Introduction

Aphasia is a language impairment disorder caused by damage to the areas of the brain responsible for language comprehension and formulation (Wernicke area, Broca area, and arcuate fasciculus in the dominant hemisphere of the brain).¹ Common causes of aphasia include cerebrovascular accidents, stroke, traumatic brain injury, brain tumour or infection, and neurodegenerative disorders like dementia or Alzheimer’s disease (Johns Hopkins Medicine). Communication through language is an elemental part of being human and being diagnosed with aphasia can greatly deteriorate your quality of life. Aphasia can affect your reading, writing, speaking and listening abilities (NHS). The most common treatment for aphasia is speech therapy and it is pivotal to understand the type of aphasia you are diagnosed with to receive the appropriate speech therapy for recovery. 

Types of aphasia

Key components of language include semantics, morphology, phonology, grammar, and syntax. Aphasia symptoms can range from mild to extreme loss of any of these important language abilities. Aphasia can be broadly divided into fluent and non-fluent aphasia (NIDCD). 

Fluent aphasia

In fluent aphasia, a person can formulate and converse fluently but some words or sounds may not be accurate. Wernicke’s aphasia (receptive aphasia) is the most common type of fluent aphasia, which is caused by damage to the Wernicke area in the temporal lobe of the brain (Johns Hopkins Medicine). This results in a lack of meaningful sentences/ jargon during conversation. For example, if the examiner asks “Hi, how are you doing today?”, you might respond with “I’m happy, are you pretty.”¹ Here, you are unaware of the fact that your sentence does not make any sense within the context of the conversation. 

Influent aphasia

In non-fluent aphasia, speech is very interrupted because it is difficult to formulate and use the appropriate sounds or words in the conversation. The most common type of non-fluent aphasia is Broca’s aphasia (expressive aphasia), which is caused by damage to Broca’s area in the frontal lobe of the brain (Johns Hopkins Medicine). This causes you to speak in short phrases with a lot of effort and you can understand others and formulate meaning in your speech, unlike Wernicke’s aphasia. For example, if the examiner asks “When did you graduate college?”, you might respond with “I was… umm… 7 years ago.”¹ Here, you are aware of the context in the conversation but it takes great effort to string together a whole sentence in your answer and often results in short phrases.

Other common types of aphasia include global aphasia, conduction aphasia, or anomic aphasia (NIDCD). 

Role of speech therapy in aphasia

Often, in cases of aphasia due to brain injury, affected individuals undergo natural changes in the damaged areas of the brain as part of their recovery, which improves their language and communication abilities for many years. Although many individuals can recover their speech within the first few months without any treatment, aphasia can persist even after the initial stages of recovery (NIDCD). Speech therapy is commonly used to help those affected by aphasia gradually regain their normal communication skills and independence (NHS). Speech and language therapists/pathologists are professionals who can aid in the delivery of your individualised speech therapy plan. Speech therapy has been found to enhance your memory, attention, and problem-solving skills associated with the use of language. 

To determine the most effective strategy for the delivery of speech therapy, it is important to consider the individuals’ age, physical and mental health status, and the cause and extent of damage in the affected areas of the brain. If the individual is aware of their inability to communicate properly, it can cause a lot of frustration and stress, which deteriorates their mental health as well. Thus, early diagnosis of depression is more important during treatment. 

Treatment techniques in speech therapy

Speech therapy techniques can be restorative and/or compensatory (ASHA). Restorative techniques aim to help the individual restore or improve their communication skills, and compensatory techniques utilise alternative ways of communication for the individual such as gestures, pictures, or electronic devices. Treatments can also be tailored towards expressive language, reading, writing, partner approaches and multimodal treatments. Common examples of speech therapy treatments are listed below:

• Language exercises such as repetition and word retrieval exercises are commonly used for individuals who have difficulty understanding words or expressing themselves with the right words
• Melodic intonation therapy (MIT) uses melodic concepts like rhythm, pitch, and stress to enable expressive language with the intonation of simple phrases like “I love you” in individuals with nonfluent aphasias that lack expressive language
• Constraint-induced language therapy (CILT) is used to help individuals increase spoken language or verbal expression by restricting the use of compensatory aids like gesturing or writing
• Augmentative and alternative communication (AAC) is a compensatory technique which uses low-tech and high-tech devices (voice output communication aids or VOCA) to improve comprehension and offer verbal and written modes of expression
• Group therapy allows you to interact with other individuals with aphasia or with family members to improve language and communication in a naturalistic environment and develop social networks through therapy sessions

Recent technology like transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS) has shown promising results in therapy and improvements in word finding, function, and activity outcomes 1. However, these technologies are expensive, time-consuming, and more practical for research than treatment options. Research has found that short, intense treatments with larger sets of words and more words per hour within sessions, provide better improvements during recovery compared to more long-term and less intense treatments.²

Recovery timeline

Factors that influence the recovery of individuals with aphasia include age, severity of the disorder, health status, motivation levels and support available during the recovery.³ Most individuals show improvements within two to three months and tend to reach a peak around six months from the onset of aphasia, after which the recovery rate seems to decrease with time.¹ Therefore, early diagnosis and interventions are pivotal for recovery from aphasia.

Role of caregivers and family

The support from family members and caregivers has a direct impact on the affected individual’s recovery process (NIDCD). Family members are encouraged to create a comfortable environment and participate in therapy sessions as much as possible (ASHA). Aside from reinforcement of therapy techniques at home, caregivers and family members are also encouraged to be patient and maintain their composure. However, caregivers and family members often face the emotional and social challenges of providing support since individuals with aphasia are bound to become frustrated during the recovery process.¹ So, it is important to increase education and awareness among friends and family on the impact of living with aphasia for efficient and speedy recovery and enable independence in the affected individuals.⁴

Summary

Aphasia is a language impairment disorder which hinders your ability to communicate and is caused by damage to the areas of the brain responsible for language. Aphasia can be divided into fluent aphasia (e.g. Wernicke’s aphasia) and non-fluent aphasia (Broca’s aphasia). Although many individuals can recover their speech within the first few months without any treatment, aphasia can persist even after the initial stages of recovery. The most common treatment for aphasia is speech therapy, guided by speech-language therapists/pathologists. To determine the most effective strategy for the delivery of speech therapy, it is important to consider the individuals’ age, physical and mental health status, and the cause and extent of damage in the affected areas of the brain. Speech therapy techniques may be restorative, like language exercises, or compensatory, like augmentative and alternative communication (AAC). Most individuals show improvements within two to three months and tend to reach a peak around six months from the onset of aphasia, after which the recovery rate seems to decrease with time. Early diagnosis and interventions are pivotal for recovery from aphasia. It is also important to raise awareness and education on aphasia among family and friends of affected individuals to aid in the recovery process.