Living With Aphasia

What Is Aphasia?

You may have heard the term aphasia (pronounced “uh-fey-zhuh”) from your loved one’s medical team. This disorder is also being discussed in the news currently, due to actor Bruce Willis’ diagnosis. Aphasia is the medical term for problems with language and communication after a stroke, acquired brain injury, brain tumor, or degenerative diseases, like dementia. Aphasia as a language disorder happens when a person has brain damage. It can make it difficult for a person to speak, understand, read, and write. It does not make a person less smart or cause problems with how they think. It is a loss of language, not intelligence (ASHA, 2021a). Brain damage can also cause other problems along with aphasia, such as speech problems, swallowing problems, or cognitive problems, for example, problems with memory or organizing our thoughts.

How Common Is Aphasia?

According to the National Aphasia Association (2021) approximately 180,000 individuals are diagnosed with aphasia each year in the United States. It is more common for older adults to have aphasia than younger ones, although children and young adults can have an acquired brain injury, degenerative disease, or other illness that causes aphasia. The incidence of aphasia in men versus women is similar, although different aphasia types may be more common in one gender than the other. 

What Are Some Common Causes of Aphasia?

Stroke is the most common cause of language problems and aphasia in adults. According to the National Aphasia Association (2021), about 25%–40% of individuals who survive a stroke have aphasia as one of their disabilities. A stroke may damage areas of the brain important for language, because of too much blood flow (hemorrhage) or too little blood flow (ischemia) in the brain. You may have also heard the term brain attack. This is a relatively new label being used in doctor’s offices and public places instead of the word stroke. It helps the average person understand the need to get help quickly, just as in the situation of a heart attack. Important stroke symptoms that everyone should know are (1) sudden onset of slurred speech, (2) confusion, (3) weakness or numbness on one side of the body, (4) problems with vision, (5) falls, and (6) severe headaches. It is important to seek immediate medical attention if your loved one is showing signs of a stroke. You may have seen or heard about FAST. This is an acronym to help people remember the initial warning signs of a stroke. Here’s what it stands for:

Face       
Ask the person to smile.
Does one side of the face droop?

Arm       
Can the person raise both arms?
Is one arm weak or numb?

Speech  
Does the person sound slurred?
Can they speak and understand?

Time      
If you notice any of the above signs, time is of essence. Be sure to call 911 immediately to get help.

For more information on FAST, please visit the American Stroke Association (2021).

Some medical conditions cause a person to be at risk for having a stroke. These include diabetes (elevated blood sugar), hypertension (high blood pressure), obesity (abnormal fat accumulation in the body), high cholesterol, arteriosclerosis (thickening and hardening of the arteries), atrial fibrillation (heart palpitations), smoking (narrows blood vessels), and an inactive lifestyle, to name a few.

Traumatic brain injury (TBI) is another possible cause of language problems and aphasia in adults. Here, the person has had a trauma to his or her brain. The most common causes of TBI are falls and motor vehicle crashes. In the news, there has been lots of talk about sports-related TBIs, which are on the rise (for example, brain damage sustained during a football game or boxing match). There is more awareness now of this type of acquired brain injury. Some other less common causes of aphasia in adults include things like seizures (sudden and often unexpected change in brain function and consciousness), brain tumors, infections (such as meningitis), metabolic problems (such as a deficiency in vitamin B-12), or degenerative diseases or disorders, like dementia (see chapter 6). Unlike aphasia caused by stroke, in these cases, the language problems typically occur with other cognitive deficits, such as memory problems or confusion. (For more information, see Mayo Clinic, 2020.)

What Are Some Tips for Better Communication with Someone with Aphasia?

Many helpful websites related to aphasia have tips for better communication with your loved one with a language problem (see the list of resources at the end of this chapter). The following are a few common tips for better communication with your loved one with a language and communication problem:

Attention: Get your loved one’s attention first by calling their name. Be sure they are ready to take part in conversation with you.

Eye contact: Keep eye contact with your loved one throughout the communication exchange. Eye contact will help you know if your loved one is paying attention, understands you, or is confused. Your loved one can also get helpful information from your facial expressions and body language as you talk with them (for example, watching your mouth as you speak, seeing you smile or frown to show emotion, or watching your hand movements).

Keep your words short and simple but adult: Make sure you are not “talking down” to your loved one. Repeat any keywords important for your loved one to understand. And don’t shout, unless your loved one is hard of hearing.

Speak slowly: Slow your speech and allow your loved one time to understand what you said.

Use yes or no questions as appropriate: Yes or no questions are easier to understand and answer than ones for which your loved one needs to come up with their own answer.

Find other ways to communicate: If your loved one does not understand you, use other ways to communicate. For example, you can try using drawings, gestures, pointing, writing, and facial expressions to help your loved one better understand. You can also have your loved one try one or more alternate ways to communicate when they are having trouble talking.

Be a good listener: Listen intently and ask your loved one to repeat if needed. You may also rephrase the question for them (for example, “I think you are asking for more coffee
—is that right?”).

Be patient: Be as patient as possible and don’t rush the communication exchange between you and your loved one. It may take longer than usual.

Offer help: Try not to answer for or finish your loved one’s sentences. If they are struggling or stuck on a word, offer help and respect if your loved one does not want help at that moment.

For more information on aphasia and communication, memory, and swallowing problems caused by brain injury or degenerative disease, please see our recently published book:

A Caregiver’s Guide to Communication Problems from Brain Injury or Disease by Drs. Barbara O'Connor Wells, Connie K. Porcaro, and a panel of speech-language pathology experts.

References

American Speech-Language-Hearing Association (ASHA). (2021a). Aphasia. Retrieved February 2, 2021. https://www.asha.org/public/speech/disorders/Aphasia/.

American Stroke Association. (2021). F.A.S.T Infographic. Retrieved March 1, 2021. https://www.stroke.org/en/help-and-support/resource-library/fast-materials/2019-fast-infographic.

Cleveland Clinic. (2020, May 4). Brain bleed, hemorrhage (intracranial hemorrhage). https://my.clevelandclinic.org/health/diseases/14480-brain-bleed
-hemorrhage-intracranial-hemorrhage.

Mayo Clinic. (2020, October 20). Aphasia. https://www.mayoclinic.org/diseases-conditions/aphasia/symptoms-causes/syc-20369518.

National Aphasia Association. (2021a). Aphasia definitions. Retrieved February 2, 2021. https://www.aphasia.org/aphasia-definitions/.