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What is aphasia?
Difficulty communicating is fairly common after stroke. Speech therapy and family support can help.
If you've spent time in a country where you have a limited grasp of the language, you know how frustrating communication barriers can be.
You may not be able to speak in full sentences, you mispronounce words, and your vocabulary has gaps where there used to be familiar words. When people talk too fast you can hardly understand them, and when they talk slowly you feel lucky to get the drift of the conversation.
Now imagine you can never go home.
People with aphasia experience the same sorts of stumbling blocks. Aphasia is caused by a brain injury—usually a stroke, but sometimes a head injury, brain cancer or some other illness.
It can happen to anyone at any age, but most people with aphasia are older. At least a million people in the United States have aphasia.
Aphasia may affect a person's ability to speak, to understand what is said to them, or both. It may also affect the ability to read, to write or both. A person who has aphasia may have only minor difficulty with speech or near total inability to understand language or communicate.
There are many types of aphasia, depending on which area of the brain has been affected by illness. According to the National Institute on Deafness and Other Communication Disorders (NIDCD), some of the more common varieties of aphasia are:
Global aphasia: This is the most severe form of aphasia. People with it can speak only a few words and may not be able to understand any language. They cannot read or write. It is often seen immediately after a stroke. Depending on the amount of brain damage, the person may recover some or most of their ability or may have permanent disability.
Broca's aphasia: People with this kind of aphasia have a hard time speaking and speak in short phrases—fewer than four words. A person may say, "Go outside." This may mean, "I want to go outside; it's a beautiful day." It may also mean, "You go outside; I'll meet you there." Or it could mean, "My wife went outside; she'll be right back." The person may be able to understand most of what is said and be able to read but have little ability to write.
Mixed nonfluent aphasia: This kind of aphasia also causes speech to be very difficult, similar to Broca's aphasia. However, people with this form also have limited comprehension of speech and cannot read or write beyond a very basic level.
Wernicke's aphasia: People with this form of aphasia have difficulty understanding what is said to them but are able to speak fluently. However, what they say may not make much sense. They may speak in long sentences with unnecessary or even made-up words, and they may not realize that what they say is hard to understand. Reading and writing may be difficult or impossible.
Anomic aphasia: This form of aphasia makes it difficult to remember the words for the very thing a person is talking about—in particular, the important nouns and verbs. This difficulty in finding words also appears when the person tries to write. People with this form of aphasia understand speech and usually read adequately.
Some people completely recover from aphasia. This usually happens when a person has had a certain type of stroke, called a transient ischemic attack. In this type of stroke, blood flow to the brain stops but is quickly restored. Language abilities may return in a few hours to a few days.
In most cases, recovery is not as fast or as complete. Many people with aphasia experience a period of recovery—anywhere from a few hours to a month—in which some language abilities return.
For these people, speech-language therapy is often helpful. A speech-language therapist helps individuals use the skills they still have, restore skills when possible, and learn new ways to communicate, according to the NIDCD.
Technology has created new opportunities for those with aphasia. For instance, they can use speech-generating applications on a device such as a tablet. In addition, they can participate in virtual therapy sessions through their home computer.
The therapist can also help the family of the person with aphasia learn how to cope with the condition, according to the American Speech-Language-Hearing Association.
Group therapy provides a comfortable place for a person to practice new communication skills. And groups such as stroke clubs provide support and information for both the person with aphasia and their family.
Most individuals who receive therapy experience improved communication, and they can be helped even 10 years or more after onset, says the National Aphasia Association. But there is no medical cure for for aphasia.
How families can help
It is important that a person with aphasia be able to communicate as successfully as possible from the beginning of recovery. Family members can help in these ways:
- Make sure you have the person's attention before talking.
- Use short, simple sentences.
- Talk in a manner appropriate for an adult.
- Don't speak more loudly than you did before, but emphasize key words in sentences.
- Include the person in group conversations.
- During conversation, turn off the television, radio, stereo, etc., and try to keep other forms of background noise at a minimum.
- Give the person plenty of time to understand what is being said and to respond. It takes people with aphasia longer to process language.
- Praise all attempts to communicate—whether by speech, gesture, pointing, writing or drawing.
- Don't expect perfection or criticize mistakes.
- Strive to communicate clearly. Repeat or write down key words. Use gestures and visual aids. Repeat a statement when necessary.
- Avoid being overprotective of the person. Encourage them to be as independent as possible.
- Don't speak for the person with aphasia unless it is absolutely necessary. Ask permission before speaking for them.
- Continue normal family life as much as possible—family dinners, company, going out.
- Try to involve the person in family decision making and keep them informed of events.
- Help the person get involved in activities outside the home, such as support groups and clubs.