Many Stroke Survivors experience some kind of language impairment. As speech therapists this is one of the areas we address with our patients. Tamlyn Laubscher (Speech Therapist) and myself have put this together to help explain what this condition is:
What is aphasia?
Aphasia is a term used to describe a communication disorder that results from damage or impairment of the language parts of the brain (typically in the left half of the brain). It may also be referred to as dysphasia in some literature but not to be confused with dysphagia (a swallowing disorder). How the aphasia presents and the severity of the symptoms differ depending on the location and extent of brain damage.
Aphasia may cause difficulties across the modalities of speaking, listening, reading, and writing. It does not affect the individual’s intelligence but rather the ability to express their thoughts and/or interpret others thoughts. Individuals with aphasia may also have other associated difficulties, such as dysarthria, apraxia, or swallowing problems.
What causes aphasia?
Aphasia is most often caused by stroke. According to the National Aphasia Association, about 25% to 40% of people who survive a stroke present with aphasia. It could also arise from many other conditions that damage or impair the language centres in the brain such as brain tumours, traumatic brain injury, and progressive neurological disorders (Alzheimer’s, Dementia etc.).
Aphasia may be mild or severe. A person with a mild aphasia may be able to hold a conversation but have difficulty finding the right words at times, or difficulty interpreting complex responses. A person with severe aphasia may be completely non-verbal.
Types of Aphasia
There are various classifications for the various types of aphasia but for the sake of simplicity I like to think about it like this:
|Type of Aphasia||Sight of Lesion||Characteristics|
(Aka expressive aphasia)
|Broca’s area, the left frontal lobe||· Word finding difficulties
· Word substitutions: related or unrelated
· Sound substitutions
· Made-up words
· Difficulty with sentence construction
· Fluent but jargon-like speech
· Difficulty with writing
(aka receptive aphasia)
|Wernicke’s area: the posterior region of the left temporal lobe||· Difficulty identifying objects/pictures named
· Difficulty following instructions
· Difficulty following conversations
· Difficulty understanding in noisy environments
· Misinterpretation of language (jokes, sarcasm, making inferences)
· Reading comprehension can reflect verbal comprehension
|Global Aphasia||General left hemisphere damage||· Both expression and understanding are affected
· Reading and writing skills are impaired
The various other sub-types are Conduction Aphasia; Transcortical Sensory Aphasia; Transcortical Motor Aphasia and Anomia. More information can be found on the website of the National Aphasia Association.
Although there are different types of aphasia, very rarely is there a “pure aphasia” where it is clear cut one or the other. The different types can co-occur or only effect one modality, it varies with each individual.
How is Aphasia Diagnosed?
It is best for the assessment for aphasia to be carried out soon after the stroke or upon noticing language difficulties.
A speech language pathologist will carry out the assessment. It can be assessed both informally and formally using various measures.
How do you communicate with someone that has aphasia?
Here are five key points to remember when communicating with a person with aphasia:
- Make sure you have the person’s full attention and minimize distractions
- Give them time to process what you have said and respond. Try to not change the subject of conversation too quickly. When the person with aphasia is replying, try not to pressure them for a response and give them plenty of time to answer.
- Use gesture/pictures/written aids to supplement your communication. Using yes/no questions can also help simplify your language and may elicit a more reliable response
- Try to keep sentences short and simple and avoid questions that require a complicated answer.Rephrase and simplify statements or questions if the person with aphasia doesn’t appear to understand
- Attempt not to correct their language as they may find this frustrating but rather ask for clarification if you don’t understand what they are saying “did you mean…
It is important to remember that this is a language disorder affecting the way they communicate and not a reflection on their innate intelligence. It’s important that you continue to have as normal a conversation as possible and avoid “talking down” to the person. Help them learn to laugh at their mistakes and acknowledge when it is difficult for them to communicate.
What are the Complications associated with Aphasia?
Aphasia can impact a number of aspects of life. Communication is a big part of day to day living. It can negatively affect personal relationships and work and can cause the person with aphasia to suffer frustration and distress.
Some research suggests that approximately a quarter of those suffering from aphasia will experience some sort of depression at some point in their recovery period. It may be comforting to both the person with aphasia and their caregivers to seek out a support group in this instance. You can check out our support group or follow the links below to find another option
- Mended hearts (Cape town) for more info – http://www.heartfoundation.co.za/support-groups
- Stroke aid (JHB) for more info – strokeaid.co.za
- Stroke survivors foundation (all around SA) for more info – strokesurvivors.org.za
If you would like more info on strokes and associated disorders refer to the below websites and associations:
Paddock, M. (2014, September 15). “What is aphasia? What causes aphasia?.” Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/217487.php. On 15th October 2016.
The American Speech-Language-Hearing Association (ASHA). “Ahpahsia”, ASHA.Org. Retrieved from: http://www.asha.org/public/speech/disorders/Aphasia/ (15th October 2016)
WebMD Medical Reference Reviewed by Neil Lava, MD (2016, September , 11) Retrieved from: http://www.webmd.com/brain/aphasia-causes-symptoms-types-treatments#2 On 15th October 2016.
Other Sources: American Stroke Association: “Aphasia vs. Apraxia.”
National Stroke Association: “Aphasia.”
National Institute on Deafness and Other Communicative Disorders: “Aphasia.”
The National Aphasia Association: “Understanding Primary Progressive Aphasia.”