Recent health concerns surrounding performers Bruce Willis and Wendy Williams have put the spotlight on aphasia and have led people with this condition to question whether theirs will get worse over time. In fact, most forms of aphasia can improve, but it’s helpful to be aware of the various types of aphasia and how they are managed, says speech-language pathologist Susan Wortman-Jutt, MS, CCC-SLP.
We all forget a specific word occasionally and have experienced that “tip of my tongue” feeling when trying to recall someone’s name or a town where we once vacationed. Aphasia is different—it affects your ability to remember the name of everyday objects, such as “pen” or “eyeglasses.” What’s more, it can keep you from having normal conversations or even holding a job because the words just don’t come out. It also can create reading and writing difficulties, even when verbal difficulties are mild.
Aphasia results from an underlying condition, such as stroke, brain injury or a neurological disease or disorder…and there are different types of aphasia. Willis and Williams have primary progressive aphasia (PPA), the rarest form and the only one that gets worse over time. It’s caused by having a progressive neurological disease, such as frontotemporal dementia or Lewy body dementia, that damages the brain’s frontal lobe, typically on the left side, where the language centers are located. That means language-related—rather than memory-related—symptoms appear first. For example: rather than forgetting how to use the microwave, you have difficulty remembering the word “microwave.”
When aphasia is the result of a stroke or brain injury, aphasia symptoms often improve with treatment. Between 30% to 40% of people who have a stroke experience some degree of aphasia.
Other causes of aphasia are a brain tumor—aphasia may resolve if the tumor is removed—or a brain infection. Depending on the type and severity of the infection, aphasia can be transient, resolving with treatment for the infection, or chronic, in the case of a severe infection.
Important: There are other causes of mild, temporary word-finding difficulty that are not actually aphasia. Word-finding difficulty can be related to depression, certain medications or hormonal changes.
Under the aphasia umbrella are two different subtypes related to the exact location of the damage to the brain…
Damage that’s more anterior or toward the front is linked to nonfluent or expressive aphasia, such as Broca’s aphasia (named for a specific area of the brain). This is when you know what you want to say, but you just can’t think of or formulate the word. It may cause difficulty finding “linking words,” such as conjunctions. For example: “I used to work in a factory” may be spoken as, “I worked factory.”
Damage that’s more posterior is linked to fluent, or receptive, aphasia, such as Wernicke’s aphasia (named for another specific area of the brain). This is when your ability to process language is impaired—you say words, even forming long sentences with ease, but what you are saying doesn’t make any sense to the people you’re speaking to because the words in the sentence have little to no relation to each other or the topic of the discussion.
Many people with aphasia also have motor speech difficulty—that’s when you know what you want to say, but your lips, tongue and other muscles used for speech don’t cooperate, so the sounds don’t come out correctly.
With nonfluent aphasia, treatment with a speech-language therapist focuses on verbal expression, or word production, to maximize your verbal output. There will be intense stimulation with an onslaught of language-based exercises in a drill-like fashion to get you to use the part of the brain involved in word finding. Example: You may first work on putting very brief sentences together, then increasingly longer and longer sentences.
Simultaneously, you’ll learn compensatory strategies that help when you get stuck on a word, so you can talk your way around what you’re trying to say in an adaptive way. Example: When you’re trying to think of the word “eyeglasses” but can’t find it, you might instead say, “the thing that people wear to help them to see better, they wear it on their face, it comes in different colors.” Describing your way around it may help you get the actual word or help the person listening to you know what you mean, so that your conversation can continue.
Using written language also might be a word-finding strategy if you are able to write. Your therapist could help you write out the word you’re searching for or show you how to cue yourself with letters of the alphabet.
With fluent aphasia, treatment is more focused on comprehension. Your therapist might set out an assortment of objects and written cards, have you match the cards to the objects and then have you listen to the word. This helps you associate the sound of the word with the card and the object, so you begin to make connections between what you’re hearing and the meaning of the word itself.
Because there can be very subtle deficits in comprehension with nonfluent types of aphasia and difficulty with word finding with fluent types of aphasia, it might be necessary to work on both at once.
Some people find it helpful to carry a book with their most common words and phrases written in it. You might prefer a high-tech version of this alternative and augmentative communication (AAC) by using a device (similar ones are used by people with ALS or cerebral palsy). Your most frequently used words are on the screen of a laptop or handheld device, allowing you to supplement your verbal communication with computer-generated words. This is especially valuable for people with primary progressive aphasia, but some people with other types of aphasia also use them as a tool for those times when they experience a verbal communication breakdown. There also are apps you can use to practice speech exercises prescribed by your speech therapist. Patients at Burke Rehabilitation use Constant Therapy, a leading neurocognitive app that has exercises that can be individualized to your needs, as one example.
Important: Loved ones of someone with aphasia should also learn techniques from the speech-language therapist, including how to listen, when and when not to intervene when he/she is having difficulty, and how to use their assistive devices to facilitate communication.
The concept of Intensive Comprehensive Aphasia Programs (ICAP) began just over a decade ago, and research has shown that this high-level therapy has a positive impact on people with aphasia. Traditional speech therapy is given for 45 to 60 minutes a day, two days a week. While the traditional format is helpful, it can take longer to yield positive results. With an ICAP, the minimum is three hours a day, three days a week. Burke Rehabilitation has had positive results with its program that includes four hours of speech therapy, five days a week, for four weeks. The program includes work with the Constant Therapy app during a portion of each day so that participants can work on the specific exercises that are helpful to them. The Burke program also has weekly occupational therapy, neurologic music therapy and even canine therapy, all with a language focus— every single part of the ICAP is used to enhance language production. Supplemented by practice at home, even people who suffered a stroke or brain injury years ago have made impressive improvements.
Note: Traditional speech therapy usually begins immediately after stroke or brain injury to capitalize on changes taking place in the brain during the acute phase of recovery (up to three months after injury). With ICAPs, however, this rigorous treatment is not usually recommended until six months after injury, so that the brain and body are physically ready to handle this level of treatment.
If you make good progress in your aphasia recovery during the first three months after a stroke or brain injury—the acute phase of recovery— it’s likely you’ll continue to recover well. That’s because the therapy you are getting in that acute phase is priming the brain for continued improvement, just as you prime a canvas before you start painting. But even people in the chronic phase of recovery can continue to make positive improvements.
One of the best prognostic indicators of whether someone is going to recover well from aphasia is how involved their loved ones are—how much support, additional stimulation and help they get at home using the strategies and exercises they learned in therapy.
Realistically, for most people with aphasia, even those who make an excellent recovery, language will be somewhat different than it was. It’s rare to achieve a 100% full recovery except in the earliest stages.
Standardized assessments, which every speech-language pathologist has in their toolkit, can help to identify strengths and weaknesses. No matter how severe the aphasia, everyone has strengths, and it’s up to the therapist and the person with aphasia to find them together.
