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Information

Editors

MinnaHissa
Riitta-LeenaManninen

Aphasia

Essentials

  • Aphasia is a language function disorder due to damaged or dysfunctional brain tissue.
  • Aphasia may affect speech or writing skills and the way these are used. It may involve difficulty finding words, recognizing the meaning of words and using words and linguistic structures, as well as difficulty grasping the speech of other people and/or written text.
  • There are many types and degrees of severity of aphasia affecting people's functional ability and restricting their ability to participate in various areas of life.
  • Aphasia may sometimes be so mild that it will not appear in daily conversations but will do so in demanding narrative tasks or processing of information, for example. Even mild symptoms of aphasia may cause strain and affect coping with studies or work tasks.

General remarks

  • Language functions are directed by the left cerebral hemisphere in 80-90% of right-handed and 65-70% of left-handed people. The right hemisphere also participates in speech production and reception and in various phases of processing pragmatic language features.
  • About 45% of patients with cerebrovascular disease have aphasia in the acute phase and about 10-17% as a long-term symptom.
  • The location of the cerebrovascular changes, the size of the lesion and the number of lesions affect not only the type and severity of aphasia but also its long-term prognosis. Other factors affecting the prognosis include age, gender, level of education and other diseases.
  • Depression and any social isolation after falling ill have been found to hinder recovery. Recovery also depends on motivation for rehabilitation and on the quality and duration of rehabilitation.

Main types of aphasia

  • Aphasia is traditionally divided into fluent and non-fluent types.
  • In patients with non-fluent aphasia, speech production is awkward, effortful and hesitant. Comprehension is often well preserved - better than speech.
  • In patients with fluent aphasia, speech production is fluent and apparently clear but speech may be empty in content and show a variable phonology. Jargon and neologisms may occur. In patients with fluent aphasia, speech comprehension is often impaired, and it may be difficult for them to realize that their speech is abnormal.
  • In aphasia, features of various types of aphasia are often present, and the emphasis on these may change with recovery. Defining the type of aphasia is used as a basis for choosing methods of rehabilitation.

Degrees of severity of aphasia

  • Definition of severity of aphasia according to the Boston Diagnostic Aphasia Examination
  • When defining the severity of aphasia, its effect on the patient's immediate surroundings and ability of interacting with others should also be considered.

Degrees of severity of aphasia

GradeDescription
0No usable speech or auditory comprehension
1All communication is through fragmentary expression; great need for inference, questioning, and guessing by the listener. The range of information that can be exchanged is limited, and the listener carries the burden of communication.
2Conversation about familiar subjects is possible with help from the listener. There are frequent failures to convey the idea, but the patient shares the burden of communication.
3The patient can discuss almost all everyday problems with little or no assistance. Reduction of speech and/or comprehension, however, makes conversation about certain material difficult or impossible.
4Some obvious loss of fluency in speech or facility of comprehension, without significant limitation on ideas expressed or form of expression.
5Minimal discernible speech handicap; the patient may have subjective difficulties that are not obvious to the listener. The patient is capable of using sentence expression but finding words, for example, may be slower than normal or incorrect words may occur at times.

Recovery from aphasia

  • Spontaneous recovery takes place mostly during the first month, but an initial period of rapid recovery continues for six months or even longer. Recovery depends on many structural and functional factors.
  • Even later on, at the chronic stage, rehabilitation can be used to improve and support the plasticity of the brain.

Rehabilitation and prognosis of aphasia

  • In rehabilitation, training is used to modify brain function. The timing and intensity of rehabilitation are significant for the results. Rehabilitation is aimed at reorganization and activation of language functions.
  • At the acute stage, already, a speech therapist should use observation, interview and standardized tests to assess the patient's cognitive-linguistic functions. Based on this, the type and severity of the disorder as well as the need for and aims of rehabilitation are defined.
  • The aim is to improve the patient's linguistic performance and expression and thus his/her participation in various areas of life. Rehabilitation should be planned individually according to the type of language disorder and the patient's communication needs and life situation. It may be provided as individual and/or group rehabilitation.
  • Methods of rehabilitation may focus on the disorder (direct methods) or on the consequences (indirect methods).
    • Methods focusing on the disorder target the features of the language disorder and language functions. Therapy is based on recognizing the symptoms of aphasia and any preserved language functions.
    • Rehabilitation focusing on consequences aims to reduce or eliminate the effects of the aphasia and may therefore focus on guiding the patient's relatives and increasing social activity, for instance.
    • Both approaches may be necessary, depending on the patient's life situation.
  • The patient can also be assigned exercises to be done independently to intensify rehabilitation.
    • Independent computer-assisted training has given encouraging results in both acute and chronic phases of aphasia. Training should be based on a clinical assessment of the benefits that the training programme offers for the patient.
  • As aphasia also affects the patient's immediate surroundings, his/her relatives need guidance in how to support communication with the person.
  • Depending on local legislation, patients with severe speech defects may be entitled to an interpreter service if, for example, the disadvantage from aphasia is considered to be chronic. Find out about the locally applied policies.
  • The long-term prognosis is greatly influenced by the patient's ability to adjust to the life change brought on by the disability. A supportive approach to care, encouragement to accept and live with the loss as well as management of possible depression are all beneficial for adjustment. Support and training should also include close family members. Peer support and adaptation training provided by patient organisations can contribute towards long-term adjustment.
  • See also local online resources for patients.

Suggestions on communication

  • Allow a sufficient amount of time.
  • Talk to the patient, not to the person accompanying the patient. Only one person should speak at a time.
  • Speak clearly but naturally whilst facing the patient.
  • Use everyday language. Do not raise your voice.
  • Eliminate environmental noise (close the window and switch off the radio, etc.).
  • Bring up one topic at a time, repeat if necessary using alternative words (additional cues will improve comprehension).
  • Bear in mind the potential of gestures, facial expressions, drawings etc. as part of the overall communication.
  • Allow the patient time to answer, do not guess his/her answers. Ask yes/no questions. You can clarify and ask whether you have understood correctly. Give feedback and tell the patient if you did not understand.
  • Formulate your questions in an unambiguous way (not like this: Do you smoke and use alcohol and how much? but like this: Do you smoke? How much? How about alcohol? etc.).
  • Provide written instructions to accompany all your verbal ones.
  • Ask how the family is coping.
  • Remember: Depression is common among aphasic patients but is difficult to diagnose. “Listening” to one's own emotional reactions will help in the recognition.
  • Communication is always best in a calm and relaxed atmosphere.

    References

    • Plowman E, Hentz B, Ellis C Jr. Post-stroke aphasia prognosis: a review of patient-related and stroke-related factors. J Eval Clin Pract 2012;18(3):689-94. [PubMed]
    • Vickers CP. Social networks after the onset of aphasia: The impact of aphasia group attendance. Aphasiology 2010;24:6-8, 902-913.