Frequently asked questions about aphasia

What is aphasia?

Aphasia is the loss of understanding and/or expressing language, usually caused by brain damage, such as from a stroke or traumatic brain injury.  It can also occur as a symptom of dementia.  

What are the symptoms of aphasia?

Aphasia can impact:

  • Your ability to understand other’s speech. It may feel like everyone around you is talking in a foreign language, or it may seem like others just don't make any sense.  You may have a hard time "holding onto" what the person says long enough to respond to it.  
  • Your ability to express yourself.  You may have “fluent” aphasia, where real or nonsense words flow when you speak, but they don’t make sense/aren’t the message you were intending.  You may have “nonfluent” aphasia, where speech is very halting and difficult to get the words out.  
  • Your ability to read. Reading a sentence, a medication bottle, or the newspaper may not make any sense.
  • Your ability to write.  Your hand writes the wrong letters/words, or cannot form the letters at all.  
  • Any combination of the above

Aphasia affects language.  Aphasia does NOT affect intelligence.  Aphasia may make it more difficult and more tiring to pay attention to language and communication, limiting function. Difficulty paying attention and comprehending do affect memory function, and aphasia may limit the ability to accurately participate in cognitive testing. Aphasia is a communication impairment and every effort must be made to allow the person to make and communicate their own decisions.  A skilled speech pathologist will consider the language impairment's impact limiting the results and accuracy of any cognitive testing.

WHAT is apraxia?

Apraxia is a motor disorder where there is a "disconnect" between the brain's motor planning and the body carrying out the action. Often the muscle function and strength is normal, but the actions either don't occur how you want them to (You think "make a fist", but your hand doesn't do it) or the wrong movement occurs (you hold up 1 finger instead of 2, or you say "tac" or "pat" instead of "cat".    The person may or may not recognize the error.  

Apraxia can occur by itself, but more often it occurs with aphasia or dysarthria.  Apraxia is caused by damage to the brain.  It can be caused by a stroke, traumatic brain injury, neurological condition, dementia, brain tumors, or something else.  

Signs of apraxia include:

  • difficulty following directions to open the mouth, or make certain sounds intentionally.
  • rearranged or substituted sounds or syllables.
  • automatic speech (like greetings, or swearing) comes out easier than intentional speech (answering a question).
  • errors are inconsistent.

You can learn more about apraxia at the American Speech Hearing Association's website.

WHAT is dysarthria?

Dysarthria is a disorder in clarity of speech caused by muscle weakness, resulting in the person being harder to understand.  

Signs of dysarthria include:

  • Slurred speech
  • abnormal rate of speech - some people present with slowed rate, others speak rapidly
  • "mumbling"
  • limited tongue, lips, and/or jaw movement
  • difficult to understand

You can learn more about dysarthria at the American Speech Hearing Association's website.

What causes aphasia?

Aphasia is caused by injury to the brain.  It may result from a stroke, traumatic brain injury, seizures, brain atrophy (as in dementia), or other causes.

How common is aphasia?

    Over 2,000,000 Americans have aphasia.  It’s more common that Parkinson’s or many other disorders, yet not well-known.   It affects more than 1 in 250 people.  Nearly 180,000 Americans acquire this isolating disorder every year.

How is aphasia treated?

Aphasia is treated with speech therapy provided by a certified Speech Pathologist.  The SLP will develop an individualized program using research-based techniques designed to help the person recover communication skills while also compensating for deficits.  Alternative communication like a communication board or signs/gestures may be used to allow the client to communicate effectively. Family members and any possible caregivers are an important part of the process to help the client practice.  Learn more about Speech Spark’s approach to aphasia recovery (LINK)

 

How long does it take to recover?

    It depends on many factors including: age, severity and location of injury, medical complications, support system. Some people recover completely in 2-3 months.  Others, with hard work, patience, compensation and practice, can continue to improve over several years or decades.  Some people never fully "recover".  Often a person's goals shift from "What I was like before the stroke" to "What will make my current situation more successful / satisfying".   

Is aphasia the only communication problem after a stroke?   What else could be causing the problem?

A stroke can damage the nerve pathways, causing weakness or paralysis.  This can happen in an arm or a leg.  It can also occur on the face and result in dysarthria, a muscle weakness which can make it harder to effectively make speech sounds.  The person’s speech may sound slurred or distorted and difficult to understand.  

Sometimes the damage in the brain can affect motor planning.  This motor planning problem is called apraxia and can cause the the wrong sounds to come out when a person speaks.  They may mix up syllables, leave out sounds, add extra sounds, or any combination.   The person recovering from apraxia may or may not be aware of the errors, but it can cause significant frustration for both the speaker and the listener.   

 

My therapist said I plateaued in my recovery.  What can I do?  

    Ah, the myth of the plateau. Progress is important in the recovery.  It helps to motivate the client and their families, and is required for most insurance companies to consider continuing coverage of therapy.  If your progress has slowed, there are things you can try:

  • Change up your program.  Try different tasks, different modalities (if you were focused on auditory comprehension, work on reading.  Working on writing?  Switch to verbal).  Have open dialogue with your therapist about where you are feeling frustrated, what areas of your life are impacted, and what you might want to try.  You and your therapist are a team working towards your communication goals.  
  • Consider changing your therapist.  All therapists approach their practice a little differently.  We all have different personalities, experience, expertise, and time.  Sometimes a different approach is beneficial to break through that plateau.
  • Check your level of practice and motivation.  Are you practicing daily? Ask your therapist to change the tasks in your home practice program.  Is depression a factor?  Depression commonly occurs with people with aphasia, and can significantly limit progress.  Are you just burned out and need a break?  That's okay too.  
  • It IS okay to take a break from therapy and be done for awhile.  Practice your home program. With the right supports, participating in life can be the best therapy there is, providing consistent functional practice.  You can always return to skilled speech therapy in the future if you choose.  

 

I haven’t had a stroke, or been diagnosed with “aphasia”, but I do notice it’s harder to collect my thoughts and to think of the exact word I want to say.  It’s frustrating.  What can I do?

    Contact me for a free consultation.  Many factors can cause these symptoms, and there are many strategies and exercises that can help.  We will create a plan to decrease your frustration and help you say what you want to say, when you want to say it.