What is aphasia?
For most people, the damage is on the left side of the brain. Aphasia is often caused by a stroke but it can also happen after a brain injury (for example, after a car accident or fall) or brain tumors. Dementia may also lead to a form of aphasia.
About a third of stroke survivors experience aphasia. Globally, an estimated 12 million people are living with aphasia. Aphasia is a highly varied condition with each person experiencing a different severity and type of aphasia.
As communication is so central to everyday life activities, aphasia has a significant impact on daily conversations, the ability to work, manage everyday tasks such as banking and shopping, and family and social relationships. These impacts can also affect the person with aphasia’s mood and overall wellbeing.
How is aphasia assessed?
A speech and language therapist (or speech and language pathologist) assesses the type and severity of the communication disability for each individual with aphasia. The assessment will determine the person’s communication needs and goals. The speech and language therapist/pathologist will measure different aspects of language use and determine what challenges the language and communication problems will have on typical daily activities.
If the person with aphasia has a history of bilingualism or multilingualism, efforts should be made to assess all the languages known by the person by involving an interpreter or family members and friends. Guidelines on working with interpreters can be found in the Suggested Readings section below.
An aphasia assessment will cover how well the person can;
- speak (for example, can they name common objects, such as pen or flower?)
- understand (for example, can they follow instructions or answer general knowledge questions?)
- read (for example, can they read from a newspaper?)
- write (for example, can they write their name and address or a text message?)
- use numbers (for example, can they perform a simple addition calculation?)
- use other forms of communication, such as gesture and body language to assist communication when language fails.
Assessment will explore the impact of a person’s aphasia on their conversation and other communication activities (for example texting, using a computer, completing forms) and their participation in social and vocational life. Sometimes the assessment will involve family members to determine which communication supports and strategies work best.
After assessment, what next?
Speech and language therapy helps the recovery of people with aphasia. Depending on the information gathered during these assessments, the therapist will understand what language and communication difficulties the person is having and what their communication needs are. This information helps to plan therapy. Usually, a therapy plan that matches the specific communication needs of the person with aphasia is developed. Therapy sessions may be individual or in groups. The treatment program may also involve training and advice for communication partners to enable effective communication. Screening and referral for problems with mood, and support for general wellbeing may also be provided. There are many approaches to aphasia therapy. In general, no one approach is better than the other. Computer software is frequently used to support language and communication rehabilitation practice. Community level aphasia support and long-term rehabilitation programs exist in many countries, often managed by voluntary and not for profit organisations.
What does it mean to be diagnosed with aphasia?
Aphasia affects people differently. Some common issues for individuals include:
- having problems “finding” the word they want to say
(though they “know what they want to say)
- only being able to use a few words or short incomplete sentences
- producing long passages of speech which are difficult to follow or understand
- having difficulty understanding other people speaking, especially if there are many people in a conversation and if the information is complex or the speech is very fast
- reading or writing may be very challenging. For some individuals they may only be able to write their name or read a street sign.
When someone is diagnosed with aphasia, all aspects of an individual’s life involving communication can be affected with social and emotional consequences. They may have problems with their memory, their ability to concentrate, fatigue, visual or mobility problems.
What are the chances of recovery?
For some people with very mild aphasia the symptoms may completely resolve. For others with moderate or severe aphasia the symptoms may persist for months, years or be lifelong. Improvements in communication can occur even several years after the brain injury. Research is ongoing to identify the key elements, for example, age or initial aphasia severity, that can be used to predict who will make a significant versus a poor recovery from aphasia.
Do bilinguals (speakers of two languages) and multilinguals (speakers of more than two languages) that develop aphasia recover the first language they learned or their strongest (dominant) language better than their second or weaker language?
No. When persons who were bilingual or multilingual speakers experience aphasia after a brain injury, they generally recover their languages in parallel. Their aphasia symptoms are similar in both languages and may recover these languages to the same extent as before the brain injury. However, many other recovery patterns may also occur; unequal recovery of the languages known by the person before the brain injury, different aphasic symptoms in different languages, or unusual use of the languages, such as involuntary language “mixing”.
Is it important to know the language history of bilingual/multilingual persons before the aphasia to understand their aphasic symptoms?
Yes. Knowledge of how bilingual and multilingual persons with aphasia acquired, learned, and used their languages before aphasia is crucial to interpret their difficulties. Asking relatives and, if possible, individuals about their languages (age of acquisition and use at home as well as in school and work) and how proficient they were in the languages before the stroke is necessary. Importantly, an accurate distinction between genuine disorders due to the aphasia and typical language and communication abilities of the speaker prior to the brain injury cannot be made without having information on the pre-injury language abilities and use.
What impact does aphasia have on the Individual with aphasia and family member?
Communication is a vital human activity. Aphasia has a substantial impact on the individual and their family. People may feel socially disconnected and emotionally uncomfortable about their communication difficulties. People with aphasia will struggle to communicate with family, healthcare professionals and the community. Many people with aphasia become isolated from their friends, experiencing extreme loneliness, anxiety or depression. Others may experience negative attitudes, or unskilled communication partners. Family members are often required to take on new roles in place of the person with aphasia. In addition, family members may also be required to act as a kind of translator for the individual with aphasia. These additional responsibilities, along with changed relationships and roles, can create considerable carer burden. Health practitioners need to be aware of and seek to manage mental health issues and support needs in people with aphasia and their significant others.
How can we help someone with aphasia function in their environment?
The type or complexity of the language being used, and the level of social or communication support in the environment can make a difference in how much someone with aphasia can take part in communication activities and feel socially connected. To support participation and a sense of connection, we can alter the communication environment to facilitate everyday interactions. When speaking with people with aphasia, try to support their communication. The speech therapist may be able to advise you on how best to do this.
What you can do is:
- speak in short, simple sentences
- repeat if you need to facilitate better understanding
- speak at your usual volume
- give lots of time for a response
- make eye contact
- speak directly to the person
- use a gesture or write down important words to help understanding
- check that the person with aphasia has understood.
- encourage the person with aphasia to use gesture, writing or drawing if talking is difficult
Does culture have an impact on aphasia services?
Yes. Attitudes to the language disability associated with aphasia and perception and engagement in clinical services may be shaped by the cultural background of the person with aphasia and their relatives and friends.
For example, in some cultures the aphasia experienced by a person may be considered a “punishment from God” or “an evil spirit” thus minimizing client or family motivation to seek therapy. Similarly, rather than seeking professional services, relatives may take a person with aphasia to a local healer or use home remedies to help recovery. It is important to bear in mind, however, that culturally-shaped behaviours and attitudes are not equally shown among all members of an ethnic group. While some people may be very conservative in their cultural attitudes and beliefs, others may have different perceptions shaped by other cultural influences.
Additional Resources Available on the Web:
American Speech-Language-Hearing Association (USA)
The National Aphasia Association (USA)
Aphasia Access (USA)
Stroke Association (UK)
Includes Aphasia Etiquette Animation
Aphasia Alliance (UK)
Aphasia Hope Foundation (USA)
Aphasia Institute (Canada)
Australian Aphasia Association (Australia)
American Speech Language Hearing Association. (2020). Collaborating with interpreters. Retrieved from https://www.asha.org/practice-portal/professional-issues/collaborating-with-interpreters/
American Speech Language Hearing Association. (2020). Working with bilingual clients with aphasia. Retrieved from https://www.asha.org/practice/multicultural/bilaph/
Armstrong, E., McKay, G., & Hersh, D. (2017). Assessment and treatment of aphasia in
Aboriginal Australians: Linguistic considerations and broader implications for cross-cultural practice. Journal of Clinical Practice in Speech-Language Pathology, 19, 27-34.
Brewer, K. M., & Andrews, W. (2016). Foundations of equitable speech-language therapy for all: The treaty of Waitingi and Māori health. Speech, Language, and Hearing, 19, 87-95.
Centeno, J. G. (2009). Issues and principles in service delivery to communicatively-impaired minority bilingual adults in neurorehabilitation. Seminars in Speech and Language, 30 (3), 139-153.
Centeno, J. G. (2010, October). The relevance of bilingualism questionnaires in the personalized treatment of bilinguals with aphasia. Perspectives on Communication Disorders and Sciences in Culturally and Linguistically Diverse Populations, 17, 65-73.
Centeno, J.G., Ghazi-Saidi, L., & Ansaldo, A. I. (2017). Aphasia in multilingual populations. In I. Papathanasiou & P. Coppens (Eds.), Aphasia and related neurogenic communication disorders – 2nd ed. (pp. 331-350). Boston: Jones and Bartlett.
Howe, T., Davidson, B., Worrall, L., Hersh, D., Ferguson, A., Sherratt, S., & Gilbert, J. (2012). ‘You needed to rehab… families as well’: family members’ own goals for aphasia rehabilitation. International journal of language & communication disorders, 47(5), 511-521.
Penn, C. (2012). Towards cultural aphasiology: Contextual models of service delivery in aphasia. In M. Gitterman, M. Goral, & L. K. Obler (Eds.), Aspects of multilingual aphasia (pp. 292–306). Multilingual Matters.
Penn, C., Armstrong, B., Brewer, K., Purves, B., McAllister, M., Hersh, D., Godecke, E., Ciccone, N., & Lewis, A. (2017). De-colonizing speech-language pathology practice in acquired neurogenic disorders. Perspectives of the ASHA Special Interest Groups (SIG 2), 2(part 3), 91-99.
Roberts, P. M. (2008). Issues in assessment and treatment for bilingual and culturally diverse clients. In R. Chapey (Ed.), Language intervention strategies in aphasia and related neurogenic communication disorders (5th ed.). Baltimore, MD: Lippincott, Williams and Wilkins.
Siyambalapitiya, S., & Davidson, B. (2015). Managing aphasia in bilingual and culturally and linguistically diverse individuals in an Australian context: Challenges and future directions. Journal of Clinical Practice in Speech Language Pathology, 17, 13-19.