Aphasia is a language disorder resulting from damage to the brain areas responsible for language. For most individuals, these areas are located on the left side of the brain. Aphasia typically occurs suddenly, often following a stroke or head trauma, but it can also develop gradually due to a brain tumor or a progressive neurological condition. This disorder affects the ability to express and understand language, as well as reading and writing skills. Aphasia can coexist with speech disorders like dysarthria or apraxia of speech, which are also caused by brain damage.
Who is at Risk of Developing Aphasia?
While aphasia is more commonly seen in middle-aged or older adults, it can affect anyone, including young children. According to the National Aphasia Association, approximately 1 million people in the United States have aphasia, and nearly 180,000 Americans acquire it each year.
What are the Primary Causes of Aphasia?
Aphasia is directly caused by damage to one or more of the brain’s language areas. The most frequent cause of this brain injury is a stroke. A stroke happens when a blood clot or a ruptured blood vessel disrupts blood flow to a specific part of the brain. When brain cells are deprived of their normal blood supply, which carries oxygen and essential nutrients, they begin to die. Other potential causes of brain injury that can lead to aphasia include:
- Severe head injuries
- Brain tumors
- Gunshot wounds
- Brain infections
- Progressive neurological disorders, such as Alzheimer’s disease
Exploring the Different Types of Aphasia
Aphasia can be broadly classified into two main categories: fluent and nonfluent aphasia. Within these categories, there are several specific types.
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Wernicke’s Aphasia: Damage to the temporal lobe of the brain can lead to Wernicke’s aphasia, the most prevalent type of fluent aphasia. Individuals with Wernicke’s aphasia might speak in lengthy, grammatically correct sentences that lack meaning. They may incorporate unnecessary words or even invent new words. For instance, someone with Wernicke’s aphasia might say something like, “You know that smoodle pinkered and that I want to get him round and take care of him like you want before.” As a result, understanding what the person is trying to convey can be challenging. People with Wernicke’s aphasia are often unaware of the errors in their speech. Another characteristic of this type of aphasia is difficulty comprehending speech.
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Broca’s Aphasia: The most common type of nonfluent aphasia is Broca’s aphasia. People with Broca’s aphasia have damage primarily affecting the frontal lobe of the brain. They often experience weakness or paralysis on the right side of their body, particularly in the arm and leg, because the frontal lobe also plays a crucial role in motor control. While individuals with Broca’s aphasia can generally understand speech and know what they want to say, they often speak in short, effortful phrases. They frequently omit small words like “is,” “and,” and “the.” For example, a person with Broca’s aphasia might say, “Walk dog,” meaning “I will take the dog for a walk,” or “book book two table,” for “There are two books on the table.” People with Broca’s aphasia usually understand the speech of others relatively well. Because of this awareness, they are often conscious of their difficulties and may become easily frustrated.
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Global Aphasia: Global aphasia arises from extensive damage to the language areas of the brain. Individuals with global aphasia experience severe communication impairments and may have very limited speaking or language comprehension abilities. They might be unable to say even a few words or may repeat the same words or phrases repeatedly. Understanding even simple words and sentences can be difficult for them.
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Other Types of Aphasia: There are other types of aphasia, each resulting from damage to different language areas in the brain. Some individuals may struggle to repeat words and sentences even though they understand them and can speak fluently (conduction aphasia). Others may have difficulty naming objects, even if they know what the object is and its purpose (anomic aphasia).
In some cases, blood flow to the brain is temporarily interrupted and quickly restored, resulting in a transient ischemic attack (TIA). In these situations, language abilities may return within a few hours or days.
How is Aphasia Diagnosed?
Aphasia is typically first identified by the physician treating the individual for their brain injury. To confirm the presence of brain injury and pinpoint its exact location, most individuals undergo a magnetic resonance imaging (MRI) or computed tomography (CT) scan. The physician will also assess the person’s ability to understand and produce language, such as following commands, answering questions, naming objects, and engaging in conversation.
If aphasia is suspected, the patient is usually referred to a speech-language pathologist, who conducts a thorough evaluation of the person’s communication skills. This evaluation includes a detailed assessment of the person’s ability to speak, express ideas, converse socially, understand language, and read and write.
What are the Available Treatment Options for Aphasia?
After a brain injury, significant changes occur in the brain to facilitate recovery. As a result, individuals with aphasia often experience substantial improvements in their language and communication skills within the first few months, even without treatment. However, in many cases, some degree of aphasia persists after this initial recovery period. In these situations, speech-language therapy is employed to assist patients in regaining their ability to communicate.
Research has demonstrated that language and communication skills can continue to improve for many years, sometimes accompanied by new activity in brain tissue near the damaged area. Factors influencing the extent of improvement include the cause of the brain injury, the location and extent of brain damage, and the individual’s age and overall health.
Aphasia therapy aims to enhance a person’s ability to communicate by helping them:
- Utilize remaining language abilities.
- Restore language abilities as much as possible.
- Learn alternative ways of communicating, such as gestures, pictures, or electronic devices.
Individual therapy is tailored to the person’s specific needs, while group therapy provides opportunities to practice new communication skills in a supportive setting.
Recent technological advancements have provided new tools for people with aphasia. “Virtual” speech pathologists offer patients the flexibility and convenience of receiving therapy at home through a computer. Speech-generating applications on mobile devices like tablets can also serve as alternative communication methods for individuals who struggle with spoken language.
Increasingly, patients with aphasia are participating in activities such as book clubs, technology groups, and art and drama clubs. These experiences help patients rebuild their confidence and social self-esteem, as well as improve their communication skills. Stroke clubs, regional support groups formed by stroke survivors, are available in most major cities. These clubs can assist individuals and their families in adjusting to the life changes associated with stroke and aphasia.
Family involvement is often a crucial component of aphasia treatment because it equips family members with the best ways to communicate with their loved one. Family members are encouraged to:
- Participate in therapy sessions, if possible.
- Simplify language by using short, uncomplicated sentences.
- Repeat content words or write down keywords to clarify meaning as needed.
- Maintain a natural conversational manner appropriate for an adult.
- Minimize distractions, such as a loud radio or TV, whenever possible.
- Include the person with aphasia in conversations.
- Ask for and value the opinion of the person with aphasia, especially regarding family matters.
- Encourage any type of communication, whether it is speech, gesture, pointing, or drawing.
- Avoid correcting the person’s speech.
- Allow the person plenty of time to talk.
- Help the person become involved outside the home. Seek out support groups, such as stroke clubs.
Current Research Efforts in Aphasia Treatment
Researchers are actively investigating new types of speech-language therapy for individuals with both recent and chronic aphasia. The goal is to determine if these innovative methods can more effectively improve word retrieval, grammar, prosody (tone), and other aspects of speech.
Some of these new methods focus on enhancing cognitive abilities that support language processing, such as short-term memory and attention. Others involve activities that stimulate the mental representations of sounds, words, and sentences, making them easier to access and retrieve.
Researchers are also exploring drug therapy as a potential approach to treating aphasia. Some studies are evaluating whether drugs that affect chemical neurotransmitters in the brain can be used in conjunction with speech-language therapy to enhance the recovery of various language functions.
Other research efforts are focused on using advanced imaging techniques, such as functional magnetic resonance imaging (fMRI), to investigate how language is processed in both healthy and damaged brains and to understand recovery processes. This type of research could advance our knowledge of how the areas involved in speech and language comprehension reorganize after a brain injury. The findings could have significant implications for the diagnosis and treatment of aphasia and other neurological disorders.
A relatively new and promising area of aphasia research involves noninvasive brain stimulation combined with speech-language therapy. Two such brain stimulation techniques, transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS), temporarily alter normal brain activity in the stimulated region.
Researchers initially used these techniques to better understand the brain regions involved in language and recovery after a stroke. More recently, scientists are exploring whether this temporary alteration of brain activity might help individuals relearn language skills. Several clinical trials funded by the National Institute on Deafness and Other Communication Disorders (NIDCD) are currently testing these technologies.
NIDCD-funded clinical trials are also investigating other treatments for aphasia. A list of active NIDCD-funded aphasia trials can be found at ClinicalTrials.gov.
Finding Additional Information and Support
The NIDCD maintains a directory of organizations that provide information on the normal and disordered processes of hearing, balance, taste, smell, voice, speech, and language.
Use the following keywords to help you find organizations that can answer questions and provide information on aphasia: aphasia, stroke, language disorder, speech therapy.
