The famous actor Bruce Willis recently announced his aphasia diagnosis. Although aphasia is more common than Parkinson’s, cerebral palsy, or muscular dystrophy, affecting millions of people in the U.S., many people aren’t familiar with it.

What causes aphasia?

Aphasia is an impairment of language skills caused by damage to the parts of the brain responsible for language. Being diagnosed with aphasia means that your ability to speak, understand language, read, and/or write is impaired. There are several types of aphasia, which are determined by where in the brain the injury took place.

Most cases of aphasia occur in adults who have experienced a stroke, but other cases result from a traumatic brain injury (TBI), neurodegenerative disease, tumor, or certain infections. According to the National Aphasia Association, aphasia affects about 2 million Americans. About 180,000 Americans are diagnosed with aphasia each year.

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What are the symptoms of aphasia?

The symptoms of aphasia can vary. But people with aphasia may:

  • Have difficulty remembering the names of items
  • Have difficulty formulating sentences
  • Produce only short or incomplete sentences
  • Substitute one word for another or one sound for another
  • Speak in sentences that don’t make sense (such as “chair hotel sand time”)
  • Say unrecognizable words (also known as jargon)
  • Lose the ability to read and or write
  • Not understand what other people are saying

What are the types of aphasia?

The different types of aphasia are as follows:

Global aphasia: This is known to be the most severe type. Those with global aphasia lose the ability to read and write. While they may produce a few words, they often understand little to no spoken language. Many people are diagnosed with global aphasia immediately after having a stroke, and it can improve quickly if the damage to the brain isn’t too severe. The more severe the brain damage, the longer the recovery time.

Broca’s aphasia: This is one of the most common types of aphasia. A person with  Broca’s aphasia often understands language and can read, but writing and speaking are a real challenge. Those with Broca’s aphasia often report the sensation of a word being on “the tip of their tongue,” but they’re unable to think of the word or say it. Their vocabulary is limited, and their speech is described as halting and effortful. For example, a person with Broca’s aphasia may say “Want sweet” instead of “I want ice cream.”

Some people with Broca’s aphasia develop behavioral problems due to their frustration, since they understand what’s going on around them but can’t communicate their thoughts seamlessly.

Mixed non-fluent aphasia: This type of aphasia is characterized by limited and effortful speech, often resembling Broca’s aphasia. The difference between the two is that people diagnosed with mixed non-fluent aphasia also have limited comprehension of language, and they can’t read or write past a basic level.

Wernicke’s aphasia: People with this type of aphasia have a hard time understanding the meaning of spoken words. Reading and writing are usually severely affected. However, the person can still generate connected speech and use intonation–the natural “up-and-down” inflection we use in our voices when we speak. A person with Wernicke’s aphasia strings together irrelevant or made-up words to form a sentence, leaving the listener confused. Here is an example of what a person with Wernicke’s aphasia may say: “Sweet wooden relax gron land tobeby.”

Anomic aphasia: This form of aphasia occurs when a person understands language well, but has difficulty producing nouns and verbs. This makes writing a challenge. It also leads to vague speech, where the speaker is talking around the word instead of providing a label for what they want to say. An example of this might sound like: “Hot, ya know… so ouch on the… sizzle.”

Primary progressive aphasia (PPA): This is a neurological disorder in which, over time, one’s language skills slowly deteriorate. PPA isn’t like other forms of aphasia, which result from a stroke or traumatic brain injury. PPA is a neurodegenerative disease like Alzheimer’s disease. It is caused by deterioration of the brain tissue that’s responsible for language and speech production. The person’s memory and ability to complete tasks independently are also affected.

How is aphasia diagnosed?

In order to confirm a diagnosis of aphasia, an evaluation by a speech-language pathologist is needed. The speech therapist assesses the following areas:

  • Naming
  • Repetition
  • Comprehension of language
  • Reading
  • Writing

In addition to a speech and language evaluation, diagnostic imaging procedure(s) may be needed to obtain an image of what’s happening in the brain. These diagnostic imaging tests may include an MRI, CT scan, or PET scan.

How does speech therapy help aphasia?

Some people will see natural improvements in their language and communication ability in the first few months following a brain injury, even without treatment. However, even after this recovery period, symptoms remain in many people, and speech-language therapy is usually recommended.

Speech therapy helps people with aphasia regain their ability to communicate. The main goal of speech therapy is to relearn communication skills lost, restore as much language as possible, and improve current communication skills.

The best speech therapy for someone with aphasia is individualized, since what works for one person may not work for another. Also, speech therapy evolves as the person with aphasia improves and can take on more difficult tasks.

Depending on a person’s speech, language, and social needs, speech therapists will work with the affected individual, as well as their family and caregivers, to set goals. Some therapeutic interventions that may be used in speech therapy include the following:

Melodic intonation therapy (MIT): This type of therapy is typically aimed at those with more severe forms of aphasia. It helps them use the musical elements of speech (melody, tone, stress, and rhythm) to relearn how to speak. Basically, it’s a version of singing what you want to say. Other techniques used in MIT include reducing speech rate and left hand tapping.

MIT can be effective since it uses the side of the brain that’s not language dominant, compensating for the weaker side of the brain that’s been impaired. Over time, the speech therapist will provide less and less support until the person can produce speech independently. MIT also helps the person improve their connected speech.

Semantic feature analysis (SFA): This type of speech therapy is a word-finding approach. With SFA, the person with aphasia selects important semantic features of a word that’s tough for them to say in the moment. For instance, if the person is having trouble finding the word for “dog,” they would be prompted with specific questions, such as “Where do you find this? What does it do?”

Oral reading for language in aphasia (ORLA): This therapeutic approach consists of reading sentences aloud repeatedly. The goal is to improve the person’s reading comprehension. For more severe cases, speech therapists will teach individuals alternative ways of communicating that don’t involve speech. These might include using simple hand gestures, writing, pointing to letters and pictures, or using a computer or electronic devices. These forms of communication are referred to as augmentative and alternative communication, or AAC.

As you can see, “aphasia” is an umbrella term encompassing different types of language-related challenges. But regardless of the type, speech therapy helps to maximize the person’s quality of life. The ultimate goal of speech therapy for aphasia is to improve the person’s ability to communicate and connect with others.