Understanding aphasia
Every 40 seconds, someone in the United States has a stroke, according to the Centers for Disease Control and Prevention. Strokes can cause a variety of long-lasting health problems, including paralysis, coma, and even death. But for millions of Americans, strokes and other brain injuries result in a significant communication problem that many Americans cannot even define: aphasia.
Aphasia is a condition that occurs when brain injury limits a person’s ability to understand or produce speech or written language. People living with aphasia retain their knowledge and memory, but they lose some or all of their language-processing ability. Mild aphasia symptoms might include the inability to recall words when speaking or the replacement of a certain consonant sound with a different sound. Someone with more significant damage to their brain might lose the ability to speak or understand conversation.
In her words: What is Aphasia?
Transcript
Aphasia is a language disorder acquired after stroke or other brain injury that affects over two million Americans with approximately one hundred thousand new cases each year. Because aphasia affects everyday communication, it can have far reaching negative impacts on an individual, including stress on family relationships, social isolation, loss of career, loss of autonomy and loss of identity.
Unfortunately, there are health care disparities in aphasia, including meeting the mental health needs of individuals with aphasia. More holistic approaches incorporated early in the career process can help alleviate these health care disparities.
Disparities and aphasia
Despite being a little recognized condition, aphasia affects twice as many people as Parkinson’s disease. The communication deficits resulting from aphasia lead to problems throughout every aspect of people’s lives.
People living with aphasia face problems not faced by other stroke victims. Chaleece Sandberg, assistant professor of communication sciences and disorders, works to raise awareness about aphasia and improve treatment for people living with the condition.
“Strokes are most common in people over the age of 40,” said Sandberg. “These people have careers, social circles, and fully developed lives. Then, they have a stroke, they get aphasia, and everything crumbles. Usually, they can’t do the same jobs they used to have. They lose their friends. They may not be able to communicate with family members, so all the roles in their lives change.
“On the inside, these people retain the same identity they had before their stroke,” Sandberg continued. “But their interactions with the world are completely different, and they lose a lot of personal power which, understandably, is devastating.”
Author
Aaron
Wagner
Ensuring appropriate treatment quickly
Encouragingly, people living with aphasia can recover lost communication ability. Sandberg’s research focuses on the development of optimal treatment plans for people living with aphasia so that they recover the maximum amount of communication ability.
One critical factor for the recovery of communication ability is how quickly services and communication supports are put into place after a stroke. Immediately following a brain injury, medical staff focus on life-or-death matters. Some people with more mild aphasia are even discharged from emergency services without any referral for communication evaluation. Evaluating the presence of aphasia and accommodating the communication needs of people with aphasia, however, should happen as soon as possible, according to Sandberg. When people cannot communicate effectively, they cannot understand instructions or express their problems, and this can result in inappropriate care with serious consequences.
After a stroke, the brain attempts to heal, and therapy should be started during this critical period for regaining ability. During this healing phase, the brain is more plastic than it will be over the long run. Currently, however, inpatient services focused on communication for people with aphasia are inadequate, which limits the amount of ability they recover. The COVID-19 pandemic has exacerbated this and other aspects of treatment for people living with aphasia.
Though some people who receive later treatment can make tremendous gains, many people recover less ability than they would have with earlier treatment. Even referral to outpatient care is low, and the amount of outpatient care is insufficient when it is provided. Additionally, although aphasia is a chronic condition, people living with aphasia have limited access to long-term services.
“The ability to communicate is such a fundamental part of who we are as people,” said Sandberg. “We need to organize care so that people living with aphasia can recover as much communication ability as possible.”
Another common hurdle in aphasia treatment is a disconnect between the speech language pathologists who facilitate language recovery and the rehabilitation specialists who are responsible for patients’ other needs. For people living with aphasia, there are complex connections between their communication, neurological, physical, psychosocial, psychological, and vocational needs. Research shows that by integrating those services, people living with aphasia can enjoy both improved communication abilities and quality of life.
How to support people living with aphasia
According to Sandberg, one of the most important things you can do to support people living with aphasia is to be aware of the problem. Additionally, if you know someone with aphasia, there are free ways to learn communication skills that can help you retain your relationship with that person.
Recognizing the different types of aphasia
There are several types of aphasia, and the severity varies from person to person. These videos depict examples of two common types of aphasia.
People with Broca’s Aphasia have difficulty finding words when they speak. They retain their ability to understand other people.
People with Fluent Aphasia can speak fluidly, but the words do not make sense and come out in a ‘word salad.’ These people often have difficulty understanding speech or written language.
“One winter,” Sandberg explained, “I was working with a gentleman with aphasia, and I asked him what he was doing that weekend. He replied, ‘Normally, I would hold a Super Bowl party, but none of my friends will come to my parties anymore.’
“This struck me as deeply sad because nothing could be easier than watching a football game on TV with someone; that doesn’t require a lot of communication. If your friend has aphasia, you can and should still be there for them. Maybe you can’t play Scrabble with them, or maybe you still can. But you can find a way to spend time with them. Put aside any fear, put aside any discomfort, and put aside any false sense that people just want to be left alone. They most likely do not; though they may need some reassurance that you will not think less of them for having difficulty communicating. Educate yourself and be there for your friends and family.”
Sandberg says that anyone can learn to be a communication partner for a person who has aphasia. She recommends allowing extra time for people with aphasia to respond, speaking slowly, and respecting the person’s intelligence. She says that partners can facilitate conversation by pointing or gesturing, using photos or videos when possible, and writing out choices. Most importantly, she says that people should respond to communication attempts, confirm understanding, and always remember that the person is still in there.
“First and foremost, people living with aphasia have not lost their intelligence, and revealing competence is so important.” Sandberg continued. “There is no telling what kind of progress each person living with aphasia can make. I have seen people with significant damage to the left hemisphere of their brains who can still have meaningful social conversations. I saw amazing improvement from a man who I started working with 20 years after his stroke.”
“The brain is way more powerful than we give it credit for.”
Author
Aaron Wagner
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