Aphasia

Aphasia, or language-related problems, occur when the stroke patient finds difficulty in finding the right word, constructing sentences and clearly explaining things. This generally is a result of damage to the speech areas of the brain, and occurs most commonly in those who have had the stroke in the left side of the brain.

There are two types of aphasia, and these are explained here.

Expressive Aphasia

Expressive aphasia occurs when the person knows what they are trying to say, but the words just don't seem to come. They  have difficulty in putting words together and finding the right word to use. It is also called Broca's, non-fluent or anomic aphasia.

The speech of people affected by expressive aphasia is laboured, hence the alternate term, non-fluent aphasia. They appear to be struggling to actually find the right word from their memory. It can take a relatively long time to say a relatively simple sentence. Some words may be missing. For other words, the person may use a "workaround" phrase to explain what they are trying to say, as the right word escapes them.

The person understands what others are saying (or writing), but has difficulty in their own use of language. These difficulties affect both spoken and written language.

Expressive aphasia is caused by damage to Broca's area in the brain (hence the alternate term). This affects around 40% of people who have a stroke that affects the left side of their brain.

People who are affected by expressive aphasia, are often also affected by verbal or oral apraxia (difficulties in managing the oral muscles to produce the words) and/or dysarthria (weakness in the oral muscles which impacts the ability to form words).

This condition can be extremely frustrating, as the person knows what they want to say, but are unable to communicate effectively and efficiently. It can be terribly isolating. To assist someone so affected, gather your patience and offer them your focus and respect whilst they try to complete their sentences.

Such patients are very susceptible to depression arising from their frustration and isolation.

Receptive Aphasia

Receptive aphasia is where understanding of spoken word is affected. It is also called Wenicke's or fluent aphasia.

The stroke patient may have poor auditory comprehension of what someone else is trying to say, or what they say may be incomprehensible to the listener. In the latter case, this is caused by the affected person speaking words fluently at an appropriate speech rate, however the words themselves don't logically relate to each other.

The cause of this is damage to Wernicke's area of the brain (hence the alternate term). The brain doesn't separate the physical sounds that the words make and fails to sequence them properly. The person affected also is typically not aware that their speech isn't making sense to the listener - this can cause frustration and irritation.

When speaking with someone who suffers from this condition, you can assist by speaking slowly and pausing slightly between words.

What Hope Is There?

As with much stroke therapy, the general consensus has been that a patient will achieve the greatest improvement shortly after the stroke occurs. And accordingly, most aphasia-related speech therapy is discontinued after months, or sometimes around a year.

However, there is hope.

In Norman Doidge's book, The Brain that Changes Itself, (available from our book store), he tells of the experimentation undertaken by Dr Friedmann Pulvermuller, who applied the principles of constraint induced therapy to create an experimental aphasia treatment. The experiment was conducted using a group of 17 stroke patients who had had their stroke (on average) over eight years previously. All patients received three hours of therapy each day over a period of 10 days. Seven of the patients had conventional therapy and 10 of them had the expiremental constraint induced therapy.

Those receiving conventional therapy made no improvement. Those who had received the experimental therapy achieved a 30% improvement in their communication, as measured by standard language tests.

Check out this article which provides further information about constraint induced thereapy and aphasia.