Minnesota Adult Basic Education Disabilities

What is Aphasia?

Aphasia is a neurological disorder caused by damage to the portions of the brain that are responsible for language. Primary signs of the disorder include difficulty in expressing oneself when speaking, trouble understanding speech, and difficulty with reading and writing. Aphasia is not a disease, but a symptom of brain damage. Most commonly seen in adults who have suffered a stroke, aphasia can also result from a brain tumor, infection, head injury, or dementia that damages the brain. It is estimated that about 1 million people in the United States today suffer from aphasia. The type and severity of language dysfunction depends on the precise location and extent of the damaged brain tissue.

Generally, aphasia can be divided into four broad categories:

1. Expressive aphasia involves difficulty in conveying thoughts through speech or writing. The patient knows what he wants to say, but cannot find the words he needs.
2. Receptive aphasia involves difficulty understanding spoken or written language. The patient hears the voice or sees the print but cannot make sense of the words.
3. Patients with anomic or amnesia aphasia, the least severe form of aphasia, have difficulty in using the correct names for particular objects, people, places, or events.
4. Global aphasia results from severe and extensive damage to the language areas of the brain. Patients lose almost all language function, both comprehension and expression. They cannot speak or understand speech, nor can they read or write.

In some instances, an individual will completely recover from aphasia without treatment. In most cases, however, language therapy should begin as soon as possible and be tailored to the individual needs of the patient. Rehabilitation with a speech pathologist involves extensive exercises in which patients read, write, follow directions, and repeat what they hear. Computers and technology have become popular therapy tools.

The outcome of aphasia is difficult to predict given the wide range of variability of the condition. Generally, people who are younger or have less extensive brain damage fare better. The location of the injury is also important and is another clue to prognosis. In general, patients tend to recover skills in language comprehension more completely than those skills involving expression.

Finding resources and support for people who live with aphasia can be difficult but is improving. In addition to hospitals and rehabilitation centers, community education/Adult Basic Education can offer additional options.  In Minnesota, for assistance in forming a literacy group for individuals with aphasia, contact Lori Leininger, Certified Brain Injury Specialist, Minnesota Adult Basic Education teacher in the Robbinsdale Area Schools and PANDA grant (Physical and Neurological Disabilities Assistance) Coordinator at lori_leininger@rdale.org. For questions on aphasia contact Gail Lommen, MS CCC-SLP and MN state representative to the National Aphasia Association at gail.lommen@northmemorial.com.

Aphasia Literacy Group

The Robbinsdale Area Schools Adult Academic Program, in collaboration with North Memorial Hospital and Courage Center, also provides weekly academic groups for adults with aphasia. The groups are an opportunity to interact with other stroke survivors, while improving communication, reading, writing and basic math skills. The groups are held at New Hope Learning Center, 8301 - 47th Avenue North, New Hope, Minnesota 55422. Contact: Lori Leininger, Lead Teacher, 763-504-4093, lori_leininger@rdale.org.

About Aphasia

Imagine looking at the headlines of the morning newspaper and not being able to recognize the words; or trying to say “put the car in the garage: and it comes out “put the train in the house” or “widdle dee car ung sender plissen.”  Thousands of alert, intelligent men and women find themselves suddenly plunged into a world of jumbled communication because brain damage from a stroke has left them with aphasia.

Aphasia is a disturbance of speech and language abilities resulting from damage to the speech and language centers of the brain.  In most people, the speech and language center is located in the left side of the brain.  The type and extent of impairment varies from person to person depending on the location and amount of damage caused by the stroke.  Whether it is permanent or temporary depends on the extent to which the brain cells are damaged and how effectively the body can restore blood supply to these parts.

Aphasia does not affect intelligence. Stroke survivors remain mentally alert, even though their speech may be jumbled, fragmented, or totally incoherent, and they may not be able to comprehend words spoken to them.  It’s like being in a foreign land, unable to speak or understand the native tongue.  The problem is not one of intelligence, but of communication.

Stroke survivors with aphasia may also have a weakness or paralysis of the right side of their body.  Some people will have a visual-field cut and are unable to see objects to the right.  There may also be some behavior changes.  The survivor may cry or laugh for no apparent reason and continue to do so without control.  They may also appear confused or may become depressed.

Aphasia may affect how a stroke survivor understands what is heard and seen (receptive aphasia), as well as the ability to write, gesture and speak (expressive aphasia).

Almost all people with aphasia have some difficulty understanding spoken language.  The person may not associate the spoken word with an object or picture. They may be able to understand a simple command such as “wash your face,” but they get lost if you say “Go to the bathroom, wash your face and brush your teeth.” Or the longer command may sound like “Go to the bathroom, wash your face and breetle you tucks.”

A stroke survivor with aphasia may have trouble with reading. Some may be able to read single words, but cannot read sentences. Others may be able to read sentences, but cannot retain all the information contained in a paragraph or story.

The most noticeable characteristic of aphasia is a problem with speech.  Most people with aphasia have trouble in finding or selecting a word.  They know the word but can’t say it. The degree of difficulty is related to the location and extent of brain damage caused by the stroke.  For some survivors, their only speech may be utterances like “ba-ba-ba,” or “no.”  These automatic utterances may be counting, saying the alphabet or swearing.

The ability to write is also affected by aphasia.  In most cases, their writing will be about as good as their speech.  In many cases, the survivor must learn to write with the left hand because of paralysis or weakness on the right side of the body.  This makes writing harder.

The outcome of aphasia is difficult to predict. Generally, the younger the survivor the brighter the outlook.  The location and extent of the brain damage affect the quality and rate of recovery.

Therapy should begin as soon as possible and should be tailored to the individual.  Although the results of therapy can never be predicted with absolute certainty, almost all survivors benefit.

Helping A Stroke Survivor Who Has Aphasia Communicate

Communication with stroke survivors who have aphasia can be made easier by following these guidelines:

1. Include the survivor in your conversation. No one likes to be ignored.
2. Don’t talk about the stroke survivor in their presence, even if they appear unable to respond. ALWAYS assume they can hear and understand.
3. It is easier for people with aphasia to understand if only one individual is talking with them at a time. Extra noise only creates confusion for a person who has had a stroke.
4. Talk to the survivor in a normal tone of voice.
5. Be sure to give him or her enough time to respond.
6. Ask if help is wanted before giving assistance.
7. Attempt to phrase the conversation so that the survivor can respond, i.e., asking yes-no questions. The survivor should never be forced to respond.
8. Stand where he or she can see you. Avoid standing in front of a bright light.
9. Use sentences that are short and to the point. For example, instead of saying, “Your wife called and she will be here to pick you up shortly,” you could say, “Your wife called.” (pause) “ She will come to pick you up.” (pause) “She will be here shortly.”
10. Remember that people with aphasia may tire easily and will not respond as well.
11. Never promise people with aphasia complete recovery, nor tell them that they will never improve. Rather, focus attention on any small improvements they have made up to that point.
12. Since communication is the most important goal, it is not essential that words and grammar be perfect. Initially, there is no need to correct all their attempts.
13. Don’t pretend to understand. If you’re having difficulty understanding the stroke survivor, be honest. Tell them, “I’m sorry, I don’t understand, let’s try again.”
14. If a person with aphasia says a word or phrase once, don’t necessarily expect him or her to say it again.
15. Above all, remember that even though they have a communication problem, they should be treated as an adult.