Aphasia
See also: Voice DisordersAphasia is when someone has difficulty with their language or speech. It is generally a neurological problem caused by damage to the left side of the brain. This may happen, for example, following a stroke, a brain tumour or a traumatic head injury. It is not a mental illness or issue with intelligence, only expression and understanding.
Some people with aphasia are aware that they have trouble speaking or understanding. However, others are unaware of the issue, leading to frustration when others do not understand them, or they are unable to sustain a conversation. This page explains more about the condition, including causes, symptoms and treatment.
Understanding Aphasia
Aphasia is, effectively, a loss of language.
People with aphasia tend to have trouble with all four uses of language: reading, listening, speaking and writing. Aphasia can therefore cause problems with communication, and can be considered a barrier to effective communication.
Aphasia or dysphasia?
Another term similar to aphasia that may be used to describe language difficulties is dysphasia. Some sources suggest that there is a distinction between the two, and aphasia may describe a total loss of language, while dysphasia is used for a partial loss. However, in healthcare, the term aphasia is now commonly used for both because of the potential confusion caused by the use of two similar terms (and also between dysphasia and dysphagia, difficulty swallowing).
In other words, there is no longer really a distinction, and only the term aphasia is used.
Aphasia is surprisingly common. The Stroke Association estimates that over 300,000 people in the UK live with this condition.
Aphasia can be divided into two main different types:
‘Expressive’ aphasia; and
‘Receptive’ aphasia.
The distinction depends on whether people have difficulty expressing themselves or understanding. People with both may be described as having ‘global’ aphasia.
It is important to emphasise that aphasia has nothing to do with intelligence. People with aphasia generally know what they want to say, but they are unable to express their meaning. They may describe themselves as ‘stupid’, or ‘feeling stupid’, but this is not the case.
Aphasia following a stroke has been described as a filing cabinet that has fallen over. The words are there in the jumble, but it can be difficult to find them.
Read and Spell blog on aphasia.
Causes of Aphasia
Aphasia is caused by damage to the part of the brain that manages speech and language.
This might happen through a traumatic head injury, or through a stroke, or brain tumour. The Stroke Association estimates that around one-third of people who have a stroke develop aphasia.
It can also happen over time to people with progressive neurological conditions such as dementia. It is generally more common among older people, but mostly because strokes and dementia are more likely among this age group.
If aphasia occurs suddenly, without an obvious head injury, you should see a doctor to check for the underlying causes.
To identify aphasia, doctors may carry out simple tests such as asking people to describe objects in the room, or read a piece of text and write something. They may also use scans and other imaging to check for underlying brain damage.
Temporary aphasia
There are also conditions that can cause temporary aphasia. These include migraines and epilepsy. For example, someone having a migraine may be unable to speak or write clearly. They may be able to hear that they are not speaking coherently, or it may only be apparent when people stare at them as they speak.
Symptoms of Aphasia
Aphasia appears differently in different people.
Generally, most people with aphasia seem to have trouble speaking. This is a form of expressive aphasia. Expressive aphasia also affects writing or typing: anything that requires ‘outward’ communication.
People with expressive aphasia may therefore use the wrong word, or be unable to think of the work that they want to use. They may also put sounds together incorrectly, so that it sounds like they are using nonsense words. Their sentences may also not make sense. They might miss out words from the sentence, and start to use basic language like a young child (“I go now”, “I hungry”). They may also speak very slowly, or with frequent pauses to think of the word they want to use. Another area that is often difficult for people with aphasia is telling the time or using money.
This is complicated still further because some people with aphasia are aware of the issue. However, others hear their own words ‘correctly’, and therefore find it frustrating when other people do not understand them.
People with receptive aphasia have trouble understanding language. This might mean that they do not understand what is said to them, but it may also affect understanding of written language, and even gestures, pictures or drawings. This is harder to identify, but can often emerge because their answers to questions, or contributions to a conversation, do not make sense.
The symptoms may also develop at different paces in different people.
For those who have a brain injury such as a stroke or a head injury, the symptoms will usually start immediately after the event. However, symptoms usually develop more gradually in people with a progressive condition like dementia, or a brain tumour.
Dementia and aphasia
The most common forms of dementia are generally associated with fairly mild symptoms of aphasia. For example, people with dementia may forget the names of people or places even though they recognise the person or a picture of the place.
However, there is also a rarer form of dementia that causes severe aphasia. This is known as primary progressive aphasia. In this form, aphasia is usually the first sign of dementia, but later the person may also have problems with movement, memory, and thinking, and experience behavioural changes.
Treatment for Aphasia
The main treatment for aphasia is speech and language therapy.
Speech therapists aim to either help people to recover some of their language, or teach them alternative ways to communicate. There are now several apps that can help, but it is generally best to start using them with the help of a speech therapist, rather than using them by yourself, without support.
It is important to seek treatment for aphasia, because many people recover quite a lot of language with the help of speech therapy.
This is particularly true for those who have had a sudden brain injury such as a stroke or head injury, but less true for those with progressive conditions. For them, speech therapy is likely to focus on finding other ways to communicate that they will be able to use when their condition worsens.
Aphasia can mean that people become isolated, and this may in turn lead to depression.
Finding out more
To find out more about how to get help and support with aphasia, you may want to look at the NHS website in the UK.
Various charities and non-governmental bodies also have useful information on their websites, including the Stroke Association
The Aphasia Alliance is a group of organisations that provides help for people with aphasia and their families.
Communicating with Someone with Aphasia
There are several techniques that may be useful for communicating with someone with aphasia. These include:
After you have spoken, give the person with aphasia plenty of time to respond. Don’t rush to fill a conversational ‘gap’, as this may make them feel pressured, and increase anxiety.
Use short, simple sentences.
Don’t jump between conversational topics. Keep the same topic for a while, to give them time to adjust.
Try to avoid open-ended questions. Stick to closed questions (those with a yes/no answer). There is more about this in our page on Types of Questions.
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Don’t finish their sentences, or supply words. As with people who stammer, this can feel patronising and rude.
Switch off background noise, like televisions or radios. This gives them a better chance to hear you, but also minimises distractions. It is also a good idea to make sure that you have their attention before you start to communicate.
If you don’t understand, don’t pretend that you do. Again, this can come across as patronising and rude.
Use visual aids. Draw diagrams, point, gesture, and show them objects to help them to understand better.
Prompt them to think of the word by suggesting strategies such as finding another similar word, explaining the meaning, or even describing the shape of the word.
A Final Thought
Aphasia can be, and often is, a barrier to effective communication.
However, with the right treatment and support, people with aphasia can recover a considerable amount of language—and those around them can also help them to communicate more effectively. Communication is, after all, a two-way street.