Speech Disorders (Aphasia)

Aphasia refers to the inability to understand or difficulty understanding spoken or written words and/or expressing one's thoughts and emotions.

What Is Aphasia?

Aphasia refers to the inability to understand or difficulty understanding spoken or written words and/or expressing one's thoughts and emotions. Individuals with aphasia may also have trouble reading, writing or using gestures to communicate. Aphasia is not a disease but results from damage to the brain.

What are the Common Causes of Aphasia?

Aphasia occurs when there is injury to one or some parts of the brain that control language processing. A stroke is a common cause of aphasia. However, other brain injuries arising from accidents, tumour and infections may also result in aphasia.

What Are the Signs and Symptoms of Aphasia?

There is no visual sign to identify a person with aphasia, unless another person starts to talk to him or asks him to perform some tasks. No two people with aphasia are the same, as they all have different presenting symptoms. Certain individuals with aphasia may show deficits in memory and thought processing, while others will not have any such difficulties.

A person with aphasia may exhibit one or many of the following communication issues:
Expressing the words for everyday items (e.g. spoon, soap, bus, train)
Answering simple and complex questions (e.g. “What is the day today?” “Why are you in the hospital?”)
Following simple and complex instruction (e.g. “Raise your arms.” “Put the pen inside the case and turn the book to page 5.”)
Understanding and joining in a group conversation
Understanding hidden meanings in messages (e.g. jokes, sarcasm, idiomatic expressions)
Reading comprehension (e.g. road signs or the menu)
Reading aloud

Someone with aphasia may also exhibit the following communication patterns in their attempts to participate in verbal interactions:
1. Talking around a word
For example:
A person with aphasia may say: “I want…this thing that I can…drink water with” instead of saying “I want a cup”.
2. Producing only key words in a statement, so much so, it sounds “broken”
For example:
A person with aphasia may say: “Mother…cook…lunch…kitchen” instead of “The mother is cooking lunch in the kitchen”.
3. Using the wrong word that sounds like the target word
For example:
A person with aphasia may say: “cat” for “cup”.
4. Using the wrong word that bears similarity in meaning with the target word
For example:
A person with aphasia may say: “spoon” for “fork” as both are eating utensils.

What are the Risk Factors of Aphasia?

Stroke is a major risk factor of aphasia. The risk factors of stroke include:
High blood pressure
Diabetes mellitus
Cigarette smoking
Previous mini-stroke (also known as transient ischemic attack, TIA)
High cholesterol
Heart disease

What Types of Aphasia Treatment are Available?

There is no medicine or surgery to treat aphasia. Some patients with aphasia may recover spontaneously without treatment. This may happen when the brain heals naturally, which mostly occurs months immediately after the brain damage.

For most people with aphasia, speech therapy is essential in improving communication. The objectives of speech therapy are:
To make the most of retained language abilities
To find new ways of communication to compensate for lost language functions

In order to achieve therapy goals, the speech therapist may teach the patient specific strategies tailored to the patient’s individual needs. Picture cards/boards and reading exercises may be used to complement learning. Family members play a major role in the success of any speech and language intervention programme.

Family, friends or carers may try the strategies listed below to encourage effective communication outside the clinical setting. These techniques are:
Making sure that the person is aware that you are speaking to him
Making appropriate eye contact
Giving the person enough time to respond to your question
Giving simple instructions
Repeating your statement clearly and slowly if it appears that you have not been understood
Using simple and concrete words (e.g., use “eat” instead of “consume”)
Incorporating appropriate non-verbal methods like gestures, facial expressions to supplement your verbal communications

Aphasia may cause frustration and anxiety to both the patient and their loved ones. To minimise these, family members may consider the following when communicating with the person with aphasia:
As someone with aphasia is not hard of hearing, refrain from shouting at the person.
Do not ignore the person with aphasia in a group conversation.
Refrain from restricting the person’s social activity; a person with aphasia need not be restrained at home.
Refrain from finishing the person’s sentences when he seems to be groping for the right word.
Refrain from speaking to the person as if he/she is a child.

Can Aphasia Be Prevented?

As a stroke is one of the main risk factors for developing aphasia, taking steps to prevent a stroke will in turn help reduce the risk of developing aphasia. It is recommended to:
Exercise regularly
Eat plenty of fruits and vegetables
Limit dietary salt and fat
Stop smoking
If you drink, do so in moderation
Maintain a healthy weight
Monitor and control your blood pressure
Keep existing conditions, such as diabetes and high cholesterol, under control

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