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Aphasia (Speech Problems): Types, Causes, Symptoms and Treatment

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Aphasia is a disorder that results from damage to areas of the brain that produce and process language. A person with aphasia can have trouble speaking, reading, writing, and understanding language. Impairment in these abilities can range from mild to very severe (nearly impossible to communicate in any form). Some people with aphasia have difficulty in only one area of communication, such as trouble putting words together into meaningful sentences, trouble reading, or difficulty understanding what others are saying. More commonly, people with aphasia are limited in more than one communication area. Nearly all patients with aphasia have word-finding difficulties – that is, coming up with the correct name of persons, places, things, or events.

Aphasia (Speech Problems)

Each person’s experience with aphasia is unique. It depends on the location(s) of the stroke or brain injury that has caused the aphasia, extent of damage, age of the person, general health of the person and ability to recover.

Are there different types of aphasia?

Yes. There are many types of aphasia. In addition, there are several ways to categorize the different types of aphasia.

One common way categorizes aphasia based on three factors:

  • Speech fluency: Can the person speak with ease and in sentences (fluent) or can they only speak a few words at a time and with great effort (non-fluent)?
  • Language comprehension: Does the person have good or poor understanding of spoken or written words?
  • Ability to repeat: Can the person repeat words and phrases?

Many clinicians also broadly define aphasia by expressive or receptive types:

  • Expressive: How much trouble does the person have expressing thoughts and ideas through speech or writing?
  • Receptive: How much trouble does the person have understanding spoken language or reading?

Who is at risk for aphasia?

Aphasia can happen to anyone, regardless of age; however, it is more common in those who are middle-aged and older. In the Unites States, approximately 1 million people have aphasia, according to the National Aphasia Association. In addition, about 180,000 people are diagnosed with aphasia each year.

What causes aphasia?

Aphasia results from damage to one or more of the areas of the brain responsible for language. Aphasia can occur suddenly, such as after a stroke (most common cause) or head injury or brain surgery, or may develop more slowly, as the result of a brain tumor, brain infection or neurological disorder such as dementia.

Related issues. Brain damage can also result in other problems that affect speech. These problems include dysarthrias (weakness or lack of control in the muscles of the face or mouth resulting in slowed or slurred speech), apraxia (inability to move lips or tongue in the right way to say sounds) and dysphagia (swallowing problems).

What are the signs and symptoms of aphasia?

Signs and symptoms of aphasia vary depending on the portion of the brain affected, extent of the area affected and type of aphasia. Possible symptoms include:

  • Trouble naming objects, places, events or people even though they are known to the person (“tip of the tongue” phenomenon)
  • Trouble expressing oneself (finding the right words) when speaking or writing
  • Trouble understanding conversation
  • Trouble reading
  • Trouble spelling
  • Leaving out small words like “the,” “of” and “was” from speech
  • Putting words in the wrong order
  • Being unaware of mistakes in one’s spoken language
  • Speaking only in short phrases, which are produced with great effort
  • Speaking in single words
  • Making up words
  • Mixing up sounds in words (saying “wog dalker” for “dog walker”)
  • Saying the wrong word (saying “bird” instead of “dog”) or substituting a word that doesn’t make sense (saying “ball” for “phone”)
  • Speech limited to only a few words or repeating the same words or phrases over and over
  • Trouble putting words together to write sentences
  • Trouble using numbers or doing math

How is aphasia diagnosed?

Imaging tests, such as magnetic resonance imaging (MRI) and computed tomography (CT) may be ordered. These tests identify the cause and areas of the brain that are damaged. Your physician may perform a basic language skills exam in which the patient is asked to carry on a conversation, name objects, answer questions and follow instructions. If your physician suspects aphasia, the patient is usually referred to a speech-language pathologist for a comprehensive exam. This healthcare professional is specially trained in identifying and improving language and communication abilities.

The speech-language pathologist will conduct tests to assess abilities such as grammar, ability to form sounds and letters, understanding (comprehension) of words and sentences, and object knowledge. Tests may involve picture descriptions, using single words to name objects and pictures, matching spoken words to pictures, answering yes/no questions, following directions and other tests.

How is aphasia treated?

Treatment is aimed at improving language and communication abilities and developing other communication methods as needed. Rehabilitation, with a speech-language pathologist, includes reading and writing exercises, listening and repeating wording exercises, learning expressive language skills such as using facial expressions and gestures to communicate, following direction exercises and many more exercises. If traditional ways of learning to communicate are not successful, patients are also taught other ways to communicate, such as pointing to cards with words, pictures or drawings. Handheld computers, tablets devices, smartphones with accompanying “apps” can help people with aphasia communicate. There are also devices or apps that can help create sentences or generate speech. Ask your speech-language pathologist for recommendations about aphasia assistive technologies that may be best for you.

Can aphasia be prevented?

Generally speaking, no. However, reducing your risk of preventable causes of brain damage, such as stroke, and taking steps to maintain brain health as much as possible is always wise advice for a long and healthy life. Healthy living involves eating healthy (follow the Mediterranean or DASH diet); exercising daily; maintaining a healthy weight; limiting alcohol intake; keeping blood glucoseblood pressure and cholesterol under guideline limits; quitting smoking and getting an adequate amount of sleep.

What’s the outlook (prognosis) for people with aphasia?

The cause of the brain injury, extent and area of the brain damage, and age and health of the affected person all play a role in prognosis and brain recovery. Because of these factors, the degree of recovery and speed of recovery of language and communication skills varies from person to person.

If stroke is the underlying cause of the aphasia, sometimes language abilities return to normal within hours or days. In others with stroke, language difficulties may be lifelong and range from mild, subtle difficulties to significant aphasia. If the aphasia is caused by a neurodegenerative condition such as dementia, language and communication skills will continue to decline over time. There is no cure for dementia. Currently approved medications only slow the progression of symptoms.

Are there any newer approaches to diagnose or treat aphasia?

New drugs are under development that affect the chemical neurotransmitters (the way the brain’s cells communicate with each other). It is hoped that the drugs in combination with speech-language therapy will improve the recovery of language functions.

Researchers are looking into the role of brain stimulation techniques, such as transcranial magnetic stimulation and transcranial direct current stimulation. These techniques temporarily alter normal brain activity in the area where they are applied, which, under the guidance of speech-language therapists, may help people relearn communication and language skills.

Other research is exploring new ways to learn how language is processed in both damaged and normal brains and to learn how the speech and language areas of the brain recover after injury. This information could help with diagnosis and with assessing treatment progress. Functional magnetic resonance imaging is one imaging techniques being explored for this use.

What can family members do for a loved one with aphasia?

Family members need to be involved with their loved one with aphasia in order to learn how best to communicate with them.

Family members can:

  • Go to speech-language therapy sessions with their loved one.
  • Speak in short simple sentences.
  • Ask questions that can be answered with “yes” or “no”.
  • Repeat or rephrase their language as needed (to be more easily understood by the person with aphasia).
  • Include their loved one in conversations.
  • Turn down the volume on the TV/radio and get rid of other distractions when talking.
  • Give their loved one time to speak on their own.
  • Try not to correct the person’s speech or answer questions for them (unless the person with aphasia is looking for help).
  • Encourage the use of other means of communicating, including gestures, pictures, pointing, drawing, electronic devices.
  • Help your loved one find support groups (stroke clubs or aphasia support groups). Attend meetings with them.
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