Family involvement is often a crucial component of aphasia treatment because it enables family members to learn the best way to communicate with their loved one.
Aphasia is a language disorder that presents as a speech problem and robs you of your ability to communicate. It is usually caused by some kind of brain trauma, for example, a stroke or a head injury. The damaged parts of the brain affect language and memory. Aphasia can also be the result of brain tumours, brain infections, or neurodegenerative diseases, but the latter is far less prevalent.
Bruce Willis has recently been diagnosed with Aphasia and unfortunately, the diagnosis will affect his ability to communicate with others. When you stop to think about how communication defines us, connects us, and gives us purpose, you start to realize how devasting it might be to lose that ability.
One in three stroke survivors will have aphasia (at least initially), and it’s estimated that more than 2.5 million people are living with aphasia in the US alone. More people have aphasia than Parkinson’s disease.
Aphasia and the frustration in communicating
When someone can’t speak well, it’s easy to assume they aren’t very bright. However, with aphasia, this simply isn’t true. People with aphasia are as intelligent as they were before they got aphasia. Since aphasia is a result of damage to the language centre of the brain, it doesn’t affect what people know or how they think.
People with aphasia know what they want to say. They have the same ideas, emotions and thoughts as you do. They have advice to give – jokes and stories to tell. All these messages are trapped inside a brain that won’t let them out like it used to. Only the keywords come out, the timing is off, or the wrong words are spoken. Imagine how FRUSTRATING that must be!
A common question is: Can they write what they want to say? This would be possible if aphasia was only a speech problem but it is a speech and language problem so it’s unfortunately not possible for someone with aphasia to write down what they want to say.
Aphasia and mental health
One person may suffer from depression, while another seems almost unfazed. Mental health is an important factor in stroke and aphasia recovery.
Some people with aphasia keep trying to communicate, while others withdraw. Personality and confidence can play huge roles in the impact aphasia has on a person’s life.
The types of Aphasia
The most common types of Aphasia are Broca’s aphasia, Wernicke’s aphasia and Anomic aphasia.
Broca’s aphasia (non-fluent aphasia)
Broca’s aphasia is when people find it very difficult to find and say the right words, although they probably know exactly what they want to say.
People with Broca’s aphasia may only be able to say single words or very short sentences, although it’s usually possible for other people to understand what they mean. This can be very frustrating.
The features of Broca’s aphasia are:
Wernicke’s aphasia (fluent aphasia)
Wernicke’s aphasia is when someone is able to speak well and use long sentences, but what they say may not make sense. They may not know that what they’re saying is wrong, so may get frustrated when people don’t understand them.
People with receptive aphasia (Wernicke’s aphasia) have a lot of trouble understanding, but they also can’t express themselves well either. While their speech is often fluent and effortless, it doesn’t make sense and contains a lot of wrong or made-up words.
The features of Wernicke’s aphasia are:
- Impaired reading and writing.
- An inability to grasp the meaning of spoken words (producing connected speech is not affected).
- An inability to produce sentences that hang together.
- The intrusion of irrelevant words in severe cases.
The features of anomic aphasia are:
- An inability to supply the words for the very things the person wants to talk about, particularly the significant nouns and verbs.
- Speech that’s full of vague expressions of frustration.
- Difficulty finding words in writing as well as in speech.
The fourth type of aphasia is:
Primary progressive aphasia (PPA) is a condition where language capabilities become slowly and progressively worse, leading to a gradual loss of the ability to:
- Understand what other people are saying.
Deterioration can happen slowly, over a period of years. Other mental functions such as memory, reasoning, insight and judgement are not usually affected. Most people with aphasia have trouble in all four areas of language to some degree or another.
It’s important to get an accurate diagnosis for PPA. This is to rule out other degenerative brain disorders like Alzheimer’s disease where language and memory and reason are affected.
Aphasia can create numerous quality-of-life problems because communication is so much a part of your life. Communication difficulty may affect your:
- Day-to-day function
Language barriers may lead to embarrassment, depression and relationship problems.
Treatment for aphasia
Research has shown that language and communication abilities can continue to improve for many years and are sometimes accompanied by new activity in brain tissue near the damaged area. Factors that may influence recovery include the cause of the brain injury, the area of the brain that was damaged and its extent, and the age and health of the individual.
Aphasia therapy aims to improve a person’s ability to communicate by helping him or her to use remaining language abilities, restore language abilities as much as possible, and learn other ways of communicating, such as gestures, pictures, or the use of electronic devices. Individual therapy focuses on the specific needs of the person, while group therapy offers the opportunity to use new communication skills in a small-group setting.
“Virtual” speech pathologists provide patients with the flexibility and convenience of getting therapy in their homes through a computer. The use of speech-generating applications on mobile devices like tablets can also provide an alternative way to communicate for people who have difficulty using spoken language.
Increasingly, patients with aphasia participate in activities, such as book clubs, technology groups, and art and drama clubs. These experiences help patients regain their confidence and social self-esteem, in addition to improving their communication skills.
Advanced treatment research
A relatively new area of interest in aphasia research is noninvasive brain stimulation in combination with speech-language therapy. Two such brain stimulation techniques, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), temporarily alter normal brain activity in the region being stimulated.
Prognosis of aphasia
Most improvement occurs within the first few months and plateaus after one year. A person with aphasia may never regain their full speech and language skills. Patients with Broca’s aphasia appear to have the best prognosis for improvement of language function in the first year of stroke. The extent of improvement in patients with global aphasia is better than that of patients with Wernicke’s aphasia.
As much as people with aphasia need to improve their word finding and sentence comprehension, they also need to boost their confidence, maintain hope, and find purpose.