Aphasia- What is it?
“Help – My Loved One Just Had a Stroke and Can’t Talk!”
Most of us can relate to the frustration of a dropped cell phone call caused by connection problems with your supplier. Now imagine waking up one morning to find that your communication skills seem to have been disconnected in your brain. Suddenly, speaking even the most simple of words is a challenge; others speak yet do not make any sense. You try to write something down and discover you can neither read nor write!
A common theme in the stories of individuals describing their stroke experience is one of being thrust on a sudden, unexpected journey to an unknown destination. The road is intensely rough; there is no guidebook map or itinerary. The language spoken by others often sounds foreign, almost as if one has landed in a strange, new world. Individuals often describe intense feelings of frustration and isolation.
Feelings of shock and fear give rise to many questions. Some commonly asked ones include: “What happened?; Where am I?; Why did this happen to me?; When will this be over?; How do I get back to normal or to where I was?”
This strange place you find yourself is the “land of aphasia”.
Aphasia is an acquired communication disorder caused by damage to the language centers in the brain. Although it most frequently occurs as the result of a stroke, other illnesses, infections, brain tumors or head trauma can also cause aphasia.
The Ontario Association of Speech-Language Pathologists and Audiologists reports that at least 30% of people experience a loss of language skills post-stroke. It is important to know that while aphasia impairs a person’s ability to process language, it does not affect their intelligence. It can affect the ability to speak, understand others, read and write.
Many people with aphasia understand what is happening and being said around them. Sometimes their ability to show this is “hidden” by aphasia, which prevents them from accessing and using language to engage in conversation and other activities. They will communicate in different ways.
Other individuals may have difficulty understanding what is being said to them. Supports are available to help improve comprehension. Gestures can greatly enhance the message being spoken, especially when they resemble the word said (i.e., iconic gestures – such as holding up a hand in the gesture of drinking are easily recognized and understood). Written key words are also helpful. It is important to know that usually these people hear just fine – so speaking louder does not help; it may even distort words.
Unfortunately, in some cases, aphasia can be severe enough to make communication almost impossible; other times it can seem relatively mild. It may affect only one part of language use, such as the ability to easily find the names of objects or to put words together to form sentences, or the ability to read. Any combination of deficits is possible and each individual is unique.
Common Names for Types of Aphasia
Common Names for Types of Aphasia
Adapted from :The National Aphasia Association (www.aphasia.org).
Although each individual with aphasia is unique in terms of their communication strengths and weaknesses, certain patterns more commonly seen are known as follows.
This is the most severe type of aphasia since it affects all areas of language. A person with global aphasia can say few recognizable words, may understand very little and sometimes no spoken language, will not be able to read or to write. It often occurs immediately following a stroke, however, in cases where damage has not been too extensive, it may improve rapidly. When greater brain damage is present, there may be severe and long lasting disabilities.
Broca’s Aphasia (Non-Fluent Aphasia)
The speech output of someone with a non-fluent aphasia is often severely reduced, often limited to short strings of a few words; sound formation is often difficult. Individuals struggle retrieving vocabulary and often have a halting type of speech.
They may be able to understand speech and to read, but often have limited writing.
Mixed Non-Fluent Aphasia
This type of aphasia results in effortful and limited verbal output, similar to Broca’s aphasia. Features that distinguish it are a limited ability to understand speech and an inability to read or write beyond a very limited, elementary level.
A person with anomic aphasia understands language and can often read. Their challenge lies in persistent difficulty finding words to convey names of items and actions. Verbal output can be grammatical, yet full of vague words and phrases. Writing is also impaired because of difficulty finding words. People with this type of aphasia often express much frustration.
Wenicke’s Aphasia (Fluent Aphasia)
With fluent aphasia, a person demonstrates difficulties understanding spoken words, yet they are able to produce connected sentences. On closer look though, verbal output is quite impaired – e.g., sentences may be unrelated to each other and contain jargon or unrelated words. Reading and writing are often severely impaired.
Many other types of aphasia have been described, some representing combinations of deficits, others being more isolated such as when they affect only one unique skill – e.g., reading (alexia); writing (agraphia); etc.
Primary Progressive Aphasia (PPA)
This is a rare neurological disorder where language skills slowly become more impaired over time. It differs from several forms of dementia since individuals with PPA continue to care for themselves as well as to, participate in social and personal activities. Different patterns of difficulties have been described. A common one is marked by difficulties pronouncing sounds and words, however, comprehension is intact. A different subgroup experiences difficulties with word finding and comprehension, yet their articulation remains preserved.
A Speech-Language Pathologist works with individuals and their families to support them in many ways. In addition to providing education on the nature of aphasia, the therapist will assess an individual’s strengths and weaknesses. This may help to unravel some of the mysteries, as more information is learned about the types of communication channels available post-stroke and how to help comprehension and expression. Therapy is individualized, taking into account each person and their family needs, goals, strengths and challenges.
Speech therapy may take several paths. In some cases, there is a strong focus on improving language function in specific areas (e.g., word finding, reading, writing, etc.). Music based therapies have gained some attention and may help individuals who struggle to speak, yet are able to say words in songs. Another approach helps caregivers learn strategies that support communication in real life, natural settings.
Supportive conversational strategies are methods developed at the Aphasia Institute (www.aphasia.ca) in Toronto. These strategies can be learned by conversational partners and have been found to improve communication with people experiencing aphasia. Community groups offer opportunities for people with aphasia to gain confidence in learning to communicate in social settings.
The personal stories of individuals with aphasia and their families provide insight and offer comfort about the journey through the “land of aphasia”. They also highlight that the recovery process may continue for years, as the brain reshapes itself with the help of therapy and time.
Heart & Stroke Foundation: www.heartandstroke.com
March of Dimes Canada: www.marchofdimes.ca/EN/programs/src/Pages/src.aspx
National Aphasia Association: www.aphasia.org