Aphasia is a language disorder where people have problems speaking and writing and also understanding both the spoken and written word.
Aphasia is not a condition in itself, rather it isa symptom caused by pre-existing brain damage. Strokes, head injuries and conditions that can damage the brain over time, such as Alzheimer’s disease, or a brain tumour, can all lead to aphasia.
How common is aphasia
Aphasia is a common complication of stroke. It is estimated thata third of all stroke victims will experience some degree of aphasia after their stroke and an estimated50,000 people become aphasic due to stroke every year in the UK.
There are also an estimated 290,000people with Alzheimer’s disease in England and Wales, many of whom have some degree of aphasia.
Types of aphasia
There are three main types of aphasia which are described below.
- Fluent aphasia: (also known as Wernicke aphasia). In this type of aphasia the person can speak normally and use long, complex sentences, but the actual words they use make no recognisable sense and/or they include nonsense words in their speech.A person with fluent aphasia may say: “I handbagged the noose and, you know, then ate round the purple with fish.”
- Non-fluent aphasia: (also known as Broca aphasia). In this type of aphasia the person has great difficulty in speaking and can only manage to string a number of words together in short, halting sentences. Though the meaning of their speech is usually understandable.A person with non-fluent aphasia could say: “Want…coffee…no…milk.”
- Global aphasia: this is the most severe form of aphasia in which people have profound difficulties with expressing and understanding both written and spoken language.
It should be stressed that though aphasia is caused by brain damage, it does not mean that a person with aphasia necessarily has reduced intelligence or has any learning disability.Many people with aphasia can remain entirely rational, but the fact they can’t express themselves, makes aphasia such a traumatic and frustrating experience for people.
Where the brain damage occurs will then determine what type of aphasia a person develops.
Symptoms of aphasia
Symptoms of fluent aphasia
People with fluent aphasia are able to speak normally but the actual words they use have no recognisable sense, meaning that their speech is impossible to understand.
Often, they will insert nonsense or made-up words into their speech.
This inability to speak normally is also reflected in the way they write. They can write fluently, but the text they produce makes no sense.
People with fluent aphasia also often have problems understanding spoken language, though in some cases, they can understand written language.
In most cases of fluent aphasia, the person affected by aphasia does not realise there is anything wrong with their use of language, so can become angry and frustrated at other people’s inability to understand them.
Symptoms of non-fluent aphasia
People with non-fluent aphasia will speak slowly and haltingly; often struggling to get out their words. Their sentences are often incomplete, with many words left out, though the meaning of the sentences can usually be understood.
Their ability to write may be affected in a similar way.
A person with non-fluent aphasia can usually understand spoken language to some degree though they can often have problems understanding grammar. For example, people with non-fluent aphasia may not be able to tell the difference in meaning between “Maureen slapped the naughty boy” and “the naughty boy slapped Maureen”.
People with non-fluent aphasia can also have great difficulty in reading, especially longer, more complicated words.
Unlike fluent aphasia, a person with non-fluent aphasia is aware of their language difficulties and can often become frustrated at not being able to speak fluently.
Symptoms of global aphasia
In cases of global aphasia, all aspects of communication are impaired. These include:
- the ability to speak,
- the ability to listen and understand, and
- writing and reading abilities.
Causes of aphasia
Your ability to speak, understand, read and write is all controlled by a certain section of the brain known as the language centre.
In right-handed people, the language centre is usually located on the left side of the brain and on the right side of the brain in left-handed people.
Any sort of damage to this area of the brain can result in aphasia. Where the damage occurs will then determine what type of aphasia you develop.
Damage to the side of the brain (the temporal lobe) usually results in fluent aphasia. The damage means that the brain can still fluently express words, but is unable to choose appropriate ones. The brain also loses its ability to understand language spoken by others.
Damage to the front of the brain (the frontal lobe) usually results in non-fluent aphasia. The damage means that the brain is only able to recall a small number of basic words while trying to express itself.
Extensive damage that occurs throughout the language centre of the brain can result in global aphasia.
Ways in which the brain can become damaged include:
- Stroke: during a stroke the brain is deprived of blood and oxygen which leads to the death of brain tissue,
- severe head injury,
- brain tumour,
- infection of the brain, such as meningitis, and
- having a health condition that causes progressive damage to the brain, such as Alzheimer’s disease, multiple sclerosis or some forms of Parkinson’s disease.
A diagnosis of aphasia will usually be made by a speech and language therapist.
There are a number of tests, such as the Boston Diagnostic Aphasia Examination test, that can be used to assess all aspects of an individual’s communication skills.
These tests involves a series of simple exercises, such as asking a person to name as many words they can think of that begin with the letter F or asking them to name objects that are in the room.
The results of the different exercises can then be used to build up a detailed assessment of a person’s language capabilities.
Once a diagnosis of aphasia has been made, a MRI scan may be used to gauge the extent and location of the underlying brain damage.
Due to the high levels of aphasia among people recovering from a stroke, an aphasia assessment is usually given in the first few days after the stroke.
A complete return to pre-aphasia communication levels is not always possible, but speech and language therapy (SLT) can bring about significant improvements, even in the most serious cases of global aphasia.
Goals of speech and language therapy (SLT)
The main goals of SLT are:
- to relearn language skills: if the language centre of the brain has been damaged, it is possible to rewire the abilities needed for language into other parts of the brain,
- to make the best use of remaining language abilities, and
- to find new ways of communicating such as keeping a book of common words or phrases which can be pointed to when a certain word can’t be recalled.
There is no one single type of SLT for aphasia. Rather a variety of techniques can be tried, depending on a person’s individual circumstances.
Some widely used SLT techniques are outlined below.
Promoting Aphasic’s Communicative Effectiveness (PACE)
Promoting Aphasic’s Communicative Effectiveness (PACE) is a type of SLT that uses conversation as a tool to improve communications skill.
The therapist will use a picture or a drawing to stimulate a conversation, while the person with aphasia is encouraged to use any means of communication to respond.
Early sessions on PACE will focus on relatively simple topics of conversation, such as where the person was born. As the sessions progress, the topics of conversation become more complex and abstract, such as what is the person’s favourite film and why that is the case.
Melodic intonation therapy (MIT)
Melodic intonation therapy (MIT) is a type of SLT that is often used in the treatment of non-fluent aphasia.
During MIT sessions a person with non-fluent aphasia is encouraged to hum, and then to sing words or phrases they find hard to recall, while tapping out a rhythm.
This technique has been shown to increase the number of words a person can recall. This may be due to the fact that the part of the brain we use to recall song lyrics and music is different from the part of the brain we use to recall spoken language. So MIT teaches a person with non-fluent aphasia an alternative way to recall words and phrases.
Computerised script training (CST)
Computerised script training (CST) is a type of SLT that is delivered via a computer. CST makes use of scripts that simulate real-life conversations and social activities, allowing a person with aphasia to practice their communication skills and relearn abilities.
Group therapy, which involves asmall number of people with aphasia, provides a good opportunity for people to practice and then improve their communication skills in a supportive and non-threatening environment.
Communicating with a person with aphasia
If you live with and / or care for a person with aphasia you may be unsure about the best way to communicate with them. The advice below may be helpful.
- After speaking, allow the person plenty of time to respond. If a person with aphasia feels rushed or pressured to speak, they can become anxious which affects their ability to communicate.
- Use short, uncomplicated sentences and do not change the topic of conversation too quickly.
- Avoid asking open ended questions. Questions that only have a ‘yes’ or ‘no’ answer are better.
- Avoid finishing a person’s sentence or correcting any errors in their language. This can cause resentment and frustration for the person with aphasia.
- Try to keep any possible distraction to a minimum, such as background radio or TV noise.
- Keep paper and pen available. Write down any key words or concepts to help reinforce your message.
- Try to remember that despite their change in speech pattern, the person’s personality is unchanged. They may appear emotionally distant or abrupt but how they speak to you does not necessarily reflect how they feel about you.
Caring for someone with aphasia can be both physically and emotionally demanding, so it is important that you take some time out for yourself. See the Useful links sectionfor information on how to maintain your physical and emotional wellbeing while caring for somebody else.
Complications of aphasia
Losing the ability to communicate can be immensely frustrating, traumatic, and in many cases frightening.
Due to the associated psychological stresses caused by aphasia, depression is a common complication. Research has shown thatone infour people with aphasia will experience depression at some time.
If you are concerned that somebody you know with aphasia is depressed, you should encourage them to see their GP.
Though it can often feel like an incurable condition, there are a number of effective treatments for depression.
People with aphasia should be encouraged to attend self-help and support groups as this can reduce feelings of isolation and stress.
As stroke is one of the main risk factors for developing aphasia, taking steps to prevent a stroke will in turn help reduce the risk of aphasia.
The best way to prevent a stroke is to eat a healthy diet, exercise regularly, and avoid smoking and excessive consumption of alcohol.
See the Useful links section for more information on stroke prevention.