Surviving a stroke is the first step in recovery, which often involves intensive therapy. Aphasia, a common condition in stroke survivors, affects communication skills and can negatively impact quality of life. Its severity and manifestation vary depending on the parts of the brain affected by the stroke. The article discusses different types of aphasia, like Broca’s aphasia, Wernicke’s aphasia, Conduction aphasia, Anomic aphasia, and Global aphasia. Aphasia is diagnosed and treated by Speech-Language Pathologists, who create individualized treatment plans that can include various strategies and therapies. Support groups also play a key role in the recovery process.
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Imagine you have a stroke and survive. That’s great, of course, but surviving a stroke is just the first step of many in recovering from the consequences of a major neurological event.
Once your condition stabilizes, recovery and rehabilitation begin. For many people, this involves intensive therapy, and a stay in a short-term rehabilitation facility, dedicated to enhancing and maximizing recovery prospects during a critical window. .
Many people who experience a stroke develop a condition called aphasia.
Aphasia, also sometimes known as dysphasia, is a condition that affects many stroke survivors—yet it’s one many have never heard of.
For many, the first time they hear it is when they or someone they love is diagnosed.
Which is unfortunate—because it fuels misconceptions about aphasia and those who experience it.
This article will dispel aphasia myths, giving you a solid understanding of what it is, how it occurs, and how it’s treated.
That way, if your life or the life of a loved one is ever impacted by aphasia or dysphasia, you’ll know how to approach this issue with confidence and clarity.
Let’s start by examining what aphasia is, and how it happens.
What is Aphasia?
If you’ve been following along with our Word to the Wise series focused on stroke awareness (and if you haven’t, get started with our comprehensive overview on strokes), then you’re aware that a stroke is an attack on the brain’s blood vessels.
It impacts your brain’s ability to send and receive the signals that run your body’s essential functions.
The longer a stroke goes untreated, and the more blood vessels involved—the greater the damage and lower the chances it can be reversed.
Now, your brain has something called localization of function. This simply means that certain parts of your brain are tasked with certain functions.
While this isn’t a perfect concept—mainly because big, important functions like language and memory are too big to be contained to one area and are stored diffusely throughout your brain—it is helpful when it comes to understanding how strokes cause the issues with speech and language that are characteristic of aphasia.
See, most people are left-lateralized for language. This means that several crucial language centers are typically housed on the left hemisphere of the brain.
In particular, Broca’s Area in the left frontal lobe and Wernicke’s Area in the left temporal lobe (the one around your ear) are vital language centers that are often damaged in those who develop aphasia as the result of a stroke or traumatic brain injury.
If a stroke impacts the blood vessels feeding the language centers in the brain’s left hemisphere —you guessed it—the result is issues with speech and/or language skills.
These language issues are the hallmark of aphasia and/or dysphasia.
The roots of this term come from combining the ancient Greek words for without and utterance.
People who develop aphasia or dysphasia experience some type of difficulty with their communication skills, which impacts their ability to interact with the world, understand and be understood, and get their needs met.
Understandably, this can be a source of frustration to those who experience it and their loved ones. It can also negatively affect their quality of life.
Worse still, people with aphasia often feel marginalized—because many don’t understand that aphasia is a difficulty with language, and may wrongfully assume an individual with aphasia has cognitive or intellectual impairments.
While it’s true that aphasia, or dysphasia, can co-occur with cognitive issues—aphasia, itself, refers solely to problems with language, not intellect.
That’s why spreading knowledge and awareness about aphasia is so important in supporting those who cope with it.
Because a stroke can impact different areas of the brain and its language centers—there are many different types of aphasia, depending upon which parts are damaged.
Let’s learn about the types of aphasia, to help you understand how this condition can show up in those it impacts.
Aphasia vs. Dysphasia
Aphasia and dysphasia are terms that are often used interchangeably, as both relate to disruptions in communication due to brain damage. However, there is a subtle difference between the two. While aphasia generally refers to a complete loss of ability to understand or express speech, dysphasia is often used to describe less severe impairments in communication.
In dysphasia, a person might struggle with speaking, reading, writing, or understanding language, but unlike with aphasia, they retain some ability to communicate. This is why it’s sometimes referred to as ‘partial aphasia’. Despite this distinction, in many clinical and medical contexts, ‘aphasia’ is a term more frequently used and understood.
It’s important to remember that the severity and extent of both conditions can vary widely from person to person. They can range from mild, where a person might only occasionally struggle with finding the right words, to severe, where they may have minimal or no communication abilities at all. Whether termed as aphasia or dysphasia, early diagnosis and targeted therapy can significantly improve outcomes and help individuals regain their communication skills.
What Are The Different Types of Aphasia?
Aphasia subtype classification begins with a determination of verbal output, or fluency.
Cases of aphasia are separated into two main categories—fluent and non-fluent.
- Fluent aphasia—is the term used for aphasia types where verbal abilities aren’t impacted so much as understanding and self-monitoring of meaning and accuracy in verbal output. Fluent aphasias are characterized by issues with word usage; abnormal speech rate, rhythm, and intonation; and problems with syntax.
- Non-fluent aphasia—refers to aphasia types characterized by issues with speech and language production, including reduced phase length, impaired grammar, and difficulties with the rhythm and articulation of speech patterns.
Now let’s take a look at some of the main aphasia subtypes.
The most common type of non-fluent aphasia is Broca’s aphasia. Associated with a lesion in an area of the left frontal lobe that’s tasked with organizing thoughts into coherent words and sentences, and giving the correct messages to the speech musculature to form them into speech, Broca’s area is a vital center of our expressive language capabilities.
People with Broca’s aphasia often exhibit telegraphic speech patterns.
These individuals often produce speech that omits conjunctions, prepositions, and other parts of speech in favor of nouns and verbs.
For example, a person with Broca’s aphasia might say “You go store” instead of “I need you to go to the store for me.” This is also known as agrammatism.
Short phrase length is a hallmark of Broca’s aphasia.
In some cases, people with Broca’s aphasia have speech that’s limited to repetitive stereotypic utterances.
For example, I once worked with a man who’s stroke left him with the ability to consistently say “thank you” and “I love you.” These phrases comprised the bulk of his speech.
In most cases, the person with Broca’s aphasia is aware the phrases they’re saying aren’t conveying what they’re intending. This can cause frustration, but can also aid in the use of non-verbal communication strategies.
People with Broca’s aphasia typically understand what’s said to them, but struggle to produce speech.
Folks with this type of aphasia also usually have difficulty repeating back what’s said to them.
The most common type of fluent aphasia, people with Wernicke’s aphasia experience difficulty understanding what’s said and self-monitoring their verbalizations.
This type of aphasia is caused by a lesion to Wernicke’s area in the left temporal lobe, which is a language center responsible for making sense out of verbal and written language.
People with Wernicke’s aphasia may produce words and sentences that don’t make sense, and they may not be aware or able to correct it.
They may also have difficulty making sense of what’s said to them, which impacts their ability to follow directions, respond to questions, and participate in conversations. This is due to impaired auditory comprehension skills.
In some cases, people with Wernicke’s aphasia present with what’s known as press of speech, or logorrhea. When this occurs, a person may talk a lot, but not make much sense.
In this rare type of fluent aphasia, lesions impact the pathways connecting Broca’s area to Wernicke’s area. The result is aphasia characterized by word finding difficulties with fluent output and average phrase lengths.
The hallmark of conduction aphasia is that the person is typically aware of their errors in speech and attempts to self correct them as they occur.
In many cases, these attempts to correct errors are unsuccessful, and may serve to negatively impact the flow of speech.
Some people with conductive aphasia rely on circumlocutions (talking around words) as a strategy to compensate for their word-finding and production issues.
A hallmark of all types of aphasia is anomia. This term refers to the word-finding difficulties that are characteristic of aphasia.
In anomic aphasia, however, word-finding issues are the primary symptom, whereas other types have features in addition to anomia.
These word-finding issues are particularly apparent when an individual attempts to locate a specific, substantive term (sometimes known as tier two words).
People with anomic aphasia typically have normal phrase length and can understand and repeat what’s said to them. They may rely on circumlocution or non-specific language to compensate for their word-finding difficulties.
As you can probably guess, anomic aphasia falls under the fluent category.
When a stroke is severe and impacts many different language centers in the brain, global aphasia results.
This non-fluent aphasia type is characterized by profound anomia and very limited speech output. Auditory comprehension skills are also severely impaired.
People with global aphasia may be unable to speak at all, or may produce stereotypical utterances such as nonsense words or repeated syllables lacking clear meaning or intent.
Typically, global aphasia arises from a stroke that impacts the middle cerebral artery. This blood vessel is the major supplier to the brain’s vital language centers.
Global aphasia involves severe language deficits across all modalities of language.
When aphasia occurs that impacts more than one language center but isn’t severe enough to be classified as global aphasia, it is categorized as mixed aphasia.
Additional aphasia subtypes that are less common, but still individually classified include—
- Transcortical motor aphasia
- Transcortical sensory aphasia—according to lead aphasia researcher, Nancy Helm-Estabrooks, this type of aphasia is one of the most commonly seen in individuals with Alzheimer’s disease.
- Subcortical aphasia
Now that you know what aphasia is and why it happens, let’s take a look at how it’s treated.
How is Aphasia Diagnosed and Treated?
Aphasia, or dysphasia, is diagnosed in a number of ways.
- A neurologic history is taken to assess any prior history of neurological issues
- Mental and neurological status exams are conducted to gain a sense of the individual’s cognition and current level of functioning
- Motor system functioning is also assessed, to understand issues that might impact the ability to produce coherent speech. This includes an evaluation of reflexes and sensation
- Neuroimaging tests such as MRIs, CT, and PET scans are conducted, to gain a clear picture of how the brain is functioning
- If aphasia is suspected, a Speech-Language Pathologist will conduct formal and informal assessments to assist in determining the presence, severity, and type of aphasia. Speech-language pathologists use standardized tests and other methods to assess aphasia and inform what treatment strategies will be appropriate
Once the type and severity of aphasia are determined, a speech and language pathologist will develop an individualized plan of treatment to address the communication and language needs and deficits of the individual.
SLPs typically work closely with a multidisciplinary team of other skilled rehabilitation therapists and healthcare professionals, to ensure treatment is robust, comprehensive, and appropriate for the person.
Treatment for aphasia, or dysphasia, is highly individualized and based on the type and severity of aphasia, as well as the lifestyle goals and needs of the person being treated.
For non-fluent types of aphasia, treatment may focus on improving verbal output, clarity of speech, and the ability to produce new words, phrases, and sentences. Supplemental communication strategies may also be used, to promote the ability to communicate using non-verbal methods such as picture boards, computers, or gestures.
For fluent types of aphasia, treatment is often centered around improving self monitoring of verbalizations, and the ability to understand and follow directions.
Melodic Intonation Therapy is an example of a specific therapy program that uses music and tactile cues to support people with non-fluent aphasia to produce new functional phrases.
There are many other specific types of aphasia treatment that are used both alone and in conjunction with one another to form a holistic rehabilitation plan for addressing aphasia.
With frequency and intensity (to harness the principles of neuroplasticity), people with aphasia can make notable improvements in their speech and language skills with the support of skilled therapists.
Many people with aphasia and their loved ones greatly benefit from involvement in aphasia support groups. These groups offer support and guidance, and a way to connect with others who share awareness of this condition.
There are many stroke survivor and aphasia support groups that exist on the local and national level. Here’s a link to find online and local support groups through the National Aphasia Association, and a support group finder from Lingraphica.
You can also search for support groups in your area, and nowadays there are many free resources and groups available online for those with aphasia and their loved ones.
If you or someone you love are living with aphasia, it’s easy to feel alone and isolated. But this is far from the truth. Seek out the many communities that exist to uplift, support, and offer connection to people whose lives have been affected by aphasia.