News of Bruce Willis’s retirement from acting due to a diagnosis of aphasia highlights how this language disorder can impact someone’s livelihood by diminishing the ability to communicate with others. Sharon M. Antonucci, PhD CCC-SLP, director of the MossRehab Aphasia Center, discusses what causes aphasia, its effects on communication, and current treatments.
What is aphasia?
Aphasia is a language impairment acquired from a brain injury that affects the ability to produce and sometimes understand language. It can affect any modality of language including spoken and written. Aphasia, however, is not an impairment of intelligence or cognition.
What causes aphasia?
Stroke is the most common cause of aphasia. One in three strokes results in some degree of aphasia. Traumatic brain injury (TBI), tumor or an infection also can cause aphasia. There are also progressive forms of aphasia that get worse over time due to degeneration of brain cells.
What are the symptoms of aphasia?
Symptoms vary depending on the type of aphasia and severity of impairment. The hallmark impairment is word retrieval difficulty. A common sentiment expressed by people with aphasia is that they know what they want to say, they just can’t get it to come out the way they want. With some people who have aphasia, you might not notice any difficulties communicating when meeting them casually or briefly. Others cannot speak more than one or two words at a time, or make mistakes, saying a different word than intended or one that is not a real word. They may have difficulty putting together grammatically complete sentences. Those with motor speech impairments also will have difficulty sequencing movements or moving the muscles for speaking.
How does aphasia affect daily life?
For many people with aphasia, communication is more difficult in social situations like group conversations or when speaking on the telephone, as opposed to one-on-one in-person communication. Difficulty with communication can lead to loss of employment or job opportunities, friendships, self-confidence, and one’s sense of themselves.
Can aphasia be chronic or progressive?
It can be either. Chronic aphasia typically comes on suddenly due to a stroke, TBI or brain tumor. As long as the person does not experience another neurological event, language skills can continue to improve over time with rehab, ongoing practice, and engagement in life activities. Primary progressive aphasia occurs gradually due to brain cell degeneration within language networks. Research has shown that people with progressive aphasia respond to language treatment in regaining skills for a period of time or maintaining skills for longer than they might have otherwise.
Aphasia also can be transient, temporarily affecting verbal and nonverbal communication. People who experience seizures may have language difficulty that goes away after seizure activity stops. Seizures that continue in the same part of the brain may result in permanent damage. A ministroke (known as a transient ischemic attack) also can cause temporary aphasia due to a temporarily blocked artery. The person will have language symptoms until the blockage is cleared by typical blood flow.
What factors put people more at risk for aphasia?
Because aphasia is a symptom of an underlying neurological problem, risk factors are associated with the problem that causes aphasia. For example, in the case of stroke-related aphasia, risk factors include high blood pressure, atrial fibrillation (irregular heart rate), and high cholesterol. Other risk factors include congenital blood vessel malformations, such as an aneurysm (enlargement of an artery when ruptured can cause fatal conditions), or an arteriovenous malformation (tangled grouping of blood vessels that form abnormal connections between the arteries and veins, disrupting blood flow).
How is aphasia diagnosed?
A physician initially diagnoses the underlying cause of aphasia such as a stroke. A speech-language pathologist, then, assesses the communication impairment, differentiating it from cognitive-communicative or motor (movement) impairments.
Is aphasia treatable?
While there is no ‘cure’ for aphasia, speech-language pathologists (SLPs) use different treatments to target particular language symptoms. For those with chronic aphasia, treatments can help remediate a person’s impairment to regain language skills and develop compensatory communication strategies. Individuals with progressive aphasia may regain skills for some period of time, potentially longer than without treatment. They also can learn to use compensatory communication strategies so that they are in place as communication skills decline.
What are some aphasia treatments?
SLPs can incorporate a wide variety of treatments into a patient’s rehabilitation plan. Using semantic feature analysis, for example, people with aphasia can describe the meaning of a word they want to use (e.g., what does it look like, what is it used for) to help retrieve it. This approach also helps listeners to understand what they’re trying to say even if they cannot say a particular word.
Mapping therapy – a technique developed at Moss Rehabilitation Research Institute (MRRI) – trains people with agrammatic aphasia (characterized by difficulties with grammar and sentence structure) to identify different components of sentences (e.g., subject, object) to help them understand and speak sentences. Social rehabilitation also is critical because it provides resources through which people with aphasia can support each other, practice their skills, socialize, and make friends.
What are some of the methods to better communicate with those who have aphasia?
Having patience is one of the most important ways to provide help to those who have aphasia. Give individuals time to gather their thoughts and words. Don’t jump in to speak for them or finish sentences unless asked for help. Make the environment more conducive to communication by reducing background noise, facing the person when speaking, and listening without interruption. Use gestures, write keywords, draw, or encourage the person with aphasia to do so as part of the conversation. Restate what you understood so the person with aphasia can confirm or clarify it. (This video provides some tips.)
What services are provided by the MossRehab Aphasia Center?
The MossRehab Aphasia Center offers individual treatment through the Advanced Clinical Therapy Program and social rehab through the Aphasia Activity Center, including the Constance Sheerr Kittner Conversation Cafes (for those with chronic or progressive aphasia), Talking Book Club, and Reta’s Games Group. The Center also features a computer lab, education programs, and online resources including a blog for people with aphasia and clinicians. MossRehab patients with aphasia can also participate in research studies.
Check out the MossRehab Aphasia Center for information and resources on this communication disorder.