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Aphasia: what is it and how is it treated?

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Aphasia is a condition that affects the brain and leads to problems using language correctly.

If you have aphasia, you may make mistakes with words, sometimes using the wrong sounds in a word, choosing the wrong word, or putting words together incorrectly.

Many people with the condition find it difficult to understand words and sentences they hear or read.

Aphasia can affect people of all ages, including children. It's most common in people over the age of 65, as stroke and common progressive neurological conditions tend to affect older adults.

Symptoms of aphasia

The main sign of aphasia is difficulty with communication, although the condition affects everyone differently.

In cases where aphasia has been caused by a sudden brain injury (see Causes of aphasia), such as a stroke or a severe head injury , symptoms will usually develop straight after the injury.
In cases where there is gradual damage to the brain as a result of a condition that gets worse over time, such as dementia or a brain tumour, the symptoms may develop gradually.

There are 3 main types of Aphasia:

Expressive aphasia

If you have expressive aphasia you experience difficulty communicating your thoughts, ideas and messages to others.

This may affect speech, writing, gestures or drawing, and causes problems with everyday tasks such as using the phone, writing an email, or speaking to family and friends.

You may have some of the following signs and symptoms:

  • slow and halting speech
  • struggling to get certain words out, such as the names of objects, places or people
  • the content of your speech is stripped down to simple elements and only contains basic nouns and verbs – for example, "want drink" or "go town today"
  • spelling or grammatical errors
  • using the wrong word, such as saying "chair" instead of "table"
  • difficulty constructing a sentence
  • being able to write or speak fluently, using long sentences, but often including nonsense words or your speech lacks meaning

Receptive aphasia

If you have receptive aphasia you may find it difficult to understand things you hear or read. You may also have difficulty interpreting gestures, drawings, numbers and pictures.

This can affect everyday activities such as reading an email, managing finances, having conversations, listening to the radio, or following TV programmes.

You may notice some of the following signs and symptoms:

  • difficulty understanding what people say
  • difficulty understanding written words
  • misinterpreting the meaning of words, gestures, pictures or drawings
  • giving responses that may not make sense if you've misunderstood questions or comments
  • not being aware of your difficulties with understanding

Primary progressive aphasia

This type of aphasia occurs in people with a specific type of dementia . As it's a primary progressive condition, the symptoms get worse over time.

Usually, the first problem people with primary progressive aphasia (PPA) notice is difficulty finding the right word or remembering somebody's name.

The problems gradually get worse and can include:

  • speech becoming hesitant and difficult, and making mistakes with the sounds of words or grammar
  • speech becomes slow with short, simple sentences
  • forgetting the meaning of complicated words, and later also simple ones, making it more difficult for you to understand other people
  • speech becomes more vague, and you have difficulty being specific or clarifying what they're saying
  • you become less and less likely to join in with or start conversations

If you have PPA you may also experience other symptoms later in your illness, including changes in your personality and behaviour, difficulties with memory and thinking similar to Alzheimer's disease , or difficulties with movement similar to Parkinson's disease.

Causes of aphasia

Aphasia is the result of damage to the parts of the brain involved in speaking, reading, writing and understanding others.

Any damage to the language areas of the brain can result in loss of function, leading to aphasia.

The severity of aphasia depends on the location and type of injury sustained by the brain.

Aphasia can occur by itself or alongside other disorders, such as visual difficulties, mobility problems, limb weakness and cognitive changes.

Aphasia affects a person's language, but it doesn't affect a person's intelligence.

Ways the brain can become damaged include:

  • stroke – the brain is deprived of blood and oxygen during a stroke, which leads to death of brain tissue
  • severe head injury – for example, an injury as a result of a road traffic accident or after a serious fall from height
  • brain tumour – where an abnormal growth of cells develops inside the brain
  • health conditions that cause progressive loss of brain cells, such as dementia – Parkinson's disease does not cause aphasia, but some very similar conditions may do so, such as progressive supranuclear palsy (PSP) or corticobasal degeneration (CBD)
  • infections that affect the brain – such as meningitis (an infection of the outer layer of the brain) and encephalitis (an infection of the brain itself), although this is a much rarer cause of aphasia

How is aphasia diagnosed?

Aphasia is usually diagnosed after tests carried out by a specialist called a speech and language therapist (SLT).

Communication assessment

There are several tests used to assess communication skills.

These tests often involve simple exercises, such as asking you to name as many words as you can think of beginning with the letter F, or asking you to name objects in the room.

The results can then be used to build up a detailed picture of your capabilities in areas such as:

  • understanding basic speech and grammar
  • expressing words, phrases and sentences
  • social communication – for example, holding a conversation or understanding a joke
  • reading and writing letters, words and sentences

Imaging scans

Imaging techniques can be used to assess the extent of any brain damage. The two most widely used types for aphasia are:

Less commonly, a positron emission tomography (PET) scan may be used to assess the state and functionality of the brain. PET scans are usually only used to carry out clinical research at specialist centres.

What is the treatment?

Sometimes aphasia will improve on its own without treatment, but speech and language therapy is usually recommended.

If you were admitted to hospital, there should be a speech and language therapy team there.

If you weren't admitted to hospital or didn't see an SLT while you were there, you can ask your doctor to refer you. In some areas, you can contact your local speech and language therapy department directly.

For people with aphasia, speech and language therapy aims to:

  • help you communicate to the best of your ability
  • help restore as much of your speech and language as possible
  • find alternative ways of communicating

Evidence suggests speech and language therapy is more effective if it's started as soon as possible.

For many people, the most obvious recovery happens in the first six months. However, improvements can continue to be seen for much longer after this, even many years later.

How the therapy is carried out will depend on your circumstances. An intensive course of speech and language therapy may be recommended for some people. This involves a number of sessions spread out over a shorter period of time.

However, speech and language therapy can be exhausting, and an intensive course of treatment will not be suitable for everyone. For some people, shorter and less intensive sessions may be recommended.

Therapy may be individual sessions, groups, or using technology such as computer programmes or apps.

Therapy techniques

The specific techniques used and the aims of the treatment will depend on each person's circumstances. Some examples are described below.

If you have difficulty understanding words, your SLT may ask you to carry out tasks such as matching words to pictures or sorting words by their meaning.

The aim of these tasks is to improve your ability to remember meanings and link them with other words.

If you have difficulty expressing yourself, your SLT may ask you to practise naming pictures or judge whether certain words rhyme. They may also ask you to repeat words that they say, with prompting if necessary.

If you are able to complete tasks with single words, your therapist will work on your ability to construct sentences.

Some techniques may involve working with a computer. Other methods may include group therapy with other people with aphasia, or working with family members.

This will allow you to practise conversational skills or rehearse common situations, such as making a telephone call.

An increasing number of computer-based programmes and apps are available to help people with aphasia improve their language abilities.

However, it's important to start using these alongside a speech and language therapist.

Alternative methods of communication

An important part of speech therapy is finding different ways for you to communicate. Your therapist will help you develop alternatives to talking, such as using gesture, writing, drawing or communication charts.

Communication charts are large grids containing letters, words or pictures. They allow someone with aphasia to communicate by pointing at the word or letter to indicate what they want to say.

For some people, specially designed electronic devices, such as voice output communication aids (VOCAs), may be useful. VOCAs use a computer-generated voice to play messages aloud.

This can help if you have difficulty speaking but are able to write or type. There are also apps available on smartphones and computer tablets that can do this.

If a communication device is felt to be beneficial, funding for the purchase of an individual device can be discussed with a speech and language therapist.

Other treatments

Research is currently being carried out to study whether other treatments can benefit people with aphasia. What other treatments are available will depend on what has caused your aphasia.

These could include:

  • medications – for certain health conditions your doctor may recommend medications to help recover or mimic chemicals in your brain that have been lost or damaged
  • Electrical brain stimulation techniques – for example where a small electrical current is passed through the scalp to stimulate the brain and improve language - the evidence for how effective this is is very limited so far

Although some studies have suggested these treatments may benefit some people with aphasia, further research is necessary.

Living with aphasia

The challenges of living with aphasia can impact how a person feels and interacts with others.

In some cases, it can lead to:

If you're concerned about someone with aphasia, encourage them to discuss any problems with their doctor or a member of their care team to access the relevant support.

If the person is unable to do this themselves, they may require someone to communicate on their behalf.

Communicating with a person with aphasia

If you live with or care for a person with aphasia, you may be unsure about the best way to communicate with them.

You may find the following advice helpful:

  • after speaking, allow the person plenty of time to respond. If a person with aphasia feels rushed or pressured to speak, they may become anxious, which can affect their ability to communicate
  • use short, uncomplicated sentences and do not change the topic of conversation too quickly
  • avoid asking open-ended questions. Closed questions that have a yes or no answer can be better
  • avoid finishing a person's sentences or correcting any errors in their language. This may cause resentment and frustration for the person with aphasia
  • keep distractions to a minimum, such as background radio or TV noise
  • use paper and a pen to write down key words or draw diagrams or pictures to help reinforce your message and support their understanding
  • if you do not understand something a person with aphasia is trying to communicate, do not pretend you understand. The person may find this patronising and upsetting
  • use visual references, such as pointing, gesturing and using objects, to support their understanding
  • if they are having difficulty finding the right word, prompt them– ask them to describe the word, think of a similar word, try to visualise it, think of the sound the word starts with, try to write the word, use gestures, or point to an object
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