What is aphasia?
Aphasia is an acquired communication disorder caused by brain damage which impairs speaking, listening, reading and/or writing. Aphasia can have a substantial impact on all aspects of an individual’s life that involve communication. Typical symptoms include difficulties ‘finding’ the word to say (even though the person may very well ‘know’ what they want to say); short or ‘telegraphic’ sentences, or converesely long, fluent passages of speech which are difficult for the listener to follow; difficulties understaanding speech which is fast flowing or complex. The level of communication disability experienced by a person with aphasia results from an interaction between the impairment itself, type or complexity of activity undertaken, and the social or communication environment. People with aphasia are vulnerable to the effects of ‘barriers’ such as inaccessible information, negative attitudes, or unskilled communication partners.
What causes aphasia?
Aphasia is caused by damage to the areas of the brain which support speech and language – in most individuals this is the left side of the brain, but speech/language is a very complex system dependent on networks of interconnections distributed throughout the brain. Aphasia is most often caused by a stroke. Strokes arise from blockages, blood clots or hemorrhages (bleeds) in the brain. Other causes include traumatic brain injury or tumors; there are other much rarer causes such as dementia.
How common is aphasia?
About a third of people after a stroke affecting the left side of the brain experience some degree of aphasia. Very mild symptoms of aphasia usually resolve quite quickly, but for people with moderate or severe aphasia symptoms usually persist or are permanent, although they may improve gradually over months or years. In the UK for example (population 63.7 million), around 250,000 people are living with aphasia.
What are some of the frequently accompanying symptoms of aphasia?
People with aphasia may experience other neurological syptoms as a result of stroke or other brain injury. These include problems with memory or attention, and visual problems. Non-fluent aphasia (where speaking is often restricted to single words) may be accompanied by ‘apraxia of speech’, where the person can be seen to physically struggle to get the words out. People with non-fluent aphasia also often have weakness or paralysis affecting the right side of the body. The impact of aphasia on people’s lives can be widespread and substantial; people with aphasia may become anxious or depressed, may feel their quality of life is compromised, may lose confidence and may experience a considerable degree of social isolation.
How is aphasia assessed?
Aphasia is typically assessed by a Speech and Language Therapist / Speech and Language Pathologist. The clinician will hold interviews with the client with aphasia and significant others in their environment to determine how aphasia impacts on their lives, and identify goals for intervention.
They will also use a number of tests / assessments to determine the nature and severity of the client’s aphasia and guide their therapy. For example, they may carry out tests of speaking (e.g., how fluently they talk; whether they can say the names of pictures or objects presented to them); understanding (e.g., whether they can follow instructions or answer general knowledge questions or questions about themselves); reading (e.g., from a newspaper or magazine); writing (e.g., writing name and address); and using numbers (e.g., simple arithmetic). Results of these types of tests help the clinician to understand where the person’s particular communication difficulties lie and how severe their problems are. The clinician may need to do more diagnostic testing to find the underlying nature of the aphasia, such as problems with word forms (how the sounds of the word are constructed), word meanings (semantics), or grammar.
Clinicians also may assess how the individual with aphasia conveys ideas and takes part in conversations with another person (e.g., family member or member of the clinical team) to see how they deal with problems of word-finding or misunderstandings. This test information all helps to plan therapy.
What is the treatment for aphasia?
There is no universally accepted treatment that can be applied to all patients. Usually speech-language pathologists select an individually-tailored treatment method (with the person with aphasia and the family) from a variety of therapy approaches to increase and facilitate speech and communication. Some treatment techniques attempt to restore language abilities through language stimulation activities. Other approaches attempt to compensate for the language difficulties by using alternative methods to communicate, such as gesture or drawing. Treatment may be provided either individually or in groups. New technology provides interesting possibilities for rehabilitation, too. Computer-aided speech and language therapy may help provide more opportunities to practice and increase the intensity of therapy.
How to communicate with a person with aphasia?
Participation in conversations can be enhanced for people with aphasia by providing ‘supported communication’ in the form of skilled communication partners and appropriate communication resources. ‘Supported communication’ builds on the ability of many people with asphasia to use preserved cognitive and interactional skills. Communication partners can be provided techniques to simplity and clarify language for the individual with aphasia. Some strategies include: speak in short, simple utterances to individuals with aphasia; repeat utterances as needed; avoid speaking loudly; provide additional time for the individual with aphasia to respond; make eye contact and speak directly to the individual with aphasia; embellish communication with gestures or written words; clarify what is understood. In this view, interactional communication is collaborative and co-constructed, with the unimpaired communication partner (e.g., volunteer; healthcare practitioner; family member) being jointly responsible for achieving exchange of information and sustaining participation.
Additional Resources Available on the Web:
American Speech-Language-Hearing Association (USA)
The National Aphasia Association (USA)
Stroke Association (UK)
Includes Aphasia Etiquette Animation
Connect – the communication disability network (UK)
Aphasia Alliance (UK)
Aphasia Hope Foundation (USA)
Aphasia Institute (Canada)
Australian Aphasia Association (Australia)