Helping patients be heard: Teaming up to treat aphasia
June 13, 2018
Aphasia is an acquired language disorder, caused by injury to the brain. Stroke is the most common cause—but aphasia can also result from traumatic head injury or a brain tumor.
Aphasia can impair any aspect of a person’s language skills: speaking, reading, writing or comprehension. Different types of aphasia affect different combinations of skills.
Although there is no definitive medical “cure” for aphasia, most patients’ symptoms can be improved, especially in the first 90 days of therapy. Typically, treatment is spearheaded by a speech and language pathologist but draws on the professionalism and skill of numerous other specialties.
It’s important to understand that aphasia does not impact intelligence. Indeed, that is one of the most frustrating aspects of the disorder for patients. They still have the same thoughts, ideas, and feelings, but they just can’t access them and articulate them to others.
Main types of aphasia
Broca’s aphasia — also known as non-fluent aphasia — is named after the Broca area of the brain which affects language processing and speech production. Patients have major difficulty speaking more than three or four words at a time, hence the “non-fluent” label. They may understand everything you say to them. They may be able to read perfectly well. They just can’t get the words out. Their writing is also dysfluent, because they tend to write how they speak.
Wernicke’s aphasia — also known as fluent aphasia — mainly affects comprehension. It’s called “fluent” aphasia because patients sound quite articulate. They might even tell a joke. But they don’t understand what they’re hearing—and what they’re saying makes no sense in the context of the conversation. Their reading and writing skills are also usually severely impaired.
Anomic aphasia mainly just affects word-finding. Of course, we all have that problem on occasion, but anomic aphasia patients have such difficulty finding words that it disrupts daily life. Typically, their comprehension and reading abilities are fine but speech and writing are severely impaired.
Global aphasia — the most severe type — involves major impairment of all language skills, including both comprehension and communication. Patients don’t understand spoken or written language; they can barely utter recognizable words; and they can’t write anything coherent. We usually see global aphasia in patients who have just suffered a major stroke, or who have suffered damage to multiple parts of the brain through severe trauma.
Additionally, many aphasia patients also suffer from related conditions like dysarthria (weak mouth muscles), apraxia (loss of control of mouth muscles), or dysphagia (problems with swallowing).
Approaches to treatment
Aphasia treatment programs are tailored to patients’ specific symptoms, based on the type of aphasia they have. However, all treatment programs have the same two basic aims:
- Restoration: By exploiting the brain’s neuroplasticity, especially in the first 90 days of treatment, the goal is to help patients re-learn and restore as much communication functionality as possible.
- Compensation: This involves helping patients and their families develop coping mechanisms, as well as learning alternative communication tactics — for example, teaching spouses to ask “Yes/No” questions. Therapy may also call for assistive and augmentative technologies; e.g. speech-generating devices.
Intensive speech therapy is almost always an efficacious approach, but not all patients have the stamina or the resources for that level of commitment. Similarly, therapy can be conducted individually or in group sessions or even virtually, using online tools or apps. For instance, Swedish has a telestroke initiative whereby remote and rural patients can access the world-class stroke-related specialist based here in Seattle, including speech and language pathologists. Watch this video about the Swedish Telestroke Program.
Generally speaking, at the 90-day mark we have a very clear picture of a patient’s profile. After three months of therapy, in most cases, the patient may have plateaued in terms of challenges and opportunities. But every once in a while, we see significant improvement years after the original incident.
There is still so much we don’t know about the human brain. That’s one of the reasons my work is still so exciting and engaging after all these years.
It takes a team
While Speech - Language Pathologists (SLPs) usually take the lead in treating aphasia patients, other specialties are also involved. Frequently, aphasia patients are referred to the SLP by a neurologist whom they are seeing because they have a brain injury.
Other allied health professionals typically involved in aphasia cases include nurse practitioners, occupational therapists, physical therapists, social workers, and mental health counselors.
Swedish takes a team approach with a focus on helping our patients be heard. In fact, we consider our patients and their families to be part of the team. And we base our therapy planning on their wishes.
That’s our core success metric: Helping our patients accomplish their goals. If we can give them a voice, literally and figuratively, that’s our definition of success.
The Swedish Neuroscience Institute offers team-based, physician-supervised rehabilitation programs designed to help with people with diseases, trauma or disorders of the nervous system. Learn more about neurological rehabilitation at Swedish. Read more neuroscience articles on the Swedish blog, and subscribe for the latest health updates. You can also find resources at the National Aphasia Association.
Erica L. Cunningham, MA, CCC-SLP is a Speech -Language pathologist at Swedish Neuroscience Institute.
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This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.