A single copy of this article may be reprinted for personal, noncommercial use only.
AphasiaBy Mayo Clinic staff
Original Article: http://www.mayoclinic.com/health/aphasia/DS00685
Aphasia is a condition that robs you of the ability to communicate. Aphasia can affect your ability to express 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 slowly growing brain tumor or a degenerative disease. The amount of disability depends on the location and the severity of the brain damage.
Once the underlying cause has been treated, the primary treatment for aphasia is speech therapy that focuses on relearning and practicing language skills and using alternative or supplementary communication methods. Family members often participate in the therapy process and function as communication partners of the person with aphasia.
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
- Speak unrecognizable words
- Not comprehend other people's conversation
- Interpret figurative language literally
- 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. Some people may comprehend what others say relatively well but struggle to find words to speak. Other people may be able to understand what they read but yet can't speak so that others can understand them.
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 leave out words. A person might say "Want food" or "Walk park today." Although the sentences aren't complete, a listener can usually understand the meaning. A person with Broca aphasia may comprehend what other people say to some degree. People with this type of aphasia are often aware of their own difficulty in communicating and may get frustrated with these limitations. Additionally, people with Broca aphasia may also have right-sided paralysis or weakness.
- Fluent aphasia. Wernicke aphasia is the result of damage to the language network in the middle left side of the brain. It's often called fluent aphasia. People with this form of aphasia may speak fluently in long, complex sentences that don't make sense or include unrecognizable, incorrect or unnecessary words. They usually don't comprehend spoken language well and often don't realize that others can't understand what they're saying.
- 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 comprehending speech
- Difficulty with word recall
- Problems with reading or writing
The most common cause of aphasia is brain damage resulting from a stroke — the blockage or rupture of a blood vessel in the brain. This disruption of the blood supply leads to brain cell death or damage in areas of the brain controlling 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.
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.
Preparing for your appointment
If your aphasia is due to a stroke or head injury, you'll probably first be seen by an emergency room physician. You'll then be seen by 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 any time to prepare. If possible, bring any medications or supplements that you take with you to the hospital so that your doctor is aware of what you've taken.
When you have follow-up appointments, you'll likely need a friend or loved one 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 any tests needed?
- Is aphasia temporary or long lasting?
- What treatments are available for aphasia, and which do you recommend?
- Are there any types of services available, such as speech-language therapy or home health assistance?
- Is there any way 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 he or she needs. Your doctor may ask:
- When did the symptoms first 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 any 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 any changes in your ability to understand what you read or your ability to spell and write sentences?
Tests and diagnosis
Your doctor will likely request an imaging test, such as a computerized tomography (CT) scan or magnetic resonance imaging (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
- Tell a story or explain the plot of a story
- Explain a joke or a figurative phrase, such as "I need to unwind"
- Read and write letters, words and sentences
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. In aphasia, speech and language therapy:
- Starts early. Therapy is most effective when it begins soon after the brain injury.
- Builds on success. The speech-language pathologist uses exercises to improve and practice communication skills. These may begin with simpler tasks such as naming objects and evolve into more complex exercises of explaining the purpose of an object.
- Shifts focus. The speech-language pathologist might teach the person ways to compensate for the language impairment and to communicate more effectively with gestures or drawings. Some people with aphasia may use a book or board with pictures and words to help them recall commonly used words or help them when they're stuck.
- 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 outings. Participating in real-life situations — such as going to a restaurant or a grocery store — puts rehabilitation efforts into practice.
- May include use of computers. Using computer-assisted therapy can be especially helpful for relearning verbs and word sounds (phonemes).
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.
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 down 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 readily 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.
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.
- Clark DG. Approach to the patient with aphasia. http://www.uptodate.com/index. Accessed March 7, 2012.
- Aphasia. The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merckmanuals.com/professional/neurologic_disorders/function_and_dysfunction_of_the_cerebral_lobes/aphasia.html#v1034169. Accessed March 23, 2012.
- Aphasia. American Speech-Language-Hearing Association. http://www.asha.org/public/speech/disorders/Aphasia.htm. Accessed March 23, 2012.
- Clark DG. Aphasia: Prognosis and treatment. http://www.uptodate.com/ index. Accessed March 7, 2012.
- Aphasia. National Institute on Deafness and Other Communication Disorders. http://www.nidcd.nih.gov/health/voice/Pages/aphasia.aspx. Accessed March 23, 2012.
- Aphasia: Benefits of speech-language pathology services. American Speech-Language-Hearing Association. http://www.asha.org/public/speech/disorders/AphasiaSLPBenefits.htm. Accessed March 23, 2012.