Coping and support

People with aphasia

If you have aphasia, the following tips may help you communicate with others:

• Carry a card explaining that you have aphasia and what aphasia is.
• Carry identification and information on how to contact significant others.
• Carry a pencil and a small pad of paper with you at all times.
• Use drawings, diagrams or photos as shortcuts.
• Use gestures or point to objects.

Family and friends

Family members and friends can use the following tips when communicating with a person with aphasia:

• Simplify your sentences and slow your pace.
• Keep conversations one-on-one initially.
• Allow the person time to talk.
• Don’t finish sentences or correct errors.
• Reduce distracting noise in the environment.
• Keep paper and pencils or pens available.
• Write a key word or a short sentence to help explain something.
• Help the person with aphasia create a book of words, pictures and photos to assist with conversations.
• Use drawings or gestures when you aren’t understood.
• Involve the person with aphasia in conversations as much as possible.
• Check for comprehension or summarize what you’ve discussed.

Support groups

Local chapters of such organizations as the National Aphasia Association, the American Stroke Association, the American Heart Association and some medical centers may offer support groups for people with aphasia and others affected by the disorder. These groups provide people with a sense of community, a place to air frustrations and learn coping strategies. Ask your doctor or speech-language pathologist if he or she knows of any local support groups.

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Tests and diagnosis

Your doctor will likely give you a physical and a neurological exam, test your strength, feeling and reflexes, and listen to your heart and the vessels in your neck. He or she will likely request an imaging test, usually an MRI, to quickly identify what’s causing the aphasia.

You’ll also likely undergo tests and informal observations to assess your language skills, such as the ability to:

• Name common objects
• Engage in a conversation
• Understand and use words correctly
• Answer questions about something read or heard
• Repeat words and sentences
• Follow instructions
• Answer yes-no questions and respond to open-ended questions about common subjects
• Read and write

Treatments and drugs

If the brain damage is mild, a person may recover language skills without treatment. However, most people undergo speech and language therapy to rehabilitate their language skills and supplement their communication experiences. Researchers are currently investigating the use of medications, alone or in combination with speech therapy, to help people with aphasia.

Speech and language rehabilitation

Recovery of language skills is usually a relatively slow process. Although most people make significant progress, few people regain full pre-injury communication levels.

For aphasia, speech and language therapy tries to improve the person’s ability to communicate by restoring as much language as possible, teaching how to compensate for lost language skills and finding other methods of communicating.

Therapy:

• Starts early. Some studies have found that therapy is most effective when it begins soon after the brain injury.
• Often works in groups. In a group setting, people with aphasia can try out their communication skills in a safe environment. Participants can practice initiating conversations, speaking in turn, clarifying misunderstandings and fixing conversations that have completely broken down.
• May include use of computers. Using computer-assisted therapy can be especially helpful for relearning verbs and word sounds (phonemes).

Medications

Certain drugs are currently being studied for the treatment of aphasia. These include drugs that may improve blood flow to the brain, enhance the brain’s recovery ability or help replace depleted chemicals in the brain (neurotransmitters). Several medications, such as memantine (Namenda) and piracetam, have shown promise in small studies. But more research is needed before these treatments can be recommended.

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Preparing for your appointment

If your aphasia is due to a stroke or head injury, you’ll probably first see an emergency room physician. You’ll then see a doctor who specializes in disorders of the nervous system (neurologist), and you may eventually be referred to a speech-language pathologist for rehabilitation.

Because this condition generally arises as an emergency, you won’t have time to prepare. If possible, bring the medications or supplements you take with you to the hospital so that your doctor is aware of them.

When you have follow-up appointments, you’ll likely need a companion to drive you to your doctor’s office. In addition, this person may be able to help you communicate with your doctor.

Some questions a loved one or friend may want to ask your doctor include:

• What’s the most likely cause of these speech difficulties?
• Are tests needed?
• Is aphasia temporary or long lasting?
• What treatments are available for aphasia, and which do you recommend?
• Are there services available, such as speech-language therapy or home health assistance?
• Are there ways to help my loved one understand others or communicate more effectively?

What to expect from your doctor

Your doctor will likely have questions, too. A loved one or friend can help your doctor get the information needed. Your doctor may ask:

• When did the symptoms start?
• Do you understand what others are saying?
• Do others understand what you’re saying?
• Has the aphasia been continuous, or does it come and go?
• Have you noticed changes in your speech – such as the way you move your jaw, tongue and lips to make speech sounds – or the sound of your voice?
• Have you noticed changes in your ability to understand what you read or your ability to spell and write sentences?

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Causes

The most common cause of aphasia is brain damage resulting from a stroke — the blockage or rupture of a blood vessel in the brain. Loss of blood to the brain leads to brain cell death or damage in areas that control language.

Brain damage caused by a severe head injury, a tumor, an infection or a degenerative process also can cause aphasia. In these cases, the aphasia usually occurs with other types of cognitive problems, such as memory problems or confusion.

Primary progressive aphasia is the term used for language difficulty that develops gradually. This is due to the gradual degeneration of brain cells located in the language networks. Sometimes this type of aphasia will progress to a more generalized dementia.

Sometimes temporary episodes of aphasia can occur. These can be due to migraines, seizures or a transient ischemic attack (TIA). A TIA occurs when blood flow is temporarily blocked to an area of the brain. People who’ve had a TIA are at an increased risk of having a stroke in the near future.

Complications

Aphasia can create numerous quality-of-life problems because communication is so much a part of your life. Communication difficulty may affect your:

• Job
• Relationships
• Day-to-day function

Language barriers may lead to embarrassment, depression and relationship problems.

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Definition

Aphasia is a condition that robs you of the ability to communicate. It can affect your ability to speak, write and understand language, both verbal and written.

Aphasia typically occurs suddenly after a stroke or a head injury. But it can also come on gradually from a slow-growing brain tumor or a disease that causes progressive, permanent damage (degenerative). Where and how bad the brain damage is and what caused it determine the degree of disability.

Once the cause has been addressed, the main treatment for aphasia is speech and language therapy. The person with aphasia relearns and practices language skills and learns to use other ways to communicate. Family members often participate in the process, helping the person communicate.

Symptoms

Aphasia is a sign of some other condition, such as a stroke or a brain tumor.

A person with aphasia may:

• Speak in short or incomplete sentences
• Speak in sentences that don’t make sense
• Substitute one word for another or one sound for another
• Speak unrecognizable words
• Not understand other people’s conversation
• Write sentences that don’t make sense

The severity and scope of the problems depend on the extent of damage and the area of the brain affected.

Types of aphasia

Your doctor may refer to aphasia as nonfluent, fluent or global:

• Nonfluent aphasia. Damage to the language network near the left frontal area of the brain usually results in Broca aphasia, which is also called nonfluent aphasia. People with this disorder struggle to get words out, speak in very short sentences and omit words. A person might say “Want food” or “Walk park today.” A listener can usually understand the meaning.

  People with Broca aphasia may understand what other people say better than they can speak. They’re often aware of their difficulty communicating and may get frustrated. People with Broca aphasia may also have right-sided paralysis or weakness.

• Fluent aphasia. People with this form of aphasia may speak easily and fluently in long, complex sentences that don’t make sense or include unrecognizable, incorrect or unnecessary words. They usually don’t understand spoken language well and often don’t realize that others can’t understand them. Also known as Wernicke aphasia, this type of aphasia is the result of damage to the language network in the middle left side of the brain.
• Global aphasia. Global aphasia results from extensive damage to the brain’s language networks. People with global aphasia have severe disabilities with expression and comprehension.

When to see a doctor

Because aphasia is often a sign of a serious problem, such as a stroke, seek emergency medical care if you suddenly develop:

• Difficulty speaking
• Trouble understanding speech
• Difficulty with word recall
• Problems with reading or writing

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Measurement of Outcomes (AA: MoO)

Purpose

In order to determine if speech-language therapy has positive effect, reliable measurement tools are required to document outcomes. Currently, there is very limited information concerning the measurement of changes in speech production as a result of treatment for acquired apraxia of speech and aphasia. This study will obtain information concerning the reliability of several speech production measures over time. Thirty persons with chronic aphasia and apraxia of speech will be asked to provide speech samples in response to commonly used assessment tools on three sampling occasions so that the stability of measurements may be examined.

After establishment of appropriate outcome measures, a small, pilot treatment study will be conducted with four participants. The participants will receive a new treatment for aphasia and acquired apraxia of speech and outcomes will be measured relative to speech and language production.

Detailed Description:

A single group, repeated measures design will be used to obtain repeated speech samples from 30 persons with chronic acquired apraxia of speech and aphasia. Speech samples will be elicited using commonly employed motor speech assessment protocols; an initial sample, a sample one week following the initial sample, and a sample at four weeks following the initial sample. The following measures will be obtained from the samples: percent consonants correct, percent fluent utterances, and duration of utterance. Stability of the measures will be examined.

After the preceding measures have been analyzed, a series of four, single-subject experimental designs will be conducted. Four participants with chronic aphasia and apraxia of speech will receive a new treatment for aphasia and apraxia of speech applied sequentially to two sets of experimental picture picture stimuli. Outcomes will be measured in terms of speech production (measures described above) as well as in terms of language production.

Criteria

Inclusion Criteria:

• Veterans or nonveterans with aphasia and apraxia of speech who reside in the Salt Lake City region (commutable),
• 12 months or more post stroke or other focal brain injury, no other neurological conditions,
• Native English speakers, hearing adequate for experimental task (e.g., pass puretone screening at 35dB at 500, 1K, 2K Hz),
• Non linguistic cognition within normal limits

Exclusion Criteria:

• Less than 12 months post stroke,
• Insufficient hearing, insufficient non linguistic cognitive skills,
• Neurological conditions other than stroke,
• More than one stroke or brain injury,
• Unable to attend treatment in the Salt Lake City vicinity

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below.

Contact: Julie L Wambaugh, PhD

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Communication Strategies: Some Do and Don’t

The impact of aphasia on relationships may be profound, or only slight. No two people with aphasia are alike with respect to severity, former speech and language skills, or personality. But in all cases it is essential for the person to communicate as successfully as possible from the very beginning of the recovery process. Here are some suggestions to help communicate with a person with aphasia:

• Make sure you have the person’s attention before you start.
• Minimize or eliminate background noise (TV, radio, other people).
• Keep your own voice at a normal level, unless the person has indicated otherwise.
• Keep communication simple, but adult. Simplify your own sentence structure and reduce your rate of speech. Emphasize key words. Don’t “talk down” to the person with aphasia.
• Give them time to speak. Resist the urge to finish sentences or offer words.
• Communicate with drawings, gestures, writing and facial expressions in addition to speech.
• Confirm that you are communicating successfully with “yes” and “no” questions.
• Praise all attempts to speak and downplay any errors. Avoid insisting that that each word be produced perfectly.
• Engage in normal activities whenever possible. Do not shield people with aphasia from family or ignore them in a group conversation. Rather, try to involve them in family decision-making as much as possible. Keep them informed of events but avoid burdening them with day to day details.
• Encourage independence and avoid being overprotective.

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What is Aphasia?

Aphasia is an acquired communication disorder that impairs a person’s ability to process language, but does not affect intelligence. Aphasia impairs the ability to speak and understand others, and most people with aphasia experience difficulty reading and writing. The diagnosis of aphasia does NOT imply a person has a mental illness or impairment in intelligence.

What Causes Aphasia?

The most common cause of aphasia is stroke (about 25-40% of stroke survivors acquire aphasia). It can also result from head injury, brain tumor or other neurological causes.

How Common is Aphasia?

Aphasia affects about one million Americans -or 1 in 250 people- and is more common than Parkinson’s Disease, cerebral palsy or muscular dystrophy. More than 200,000 Americans acquire the disorder each year. However, most people have never heard of it.

Who Acquires Aphasia?

While aphasia is most common among older people, it can occur in people of all ages, races, nationalities and gender.

Can a Person Have Aphasia Without Having a Physical Disability?

Yes, but many people with aphasia also have weakness or paralysis of their right leg and right arm. When a person acquires aphasia it is usually due to damage on the left side of the brain, which controls movements on the right side of the body.

Can People Who Have Aphasia Return to Their Jobs?

Sometimes. Since most jobs require speech and language skills, aphasia can make some types of work difficult. Individuals with mild or even moderate aphasia are sometimes able to work, but they may have to change jobs.

How Long Does it Take to Recover from Aphasia?

If the symptoms of aphasia last longer than two or three months after a stroke, a complete recovery is unlikely. However, it is important to note that some people continue to improve over a period of years and even decades. Improvement is a slow process that usually involves both helping the individual and family understand the nature of aphasia and learning compensatory strategies for communicating.

Does Aphasia Affect a Person’s Intelligence?

NO. A person with aphasia may have difficulty retrieving words and names, but the person’s intelligence is basically intact. Aphasia is not like Alzheimer’s disease; for people with aphasia it is the ability to access ideas and thoughts through language – not the ideas and thoughts themselves- that is disrupted. But because people with aphasia have difficulty communicating, others often mistakenly assume they are mentally ill or have mental retardation.

Are All Cases of Aphasia Alike?

No. There are many types of aphasia.Some people have difficulty speaking while others may struggle to follow a conversation. In some people, aphasia is fairly mild and you might not notice it right away. In other cases, it can be very severe, affecting speaking, writing, reading, and listening. While specific symptoms can vary greatly, what all people with aphasia have in common are difficulties in communicating.

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There are a number of different kinds of problems that might hinder a person with aphasia from being able to say what they would like to say. The first thing to emphasize is that people with aphasia know what they would like to say, but they have difficulty finding the words they need to communicate their message.

Sometimes a person with aphasia might be able to picture an object, person, place, or other message, and just not be able to think what it is called. This is a phenomenon that happens to all of us occasionally, but for the person with aphasia it can be a constant state. Other times, a person with aphasia might know what they want to say, but a related word comes out instead. For example, the person might say “dog” when they mean to say “cat”. Other times, the sounds that make up the word that they want to say come out in the wrong order. For example, if the person wants to say “table”, it could come out “batle”. This might seem like nonsense sometimes, but it is a problem of the brain failing to select the right sounds for the intended word. Finally, some people with aphasia have great difficulty saying verbs and other small words that are important grammatical words, like articles and prepositions. These individuals sound like they are speaking in telegraphic language. For example, the person might want to say “I went to dinner with my family” but it comes out “Me and family dinner”.

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Some people with aphasia may have trouble thinking of the word that they want to write, even though they know the meaning or message that they want to communicate. In this case, the person will not be able to write the word or say it, because they cannot think of the word itself. We have all experienced this kind of problem, often called “tip of the tongue”. You know the name of a person, place, or object, you can picture it clearly, you can describe it, but you just can’t think of the name of it. When this happens to you, you can neither say the word nor write it.

In other cases, the person with aphasia may know the word that they would like to write, and they might be able to say it, but they can’t write it. In this case, the sounds that need to be put together to say the word are accessible, but the spelling of the word is not. This may seem odd to those of us without aphasia. Our abilities to pronounce words and write them are so closely intertwined that it is hard for us to imagine being able to do one but not the other. But that is what can happen in aphasia.

Sometimes certain kinds of information about the word is available. Sometimes a related word might end up being written, for example, writing “apple” when you want to write “banana”. Other times the person with aphasia might be able to write the first letter, or draw slots for how many letters are in the word, or write the first and last letters, but make mistakes on the remaining letters. In this case, preserved information about what the written word looks like is there, but it’s not complete.

Some people with aphasia might write extra letters or words, or even write down non-words.

Finally, some people who have a nonfluent type of aphasia might be able to write some words but omit “little” words or have more trouble with verbs. They will have more trouble writing sentences.

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