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Understanding Aphasia in Stroke Survivors

What is aphasia?

Aphasia, as defined by the National Aphasia Association, “is an acquired communication disorder that impairs a person's ability to process language, but does not affect intelligence.  Aphasia impairs the ability to speak and understand others, and most people with aphasia experience difficulty reading and writing.  The most common cause of aphasia is stroke (about 25-40 percent of stroke survivors acquire aphasia).  It can also result from head injury, brain tumor or other neurological causes.   Aphasia affects about one million Americans, or 1 in 250 people, and is more common than Parkinson's disease, cerebral palsy or muscular dystrophy.  More than 100,000 Americans acquire the disorder each year. However, most people have never heard of it”.

What are the different types of aphasia?

There are many different types of aphasia.  In general, the different aphasia types are classified into two major categories, based on whether or not the person with aphasia has fluent or non-fluent speech.  With fluent aphasias, the person’s ability to produce connected speech is relatively preserved.  However, this does not mean that their word choices and how they express themselves is normal.  Often times, the speech of these individuals can best be thought of as a “word salad”, because even though they can say a lot of words and sentences, it doesn’t generally make sense.  Additionally, their ability to understand both spoken and written language is impaired, and their attempts to write often are similar to their speaking abilities.  Individuals who have these types of difficulties might be referred to as having a “Wernicke’s aphasia”, or a “Transcortical Sensory” aphasia, if they have the ability to repeat words and sentences that are spoken to them.   

Other types of fluent aphasias are “Conduction” aphasia and “Anomic” aphasia.  In Conduction aphasia, the person has a relatively preserved ability to understand language, both spoken and written, but they have significant difficulty with repetition and saying specific words.  They will often produce “phonemic paraphasias”.  These are word errors in which the speech sounds produced are similar to the desired word.  For example, a “spoon”, might be referred to as a “poon”, “soon” or even “pone”.  In Anomic aphasia, the primary limitation is the ability to retrieve specific words when needed during communications.  It might best be thought of as an “it’s on the tip of my tongue” disorder.  Individuals with Anomic aphasia are generally able to understand language, both written and verbal.  Their writing abilities are often similar to their speech difficulties, in that they have difficulty thinking of specific words. 

The non-fluent aphasias are designated to those individuals who have a limited ability to produce speech, wherein their spoken messages are often very slow, halting and may contain only three to four words.  However, their ability to understand spoken and written language is a relative strength.  “Broca’s aphasia” is a type of non-fluent aphasia that fits this description.  Similar to Broca’s aphasia is “Transcortical Motor” aphasia, in which the person is able to repeat words and sentences, but they essentially have all the other characteristics of Broca’s aphasia.   

The more severe types of non-fluent aphasias are “Mixed Non-Fluent” aphasia and “Global” aphasia.  In Mixed Non-Fluent aphasia, they have speaking abilities that are similar to Broca’s aphasia, but their understanding of language is not adequate enough to classify them as having Broca’s aphasia.  The most severe form of aphasia is Global aphasia.  With this type of aphasia, the individual has severe-profound difficulties with all forms of communication (i.e. talking, listening, reading and writing).  Communication is very difficult, not only for the person with aphasia, but also for their communication partners.

To help you better understand the differences between each of the aphasias, please refer to the diagram above.

Are there other communication problems that can occur with aphasia?

Aphasia can co-exist with other types of communication impairments.  A person with aphasia might also have communication difficulties because of dysarthria or apraxia.  Both of these impairments are classified as motor speech disorders.  The American Speech-Language Hearing Association defines dysarthria as a disorder in which “the muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all after a stroke or other brain injury." Often times, the person’s speech might be “slurred”, their voice may have a breathy quality to it or they may speak very slowly. 

In contrast, apraxia of speech is defined as difficulty with “sequencing the sounds in syllables and words." Symptoms of apraxia can include difficulty imitating speech, “groping” when trying to produce speech, inconsistent speech errors or even an inability to produce any speech or sounds.

By: Kim Winter MA CCC-SLP, Speech-Language Pathologist at Hospital for Special Care

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"Aphasia affects about one million Americans, or 1 in 250 people... however, most people have never heard of it."

What should you do if you or a family member is diagnosed with aphasia?

There are several things to consider when being diagnosed with aphasia:

  • Find a certified speech-language pathologist to provide therapy and support for the communication difficulties experienced.
  • Visit the National Aphasia Association's website for a wealth of information and resources. The NAA also has a listing of aphasia support groups throughout the country.  Many PWA don’t know anyone else who has gone through the recovery process, but being able to interact with others who know what it’s like to struggle to communicate can be helpful.
  • Have an open mind about communication. Use a variety of communication methods, such as drawing, gesturing, pointing and writing, in addition to speech, when communicating with a person with aphasia. Not only is this beneficial in helping them to understand what you are trying to communicate, but it also demonstrates how these techniques can be used successfully during everyday communicative interactions.
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