What is Aphasia? 

Aphasia, pronounced uh-fay-zhuh, is a language disorder due to brain damage.  It comes from the Greek word phasia meaning speech.   When many people think of language they focus on verbal expression, but this is only one component of language. 

In addition to verbalizing, language involves comprehension for both spoken and written words.  It involves spelling and writing.  It involves nonverbal communication such as gesturing and the understanding of gestures and numbers.

And the verbal part has many components as well, including vocabulary, grammar, sentence length and word order.  So a person with aphasia could have problems with:

• Understanding spoken words
• Understanding written words
• Comprehending the meaning of gestures or symbols
• Spelling and writing
• Word-finding
• Sentence formulation
• Grammar
• Math

A common analogy is that having aphasia is similar to visiting a foreign country and not knowing the language very well, or in some cases not at all.  It’s this type of challenge that people with aphasia struggle with on a daily basis.

The severity and type of deficits with aphasia can vary widely and depend on where and how much of the brain has been affected.  

What causes aphasia?

The brain is divided into two halves called hemispheres.  In most people language is located on the left side, called the dominant hemisphere.  A stroke in this left hemisphere is the major cause of aphasia. 

A stroke cuts off the blood supply to the brain with a blood clot or hemorrhage and results in the brain damage causing aphasia.  Aphasia can also be caused by brain damage from head trauma, neurological disease or dementia.

What are the different types of aphasia?

• Broca’s aphasia causes non-fluent, hesitant, ungrammatical and sometimes labored speech.  Single words or short phrases with words left out may make speech sound like a telegram.  Comprehension is sometimes less impaired.  The Broca’s areas of the brain is near the motor area for the face, arm and leg, so the individual may also have some paralysis.
• Wernicke’s aphasia can cause nonsensical, jargonistic speech which is fluent and may be grammatically intact, but often empty of significant content.  Reading   and auditory comprehension are usually impaired.  
• Global aphasia causes severe deficits in both speech and comprehension.  There is little or no speech or comprehension of speech.  Writing and gesturing are significantly impaired.
• Mixed aphasia does not fit neatly into the above categories and can contain components of both Broca’s and Wernicke’s aphasia.

Are there some general characteristics of aphasia?

After saying that aphasia is highly varied and one size does not fit all, there are some very general characteristics to note:

• More processing time is often needed.  Repetitions may help.  Allow more time for responding.
• There may be decreased adaptation to new situations, especially those requiring language.  It may take a longer time understanding new tasks or instructions.
• Noise sensitivity may be increased.  Keep the environment quiet.
• Perseveration.  There may be a tendency to repeat words or actions with difficulty switching from one to another.
• Behavioral changes may occur such as anxiety, withdrawal, depression, and frustration.
• Some individuals have more difficulty communicating with multiple people present.  One-to-one communication may be better, especially at first.
• Certain times of the day may be better for communication and other activities.
• Intelligence is often intact, so the person with aphasia often can understand situations, humor and participate in nonverbal activities.

How is aphasia treated?

Because aphasia varies widely in the type of deficits, the treatment for aphasia is highly individualized.  A speech-language pathologist can evaluate all components of language, including oral language, auditory comprehension, reading comprehension, writing and spelling skills, math, cognitive skills and functional gesturing. 

My book contains a series of exercises to help people cope with aphasia and other cognitive conditions that effect speech, communication, and memory loss.

A treatment plan would likely target several areas of deficit, including auditory comprehension, or understanding of speech, which is the basis for language acquisition.

Will aphasia get better?

Good question.  Yes, it does get better for most people.  There are some exceptions in the case of severe global aphasia which may not improve significantly.  There are several factors that can impact progress:

• Severity of deficit at onset.  Milder deficits at the beginning tend to improve a little more.
• Age.  Sometimes younger individuals improve a little faster and more.
• Good comprehension.  When we learn language we first comprehend it before using it orally in a meaningful way.  So if a person has good comprehension, this can help the acquisition of other language skills.
• Support systems.  Common sense tells us that a person recovering from a disability will benefit from love, optimism, encouragement and good therapy.
• Stimulating social environment.  This provides opportunities and motivation for meaningful communication.
• Motivation.  It can take a lot of work to recover communication skills.
• Spontaneous recovery.  This is the recovery that the brain makes on its own following the stroke or injury.  It happens in the first 30-60 days following the stroke and varies significantly from person to person.

Some people show amazing improvement right after a stroke.  However, many stroke survivors will tell you that they feel they are continuing to recover even years after their stroke or injury.

In summary, aphasia is a complicated communication disorder caused by brain damage.  The characteristics of aphasia are varied, from very mild problems with word-finding or spelling to little or no speech or comprehension.  Recovery is also varied, but most people with aphasia are able to improve functional communication and live meaningful lives.