Speech, communicating, & aphasia

Learning to communicate again

At least one-fourth of all stroke survivors experience language impairments, involving the ability to speak, write, and understanding spoken and written language. Over 1 million people in the US are stroke suvivors with aphasia.

For some people, speaking is not affected or comes back soon after. But in my case, I had at least three kinds at speech problems:

• expressive aphasia (knowing the concept but not being able to come up with the words)
• verbal apraxia (knowing the words but not being able to remember how to say them)
• dysarthria (knowing how to say the words but not being able to say them clearly due to muscle weakness)

For articles about these three conditions, see

• http://tactustherapy.com/acquired-communication-disorders-following-stroke/
• https://www.flintrehab.com/2018/cant-talk-after-stroke-speech-recovery/
• https://www.flintrehab.com/2019/speech-therapy-after-stroke/

About one million people in the United States currently have some type of aphasia.

There are many types of aphasia, classified into fluent and non-fluent. (If you don't have aphasia but want to get an idea of what's it all about, you can go through some aphasia simulations.)

See also: The Most Common Types of Aphasia


Two types are Wernicke’s aphasia (a fluent type) and Broca’s aphasia (a non-fluent type).

Damage to the the side of the brain may result in a fluent aphasia called Wernicke’s aphasia. People with Wernicke’s aphasia can speak well but their language has no discernible meaning, or might add unnecessary words, and even create made-up words. People with Wernicke’s aphasia are often unaware of their mistakes. These individuals usually have no body weakness because their brain injury is not near the parts of the brain that control movement.

An overview of Wernicke's aphasia:

A video of a man with Wernicke’s aphasia:

Damage to the frontal lobe of the brain may result in a non-fluent aphasia called Broca’s aphasia. People with Broca's aphasia can only speak in short phrases but are produced with great effort. They often omit small words. People with Broca’s aphasia typically understand the speech of others fairly well. People with Broca’s aphasia often have right-sided weakness or paralysis of the arm and leg because the frontal lobe is also important for motor movements.

A brief overview of Broca's aphasia:

Apraxia is different than aphasia. 

Aphasia is a language disorder but apraxia is a speech disorder.

It's rare to see apraxia without aphasia, so how can you tell the difference. Often you can't -- especially if there's little to no speech output.

The person must have a fair bit of speech to see the hallmark signs of apraxia:

• slow, effortful speech 
• distorted sounds and substitutions 
• greater difficulty with saying things like puh-tuh-kuh than saying things like pa-pa-pa-pa-pa.

I sometimes give a talk about my apraxia and a video of me practicing it.

Here is a short video about the differences between aphasia and apraxia:

Communicating with People with Aphasia

A stroke support group in Virginia wanted to help people better understand and communicate with stroke survivors with aphasia. To help family, loved ones, strangers and healthcare professionals better communicate with people with aphasia they produced an 18-minute video called Patience, Listening and Communicating With Aphasia Patients. 

This 'aphasia etiquette' video provides an illustrated guide highlighting the challenges facing people with aphasia and uses the concept of Ask, Wait, Listen for patients. This concept has been developed from feedback by stroke survivors with aphasia and uses simple solutions like offering them the opportunity to express "yes", "no" or "I don't understand".

Recovery Aids
These are some helpful books and aids -- in addition to a good speech therapist:

• Parrot Software has many different programs for aphasia. 
• The videos on Rachel's English are good for apraxia.
• Check out the Aphasia Software Finder for links to helpful programs.
• If you are working on a troublesome sound, you might try some tongue twisters that use that sound. 
• Nothing can beat Scrabble or Word With Friends (for Facebook, iPad, iPhone, or Android) for helping with word retrieval.  
• Be sure to read this article about common misconceptions about AAC and aphasia.
• Speech After Stroke: A Manual for the Speech Pathologist and the Family Member  (if you are not going to a speak therapist, this is great book you can use)

• Sing-alongs are great therapy! You can try it with Mamma Mia or Frozen.
  

Melodic Intonation Therapy In some cases, people with aphasia can learn to speak by "singing out" the words. This is called Melodic Intonation Therapy. Here is a video of such a speaker:

Oliver Sacks talks about aphasia and the power of music therapy in enabling communication for those who are otherwise unable to express themselves through language:

In the months since a bullet to the brain left her in critical condition, Congresswoman Gabby Giffords has relearned how to talk -- a feat partly credited to music therapy.

Life Participation Approach to Aphasia Therapy

The Life Participation Approach focuses on real-life goals of people affected by aphasia.

How it Works: First you pick the end goal that ties into life with aphasia, and work backwards. If the goal is to send emails to family members, you might choose to get there by working on writing letters of the alphabet, then writing words, phrases, and sentences. Alternately, you may choose to get to the same goal of sending emails by using a bank of phrases the person can copy and paste into their message. For info on this approach:

• 5 Things I Didn't Understand about the Life Participation Approach to Aphasia
• AphasiaAccess and its roots in the Life Participation Approach to Aphasia

Videos
Oliver Sacks discusses how people with aphasia can continue to live successful lives:

Here are three videos of a young woman who had a stroke at 19:

• Nine months after the stoke: 

• After a year and a half: 

• After two years: 

• After 3 years: 

Tips for caregivers dealing with people with aphasia:

• Maintain a natural conversational manner appropriate for an adult.
• If needed, you can simplify your speech by using short, uncomplicated sentences; but don't talk "down" to them. Never use baby talk.
• Don't raise your voice; they are not hard of hearing.
• Minimize distractions and background noise, such as a loud radio, whenever possible.
• Be patient. Repeat the content words or write them down as needed.
• Include the person in conversations and encourage any type of communication, whether it is speech, gesture, pointing, or drawing.
• Avoid correcting the individual's speech, unless they ask for help.
• Do not finish the person's sentence or train of thought for them, unless asked.
• Allow the person plenty of time to talk.
• Don't pretend you understood what was said if you did not.
• Listen patiently. Give the other person ample time to respond. When you’re out in public, resist the urge to jump in and speak for your loved one. If you must do so, show respect by asking permission first.
• Praise a good effort. Encourage any attempts at speech by the other person. Offer positive feedback. In this situation, a solid effort counts far more than perfect execution.
• Paraphrase often. This gives you a chance to model correct speech without nagging or criticizing. For instance, if the person says, “He isn't live there,” you might say, “That’s right. He doesn’t live there.”
• Be open-minded. Speech isn't the only valid way of communicating. Accept other forms of communication, such as writing, drawing, gesturing, pictures—whatever helps the other person get a message across.
• Create a new normal. If your family enjoyed lively dinner conversations in the past, for example, keep that up. Don’t leave out the person with a communication problem. Instead, make an extra effort to involve them.
• A good video of "aphasia etiquette" of caregivers comes from the Stroke Association of Great Britain. 

And if you are confused about these medical terms beginning with a-, this is a explanation of some of them:

Agnosia	ag-NOH-sia	inability to process sensory information
Agrammatism	a-GRAM-ma-tism	inability to speak in a grammatically correct fashion
Agraphia	a-GRAF-ia	inability to communicate through writing
Alexia	a-LEK-sia	inability to see words or to read
Alogia	a-LO-gia	inability to add unprompted content seen in normal speech
Anarthria	an-AHR-three-a	inability to speak due to the progression of dysarthria (poor articulation of words)
Anomia	a-NOH-mia	inability to recall the names of everyday objects
Anosognosia	an-a-sog-NO-sia	inability to recognize their own deficits*
Aphasia	a-FAY-sah	inability to comprehend or formulate language
Apraxia	a-PRAK-sia	inability to carry out muscular movements of the mouth (motor plans)
Aprosodia	a-PRO-so-dia	inability to properly convey or interpret of rhythm, pitch, stress, intonation in speech
Asemia	a-SEE-mia	inability to comprehend or use communicative symbols, such as words or gestures

* http://strokeconnection.strokeassociation.org/Winter-2019/When-They-Dont-Know-What-They-Dont-Know

For more info on speech and aphasia, see the page on web links.