Aphasia: Speech Problems Caused by Brain Injury

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My uncle was an avid reader and loved playing word games. After a series of strokes, he had extreme difficulty communicating. The worst part of watching him struggle to find words was that he knew the words he did find were wrong. He was not only frustrated but humiliated, too.

The speech and language disorder that my uncle developed is called aphasia. It is common in individuals with a diagnosis of stroke, traumatic brain injury or other neurological conditions, such as Alzheimer’s disease and other forms of dementia. Aphasia is not uncommon, and, as caregivers, we must learn to help our loved ones communicate however we can.

What Is Aphasia?

The National Aphasia Association explains that aphasia is an acquired communication disorder that impairs a person’s ability to process language.

“This can impact a person’s ability to communicate and understand both the spoken and the written word,” explains Kathryn Kilpatrick, M.A., CCC/SLP, a speech-language pathologist with more than 40 years of experience, creator of Communication Connection and author of the five-volume Therapy Guides for Language and Speech Disorders workbooks.

It’s important to note that the brain’s inability to communicate is in no way connected to overall intelligence. This was the case with my uncle.

“Specific symptoms and their severity will vary, depending on the location and extent of the brain damage,” Kilpatrick says. “In some cases, a person’s symptoms may also include weakness or paralysis of their arm and/or leg.”

There are several different kinds of aphasia. Some are characterized by difficulty comprehending speech, while others are characterized by difficulty finding and producing words as well as stringing them together to form meaningful sentences. In some cases, the ability to read and/or write is also affected. Primary progressive aphasia (PPA) is one type that occurs due to neurodegenerative processes associated with Alzheimer’s disease and frontotemporal dementia.


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Speech Therapy for Aphasia

When is comes to post-stroke rehabilitation and regaining skills following a brain injury, Kilpatrick stresses the importance of a person undergoing an evaluation by a speech-language pathologist (SLP) to determine not only what areas of language are affected, but also the extent of their difficulties. This helps the SLP devise a personalized rehabilitation program to maximize safety, communication and quality of life.

There are a variety of therapy techniques that can be effective in the rehabilitation of a person with difficulty speaking. For example, former U.S. Representative Gabrielle Giffords sustained a traumatic brain injury during an assassination attempt in 2011 that resulted in aphasia. One of the strategies used in her treatment program was a kind of music therapy called Melodic Intonation Therapy.

“This approach uses melody and rhythm to help patients recover words and language patterns,” Kilpatrick explains. “Each situation is unique. An experienced SLP can identify strengths and weaknesses and recommend tools and techniques to improve and adapt the way a patient communicates.”

Furthermore, Kilpatrick emphasizes that a person’s support system is an essential part of their rehabilitation team. Communication is a two-way street, so all the work does not fall solely on the patient. Part of the process involves family members and friends learning the best strategies for interacting with a loved one who has speech problems.

Many different tools are available to help people with aphasia; it just takes some effort and creativity to find the most effective solutions. For instance, one of Kilpatrick’s patients was still frustrated with her word-finding problems several years after a stroke.

“She could not spell even though she could read words without any issues. Her therapy focused on creating a categorized list of words—including names—that she struggled with but wanted to use on a regular basis,” Kilpatrick recalls.

This personalized word list enabled her to write down her shopping lists and read a word aloud that she could not recall by referring to her personalized word list.

“For the first time in years, she was able to start addressing cards to her family by copying their addresses and even picking some appropriate personalized comments from a list created especially for her.”

Another of Kilpatrick’s clients learned how to use an iPad to type out what he wanted to say, since his speech was very difficult to understand.

Unfortunately, not every person is a candidate for speech therapy. Those with primary progressive aphasia may be able to participate in therapy sessions to help them improve or maintain their language abilities over the short term. However, PPA is caused by progressive brain damage related to dementia and is not reversible.

As the disease worsens, the speech and language centers in the brain deteriorate and patients typically lose the capacity to practice methods of enhancing communication and learn unconventional methods of communicating with others. For example, Monty Python member, Terry Jones, was diagnosed with frontotemporal dementia in 2015. The late actor, comedian, director and historian also developed PPA and slowly lost his ability to communicate verbally and through writing over the years. Tips and therapeutic activities may help some patients continue interacting with others, but their effectiveness is usually limited in these cases.

Tips for Communicating with Elders Who Have Aphasia

Each patient has different needs, but there are several things caregivers can do to minimize stress when trying to communicate. Kilpatrick offers the following tips:

  • Reduce distractions, such as the television, music, multiple conversations in the background or involvement with electronic devices, when trying to communicate.
  • When the person is trying to explain something, do not rush them. Give them time to process what they are trying to say.
  • When there is difficulty coming up with a word, encourage the person to describe the item, gesture or even draw it.
  • Use yes and no questions instead of asking for very specific details.
  • In some cases, the person may not be able to say a word but might be willing to accept your cue of two word choices if you believe you know what they are trying to say.
  • If there are problems with comprehension of the spoken word, it may be helpful to speak in shorter, less complex sentences.
  • When instructing someone, it is important to slow the rate of your speech and provide directions only one or two steps at a time.
  • The individual may no longer be able to read books or the newspaper due to the length and complexity of the information. Depending on their interests and what an assessment of their difficulties reveals, reading shorter stories could be something the person might be able to handle.
  • An assessment by a speech-language pathologist will help families and friends understand what the person struggles with and also provide specific recommendations for communicating more effectively.

Each Patient Is Unique

One of the important things to focus on, regardless of a loved one’s particular health issues, is how to help them maintain their quality of life. Some patients make improvements quickly, many could improve over a period of months or even years, and others may never fully recover. In cases where the underlying cause of speech difficulties is particularly severe or is guaranteed to worsen, such as dementia, speech therapy may only be able to accomplish so much.

Communication is an important part of human life. Even if a senior is unable to engage in conversation, their family and friends should still speak to them in a respectful manner and communicate through touch. These gestures will help a nonverbal patient feel less isolated and more connected with those around them.

Sources: Aphasia Definitions (https://www.aphasia.org/aphasia-definitions/); Music therapy’s breakthrough act (https://www.thelancet.com/pdfs/journals/laneur/PIIS1474-4422(12)70126-6.pdf); Terry Jones: ‘I’ve got dementia. My frontal lobe has absconded’ (https://www.theguardian.com/society/2017/apr/16/monty-python-terry-jones-learning-to-live-with-dementia?CMP=edit_2221)

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