What is Aphasia?
Aphasia is a neurological disorder caused by damage to the portions of the brain that are responsible for language. Primary signs of the disorder include difficulty expressing oneself when speaking, trouble understanding speech, and difficulty with reading and writing. Aphasia is not a disease, but a symptom of brain injury. Most commonly seen in adults who have suffered a stroke, aphasia can also result from a brain tumor, infection, head injury, or dementia. It is estimated that about 1 million people in the United States today suffer from aphasia. The type and severity of language dysfunction depends on the location and extent of damaged brain tissue.
Generally, aphasia can be divided into four broad categories:
- Expressive aphasia involves difficulty in conveying thoughts through speech or writing. The person knows what he or she wants to say, but cannot find the words.
- Receptive aphasia involves difficulty understanding spoken or written language. The person hears the voice or sees the print but cannot make sense of the words.
- Patients with anomic or amnestic aphasia (the least severe form of aphasia), have difficulty retrieving and expressing the correct names for particular objects, people, places, or events.
- Global aphasia results from severe and extensive damage to the language areas of the brain. Individuals may lose almost all language function, both comprehension and expression. In varying degrees, they have difficulty speaking and understanding speech, reading, and writing.
In some instances, an individual will completely recover from aphasia without treatment. In most cases, however, language therapy should begin as soon as possible and be tailored to the individual needs of the person. Rehabilitation with a speech pathologist involves extensive exercises in which individuals read, write, follow directions, and repeat what they hear. Computers and other technology have become popular therapy tools.
The outcome of aphasia is difficult to predict given its wide range of variability. Generally, individuals who are younger or have less extensive brain damage fare better. Whether it is permanent or temporary depends on the extent to which the brain cells are damaged and how effectively the body can restore blood supply to these parts. The location of the injury is also important and is another clue to prognosis. In general, patients tend to recover skills in language comprehension more completely than those skills involving expression.
More About Aphasia
Imagine looking at the headlines of the morning newspaper and not being able to recognize the words; or trying to say "put the car in the garage: and it comes out "put the train in the house" or "widdle dee car ung sender plissen." Thousands of alert, intelligent men and women find themselves suddenly plunged into a world of jumbled communication because brain injury has left them with aphasia.
Aphasia may affect how a person understands what is heard and seen (receptive aphasia), as well as the ability to write, gesture and speak (expressive aphasia).
Almost all individuals with aphasia have some difficulty understanding spoken language. The person may not associate the spoken word with a mental object or picture. They may be able to understand a simple command such as "wash your face," but they get lost if you say "Go to the bathroom, wash your face and brush your teeth." Or the longer command may sound like "Go to the bathroom, wash your face and breetle you tucks."
An individual with aphasia may have trouble reading. Some may be able to read single words but not sentences. Others may be able to read sentences but cannot retain all the information contained in a paragraph or story.
The most noticeable characteristic of aphasia is a problem with speech. Most individuals with aphasia have trouble finding or selecting a word. They know the word but can't say it; they recognize the word when spoken. Parts of a sentence may emerge fluently until the person comes to a noun, because naming is the problem. For some brain injury survivors, their only speech may be utterances like "ba-ba-ba," or "no." These automatic utterances may represent counting, expressing a want, or swearing.
The ability to write is also affected by aphasia. In most cases, a person's writing will be about at the same skill level as their speech. In some cases, one must learn to write with the left hand because of paralysis or weakness on the right side of the body. This naturally makes writing harder and more frustrating.
Stroke survivors generally remain mentally alert, even though their speech may be jumbled, fragmented, or totally incoherent, and they may not be able to comprehend words spoken to them. It's like being in a foreign land, unable to speak or understand the native tongue. The problem is not one of intelligence, but of communication.
Stroke survivors with aphasia may also have a weakness or paralysis of the right side of their body, including the face. Some individuals have a visual-field cut and are unable to see objects to one side or another. Uncharacteristic behavior may occur. The survivor may cry or laugh for no apparent reason and have difficulty controlling it. They may also appear confused or become depressed.
Therapy should begin as soon as possible after injury and should be tailored to the individual. Although the results of therapy can never be predicted with certainty, almost all recipients benefit.
Helping Someone Who Has Aphasia Communicate
Communication with individuals struggling with aphasia can be made easier by following these guidelines:
- Include the person in your conversation. No one likes to be ignored.
- Don't talk about the person in their presence, even if they appear unable to respond. ALWAYS assume they can hear and understand.
- It is easier for individuals with aphasia to understand if only one person is speaking to them at a time. Extra noise only creates confusion.
- Talk to the person in a normal tone of voice.
- Be sure to give him or her enough time to respond. This may mean waiting longer than you would like for the person to search for words.
- Ask if help is wanted before prompting.
- Attempt to phrase the conversation so the person can respond. The person should never be forced to respond.
- Stand where he or she can see you. Avoid standing in front of a bright light.
- Use sentences that are short and to the point. For example, instead of saying, "Your wife called and she will be here to pick you up shortly," you could say, "Your wife called." (pause) "She will come to pick you up." (pause) "She will be here shortly."
- Remember that people with aphasia may tire easily from the effort it takes to understand language.
- Since communication is the most important goal, it is not essential that words and grammar be perfect. Initially, there is no need to correct all their attempts.
- Don't pretend to understand. If you're having difficulty understanding the person, be honest. Tell them, "I'm sorry, I don't understand, let's try again."
- If a person with aphasia says a word or phrase once, don't necessarily expect him or her to say it at another time. Ability to retrieve words is variable.
- Above all, remember that even though they have a communication problem, they should be treated as an intelligent adult.
After time, a person may discover ways to retrieve a word or express him- or herself another way. For example, they may visualize how many spaces the letters of a word occupy or they may ask someone who knows them for clues. They may also learn to control frustration by giving up for the time being and trying to communicate again later. It is all right to let this happen.