Aphasia: Learning how to communicate again after a stroke

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Aphasia disorder symptoms as illustrated examples with patient, outline diagram. Condition with damaged ability to communicate. Difficulty to speak, write and understand verbal or written language.
Aphasia disorder symptoms as illustrated examples with patient, outline diagram. Condition with damaged ability to communicate. Difficulty to speak, write and understand verbal or written language.
  • Aphasia after a stroke can occur even in young adults.
  • There are different subtypes of this language disorder, but with the right treatment, recovery is possible.
  • A speech-language pathologist and neurologist tells us more.

Imagine living a life struggling to communicate with other people. Sadly, for many people living with aphasia, this is a reality. 

Aphasia, an acquired language disorder, most often occurs after a stroke, but can also result from a traumatic brain injury, brain tumour, or brain infection.

About a third of stroke survivors are affected by some form of aphasia, which impacts their ability to speak, read, write, and understand what others say to them.

“Aphasia indicates that there is a difficulty with understanding language and/or using language,” explains Nasreen Allie, speech-language pathologist and assistant director: speech therapy, Western Cape Government: Health.

She adds: “Language is a broad term which refers to the symbol system people use to communicate, the rules that govern how the sounds and words are used to form sentences, the grammar used and includes the pragmatic skills or non-verbal communication skills such as eye contact, turn-taking, and appropriateness of speech.” 

For some stroke survivors, it’s an experience equivalent to reverting to a pre-school level, where they have to relearn language and communication skills. This was the case for Thato (43), who had a stroke almost a decade ago and was left with global aphasia – the most severe form of aphasia.

She told Health24 in 2019:

I was learning the verbal difference between ‘d’ and ’t’, ‘b’ and ‘p’, ‘r’ and ‘v’ etc. I had to learn that ‘heaven' is not ‘even', ‘few’ is not ‘view’, ‘felt’ is not ‘left.’

Professor Andre Mochan, a neurologist at the University of Witwatersrand, explains: “When everything is affected, both expression and comprehension, then we call it global aphasia. It is the most disabling form of aphasia.

“If someone talks to a person with global aphasia, it sounds like gibberish to them and they can’t make sense of it, so they are not able to follow any conversation. And they are also unable to express themselves or to name anything, such as objects.”

Broca’s, Wernicke’s, and Global aphasia are some of the subtypes of aphasia, says Allie, but there are others. She breaks down these three subtypes:

  • Global aphasia is considered the most severe form of aphasia, as it affects the individual’s ability to understand and speak. The person may struggle to understand simple instructions and use words, but may be able to communicate using facial expression, intonation, and gestures. 
  • Broca’s aphasia is a non-fluent aphasia. The individual’s ability to understand is generally intact, but their speech is laboured, and grammar is impaired. The person may know what they want to say but may struggle to find the words. 
  • Wernicke’s aphasia is a fluent aphasia. The individual’s ability to understand is impaired but the person is able to produce fluent speech, which, however, does not always make sense. 

Diagnosis

For patients with post-stroke aphasia, early speech therapy intervention is vital, Allie added. 

“The process starts with an initial assessment to identify the person’s communication strengths and challenges. Therapy may be provided one-on-one, or in a group setting. This depends on the individual’s needs,” she explains, and underscores the importance of family involvement as it assists with the recovery. “Therapy does not just focus on the individual with aphasia but also assists the communication partners of the individual."

Recovery

Mochan added that post-stroke aphasia-recovery varies and is dependent on the severity of the stroke, but most survivors do achieve some sort of ability to communicate again. 

“It may sometimes lead to involving what we call the AAC (augmented and alternative communication) method. So, for example, a person who might not be able to say words can be given an iPad or slides with pictures, and they can point to something they want. If they want food they can point to a picture of food, for example.

Similarly, Allie explains that the aphasia recovery success rate is dependent on the severity of the stroke, the health of the patient, as well as the support available to them.  

Aphasia can be chronic and life-long, she says. “Even after intensive speech therapy, the individual may have residual communication difficulties which are not visible.”

This is why speech therapists may work with clients across their lifespan. If any difficulties persist, the therapist will suggest certain strategies to enhance the patient’s communication at each stage, she further explains.

Stroke, aphasia in adults under 45

If a stroke occurs in someone under 45 years of age, there are various factors that may play a role in their recovery, says Allie. These include:  

  • The severity of the damage to the brain. Time is a key factor with stroke. Getting to a hospital within the window period (3–4 hours) for treatment may lessen the severity of the stroke. 
  • The individual’s health status
  • Co-morbidities (e.g. hypertension, diabetes and obesity) and how well their lifestyle is managed
  • Adherence to a healthy diet and regular exercise schedule
  • Age: Younger people have a better chance of recovery and returning to work than older individuals.
  • Motivation and determination
  • Support from family and friends

“These factors all impact recovery. With good support in place and appropriate lifestyle changes, the chances of a young individual recovering is higher,” Allie says.

Knowing the risk factors for stroke

Mochan says while there are certain known risk factors for stroke, including smoking, high blood pressure, high cholesterol, and diabetes, in some people, even young adults, a stroke can also happen completely out of the blue without any apparent cause, which is known as a "cryptogenic", or unexplained, stroke. 

He adds:

But many people, even after severe strokes, do show improvement, so there is always hope for improvement and, in some instances, fairly good recovery.

Thatho, for example, received intensive speech therapy, neuro-occupational therapy and occupational therapy for many years after her stroke, but that came to an end in 2019. Today, she’s co-director of the Stroke Survivors Foundation, and will soon receive her Masters in Law.

Allie adds that support from family and friends is vital for the person with aphasia. “Not only does aphasia affect the individual’s ability to communicate, but impacts on the individual’s sense of who they are.”

She adds:

How we communicate is ingrained in who we are as people, and each person’s communication style is unique to them. Having the support of family and friends is important. Family and friends are part of the therapeutic journey for the individual … Having them part of therapy only helps the process.

Because the person has difficulty speaking, it does not mean their intelligence is affected, stresses Allie. “It is important to remember that individuals with aphasia are still adults and we should treat them with the same respect and dignity as prior to the stroke.”

The best thing to do is to take the time to listen to the message of the person with aphasia and not rush them to speak, says Allie. “It is very important to still include the individual in regular daily activities,” she says.  

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READ | I was fit, ate healthy, and had no risk factors – yet I had a stroke at 33. Here’s what I wish I had known

READ | Strokes are on the rise among younger people: A neurologist offers important tips to be aware of

READ | With more young people having strokes, be alert to these warning signs

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