The communication disability Aphasia has garnered much media attention recently. In recent coverage, it has been inaccurately described as a cognitive disorder. While it may occur alongside cognitive and physical disabilities (also common with brain damage), aphasia is a distinct and language-specific problem: people with aphasia know what they want to say. Though relatively common, most people do not know what it is. Raising awareness is important for including people living with aphasia in society, which is a fundamental human right. We can all play a role in supporting people with aphasia, and people with communication disability / differences, to be part of the community and valued members of our society.
What is aphasia? Aphasia covers a range of problems with language processing, i.e., how we get from thinking to communicating. These abilities are essential for being able to express ourselves and to understand language (i.e., words, sentences, conversations). Aphasia affects not only verbal (spoken and heard) language, but also written language (which we read, whether physical writing, typing or texting) and sign language (using physical gestures). When written and signed language abilities are affected, this is not due to physical impairment. Aphasia is more common in adults, but can be acquired by children too.
What types of aphasia are there? Because language processing is so complex, aphasia presents very differently from person to person (and thus requires highly specialist assessment, diagnosis and treatment from Speech & Language Therapists). At a relatively superficial level, three main groups of aphasia are described. Expressive aphasia is impaired ability to produce words, sentences, conversations to express oneself. Receptive aphasia is impaired ability to understand spoken, written and signed language. Global aphasia is when there is both expressive and receptive aphasias present.
What causes aphasia? The causes include one-off events like stroke, traumatic brain injury, or surgery. By far the most common cause of aphasia is stroke. It affects about 1 in 3 people with stroke (and there are approximately 7,500 strokes annually in Ireland). Aphasia is generally chronic and long-lasting but not progressive (which means it does not get worse over time). This is particularly salient when we consider that 1 in 4 people with stroke are of working-age. Rarely, aphasia is an early sign of progressive neurological conditions like Primary Progressive Aphasia (a group of dementias that occur in about 3 in 100,000 dementia diagnoses). In such cases, language difficulties (aphasia) occur early, often alongside cognitive and other behavioural changes, and language ability declines over time as the disease progresses.
What is the impact of aphasia? Language and communication are fundamental components of the human experience, essential to our daily lives, relationships, employment, education, and being part of the community. It’s no surprise that when somebody has aphasia, they are at high risk of social exclusion and experiencing relationship changes and psychological problems like depression. People with aphasia are also less able to advocate for the healthcare that they need. Regardless of the ‘severity’ of aphasia in terms of language impairment, aphasia can severely impact the wellbeing of people with aphasia, their families and friends. The negative effects may continue or resurface many years after stroke as a person returns to different aspects of their lives.
What is the treatment? Effective aphasia care requires input from a range of interdisciplinary health and social care professionals. It is important that people with aphasia can access Speech & Language Therapy not only in the early period post-stroke, but in the long-term as needed. This therapy is effective for treating and improving expressive, receptive and day-to-day language use at all stages of recovery. Speech & Language Therapists also play a key advocacy role and support other healthcare professionals in aphasia communication. People living with aphasia also need access to psychological care, information about aphasia and services, support for family members, and opportunities to be part of the community in ways that are meaningful to them. When aphasia occurs as part of a progressive condition, Speech & Language Therapy, as part of wider interdisciplinary care, is essential for slowing the rate of decline, as well as supporting individuals and their families in coping, communicating and maintaining independence and autonomy.
It is important to note that there are shortcomings in access to Speech and Language Therapy, stroke services and psychological support for people with aphasia. The Irish Association of Speech & Language Therapists advocate for improved support for people living with aphasia and their families. Our response to the National Stroke Strategy 2020-2025 is here: https://bit.ly/3xm4QPl
How can I have better conversations with people with aphasia? What helps will vary from person to person, so it’s important to be flexible and open to trying different things. As someone without aphasia, you might need to do a little extra ‘work’ to make the conversations more ‘equal’. You might consider your own language. How quickly are you talking? Are your sentences complicated? Do you switch topics often? You might also tune into the non-verbal parts of the conversation. Can you use and understand facial expressions, gestures like pointing or thumbs up, for example? Is there meaning in the tone of voice the person is using, e.g., rising intonation for questions? Can you use pictures, written words, or ‘props’ to share ideas? Another suggestion is to think about the environment or place you are in. Is there background distraction like a radio that can be switched off? Are you facing one another? Misunderstandings are normal and natural and, while it may feel uncomfortable, it’s important not to ignore this. For example, you might acknowledge that the person with aphasia knows what they want to say. You might agree to come back to the topic later.
Knowing the signs: While we’ve all experienced tip-of-the-tongue phenomenon and inability to find the words we want to say, it is important to seek medical attention if you notice a serious decline in your language ability, or that of your loved one. For example, inability to produce words, say words correctly, put sentences together, or follow what others are saying.
If you experience a sudden change in your speech and/or language ability (including reading and writing), this can be a sign of stroke. Please treat this as an urgent medical emergency and call 999 or 112. The signs of stroke to look out for are summarised using the FAST acronym. This stands for:
Face – sudden facial asymmetry, for example inability to smile.
Arms – ability to raise (and keep raised) both of your arms.
Speech – any sudden speech or language problems, like slurring or finding the words you want to say.
Time – urgent medical care is essential to minimise brain damage.
For further information about aphasia, please contact the Irish Association of Speech & Language Therapists or visit IASLT.IE
*With thanks to Dr. Molly Manning MIASLT who drafted this press release on behalf of IASLT.