Aphasia is an acquired communication disorder caused by damage to the brain, most commonly from a stroke. People living with aphasia often experience difficulty in speaking, understanding speech, reading, writing and using numbers.
Although it impairs a person’s ability to process language, it does not affect intelligence.
Aphasia is not like Alzheimer’s disease; for people with aphasia it is the ability to access ideas and thoughts through language – not the ideas and thoughts themselves – that is disrupted.
Who acquires aphasia?
While aphasia is most common among older people, it can occur in people of all ages, races, nationalities and gender.
Can a person have aphasia without having a physical disability?
Yes, but many people with aphasia also have weakness or paralysis of their right leg and right arm. When a person acquires aphasia it is usually due to damage on the left side of the brain, which controls movements on the right side of the body.
How long does it take to recover from aphasia?
If the symptoms of aphasia last longer than two or three months after a stroke, a complete recovery is unlikely. However, it is important to note that some people continue to improve over a period of years and even decades.
People who are living with aphasia can find long-term support in their community to improve communication skills and how to act in social situations. Minnesota provides opportunities for people living with aphasia to come together through conversation groups.
Aphasia conversation groups are led by a Speech-Language Pathologist (SLP) with expertise in aphasia. Meetings provide conversational and individualized support through peer support and community involvement, as well as opportunities for friendships and connections. In addition, it teaches communication strategies which help promote confidence and personal achievement in one’s life.
Family support and understanding is a key factor during a stroke survivor’s recovery. When it comes to family education, Speech-Language Pathologists can be important rehabilitation professionals. Leaders and volunteers help group members to actively participate in discussions using communication strategies including words, writing, drawing, and/or gestures.
Aphasia conversation groups are different than formal speech groups. Most groups are open ended and meet to discuss topics of interest to everyone.
Conversation groups help people cope with changes in their lives that occur after acquiring an injury or medical condition. Each group provides a supportive environment in which to share feelings, concerns, experiences, and hopes with others who may be in a similar situation. Groups are conducted on an ongoing basis.
Contact the Minnesota Stroke Association at 763-553-0088 for more information on conversation groups
What other effects of stroke affect communication?
Stroke can cause other problems that affect a person’s ability to communicate well. It may help to be aware of these during conversations:
Changes to the emotional content of communication
A stroke can sometimes cause subtle changes to emotional aspects of speech. For example, a person’s tone of voice may sound ‘flat’ or their facial expression may not vary. A person may have difficulty understanding humor or when to take turns in conversation. They may be aware of these effects and frustrated by them, or they may be unaware. These types of changes can happen even if there are no other communication problems after stroke. They are due to changes on the right side of the brain and can be misinterpreted as depression.
A stroke can alter vision and sometimes hearing. This can make reading and writing problems worse. Make sure the doctor is made aware of such problems so that they can be fully assessed.
Post-stroke fatigue
Many people find that they feel very tired after a stroke, both physically and mentally. Having a conversation may also take more effort than it used to, and other people may not realize this. The ability to communicate can vary significantly depending on how tired or stressed someone
is feeling.
Memory and concentration problems
Stroke can affect your short-term memory and aspects of your thinking processes, such as the ability to focus and concentrate. This can make communication slower and more difficult.
Physical problems
Physical weakness or paralysis after stroke may affect facial expressions and body language. Physical problems can also make writing difficulties worse if your dominant hand is affected. Physical pain or discomfort can be a distraction.
Changes to mood or personality
It can be frightening and frustrating if a stroke has affected your ability to communicate. Changes in the brain caused by the stroke can also affect mood, emotions and personality in other ways that can be difficult to control.
What are the treatments for communication problems?
Anyone who has communication difficulties after their stroke should receive a full assessment of their difficulties from a speech and language therapist (SLT, also called speech-language pathologist or SLP) with specialized knowledge in stroke and rehabilitation. In the hospital, this should be arranged by the multi-disciplinary stroke team as soon as possible after the stroke. If the person affected is at home, their Primary Care Provider can make a referral to community SLT services or they can contact their local hospital’s Speech and Language Therapy
Department directly.
First, the therapist will assess their strengths in language and communication skills. The SLT will use various tests to try to establish the precise nature of their problems. The therapist will establish the best methods of communication, and will explain the nature of the problem to the stroke survivor, their family and the rest of the medical team. The therapy someone has will depend on the nature of their communication difficulties and their general health following the stroke. It is likely to involve a variety of practical exercises to help rebuild their communication skills. The SLT will establish the stroke survivor’s personal needs and priorities for communication and their goals for therapy. Their progress will be monitored and support will be offered for as long as therapy is beneficial.
It helps greatly if other people such as health professionals, care staff, family and friends can be involved in supporting communication needs. They may offer advice on how to communicate or help a loved one communicate effectively. Practicing communication skills may help recovery.
A swallowing disorder called dysphagia often occurs as a result of stroke. Dysphagia may occur in up to 65 percent of stroke patients. If not identified and managed, it can lead to poor nutrition, pneumonia and increased disability.
Aspiration
Aspiration (inhaling food or drink) is a common problem for people with dysphagia. It occurs when material a person is swallowing enters their airway and lungs; pneumonia may develop. Normally, aspiration would cause a violent cough, but a stroke can reduce sensation. After a stroke, food or liquid could enter the airway/lungs without the survivor being aware of it. This is called silent aspiration.
Testing Swallowing
Speech-language pathologists are trained to test swallowing. The first step is a bedside assessment in which the speech-language pathologist may:
Efforts to make sure survivors with swallowing problems receive adequate nutrition are taken by the patient’s medical team. If it doesn’t appear safe for them to swallow anything by mouth, they may require tube feeding. The swallowing tests give the speech-language pathologist information to help create an individualized treatment plan to help patients regain their swallowing skills.
Treatment Plans
Treatment plans generally include exercises to improve coordination of muscle movements in the mouth and throat. A plan may also include techniques to compensate for lost function, such as:
Although each treatment plan is unique and designed to meet specific needs, some common precautions may help you swallow more safely. You may find it helpful to:
During a survivor’s recovery, the speech-language pathologist continually assesses their progress and determines when it’s safe for them to eat more normal foods.
Mild or major, depression is the most common emotional problem faced by stroke survivors. According to Dr. Robert Robinson, a psychiatrist at the University of Iowa, when the brain is injured from stroke, the survivor may not be able to feel positive emotions, which can lead to depression.
Depression can take hold right after a stroke, during rehabilitation, or after you go home. Depression is not a normal part of aging.
If five or more of these symptoms persist for longer than two weeks, depression is most likely the cause. Do not hide these feelings/thoughts. Talk to someone before the effects increase.
Treating depression will improve a stroke survivor’s mood, as well as their physical, cognitive or intellectual recovery. At least 80 percent of people can be effectively treated and feel relief of their symptoms within a few weeks.
Every person’s body and mind will react differently to the treatment options for depression. Different medications and/or talking to a licensed counselor or therapist are amongst the most common forms of treatment. It is also important to maintain a healthier diet and exercise regularly to improve a body’s recovery. Talk to your doctor to discuss the best path for you during your recovery.
When depressed, a person tends to have less interest or pleasure in sexual intimacy. Some medications may increase interest in sexual activity, but also may have side effects that interfere with the ability to enjoy sex. Also, if paralysis is involved, it can affect the ability to perform or enjoy sex. Speaking honestly with a partner about sexual changes is important. Together, sexual partners can often work out the best solution.
Movement
The most common physical effect of stroke is muscle weakness and having less control of an affected arm or leg. Survivors often work with therapists to restore strength and control through exercise programs. They also learn skills to deal with the loss of certain body movements.
Paralysis
Paralysis is the inability of muscle or group of muscles to move on their own. After stroke, signals from the brain to the muscles often don’t work right. This is due to stroke damage to the brain. This damage can cause an arm or leg to become paralyzed and/or to develop spasticity.
Spasticity
Spasticity occurs when the brain is unable to send proper messages to the extremities due to a stroke and a limb becomes paralyzed or experiences painful muscles spasms with uncontrollable movement or jerking. Spasticity can evolve within days or weeks after stroke or injury occurs.
Treatment Options for Spasticity
Every person will react differently to common treatments available to manage spasticity. Treatment options include physical therapy, oral medications, injection therapies, and intrathecal therapy, among others.
The most common oral medications to treat spasticity include benzodiazepines such as: diazepam, clonazepam, baclofen, and dantrolene. Studies have shown these oral medications to improve range of motion, and help reduce painful spasms, hyperreflexia, and anxiety.
Intrathecal therapy – called ITB TherapySM (Intrathecal Baclofen Therapy) – relieves severe spasticity by delivering a liquid form of medication directly to the intrathecal space where fluid flows around the spinal cord. A programmable pump is surgically placed and connected to a catheter in the body that delivers small amounts of medication to the cerebral spinal fluid.
A one-day screening test can let you know if you qualify for the therapy treatment. The screening test involves a standard medical procedure in which the medication is given through a small needle placed in your lower back. Weakness, drowsiness, or numbness are possible side effects during this process.
ITB Therapy drug side effects are usually temporary and manageable by adjusting the dose. The most common side effects include loose muscles, drowsiness, nausea/vomiting, headache, and/or dizziness. Pay close attention to the doctor’s instructions. Abrupt cessation can result in high fever, altered mental status, returned spasticity, muscle rigidity, and in rare cases has been fatal.
Exercise
Walking, bending and stretching are forms of exercise that can help strengthen the body and keep it flexible. Mild exercise, which should be undertaken every day, can take the form of a short walk or a simple activity like sweeping the floor. Stretching exercises, such as extending the arms or bending the torso, should be done regularly. Moving weakened or paralyzed body parts can be done while seated or lying down. Swimming is another beneficial exercise if the pool is accessible and a helper is available. An exercise program should be written down, with illustrations and guidelines for a helper if necessary.
Tiredness
Exercise fatigue is different from post-stroke fatigue and, while exercising, is to be expected. Like everyone else, a survivor will have good and bad days. Any of these programs can be modified to accommodate for exercise fatigue or other conditions. While overexertion and pain should be avoided, some discomfort may be necessary to make progress.
Vision
Having a stroke can result in a number of vision problems – also called visual disturbances. There are many types of vision problems and treatments. Depending on where a stroke occurs in the brain, survivors can face balance and posture problems, disorientation, trouble focusing or a reduced blink rate.
Types
Post-stroke vision problems can fall into one of two general categories.
Vision loss: Blind spots in the field of vision, also known as visual field loss, are common after stroke. A common type of vision loss is called hemianopia, the loss of half of each eye’s visual field.
Vision perception problems: Damage to the brainstem and/or cerebellum makes it difficult to process what the eye sees, to coordinate movement and to focus (as a result of double vision) and blink.
Treatment
There are many treatments for visual disturbances. Treatment plans can be customized to fit each individual’s vision problems and needs.
Consult with an optometrist, ophthalmologist or primary care provider for suggestions about specific vision problems, symptoms and treatment.
Fatigue
Post-stroke fatigue is a physiological and psychological condition that affects up to 70 percent of stroke survivors. Many have described it as hitting a physical, emotional, and/or mental wall. Post-stroke fatigue is more than “just being tired”; it is an invisible consequence of stroke and can be greatly misunderstood by the survivor and those around them. However, with proper identification and implementation of strategies, survivors can manage their post-stroke fatigue and participate in everyday activities and rehabilitation therapies with more energy and stamina.
Factors that contribute to post stroke fatigue:
Managing your fatigue:
Resuming a healthy intimate life is an important, but often challenging, part of the recovery process for the stroke survivor.
It is important for the stroke survivor and their partner to be informed about and equipped to face the changes in sexual activity and function that may follow a stroke. The need to love and be loved, and to have the physical and mental release sex provides, is important.
What are possible obstacles to resuming an intimate life?
Professionals can help
Questions about medical or sexual function can be addressed by a doctor, urologist, or gynecologist. A physician or a licensed counselor can also help discuss these changes between partners.
It is important to remember that relationships are based on mutual respect and understanding between two people. It is critical that partners talk openly and honestly with one another about sexual needs, desires, and concerns.