Aphasia

Aphasia, an impairment to one’s ability to communicate, results from damage to the parts of the brain that affect language. Aphasia can have an impact on a person’s ability to understand or express speech.

What Is Aphasia?

A communication disorder that results from damage or trauma to the parts of the brain that regulate language (typically the left hemisphere), aphasia can cause difficulties with speaking, listening, reading, and writing. Aphasia has no impact on a person’s intelligence.

Most often, aphasia is caused by stroke, but this condition can also be caused by other factors that influence brain function, such as a brain tumor or traumatic brain injury (TBI). Aphasia often occurs suddenly, but it can develop over time, such as in the case of a brain tumor or a progressive neurological disorder.

Signs and Symptoms of Aphasia

The specific symptoms of aphasia depend largely on the location and extent of the damage to the brain. People with damage to the front part of the brain may have difficulty producing fluent speech (non-fluent aphasia), but their comprehension is typically not affected.

On the other hand, those who sustain damage to the temporal lobe of the brain (fluent aphasia) may have difficulty understanding spoken language. They typically speak with a rate and rhythm of speech comparable to that of those not affected by aphasia, but they may use the wrong words, which often makes their speech seem nonsensical. People who sustain extensive damage to various parts of the brain may experience global aphasia, which typically results in communication difficulties and impairment in reading and writing as well as speech and listening.

Individuals with aphasia who have difficulty producing language may:

• Have trouble finding the word they want to say
• Switch sounds within words
• Use made-up words
• Have difficulty putting words together to form complete sentences

Problems with language comprehension may include:

• Misunderstanding what others say (especially when they speak quickly or in long sentences)
• Difficulty understanding speech in the presence of background noise
• Taking speech too literally and not understanding figures of speech (such as “it costs an arm and a leg”)

Aphasia can also cause difficulties with reading and writing. Some people with aphasia may have difficulty spelling words accurately, reading written materials, and even understanding number concepts—telling time, adding, or subtracting.

Aphasia may first be recognized by a doctor or other medical provider following a stroke or other brain injury. If a medical provider suspects a patient has aphasia, the practitioner will typically refer the individual to a speech-language specialist for further assessment and treatment. In order to diagnose aphasia, the speech therapist may ask the person to complete basic tasks such as naming an object, following a command, reading a specific written passage, and participating in a brief conversation.

Dysphasia vs. Aphasia

There is some confusion about the definitions of aphasia and dysphasia. Aphasia affects one’s ability to speak and understand speech, and dysphasia is very similar; it also causes difficulty with producing and comprehending speech. The difference between aphasia and dysphasia may lie in the severity of the symptoms, with some experts arguing that dysphasia is less severe than aphasia. However, the terms are often used interchangeably among professionals, and which term is used by be determined by geographical location.

Types of Aphasia

Aphasia can manifest in a variety of ways. Some common forms of aphasia include:

• Broca’s aphasia (also known as expressive or non-fluent aphasia): People affected by Broca’s aphasia have trouble primarily with spoken language. Their ability to comprehend language may be minimally impacted.
• Wernicke’s aphasia (also known as receptive or fluent aphasia): Those with Wernicke’s aphasia don’t have trouble producing speech as those with non-fluent aphasia do. Instead, Wernicke’s aphasia affects language comprehension, and people with this type of aphasia may not make sense when they speak.
• Conduction aphasia (also known as associative aphasia): Conduction aphasia is a rare type of fluent aphasia. Individuals with this type of aphasia typically find it very difficult to repeat phrases.
• Global aphasia: Global aphasia affects both language production and comprehension, making it one of the most severe types of aphasia. It may occur directly after a stroke or injury to the brain; in these cases, symptoms may improve depending on how much damage was done.
• Primary progressive aphasia: This type of aphasia is caused not by brain trauma, but by neurodegenerative disease. As parts of the brain associated with speech and language lose their ability to function, people lose their ability to speak and comprehend language. Primary progressive aphasia typically continues until an individual has little or no ability to speak, read, or understand language.
• Anomic aphasia (also known as dysnomia, nominal aphasia, or amnesic aphasia): This is a mild form of aphasia. It mostly affects an individual’s ability to find words and properly name things, a condition called anomia. Anomic aphasia does not typically affect comprehension or ability to speak, other than issues with word finding.

Treatment for Aphasia

There are two main categories of treatment for aphasia. Impairment-based therapies focus on improving language function and involve direct work on specific language skills with a speech-language pathologist. Communication-based therapies, on the other hand, are designed to enhance communication by teaching individuals other ways to convey their message effectively. This type of treatment may include the use of compensatory strategies and often involves support from caregivers.

Family members and other caregivers can take steps to help an individual with aphasia communicate more effectively. Techniques that can be helpful include giving the individual time to speak rather than completing sentences for them, minimizing background noise, maintaining eye contact and watching the person’s body language/gestures, encouraging the use of other ways of communicating (drawing, gesturing, writing), and using closed questions (those that can be answered with a simple “yes” or “no”) instead of open-ended questions, which may require a more complicated answer.

Currently being investigated are new types of treatment, including computer use to treat aphasia and medication, given immediately after a stroke in the hope of diminishing the severity of aphasia.

Aphasia Causes and Mental Health Comorbidities

Because effective communication is an important component of day-to-day functioning, people with aphasia may experience related issues such as social difficulties, feelings of frustration and distress, and depression. In fact, it is estimated that about 25% of people with aphasia are diagnosed with depression at some point. Individuals with aphasia may also feel embarrassed about their condition, and as a result, they may tend to avoid social situations, which can lead to isolation.

Aphasia does not necessarily lead to a mental health condition, but the condition can present challenges that might have an overall negative impact on a person’s mental health and/or emotional well-being. Some people who are diagnosed with aphasia may feel as if they are no longer themselves and may find it difficult to become accustomed to changes in their speech and comprehension.

If you or a loved one is experiencing mental health issues as a result of aphasia, help is available. Reach out to a trained mental health clinician in your area here.

References

1. Aphasia. (n.d). American Speech-Language-Hearing Association. Retrieved from http://www.asha.org/public/speech/disorders/aphasia
2. Broca’s (expressive) aphasia. (n.d.). National Aphasia Association. Retrieved from https://www.aphasia.org/aphasia-resources/brocas-aphasia
3. Bronken. B. A., Kirkevold, M., Martinsen, R., Wyller, T .B., & Kvigne, K. (2012, March 19). Psychosocial well-being in persons with aphasia participating in a nursing intervention after stroke. Nursing Research and Practice, 2012. Retrieved from http://www.hindawi.com/journals/nrp/2012/568242
4. Davis, G. A. (2011). Aphasia therapy guide. Retrieved from http://www.aphasia.org/aphasia-resources/aphasia-therapy-guide
5. Dronkers, N. F., & Baldo, J. V. (2009). Language: Aphasia. Encyclopedia of Neuroscience. Retrieved from https://www.sciencedirect.com/science/article/pii/B9780080450469018763
6. Paddock, M. (2017, February 21). Aphasia: What you need to know. Medical News Today. Retrieved from http://www.medicalnewstoday.com/articles/217487.php
7. Vandergriendt, C. (2017, December 14). What is dysphasia? Retrieved from https://www.healthline.com/health/dysphasia
8. What is aphasia? (n.d.). Retrieved from http://www.strokecenter.org/patients/caregiver-and-patient-resources/aphasia-information

Last Updated: 09-24-2019