Care and Management of Aphasia

Aphasia is a common language disorder occurring post-stroke, affecting one-third of all patients diagnosed with stroke (Stroke Association 2023a).

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 degenerative, causing a gradual loss of language function.

(American Stroke Association 2018; Stroke Association 2023b)

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

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

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 (ABIOS 2021).

Similarly, a condition known as dysarthria can weaken and paralyse the muscles involved with speech, causing a more general slurring of words (Mayo Clinic 2022).

Signs and Symptoms of Aphasia

Aphasia might cause:

• Spoken language expression impairments
  • Anomia (difficulty finding words)
  • Jargon (fluently generating sentences that have no semantic meaning)
  • Neologisms (creating words that are not meaningful or recognisable to others)
  • Semantic paraphasias (substituting words e.g. saying ‘table’ instead of ‘bed)
  • Telegraphic speech (the omission of function words such as ‘the’, ‘of’ and ‘was’)
  • Lack of awareness of own speech errors
  • Grammatical errors
  • Halting or effortful speech
  • Speaking in single words or fragmented phrases
  • Syntax errors (e.g. using words in the wrong order)
• Spoken language comprehension impairments
  • Difficulty understanding speech, or needing extra time to do so
  • Difficulty understanding complex grammar
  • Difficulty understanding long or rapid speech
  • Difficulty understanding spoken information without accompanying visual context (e.g. the radio or phone calls)
  • Difficulty understanding language that isn’t literal (e.g sayings)
  • Lack of awareness of own comprehension errors
• Agraphia (written expression impairments)
  • Difficulty writing, typing, or copying letters, words, and sentences
  • Writing only single word
  • Subsituting incorrect words or letters when writing
  • Writing or spelling nonmeaningful words or syllables
  • Using incorrect grammar or syntax when writing
• Alexia (reading comprehension impairments)
  • Difficulty recognising words by sight
  • Difficulty comprehending writen material
  • Mistinerpreting the meaning of written words
  • Difficulty comprehending function words such as articles, prepositions and pronouns.

(ASHA 2022)

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 patient to communicate more easily.

• Reduce background noise and distractions
• Use clear and simple language
• Speak in short sentences
• Allow plenty of time for the person to respond
• Augment the message with other communication modalities, e.g. gestures, facial expressions and pictures
• Converse using adult language (don’t talk down to the person)
• Gain the person’s attention first before commencing a conversation
• Keep your voice at a normal, stable volume
• Repeat back what you think the person said/meant for confirmation.

(NAA 2022; American Stroke Association 2022)

How is Aphasia Treated?

Aphasia treatment should be individualised to address the specific needs and goals of each patient. It should take a hollistic, person-centred approach. Treatment can either be restorative (aiming to improve or restore impaired function) or compensatory (aiming to help the person compensate for difficulties that cannot be retrained) (ASHA 2022).

Focusing on Receptive Aphasia

Receptive aphasia (also known as Wernicke’s aphasia or fluent aphasia), is generally caused by damage to Wernicke’s area, which is located in the posterior temporal lobe of the dominant brain hemisphere (Acharya & Wroten 2022).

Receptive aphasia causes the person to substitute one word for another, and/or substitute one sound or syllable for another, which can lead to unintelligible speech. Despite their words not making sense, the person speaks fluently with normal sentence structure, grammar and intonation. Comprehension is typically also impaired (Acharya & Wroten 2022).

Specific Receptive Aphasia Communication Tips

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

(Bartels 2013)