People with expressive aphasia understand speech, but they are unable to speak fluently themselves. With effort, some people can say short phrases, but they may leave out small words such as “the” and “and.” Others may have more severe aphasia, causing them to skip many words.

The most common cause of expressive aphasia is stroke, but it may have other causes, such as a traumatic brain injury or brain tumor. People with this condition are usually aware they have difficulty speaking, which can cause frustration.

Speech therapy can help a person make the most of their remaining language abilities and develop alternative means of communication.

This article examines expressive aphasia and how it is similar and dissimilar to other types of aphasia. It also discusses the symptoms, causes, diagnosis, treatment, and recovery process.

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Expressive aphasia is a condition where a person may understand speech, but they have difficulty speaking fluently themselves.

People with expressive aphasia can speak, but it takes effort. They often use short phrases and may leave out small connecting words in sentences. They may also use words that are close to the one they mean but not exactly.

Expressive aphasia does not only affect speech. It can also impact a person’s ability to understand directions, such as left and right. People with the condition can still read, but they may have a limited ability to write.

Broca’s aphasia is a type of expressive aphasia. It occurs when there is damage to the part of the brain known as Broca’s area.

Sometimes, people have damage only to this area of the brain, resulting in difficulties with speaking fluently while other functions remain intact.

However, people can also have damage to other parts of the brain, which may mean a person has expressive aphasia in addition to other changes.

There are two broad categories of aphasia: fluent and non-fluent. In fluent aphasia, a person can speak in long or flowing sentences, but the meaning may be unclear. Non-fluent aphasia prevents a person from speaking in flowing sentences.

Expressive aphasia is the most common type of non-fluent aphasia. The description below shows how it compares to two other forms of aphasia.

Expressive vs. Wernicke’s aphasia

Wernicke’s aphasia is the most common type of fluent aphasia. It occurs when part of the brain known as Wernicke’s area becomes damaged.

A person with this condition speaks in long sentences that do not make sense. Their sentences may include unnecessary or made-up words. People with Wernicke’s aphasia usually are not aware they have a language problem.

This chart shows how it compares and contrasts with expressive aphasia:

CharacteristicExpressive aphasiaWernicke‘s aphasia
Fluencynon-fluentfluent
Speech expressionshort phrases with missing connecting wordslong sentences
Intelligibilityusually intelligibledoes not make sense
Speech comprehension yesno
Reading and writingcan read but writing is limitedoften involves severe limits in reading and writing

Sometimes, aphasia does not fit perfectly into either of these categories, particularly if damage occurred in the areas between Broca’s area and Wernicke’s area.

Expressive vs. global aphasia

Global aphasia is the most severe type of aphasia, as it involves extensive damage to parts of the brain that deal with language. This results in extreme limitations in the ability to understand language and to speak. A person with global aphasia cannot read or write.

This chart shows how it compares and contrasts with expressive aphasia.

CharacteristicExpressiveGlobal
Fluencynon-fluentnon-fluent
Severityless severemost severe
Speech expressionshort phrases with missing connecting wordsmay involve inability to say even a few words
Speech comprehensionyesno
Reading and writingcan read but writing is limitedcannot read or write

The symptoms of expressive aphasia can include:

  • a marked reduction in spontaneous speech
  • a knowledge of what to say, but difficulty in producing the words
  • choppy-sounding speech that does not follow a typical rhythm
  • a loss of small linking words such as “and,” “am,” or “the”
  • speech that comes after a long delay and with considerable effort
  • impaired ability to repeat phrases

These symptoms result in a person communicating via short but intelligible phrases, such as “I walk dog” instead of “I am taking the dog for a walk.”

The most common cause of expressive aphasia is a stroke that affects Broca’s area, which is a part of the brain involved in language. It helps a person form words and sentences.

Consequently, when Broca’s area cannot function as it should, it results in a diminished ability to use words and language to communicate fluently.

Other things that can damage this part of the brain include:

  • brain infections
  • brain tumors
  • traumatic brain injuries

Diagnosing aphasia may include an informal evaluation of fluency and the ability to:

  • name objects
  • follow simple directions
  • repeat short phrases
  • read and write

It may also involve medical imaging, such as an MRI or CT scan. Medical imaging may identify whether any brain damage has taken place.

Difficulty communicating can create a feeling of isolation or result in a person having to dramatically change their career and routines. This can take a toll on mental health. Depression is common in people with aphasia, so a doctor may also screen for this condition.

Speech and language therapy is the main type of intervention for a person with any type of aphasia. Treatment goals include:

  • developing the use of remaining language abilities
  • restoring lost language abilities as much as possible
  • learning other ways of communicating

A person may have individual therapy, group therapy, or both. Individual therapy is specific to a person’s needs, while group therapy gives people a chance to practice communicating with others. It is also possible to receive speech and language therapy virtually via video calls.

Some of the things a speech therapist may try include:

  • Repetition: Repeating useful words or phrases to practice them may help a person regain or strengthen their language skills. People can continue to make progress in this area for years after their initial brain injury, depending on how severe it was.
  • Melodic intonation: In this approach, a speech therapist encourages a person to sing rather than speak their words. This method can help with communication because it involves using a different part of the brain to speak, meaning that if a person sings what they are trying to say, they may be able to speak more fluently.
  • Object boards: These boards have pictures of objects on them that a person might want or need. Pointing to the objects on the board allows a person to communicate. Electronic devices can also fulfill a similar function.

People with aphasia may also benefit from going to groups and clubs with others who have experienced stroke. This might include book clubs, art clubs, or drama clubs. Participating in social activities may help a person regain confidence and feel less isolated.

Clinical trials are currently investigating new treatments, including several drug therapies and transcranial stimulation. This involves a magnetic field or electrical current stimulating nerve cells.

Some people with expressive aphasia may make a significant recovery and regain many of their language abilities. However, this depends on the cause and the severity of the brain injury.

If the cause is a stroke, language recovery typically peaks within 2–6 months. Further progress is possible, but it tends to be more limited beyond this point.

Regardless of the cause, full recovery often takes many months, and it may sometimes take years, especially in cases of stroke. In that time, people may need a range of different types of support, depending on their condition.

Expressive aphasia is the most common type of non-fluent aphasia. A person with it may comprehend speech and know what they want to say, but they speak in choppy sentences. They may use short, simple phrases and leave out small words.

Conditions that injure Broca’s area of the brain can cause expressive aphasia. This interferes with the brain’s ability to transfer thoughts into speech. Speech and language therapy is the main treatment.