See our Stroke Home Page for a full list of information relating to Stroke, Dysarthria, Aphasia, and startegies for improving communication.
Aphasia
Aphasia or dysphasia is a language disorder caused by damage to the brain. It can affect expressive language (the words and sentences we speak), or receptive language (the words and sentences we hear and understand), or both. Aphasia is often occurs as a result of a stroke or brain injury and can be a lifelong difficulty following brain damage. Although some people never fully recover, there are a number of strategies and options to help with communication.
Expressive Language – Our expressive language skills allow us to speak, say words, make grammatically accurate sentences that make sense, repeat words, and use the correct pitch and intonation.
Receptive Language – Our receptive language skills help us to understand words and sentences, follow instructions, and monitor our own speech to make sure what we say makes sense. Receptive language skills also allow us to understand subtle and abstract language such as sarcasm and metaphors.
Word Finding Difficulties (anomia) – an individual with word finding difficulties may see a picture of something familiar like a picture of a seagull, but be unable to think of the name of the bird. They might be able to say “bird“, or a word closely related that sounds similar, such as “sea-lion“. Sometimes they may say a word completely unrelated.
Perseveration – When this occurs, an individual may continue to repeat the same word. For instance, they might be shown a picture of an elephant, and they can say “elephant“, they are then shown a picture of a horse and they again say “elephant“. It is as though they are stuck on this particular word.
Spontaneous Speech – these are the spoken, grammatically correct sentences we use everyday without any prompting.
Fluent Speech – these are spoken sentences and words that are clear and not interrupted by pauses, errors, jargon, or “umms” and “ahhs”
There are different types of aphasia, depending on the area of brain damage, and these aphsia’s present with different symptoms:
Global Aphasia
With global aphasia there is a more general deficit across many cognitive functions and speech, language and literacy skills are all affected to some extent. Speech may consist of a few single words or syllables, understanding, reading and writing may all be impaired.
Broca’s Aphasia
This is more of an expressive aphasia. When only the Broca’s area of the brain is affected the individual can understand most spoken words and language, but has difficulties expressing language. The individual may have word finding difficulties, non-fluent and reduced ungrammatical speech. The word finding difficulties may be particularly prominent, and the individual may often use the wrong words, such as “spoon” instead of “fork”. Other people may get stuck on a particular word (perseveration) and keep repeating it, or they may just use key words e.g. “arrive 9 o’clock station pick-up“.
Wernicke’s Aphasia
When only the Wernicke’s area is damaged the patient’s understanding of language is affected, and he may also be unable to monitor his own language. A lack of self-monitoring means that he will not be able to make sure that what he says makes sense or is in context. Speech may be fluent, but the individual may use a lot of the wrong words. Writing may also be impaired. People with Wernicke’s aphasia may have difficulties understanding what you say or following instructions.
Conduction Aphasia
Sometimes also called Associative Aphasia, this type of aphasia produces fluent speech, but the speech is often interrupted with frequent variations of particular words which are produced as self corrections. These individuals are aware of their speech errors, but have difficulty correcting them. For instance, when asked to say elephant, a person with this type of aphasia may make several incorrect attempts. However, they may be able to talk spontaneously about elephants in grammatically correct sentences when not expected to repeat the word. Despite understanding sentences, these individuals have difficulty repeating sentence. Comprehension is generally well preserved, and for many individuals this type of aphasia causes only mild difficulties.
Transcortical Motor Aphasia
With this aphasia, individuals are able to name items, but spontaneous conversational speech is difficult. These individuals do not speak much and have difficulty initiating conversation.
Transcortical Sensory Aphasia
With this type of aphasia the individual has fluent speech, but it is often jargon, or the person repeats what others are saying. There is also a severe impairment of oral and written comprehension.
Anomic Aphasia
Word finding difficulties in spontaneous speech or naming tasks is very evident with this aphasia. However comprehension is usually good, as is repetition.
There are a number of aphasia therapy approaches for Stroke and CVA. These include trying to stimulate the patient to facilitate a communicative response, or using shaping or fading techniques to train the individual to develop an appropriate response. Another approach is reorganizing the function of the brain, so the undamaged parts compensate for the damaged.
The Pragmatic approach looks to restore communicative competence by using any modalities (other communication options) available, such as gesture, drawing, writing etc. Other approaches isolate the different areas of function of the brain and pinpoint areas of difficulty/impairment and then perform therapy try and increase language and communication skills. For instance, if an individual has a naming disorder, work is done with of picture naming tasks to develop strategies aid word retrieval.
The success of these approaches may very well depend on the severity of the stroke, the area of brain damage, and the frequency and intensity of therapy. Some therapists may use a combination of approaches. Unfortunately, if the stroke is severe, it is unlikely that any of these approaches will be able to allow an individual to return to normal, full cognitive and communicative functioning. However, therapy may help an individual make some progress back towards normal functioning and/or give them other compensatory strategies to help with cognitive tasks and communication.
Strategies need to be put in place for the individual, and those around the individual have to be much more aware of their communication. See our Download Centre for more detailed infromation sheets relating to Stroke, Total Communication, and strategies to facilitate communication. icommunicate will also provide resources such as picture communication charts to the facilitate communication following stroke.
For more information about communication difficulties, and ideas and strategies to help communication, see our Resources, or for specific fact-sheets and picture charts with helpful hints about Stroke and improving communication go to the Downloads Section.
Recommended Reading
For a wider range of books, click here to see our Bookshop.