What is aphasia?

Aphasia is difficulty in communicating in someone who has suffered brain injury from a stroke, traumatic brain injury, or a brain tumor.

Aphasia can affect understanding speech, talking, reading, and/or writing. One or more of these modalities can be affected more than the others.

People with aphasia can also have other effects of brain injury which are not aphasia, but can also affect the ability to communicate.

• Dysarthria from weakness of the facial muscles can make speech unclear.
• Right sided hemiplegia (weakness or paralysis of one side of the body can make it difficult to write.
• Visual difficulties can affect reading.

Is all aphasia alike?

Unfortunately, no. Some people with aphasia have difficulty retrieving the names of people and objects. Others can say names, but have difficulty putting them into sentences.

Aphasia also varies in severity.

• Mild aphasia – the person has difficulty recalling words, but can generally function in ordinary situations. They may need assistance in phone conversations with strangers, or in complex situations.
• Moderate aphasia – the person often has difficulty recalling words or producing sentences, but can usually get his meaning across with a patient listener.
• Severe aphasia – the person needs help to get his meaning across.
• Profound aphasia – the person cannot understand or speak any words at all.

Does my loved one with aphasia know who I am?

Yes, they know who you are. They are simply having difficulty either remembering or saying your name. Most of us have had the experience of seeing someone we know, and not remembering their name. We know who they are, recall our previous interactions with them. It is only the name that is not coming up. People with aphasia have the same difficulty with close friends and family members that many of us experience with casual acquaintances.

Learning a second language – an analogy to aphasia

Recall a time when you learned another language. At the beginning, you did not understand or speak a single word. However, you could still understand situations. This is similar to a person with profound aphasia.

Next, you learned some basic words – yes, no, thank you, hello, and some basic phrases. This is similar to severe aphasia.

If you continued in your language study, you learned to make simple sentences and to understand simple questions and replies. You might also learn to read and write in your second language This is similar to moderate aphasia.

If you had the opportunity to continue learning, you could learn to speak and understand your second language in most situations. This is similar to mild aphasia.

If you continued to study and use your new language in real-life situations, you could learn to speak and understand your second language like a native speaker.

There is one important difference between aphasia and second language learning. When you are learning a second language, you can still use your native language. You can still communicate normally with others who share your language. People with aphasia have the same difficulty in their native language as you do in your second language. In a world that depends on communication, this can be profoundly isolating.

Do people with aphasia have normal “self-talk”?

We all talk to ourselves in our heads. Can people with aphasia do this? There is no way to tell from the outside. A person with severe aphasia can have normal internal speech, but is unable to express it in words. The only way to find out is to ask. I have asked a number of people with aphasia about this. Approximately half said that they experience language normally in their minds. The other half said that they had some difficulty with inner speech as well.

Do people with aphasia lose words?

The old concept of the brain was that each word was stored in a neuron. If that neuron died, the word would be lost. Now we know that the brain does not work that way. A word consists of a pattern of connections between different parts of the brain. Take the word “apple”. There are connections between the sounds in “apple”, how you write the word, the visual appearance of an apple, how an apple tastes and smells, and everything you know about apples. Every time you see or eat an apple, or see or hear the word apple, or think about apples, these connections are strengthened.

A stroke interrupts the connections that make up the word pattern. The good news is that words are not “lost”. The connections can be strengthened or re-routed by using them over and over.

Can people with aphasia recover?

Everyone can make some progress. How much progress depends on a number of factors.

Some people experience aphasia immediately after a stroke, but it resolves spontaneously in a few days.

For those with enduring aphasia, progress depends on several factors

• How much of the language area of the brain was affected by the stroke
• The age of the individual – young people recover more quickly in general, but everyone can make progress.
• How much the person works to recover language.

Is there a time limit for recovery from aphasia?

No. With continued effort, recovery can continue for many years.

How can someone recover from aphasia?

Speech is a complex physical activity like dancing or basketball. The more you practice any skill, the better you become. Just as your muscles become stronger when you exercise, your brain becomes stronger every time you perform any physical or mental activity.

Someone who wants to become good at something must spend many hours practicing. They need to practice almost every day, not just one or two hours a week. People with aphasia have to practice intensively to recover the abilities that they used to have.

Just as in learning anything, the activities you use for practice must be easy enough to be successful, but difficult enough to be challenging. If you are having trouble finding suitable practice, a knowledgeable professional can help.