A stroke is a catastrophic event that can cause multiple and long-lasting health problems ranging from mild to severe. Strokes can adversely affect vision, balance, cognition, memory, and speech, and even cause temporary or long-lasting paralysis on one side of the body.
Difficulty communicating is one of the most common complications after a stroke. Many people who have suffered a stroke have aphasia, which impairs the comprehension and production of speech, and can also affect reading and writing. It can affect single aspects of speech and language, such as articulation, word retrieval for names and objects, and formulating sentences. More commonly, however, multiple aspects of communication are impaired, both verbally and non-verbally. Different aspects of language that are affected are correlated to where the stroke has taken place in the brain.
Different Types of Aphasia
Aphasia occurs in people who have strokes, but it is also found in people who have head trauma, brain tumors, infections or progressive diseases, such as primary progressive aphasia. The National Aphasia Association has outlined and delineated between the various forms of aphasia.
Wernicke’s (receptive) Aphasia
Wernicke’s is referred to as “fluent” or “receptive” aphasia because the ability to grasp the meaning of spoken words and sentences is impaired, while the ease of producing connected speech is not very affected.
People with this type of aphasia usually have profound language comprehension deficits, even for single words or simple sentences. This is because in Wernicke’s aphasia individuals have damage in brain areas that are important for processing the meaning of words and spoken language. Such damage includes left posterior temporal regions of the brain, which are part of what is known as Wernicke’s area, hence the name of the aphasia.
People with Wernicke’s aphasia can produce many words and often speak using grammatically correct sentences with normal rate and prosody. However, often what they say doesn’t make a lot of sense or their sentences are mixed with non-existent or irrelevant words, what one may call “gibberish”. They may also fail to recognize that they are using the wrong words or non-existent words not being fully aware that what they are saying doesn’t make sense.
Broca’s (expressive) Aphasia
Broca’s Aphasia is also known as non-fluent or expressive aphasia. This is because people with Broca’s aphasia have trouble speaking fluently but their comprehension can be relatively preserved.
These individuals have difficulty producing grammatical sentences and their speech is limited mainly to short utterances of less than four words. Producing the right sounds or finding the right words is often a laborious process. Some people have more difficulty using verbs than using nouns. They may be able to read but will be limited in writing.
A person with Broca’s aphasia may understand speech relatively well, particularly when the grammatical structure of the spoken language is simple. However, they may have a harder time understanding sentences with more complex grammar. For example the sentence “Mary gave John balloons” may be easy to understand but “The balloons were given to John by Mary” may pose a challenge when interpreting the meaning of who gave the balloons to whom.
Broca’s aphasia results from injury to speech and language brain areas such as the left hemisphere inferior frontal gyrus, among others. Such damage is often a result of stroke but may also occur due to brain trauma. Like in other types of aphasia, intellectual and cognitive capabilities not related to speech and language may be fully preserved.
Mixed Non-Fluent Aphasia
Mixed non-fluent aphasia applies to people who have sparse and effortful speech, resembling severe Broca’s aphasia. However, unlike individuals with Broca’s aphasia, mixed non-fluent aphasia patients remain limited in their comprehension of speech, similar to people with Wernicke’s aphasia. Individuals with mixed non-fluent aphasia do not read or write beyond an elementary level.
Anomic aphasia is one of the milder forms of aphasia. People with this type of aphasia are left with a persistent inability to supply the words for the very things they want to talk about, particularly the significant nouns and verbs. Their speech is fluent and grammatically correct but it is full of vague words (such as ‘thing’) and circumlocutions (attempts to describe the word they are trying to find). The feeling is often that of having the word on the tip of one’s tongue, which results in their speech having many expressions of frustration.
People with anomic aphasia understand speech well and they can repeat words and sentences. In most cases they can read adequately. Difficulty finding words is as evident in writing as it is in speech.
Global Aphasia is the most severe form of aphasia and is applied to people who can only produce a few recognizable words and understand little or to spoken language. People with Global Aphasia can neither read nor write. Like in other milder forms of aphasia, individuals with Global Aphasia can have fully preserved intellectual and cognitive capabilities that are unrelated to speech and language.
Global Aphasia is caused by injuries to multiple language-processing areas of the brain, including those known as Wernicke’s and Broca’s areas. These brain areas are particularly important for understanding spoken language, accessing vocabulary, using grammar, and producing words and sentences.
Global aphasia may often be seen immediately after the person has suffered a stroke or other brain trauma. Symptoms may improve rapidly in the first few months after stroke if the damage has not been too extensive. However, with greater brain damage, a severe and lasting disability may result. If Global Aphasia has been diagnosed, it is important to work with a speech and language therapist as soon as possible.
Primary Progressive Aphasia
Primary Progressive Aphasia (PPA) is a neurological syndrome in which language capabilities become slowly and progressively impaired. Unlike other forms of aphasia that result from stroke or brain injury, PPA is caused by neurodegenerative diseases, such as Alzheimer’s Disease or Frontotemporal Lobar Degeneration. PPA results from deterioration of brain tissue important for speech and language. Although the first symptoms are problems with speech and language, other problems associated with the underlying disease, such as memory loss, often occur later.
PPA commonly begins as a subtle disorder of language, progressing to a nearly total inability to speak, in its most severe stage. The type or pattern of the language deficit may differ from person to person. The initial language disturbance may be fluent aphasia (i.e., the person may have normal or even increased rate of word production) or non-fluent aphasia (speech becomes effortful and the person produces fewer words). A less common variety begins with impaired word-finding and progressive deterioration of naming and comprehension, with relatively preserved articulation.
As with aphasia that results from stroke or brain trauma, the manifestations of PPA depend on what parts of the left hemisphere are relatively more damaged at any given point in the illness. The person may or may not have difficulty understanding speech. Eventually, almost all people become mute and unable to understand spoken or written language, even if their behavior seems otherwise normal.
Signs and symptoms of other clinical syndromes are not found through tests used to determine the presence of other conditions. PPA is not Alzheimer’s disease. Most people with PPA maintain the ability to take care of themselves, pursue hobbies, and, in some instances, remain employed.
Treatment and Support for People with PPA
People with primary progressive aphasia are fighting against a condition in which they will continue to lose their ability to speak, read, write, and/or understand what they hear. Usually people with aphasia that results from stroke or head injury will experience improvement over time, often aided by speech therapy. This is not the case for people with primary progressive aphasia. However, individuals with PPA may benefit during the course of their illness by acquiring new communication strategies from speech-language pathologists. Some families have also learned new strategies through participation in Aphasia Community Groups.
Many people with aphasia find it helpful to carry identification cards and other materials that can help explain the person’s condition to others. ID cards are available from the National Aphasia Association website (https://www.aphasia.org). Some communication-assistive devices may also be helpful. Non-verbal techniques for communicating, such as gesturing and pointing to pictures, may help people with PPA express themselves.
The Importance of Speech Therapy
It is crucial to seek the support of a speech and language therapist immediately after experiencing a stroke or other trauma to the head. The spontaneous recovery phase in the first few months necessitates the guidance of a speech therapist in order to maximize recovery of as much speech and language as possible. Continued support beyond the spontaneous recovery window will help to strengthen and maintain the skills that have been compromised.
In working to cope with the skills that have been lost, the speech therapist helps the individual and his/her family and/or caregivers to understand and use supplemental and alternative means of communication. The speech therapist will provide practical and meaningful support to the individual who has experienced the stroke or other traumatic brain injury, as well as resources and practice for the family and caregivers. Counseling is also available.
At Vibe Speech Therapy, we understand the devastating loss of losing your communication skills. We provide a comprehensive program that you can integrate into your life. We are here to help you regain and retain as much of your communication skills as possible.
Contact Vibe Speech Therapy to learn more about how we can help you.