Aphasia

Pronounced 'aye-faze-yuh'

Aphasia is a disorder that affects speech and language. It may develop after a stroke, head injury or brain tumour. Aphasia is a loss/disruption of language – it is not a loss of intellect, vision or hearing.

On this page, you can find the following information:

Key points

  1. More than 17,000 New Zealanders have stroke-acquired aphasia – a language disorder caused by damage to parts of the brain that control for language. 
  2. A person with aphasia's mind and intelligence remains the same, however they may find it hard to talk, write, read, and understand what is being said.
  3. Aphasia affects each person differently and can be mild to severe. Someone who has aphasia might not have a physical disability, or appear to be any different from a person without aphasia.
  4. Communication difficulties may change from day to day – some days will be better than others. 
  5. Being patient and finding the best ways to communicate with your loved one is an important part of aphasia treatment and recovery.
  6. Apraxia of speech may accompany aphasia. Apraxia is when you know what you want to say but your brain has trouble communicating with your speech muscles.

What is aphasia?

Aphasia is the partial or total loss of the ability to articulate (put into words) ideas or understand spoken or written language. It results from damage to the brain caused by injury or disease. Aphasia may be accompanied by apraxia of speech.

What is it like to have aphasia?

Aphasia would be like going to bed tonight then waking up in a different country where you don't speak the language. If you had aphasia you may find one or more of the following difficult to do:

  • Speak – ask for milk at the supermarket, get directions from a passerby, have conversations, use the phone.
  • Understand what is being said – talking to people, understanding jokes, watching TV.
  • Write – signing your name, filling out forms, writing a letter.
  • Understand what you're reading – whether it be magazines, shop signs at the mall, TV adverts, books.
  • Saying what you want to say – your thoughts may be fine on the inside, but you may struggle to get them out correctly. 
  • Use numbers – calculating change, getting cash from the ATM.
  • In some cases you may only be able to communicate using facial expression and gesture, eg, smiling, or frowning, thumbs up for ‘yes’ or thumbs down for ‘no’.

Quotes from people with aphasia

Imagine how challenging it would be knowing what you want to say, but being unable to express your thoughts – having others misunderstand you all the time. The following quotes from people who have experienced aphasia give us some insight.

  • “They were talking to me and sometimes I didn’t even know ... they’d say something but by the end of the sentence they were saying I didn’t know what it was because I’m still thinking of the first little bit. It was ... that was strange, you know, because I really wanted to get into people’s conversations but I couldn’t ... and I would look at them.”
  • “It’s just as if there’s an empty space – like opening doors and there’s nothing in there. But that is the only way I could describe it. It was just as if my brain was a cake and a piece of it was cut out”.

What are the causes of aphasia?

Aphasia is most often caused by stroke – about a third of the people who suffer a stroke will get aphasia. This means there are more than 17,000 Kiwis currently living with aphasia.

Aphasia can also happen after:

  • disease of the brain
  • traumatic brain injury
  • a brain tumour
  • other neurological disease.

Aphasia can occur in anyone of any age, however about 75% of cases occur in older people. The impact of aphasia on families can be enormous. 

How is aphasia diagnosed?

Aphasia tends to be first diagnosed by the doctor treating the person for their brain injury, most likely a neurologist. The doctor will do tests that involve following commands, answering questions, naming items and chatting/talking.

If the doctor thinks you have aphasia, you may be sent to a speech-language therapist, who will test your ability to comprehend language, talk and have a conversation, read, express thoughts and write. They will also assess your ability to swallow and to use other forms of communication. 

How is aphasia treated?

Sometimes a full recovery from aphasia can be made without any treatment.

  • This kind of recovery usually happens after a stroke where blood flow to the brain is only interrupted for a short time, then quickly re-connected.
  • This is known as a transient ischemic attack.
  • In this situation, full language capacity can return within hours or days.

Mostly, however, language recovery is slow and less complete.

  • Even though many people with aphasia achieve some quick recovery, where some language ability returns within a few days to 3–4 weeks after the brain injury, some level of aphasia usually remains.
  • In these cases, speech-language therapy can be very useful.
  • Recovery tends to continue over a 2 year time period. 

What factors affect recovery from aphasia?

Many health professionals think that treatment is most effective early in the recovery period. Some factors that affect recovery and improvement are:

  • The specific event that caused the brain damage.
  • The part of the brain that was damaged.
  • The seriousness of the brain injury.
  • The age and health of the person.

Other factors can include education level, handedness and motivation to recover.

Read more about therapy for aphasia.

How can I communicate with someone who has aphasia?

Communication problems will tend to be worse in a noisy environment, or if the person with aphasia is feeling tired, ill or under stress. 

Finding the ways to communicate with your loved one is an important part of aphasia treatment and recovery. These are a few methods you can try to improve communication with a person with aphasia:

  • Speak clearly, and quite slowly – put pauses in your speech, think of them like commas and full stops in your speaking.
  • Give them plenty of time to respond.
  • Avoid background sounds/interruptions and people speaking at the same time.
  • Try to use simple, short and clear sentences – one topic at a time.
  • Use simple and easy gestures with your speech to support what you are talking about.
  • Always have a pen and paper with you to write things down, or do drawings. Some people will find writing or reading easier than talking.
  • Use yes/no questions – eg, ‘Do you want an apple?’ not ‘What do you want to eat?’
  • Provide options – eg, ‘Do you need to visit the supermarket or the bank?’ Be honest if you don't understand and double check that they have understood what you said.
  • Be flexible – try different ways of communicating, try to understand their overall message, be realistic, never expect or aim for perfect conversation.
  • Ask for help.

Support

Support groups can help both the person with aphasia and their whānau with the changes that come with aphasia and stroke. 

Support services, resources, advocacy, & information for people with aphasia & their caregivers/whanau AphasiaNZ
Support resources, stories, news and updates The National Aphasia Association

What is the difference between aphasia and apraxia of speech?

Both apraxia and aphasia are speech or communication disorders, apraxia is a motor speech disorder that may accompany aphasia. Apraxia is caused by damage to the parts of the brain that control muscles needed for speech, eg, your lungs, voice box, lips and tongue. It is not due to muscle weakness but to a lack of communication between your brain and those muscles. You know what you want to say, but your brain has difficulty in telling the speech muscles how to move. It most often happens after a stroke or a head injury.  

This is unlike aphasia, where there is the partial or total loss of the ability to articulate (put into words) ideas or understand spoken or written language.

If you have apraxia of speech you may have occasional problems with a word or may not be able to speak at all. Some people recover quickly, others take a lot longer. You can read the Healthinfo information on apraxia of speech to find out more. 

Learn more

About aphasia AphasiaNZ
Information about stroke Stroke Foundation of NZ 
Neurological disorders and traumatic brain injury The Hopeworks Foundation
What is aphasia? The Internet Stroke Centre
Different kinds of aphasia The National Aphasia Association
Apraxia of speech HealthInfo, NZ

References

Aphasia booklet AphasiaNZ 
Neurological disorders and traumatic brain injury The Hopeworks Foundation
Apraxia of speech HealthInfo, NZ, 2021

Credits: Health Navigator Editorial Team , Adapted from Aphasia NZ.