Aphasia: An Overview

What is aphasia?

Aphasia is an acquired communication disorder defined as the loss or impairment of the ability to use or comprehend words. Aphasia is strictly related to language, including speaking, listening, writing, and/or reading. It does not affect intelligence. Just because someone has aphasia does not mean that they are any less intelligent than they were before.

Aphasia is one of the most common conditions caused by brain injury (including stroke and aneurysm). Over two million people in the U.S. are currently affected by aphasia according to the National Aphasia Association, but few outside the clinical world know what it is. In fact, given its prevalence, most of us have encountered someone with aphasia but just don’t know it by name.

What causes aphasia?

Anything that damages the language centers of the brain can cause aphasia, including:

  • Stroke, which occurs when a clot blocks a blood vessel in the brain, which prevents blood supply to areas of the brain supplied by that vessel.
  • Traumatic brain injury (also known as TBI), an event where the brain is hit and damaged by trauma, or by disease, such as brain tumor or encephalitis.
  • Hemorrhage or aneurysm, when a blood vessel ruptures in the brain. Blood is “poisonous” to the brain, so if any parts of the brain are exposed to blood during a hemorrhage, they will be damaged.

Who is impacted by aphasia?

Nearly 180,000 more Americans acquire aphasia each year, usually after stroke or brain injury. Aphasia affects people of all ages, races, nationalities and genders. More than 800,000 people/year have a stroke in the United States, and an estimated 1.7 million experience brain injury, both of which are common causes of aphasia. Aphasia is more prevalent than Parkinson’s, ALS, cerebral palsy, and muscular dystrophy.

How does aphasia impact daily life?

Aphasia affects an individual’s daily life in many ways – just think of what you’re doing right now – you’re reading this article, or you may even be reading it out loud to someone. If your language were impaired, you might not be able to read this page, a newspaper, or even signs on the street. You might not understand your friend on the phone when they call you. You might be in a meeting and just cannot come up with the words to say. It can feel very disorienting.

Aphasia presents on a spectrum – it can be somewhat mild (for example, constantly feeling like “the word is on the tip of your tongue”), or it can be very severe (for example, feeling like you’re in a foreign country where you don’t speak the language). Aphasia affects different systems, and it can be very isolated in terms of which language systems it impacts. It does not always affect comprehension and it does not always affect reading or writing, i.e, everyone is different, depending on what part of the brain was injured.

There are several important communication tips to use if you are communicating with aphasia, or communicating with someone who has aphasia.

What are the different types of aphasia?

There are five main types of aphasia, but every person with aphasia is unique. Different components of language may be damaged more or less in each individual, resulting in different manifestations of speech and language issues.

Below are brief summaries of common aphasia types that you may hear medical professionals using:

1. Global Aphasia: When a brain injury affects extensive portions of the front and back regions of the left hemisphere, the result may be global aphasia. People with global aphasia may:

  • Have difficulty understanding words and sentences
  • Have difficulty forming words and sentences
  • Get out only a few words

2. Broca’s Aphasia: A type of non-fluent aphasia, these individuals typically present with damage that affects the brain’s frontal lobe. This aphasia is called a “non-fluent” or “expressive” aphasia because you may understand and know what you want to say, but can only speak in short phrases and with a lot of effort. You might also omit grammatical words such as “is,” “and” and “the.” This is called “agrammatism”. Why “Broca’s Aphasia”? French physician, Pierre Paul Broca, specialized in the study of language in the 1860’s. He treated an individual who presented with symptoms of speech loss, yet maintained his intellect. Broca named this new disorder, aphémie – the ‘loss of articulated speech’. The American Stroke Association provides the following examples of the impact of Broca’s aphasia. If you have it, you might experience:

  • Difficulty forming complete sentences.
  • Leaving out words like “is” or “the.”
  • Trouble understanding sentences.
  • Using a word that’s close to what you intend, but not the exact word; for example, saying “car” when you mean “truck.”

3. Wernicke’s Aphasia: A type of fluent aphasia, these individuals typically present with damage that affects the brain’s left temporal lobe. This aphasia is called “fluent” or “receptive” aphasia because although you can produce many words (are “fluent”), and use grammatically correct sentences, what you say may not make sense, or your speech may include non-existent or non-relevant words. You also may not be fully aware that what you’re saying doesn’t make sense. Why “Wernicke’s Aphasia”? It’s named after 19th-century German neurologist Karl Wernicke, who first related this disorder to damage in the left posterior temporal area of the brain. The American Stroke Association provides the following examples of the impact of Wernicke’s Aphasia. If you have it, you might:

  • Say many words that don’t make sense.
  • Use the wrong words; for instance, you might call a fork a “gleeble.”
  • String together a series of meaningless words that sound like a sentence but don’t make sense.

4. Anomic Aphasia: This is the mildest type of aphasia – if you have anomic aphasia, you have relatively preserved speech and comprehension, but difficulty in finding words. Interestingly, with anomic aphasia, less frequently-used words are typically more difficult to retrieve and produce than frequently used words.

5. Primary Progressive Aphasia (also known as PPA): A type of frontotemporal degeneration in which symptoms begin gradually, sometimes even before age 65, and worsen over time. People with PPA can lose the ability to speak and write, and eventually to understand written or spoken language. Sometimes this condition is confused with dementia. Speech therapy can be provided throughout the course of the disease, with the goal being to maximize communication ability for as long as possible.

How is aphasia treated?

Many treatment options are available, usually through speech-language pathologists (SLPs) in rehab centers, skilled nursing facilities, clinics, or at home. These treatments seek to help those with aphasia reclaim their lives and return to work if that is a goal.

Treatment may include some or all of these activities:

  • Working one-on-one with a SLP on language and daily living skills. For example, sessions may focus on conversation, reading the newspaper, and summarizing the main messages to a clinician or family member.
  • Working on a customizable app like Constant Therapy to target specific speech skill areas both in the clinic and at home. For example, Constant Therapy’s Word Retrieval & Speaking tasks have many individual exercises that help the brain to find words more easily again.
  • A weekly book club or video conference to practice conversation skills and understand spoken language.
  • Participating in research studies to help scientists discover the most effective ways to create individualized treatment programs for aphasia.

The most important thing to know is that, because of neuroplasticity, there is no end to recovery. The myth that individuals only have a year or less to recover after a stroke or brain injury and after that there is no more improvement, has been proven by science to be false, and confirmed so in our own published, scientific studies. If you have aphasia, you can continue to improve with the right therapy for the rest of your life.

Expert opinion
Recovery from aphasia is possible. What we know about neuroplasticity is that the brain can rewire itself. It can rebuild and regain lost skills by either forming new connections or strengthening existing connections within the brain. Intensive and consistent practice is important to form those new connections; to regain speaking, listening, reading and writing skills.
Emily Dubas
MS, CCC-SLP, Staff Clinician
How does Constant Therapy help individuals with aphasia?
The easy-to-use app, when part of a brain rehabilitation plan, can restore communication skills associated with aphasia. Constant Therapy means not waiting a week in between in-clinic therapy sessions to learn new tasks. It means continuing recovery long after in-clinic sessions have run out. It means therapy, constantly, on your terms.
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