Aphasia: Understanding the Language Changes That Can Happen After Stroke or Brain Injury
Imagine knowing exactly what you want to say, but being unable to get the words out. Or hearing someone ask you a question and knowing that the words they are saying should make sense, but struggling to understand what they mean.
For someone with aphasia, everyday communication can suddenly become much more difficult.
Aphasia is a language disorder that can affect a person’s ability to speak, understand, read, and write. It most commonly occurs after a stroke, but it can also result from other types of brain injury or neurological conditions.
Importantly, aphasia does not mean that someone has lost their intelligence. A person with aphasia may still have the same thoughts, knowledge, memories, opinions, and personality they had before their brain injury. The difficulty is accessing or processing language.
What Causes Aphasia?
Aphasia occurs when areas of the brain responsible for language are damaged.
The most common cause is a stroke, particularly when a stroke affects the left side of the brain, where language is typically processed.
Aphasia can also occur following:
Traumatic brain injury (TBI)
Brain tumors
Brain surgery
Infections or inflammation affecting the brain
Other neurological conditions that cause progressive language changes
The type and severity of aphasia depend on several factors, including the location and extent of the brain injury.
How Can Aphasia Affect Communication?
Aphasia can affect different areas of language, and a person may experience difficulties in one area while having relatively strong abilities in another.
Speaking
One of the most noticeable effects of aphasia can be difficulty speaking.
A person may:
Have trouble finding the word they want to say
Substitute one word for another
Use a word that sounds similar to the intended word
Have difficulty putting words together into sentences
Speak in shorter or less complex sentences
Repeat certain words or phrases
Sometimes a person may know exactly what they want to say but feel as though the word is “stuck.”
Understanding
Aphasia can also affect a person’s ability to understand spoken language.
Someone may have difficulty understanding:
Questions
Directions
Conversations
Longer or more complicated sentences
Fast-paced speech
Reading
Someone who previously read books, newspapers, text messages, or emails with ease may suddenly have difficulty:
Recognizing written words
Understanding sentences
Reading aloud
Following written instructions
Understanding information in a letter or text message
Reading difficulties can range from mild to severe and may occur alongside speaking or comprehension difficulties. It is also important to remember that someone may be able to read and comprehend the information fine, but not be able to read the words aloud.
Writing
A person may have difficulty:
Spelling familiar words
Writing their name
Forming sentences
Writing down information they know
Completing forms
Sending text messages or emails
Someone may also be able to write some things more successfully than they can say them or vice versa.
What Does Speech Therapy for Aphasia Look Like?
Speech therapy for aphasia is not simply about sitting at a table and repeating words.
Treatment should be based on the individual’s communication needs, goals, strengths, and challenges.
A speech-language pathologist may work on skills such as:
Word finding: Helping a person retrieve the words they want to say and teaching strategies to communicate when a word is difficult to access.
Sentence formulation: Working on putting words together to express thoughts, needs, and ideas more effectively.
Comprehension: Improving understanding of spoken or written language and developing strategies to support comprehension.
Reading and writing: Addressing functional reading and writing skills that are important in everyday life.
Conversation: Practicing real-life communication rather than focusing only on isolated words or exercises.
Communication strategies: Teaching ways to communicate when traditional speaking is difficult. This may include gestures, writing, drawing, pictures, communication boards, or technology.
Communication partner training: Helping family members, caregivers, and other communication partners learn how to make conversations more successful.
The Goal Isn’t Always “Perfect Speech”
One of the most important things to understand about aphasia treatment is that communication doesn’t have to be perfect to be successful.
For one person, the goal may be being able to tell their spouse what they need.
For another, it may be ordering their own meal at a restaurant.
Someone else may want to be able to participate in conversations with their grandchildren, make a phone call, manage appointments, or tell a story.
The goal is to help each person communicate as successfully and independently as possible in the situations that matter to them.
Supporting Someone With Aphasia
Family members and friends also play an important role in communication recovery.
If you’re communicating with someone who has aphasia, try to:
Give them extra time to respond.
Speak directly to them.
Keep distractions to a minimum when possible.
Use writing, gestures, pictures, or other supports when helpful.
Ask one question at a time when needed.
Don’t automatically finish every sentence for them.
Don’t assume that difficulty speaking means difficulty understanding.
Continue including them in conversations.
Most importantly, remember that the person with aphasia is still the same person. Their ability to communicate may have changed, but their thoughts, feelings, experiences, personality, and desire to connect with others are still there.
Aphasia Recovery Is Personal
Recovery doesn’t always mean returning to exactly the way communication was before the injury. Sometimes progress means finding a word more easily. Sometimes it means learning a strategy that helps someone communicate around a difficult word.
Sometimes it means becoming confident enough to participate in a conversation again. And sometimes it means finding a new way to communicate when speaking isn’t enough.
Every one of those things can represent meaningful progress.
If you or someone you love is having difficulty communicating after a stroke or brain injury, a speech-language pathologist can help identify the person’s strengths and challenges and develop a treatment plan focused on the communication skills that matter most in everyday life.
Aphasia may change the way someone communicates. It does not change who they are.
