Aphasia: Care and Management

Aphasia is the most common language disorder post-stroke, affecting one-third of all patients diagnosed with stroke (Stroke Association 2015).

Communication is a complex neural process. It involves a careful sequence of expression, muscle movements, breathing, speaking, and comprehension. When a patient who has had a stroke experiences speech difficulty, word-finding difficulty, or speaks with made-up or inappropriate language, they are highly likely to be experiencing aphasia (American Stroke Association 2018).

Key Types of Aphasia

• Expressive aphasia/Broca’s aphasia (non-fluent) is caused by damage to the frontal regions of the left brain hemisphere. Speech production is halting and effortful. In severe cases speech is reduced to single words, however, comprehension remains intact.
• Receptive aphasia/Wernicke’s aphasia (fluent): Speaking itself is not difficult, but the individual produces jargon and nonsensical words and phrases rather than meaningful sentences. Comprehension is poor.
• Anomic aphasia: The individual experiences word-finding difficulty; they use non-specific nouns but are able to describe the intended word. Comprehension is generally good.
• Global aphasia is severe impairment of both receptive and expressive language, usually associated with a large left-hemispheric lesion.
• Primary progressive aphasia is a form of dementia that causes gradual loss of language function, usually beginning with word-finding difficulties, then grammar and comprehension.

(National Aphasia Association 2017; American Stroke Association 2018)

The left cerebral hemisphere of the brain is involved in the process of speech. Damage to these areas often causes communication problems (Hammond 2019).

In addition to aphasia, a person’s communication abilities after a stroke can be affected in other ways.

One example is dyspraxia, a condition that affects the co-ordination of messaging from the brain to the muscles associated with speech. This results in a general lack of co-ordination or difficulty moving the mouth and tongue to form speech (QLD DoH 2027).

Similarly, a condition known as dysarthria can weaken and paralyse the muscles involved with speech, causing a more general slurring of words (Mayo Clinic 2018).

Language Systems Affected by Aphasia

• Phonological: The sound system of language responsible for recognising distinct speech sounds heard in language.
• Semantic: referred to as the ‘meaning system’ allowing for the understanding and expression of language nuances.
• Pragmatic: functional use of language influenced by culture and context.
• Syntactic: relates to language structure (i.e. word order, sentence structure and grammar).

(ASHA 2020)

Aphasia Communication Tips, Care and Management

When caring for a person with aphasia, consider implementing some of the tips below as they will assist the person with aphasia to communicate more easily.

• Reduce background noise and distractions;
• Use clear and simple language;
• Allow appropriate time for conversation, giving the person time to respond;
• Stay on one topic at a time;
• Augment the ‘message’ with other communication modalities, e.g. gestures, facial expression and pictures;
• Converse using adult language (don’t talk down to them);
• Gain the person’s attention first before commencing a conversation;
• Keep your voice at a normal, stable volume;
• Establish the topic of conversation with the person prior to communication; and
• Ensure sensory aides are within reach, e.g. glasses, hearing aids, dentures etc.

(National Aphasia Association 2013)

The main treatment for aphasia is speech therapy. Speech pathologists are able to assess strengths and weaknesses of the patient’s language and communication skills. By identifying individual strengths, a base can be established from which communication enhancement, comprehension and expression can be improved (NHS 2018; ASHA 2017).

Focusing on Receptive Aphasia

Receptive aphasia (also known as Wernicke’s aphasia, fluent aphasia and sensory aphasia), is caused by damage to the posterior left portion of the brain in the medial temporal/parietal lobes (National Aphasia Association 2015).

Receptive aphasia involves a breakdown in the phonological system, removing the person’s knowledge of the sequence of sounds within words; consequently alternative sounds can be used instead. Core elements of the phonological and semantic systems are affected which significantly impairs the person’s auditory-verbal comprehension (visual comprehension is not as impaired) (National Aphasia Association 2015; Thompson et al. 2015).

People with receptive aphasia may:

• Be unable to understand what others are saying;
• Experience difficulty in following long and complex sentences/discussions;
• Lose focus when background noise/distractions are present, or when one or more people are speaking;
• Be able to read headlines but not able to comprehend the text body; and
• Be able to write but not able to read what was just written.

(Hoffman 2017)

Specific Receptive Aphasia Communication Tips

• Use gestures;
• Write down key words when speaking to the patient;
• Talk about things that are relevant to the current context of the conversation (e.g. asking the patient if they would like a drink at the dining table);
• Slow your rate of speech (as the patient cannot process speech as quickly as they used to), but do not talk down to the patient; and
• Maintain eye contact; this will help give the patient context and cues.

(The Aphasia Center 2013)

Additional Resources

• American Stroke Association
• Brain Foundation, Aphasia
• National Aphasia Association
• The Royal Children’s Hospital Melbourne, Language Disorders Aphasia
• Different Types of Strokes

References

• American Speech-Language-Hearing Association 2017, Aphasia, American Speech-Language-Hearing Association, viewed 28 May 2020, https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934663§ion=Treatment
• American Stroke Association 2018, Types of Aphasia, American Stroke Association, viewed 27 May 2020, https://www.stroke.org/en/about-stroke/effects-of-stroke/cognitive-and-communication-effects-of-stroke/types-of-aphasia
• The Aphasia Center 2013, 6 Strategies to Help Comprehension for Wernicke's Aphasia, The Aphasia Center, viewed 28 May 2020, https://theaphasiacenter.com/2013/12/6-strategies-help-comprehension-wernickes-aphasia/
• Hoffman, H 2017, Communicating After a Stroke: Understanding Aphasia, Saebo, viewed 28 May 2020, https://www.saebo.com/blog/communicating-stroke-understanding-aphasia/
• Mayo Clinic 2018, Dysarthria, Mayo Clinic, viewed 27 May 2020, https://www.mayoclinic.org/diseases-conditions/dysarthria/symptoms-causes/syc-20371994
• National Aphasia Association 2013, Aphasia Communication Tips, National Aphasia Association, viewed 28 May 2020, https://www.aphasia.org/aphasia-resources/communication-tips/
• National Aphasia Association 2017, What are the Different Types of Aphasia?, National Aphasia Association, viewed 27 May 2020, https://www.aphasia.org/stories/different-types-aphasia/
• NHS 2018, Treatment (Aphasia), NHS, viewed 28 May 2020, https://www.nhs.uk/conditions/aphasia/treatment/
• Queensland Department of Health 2017, Understanding Dyspraxia after Acquired Brain Injury, Queensland Department of Health, viewed 27 May 2020, https://www.health.qld.gov.au/__data/assets/pdf_file/0021/674040/dyspraxia_fsw.pdf
• Stroke Association 2015, Communication Problems, Stroke Association, viewed 27 May 2020, https://www.stroke.org.uk/effects-of-stroke/communication-problems
• Thompson, H E, Robson, H, Lambon Ralph, M A & Jefferies, 'Varieties of Semantic ‘Access’ Deficit in Wernicke’s Aphasia and Semantic Aphasia’, Brain, vol. 138, no. 12, viewed 28 May 2020, https://academic.oup.com/brain/article/138/12/3776/412124

(Answers: b, c, a)