Aphasia

As you may know, our brains have two halves - the left side and the right side. Our language skills typically take place and are developed on the left side, and when areas of this side of the brain are damaged, it can lead to an impairment of our language abilities.

Aphasia is a language disorder that occurs as a result of this damage. It can make it difficult for an individual to speak, understand, read, and write. The severity of aphasia can range dramatically - in some individuals, communication can be almost impossible, while in others, it can have very minor effects.

Additionally, aphasia can disrupt only a single aspect of language, such as the ability to coherently string words together in sentences or recall the names of people and objects. However, more commonly multiple parts of communication are involved. This can make it difficult for individuals to communicate with loved ones, navigate activities of daily living, socially connect with friends and family, or perform in the workplace.

It’s important to recognize that people with aphasia are not any less intelligent as they were before - they simply have trouble recalling information like they used to. While they may trouble using communication to express their thoughts and ideas - it is not the thoughts and ideas themselves that are disrupted. People with aphasia are just as smart as they once were, they simply need help with compensatory strategies to better communicate.

Different aspects of language take place in different parts of the brain. Over time, researchers have been able to identify and recognize different patterns of speech impairment that correspond to the location of the brain damage. Below are a few types of aphasia and common symptoms that can take place as a result.

• Wernicke's Aphasia: This type of aphasia results from damage to the temporal lobe of the brain. People with Wernicke’s aphasia most often have difficulty grasping the meaning of spoken words. While they can usually produce speech, their sentences may not make sense and they may add unnecessary words or create made-up words. Often, they are unaware of these mistakes. As a result, it can be difficult for listeners to follow, understand, or derive meaning from what an individual is trying to say.
• Broca’s Aphasia: Broca’s aphasia can result when the frontal lobe of the brain is injured. It can impact how an individual puts words together to create complete and coherent sentences. These individuals often have severely reduced speech output, talking in short sentences that are produced with great effort. As a result, their vocabulary may be limited, they may have difficulty forming intelligible sentences, and they often omit small words such as “is,” “the,” or “and.”
• Global Aphasia: This is generally the most severe form of aphasia that results from extensive damage to portions of the brain responsible for language. Individuals can have severe communication problems: they may produce few recognizable words, understand little or no spoken language, and not be able to read or write. They may also say the same few words or phrases repeatedly.

There are several other types of aphasia. Diagnosis by a physician or speech-language pathologist can help isolate and determine the type of aphasia an individual may be experiencing, and recommend appropriate treatment options best suited to help.

While each of these conditions can affect an individual’s speech production and communication abilities, there are notable differences. Recognizing this distinction is important to make the most informed treatment decisions.

• Apraxia of Speech: While acquired apraxia of speech can also happen as a result of brain injury, it affects a person’s ability to coordinate muscle movements involved in speech production (such as the tongue, lips, and jaw). Apraxia makes it difficult for people to communicate intelligibly and formulate coherent sounds, phrases, and sentences. You can find more information on apraxia here.
• Dysarthria: Dysarthria also affects the speech production muscles, and most commonly affects a person’s enunciation. This can cause slow or slurred speech or make it hard to control their voice’s pitch and volume. Because it’s caused by a weakness or paralysis of muscles, individuals may also drool excessively or have problems retrieving enough air when speaking.

While many people have never heard of aphasia, it is actually quite common. According to the National Aphasia Association, approximately two million Americans have aphasia, with nearly 180,000 Americans diagnosed with the disorder each year. This makes it more common that Parkinson’s disease, cerebral palsy, and muscular dystrophy.

As mentioned, Aphasia is caused by damage to parts of the brain that are needed to use and develop language. Aphasia is most often the result of a stroke (with approximately 25-40% of stroke survivors acquiring aphasia). However it can be caused by any type of brain damage, including brain tumors, head injuries, brain disorders, or other neurological disorders like Alzheimer’s disease.

Aphasia can occur suddenly, such as after a stroke, or it can develop more gradually as a result of a brain tumor or neurological disorder.

As mentioned, the signs and symptoms of aphasia can vary based on which areas of the brain are affected, as well as the severity of the damaged areas. Aphasia can affect how a person talks, their ability to understand language and concepts, and their reading and writing abilities.

According to the American Speech-Language-Hearing Association (ASHA), below are some of the most common ways people can be affected.

Talking

• Difficulty thinking of the right words to say
• Using the wrong words in sentences or omitting words altogether
• Saying related but incorrect words, such as “steak” instead of “hamburger”
• Switching the sounds in words. For example, saying “bean green” instead of “green bean”
• Creating and using made-up words
• Using single words, or stringing a few words together, instead of using full and complete sentences
• Saying sentences that contain both real words and made-words. This can especially make it difficult for the listener to understand what they’re trying to say

Understanding

• Not understanding what others are saying. This can be exacerbated if someone is speaking fast, using longer, more complex sentences, is in a noisy environment, or is speaking in a group setting
• Has a hard time grasping and understanding jokes

Reading and Writing

• Difficulty reading all forms of the written word, including books, newspapers, or computer screens
• Trouble spelling and writing sentences
• Using numbers or doing math

Oftentimes, aphasia is first recognized by the healthcare practitioner that is treating the individual with a brain injury. There are a number of different clinical and diagnostic tests a physician will use that can help locate the precise area of the brain that may be damaged. This can include a magnetic resonance imaging (MRI) or a computed tomography (CT) scan.

If aphasia is suspected, the physician will typically test the individual’s speech and language abilities, including how they produce and understand language, answer questions, hold a conversation, and more. In many cases, the physician will refer the patient to a speech-language pathologist (SLP). Speech therapists are communication experts and the most qualified professionals to evaluate, diagnose, and treat speech and language issues associated with aphasia.

Some people will see natural improvements in their language and communication ability in the first few months following a brain injury, even without treatment. However, even after this recovery period, symptoms remain in many people. This can be affected by the cause and extent of the brain damage, as well as the age and health of the individual.

Speech-language therapy is used to help patients regain their ability to communicate. This can include finding ways to maximize their remaining language skills and restore as much language as possible.

Depending on a person’s speech, language, and social needs, speech therapists will work with the affected individual, as well as their family and caregivers, to develop an individualized treatment plan. The specific techniques your speech therapist uses, and the goals of their treatment, will depend on each person's unique circumstances. Here are a few examples of what a therapy session could look like:

• If an individual has difficulty producing speech or expressing themselves, the therapist may ask them to practice naming pictures or repeating certain words.
• If an individual has difficulty understanding words, the therapist may ask him or her to sort words by their meaning.
• If an individual has trouble maintaining conversations, the therapist may try to facilitate the exchange of dialogue, or rehearse conversational skills in common situations, such as practicing making a telephone call.

For more severe cases, speech therapists will teach individuals alternative ways of communicating that don’t involve speech, such as using simple hand gestures, writing, pointing to letters and pictures, or using a computer or electronic devices. These forms of communication are collectively referred to as augmentative and alternative communication, or AAC.

Expressable matches individuals and families with a certified speech therapist trained to effectively evaluate and treat speech and language disorders related to aphasia. All therapy is delivered online via face-to-face video conferencing.

Based on the client’s age, communication difficulties, and speech and language goals, the speech therapist will develop a personalized treatment plan to help them meet their needs. Adult clients can choose to attend sessions by themselves, but are also welcome to bring caregivers or family members into the treatment sessions as well.

For toddlers, school-age children, and younger adults, Expressable speech therapists will use different strategies to interact with them through video chat capabilities and ensure parents and caregivers are actively involved:

Ages 0-3: Parents work directly with their speech therapist to learn cues and at-home strategies so they can confidently practice with their child outside the session and improve their communication. For more information on the importance of parental involvement in their child’s speech therapy, click here.

Ages 3-6: Parents attend video sessions alongside their child so they both learn valuable skills from their speech therapist. Reinforcing these lessons outside the session will continue to promote at-home skill building.

Ages 7 and Up: Most children attend video sessions independently but parents are kept in the loop with updates and tips during each session.

If you’re a parent, caretaker, spouse, or family member to someone with aphasia, the following tips can make it easier to both speak with and understand them.

• Use short and simple sentences that are easy to follow and understand.
• Speak slowly and clearly, and keep your voice at a normal and consistent volume.
• After speaking, give the person plenty of time to respond in a way that doesn’t make them feel pressured or anxious.
• Try to keep distractions to a minimum, such as television, music, or background noise.
• Use visual references when communicating, such as pointing and gesturing. Also do your best to maintain eye contact.
• Try to ask simple, yes-or-no questions that are easier to answer versus more complex, open-ended questions.
• If an individual is having difficulty finding the right word, try not to answer it for them. Instead, find ways to prompt them that will help them search and find the right word. For example, you can tell them to describe the word, think of a similar word, think of the sound the word starts with, or try to write the word.