get someone to help them practice their communication skills. If they are at risk of depression, they should see their doctor about treatment.
Before meeting with a doctor, a friend can help them to practice what they want to say or write down any questions they may have.
Prevent stroke, prevent aphasia
The main cause of aphasia is a stroke, so avoiding a stroke can lower the risk of aphasia.
Precautions that can be taken to do this include:
- Exercising regularly
- Eating healthily
- Monitoring and controlling blood pressure
- Avoiding tobacco use
- Keeping alcohol consumption low
- Managing stress
If someone shows signs of a stroke, it is important to get medical attention as soon as possible, as this is crucial to recovery.
Signs that someone is having or is about to have a stroke include:
- Blurred, blackened, or double vision
- Dizziness, trouble walking, loss of balance and coordination
- Numbness, weakness, or paralysis on one side of the body
- Slurred speech
- Sudden severe headache
The F.A.S.T. acronym can help people to remember what to do:
- FACE: Has the person's face has fallen on one side?
- ARMS: Can they raise them?
- SPEECH: Is it slurred?
- TIME: If any of these three are present, call for emergency help at once
Timely help can save a person's life and increase the chance of recovery after a stroke.
Find out more about how to help someone recover their communication.