Aphasia: Loss of language, not IQ

By:    Published: August 14, 2014

Aphasia is a loss of language often caused by a brain injury/disorder, dementia or stroke. Here's how to help someone with aphasia communicate again.

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Imagine suddenly losing your ability to speak, understand, read or write even basic words and yet retaining the ability to think. That’s aphasia, a communication disorder that’s spurred by a brain injury such as a stroke or tumor or a neurological disorder.

Roughly 1 million people in the U.S. have aphasia, which is a loss of language that can negatively affect a person’s ability to speak, understand, read or write. Aphasia is always caused by a brain injury, usually a stroke, tumor or trauma.  In some cases, it’s caused by epilepsy or another neurological disorder. Some people acquire a mild loss of any or all of the communications skills, while others are severely affected.

Aphasia results from a breakdown of the two-way translation that establishes a conversation between our thoughts and language. Patients with aphasia can no longer accurately convert thought into the symbols and grammatical organization that constitute language. They also have trouble converting what they see or hear into mental images.

Naturally, it is a particularly frustrating disorder for those who have it. “People with aphasia are essentially trapped inside their own bodies. They’re just as intelligent as they were before the brain injury,” explains Melinda Corwin, PhD, associate professor and director of the Stroke/Aphasia Recovery (STAR) Program at Texas Tech University in Lubbock, Texas. “The problem is they just can’t convey thoughts using language.”

Types of Aphasia

Some aphasia sufferers are affected severely and others mildly. The type and severity of aphasia depends entirely on which regions were damaged and how extensively. The most common forms of aphasia include:

  • Global aphasia:  near total loss of the ability to read, write or comprehend language.
  • Broca’s aphasia/Non-fluent aphasia: severe difficulty organizing words in such a way that sentences follow grammatical rules, but able to read, write and comprehend.
  • Mixed non-fluent aphasia: severe difficulty speaking and very limited ability to read, write and comprehend.
  • Wernicke’s aphasia/fluent aphasia: difficulty grasping the meaning of spoken words; able to speak, but sentences are often jumbled and filled with extraneous words; reading and writing is often impaired.
  • Anomic aphasia:  Comprehension (spoken and written) generally adequate; persistent and extreme difficulty finding the right words when trying to speak or write.

If aphasia is caused by an injury, the brain tends to show some spontaneous recovery in the weeks following provided that the cause of the damage is removed or treated. Any aphasia left after this, though, will not go away without treatment. If aphasia is caused by stroke, a removed benign tumor or a head injury, working with a speech therapist or other trained professional will improve communication skills. Progressive aphasia, usually caused by an illness such as dementia or Alzheimer’s that will likely get worse over time, is less amenable to treatment. For treatable aphasia, therapists look to neuroplasticity, a sort of rewiring or re-learning of old skills using alternative areas of the brain.

Ok Brain, Take It From The Top

Corwin explains that the vast majority of people — about 95 percent — house their language centers in the left hemisphere of the brain. (The other 5 percent of the population happen to have their language centers housed on the right hemisphere; these are usually (though not always) people who are also ambidextrous or left-handed)  Aphasia, then, is typically a result of damage to one or several areas in the left side of the brain.

“A lot of research is being done to figure out how to tap into the undamaged right side of the brain to serve as a mediator for learning language in different ways,” says Corwin. Once the underlying illness or condition is treated accordingly, therapist try various techniques to bring aphasia sufferers online, essentially re-teaching them communication skills often using right-brain-centric techniques.

For example, recognizing and using visual symbols involves more right-brain functioning. For this reason, aphasia therapy often includes learning to communicate via artwork or with visual symbols like those found on flashcards. Sometimes treatment will also involve melodic intonation therapy (MIT). During MIT, a therapist will hold an aphasia sufferer’s hand and practice speaking to a beat, physically tapping the rhythm as they speak words and sentences.

“Our sense of music, melody and rhythm is housed more in the right side of our brains,” explains Corwin. “Singing, for example, stimulates a very different part of the brain than speaking does.” 

Some people with aphasia are taught, in fact, to sing their words and sentences again, producing communication with right-brain techniques. With intensive therapy — generally two or three hours a week over months — some will reduce or lose entirely the sing-song effect and simply say the words.

Most people with aphasia improve with communication therapy, but recovery always depends on the location and extent of the damage done to the brain, says Corwin.

Next Steps

According to Corwin, there is a very high rate of frustration and depression associated with aphasia. However, with the right assistance, most people with aphasia can learn to communicate again. In fact, one aspect of therapy involves using friends and family members as communication ramps.

“The person will aphasia can still make decisions, but we teach those around them how to talk to them, use gestures and other forms of communication.” If you’re the communications ramp for someone with aphasia, keep these points in mind:

  • Use a slightly slower speaking rate than you normally do. When you have aphasia, it’s a little harder to process info coming in. Slowing down just a bit really helps. Don’t raise your speaking voice, though, unless the person also suffers from hearing problems.
  • Minimize distractions. A blaring TV, a lot of people in the room or any other highly stimulating environment will cause someone with aphasia to get overwhelmed when trying to communicate. “If you really want to communicate, create an environment where you can focus on the topic,” advises Corwin.
  • Say the message in a little different way. Someone with aphasia may get stuck on a word you’re using or the way you’re saying something. If you get no response, rephrase your sentence.
  • Use visuals. At some restaurants, for example, you could point to pictures on the menu.
  • Always carry a pencil and paper. People with aphasia may become good at drawing pictures of what they want to say, or you may need to draw a picture of what you want to say to them. Sometimes even writing down a word helps.
  • Reduce open-ended questions. Asking “What do you want for dinner?” will require someone with aphasia to work very hard to retrieve words. Instead, you might try “Do you want roast beef or chicken?” Or, again, use pictures of food.
  • Be extremely patient. “You have to give someone with aphasia time to get his or her message out. Don’t try to talk over them, talk baby talk or speak as if they aren’t in the room,” advises Corwin. “Treat them like an adult, but slow down and be patient.”
  • Check out patient support groups. Recovery can hinge on the mental and emotional state of the person with aphasia. Naturally, it’s an alienating condition. Support groups such as those offered by The National Aphasia Association can help. http://www.aphasia.org/naa-network3.
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sources
  • Corwin, Melinda, PhD, Associate Professor and Director, Stroke/Aphasia Recovery (STAR) Program Texas Tech University Health Sciences Center, Department of Speech, Language, and Hearing Sciences. Interviewed June 2014.
  • Small S. and Llano, D., Biological Approaches to Aphasia Treatment, Current Neurology and Neuroscience Reports, November 2009, 9 (6) pp. 443-450. Accessed June 2014.
  • Damasio, A. Aphasia,  New England Journal of Medicine 1992; 326:531-539 Accessed June 2014.
  • Norton, A., Zipse, L. Marchina S. and Schlaug G. Meoldic Intonation Therapy: Shared insights on how it’s done and why it might help. Annals of the New York Academy of Sciences,  July 24, 2009; 1169 (1). Accessed June 2014.
  • National Aphasia Association. Aphasia Factsheet. http://www.aphasia.org/. Accessed June 2014.
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