Aphasia & Speech Therapy Books

Written by Julie Taylor

Expert Speech Therapy Books here on RBY - 'What I Mean Is' - Helping stroke survivors with high-functioning speech improve communication

Studies of stroke survivors suggest that between 18% to 38% may have some form of aphasia (pronounced ah-FA’ze-ah or ah-FA’zhuh). Aphasia is a language problem caused by injury to the brain. People with aphasia may have trouble speaking, reading, writing, or understanding the speech of others.

Aphasia can be very distressing and frustrating for a stroke survivor.  Thoughts and intelligence are often intact and suddenly there’s this inability to express yourself.  It’s like being a prisoner in your own head. After a stroke, survivors need to communicate with loved ones, friends, caregivers, and the members of the stroke team (doctors, nurses and therapists). Stroke survivors with aphasia may be unable to convey their fears. They may have difficulty understanding what is being said to them. Others may have trouble understanding people with aphasia.

If you have a loved one or friend who is a stroke survivor with aphasia, it can be challenging to keep the lines of communication open. There are ways to cope. There are resources to help people with aphasia, their families, friends and caregivers, adapt to living with the changes, communicate with one another, and regain confidence.

This article has been written to help you understand what aphasia is and how to live with it. You will learn bout ongoing support and resources that are available in your community and at the Heart and Stroke Foundation. These resources can help you and the person you care for learn new ways of communicating.

What is aphasia?

Aphasia is a language difficulty. It is most often causes by a stroke or other brain injury. Communication is made up of several parts or activities. Speech refers to the muscles you use to make the sounds that make up words. Language refers to you “dictionary” of words and the rules for combining words into sentences. This “dictionary” is located in your brain. Aphasia occurs when a stroke has affected the part of your brain that holds the language “dictionary” and the real challenge is translating the language in the brain (thoughts) into the spoken word.

As a rule, people with aphasia are able to think clearly. They know what they want to say, but have trouble communicating their thoughts and ideas. People with aphasia are usually still as smart as they were before the stroke. Their problem is that they have difficulty speaking, reading, and/or writing.

Aphasia is not the same as slurred speech. Slurred speech may occur when the muscles used for speaking are affected. A person with aphasia has a problem with the connection to the language centre of the brain.

Individuals may have trouble with:

• Speaking
• Understanding the speech of others
• Reading
• Writing

Many people with aphasia find it difficult to carry on conversations. Things that used to be easy, such as a casual chat with neighbours, or reading a bedtime story to their children or grandchildren, may become difficult or even impossible.

The different types of aphasia

There are different types of aphasia. The type of aphasia a stroke survivor develops depends upon which area of the brain was damaged by the stroke. Aphasia can range from being very severe to being very mild. Speech therapy and hard work can help most stroke survivors improve their ability to communicate.

The main types of aphasia are:

• Wernicke’s aphasia: The person speaks without hesitation, but words may be used incorrectly and there may be grammatical errors. Because of these errors, people may find the stroke survivor’s speech difficult to understand. The stroke survivor with Wernicke’s aphasia will often have difficulty understanding what is being said to him/her. Writing and reading may also be impaired.

• Broca’s aphasia: In this type of aphasia, the stroke survivor’s speech is reduced. In severe cases, speech may be limited to short utterances, typically bursts of less than four words. The person’s vocabulary may be limited and making sounds may be difficult or clumsy. The person may understand speech relatively well and be able to read, but ability to write may be limited.

• Anomic or nominal aphasia: The stroke survivor may understand speech well and may read adequately but have difficulty naming objects or people or coming up with nouns. The stroke survivor make have to “talk around” the names of objects or people. This can make the survivor’s speech or writing vague and difficult to follow.

• Global aphasia: This is the most severe type of aphasia and can result in the total, or near total, inability to use language. People with global aphasia can neither read or write. They may have difficulty understanding speech and expressing themselves. This type of aphasia is often seen immediately after a stroke has occurred and may improve if the damage to the brain is not too extensive. However, if there is severe brain damage, serious and lasting disability may result.

For some individuals, aphasia is a temporary condition that occurs at the time of their stroke. In time, they may recover from their aphasia. Other stroke survivors may be left with permanent language problems. Speaking difficulties may range from mild (having trouble finding the right words) to severe (being unable to speak at all). But whether the symptoms are mild to sever, aphasia can affect the ability of the stroke survivors to express their feelings.

Aphasia can put up barriers to a person’s social life. It can affect the stroke survivor’s and the ability to participate in family and community life. It is no wonder that people with aphasia, as well as their families, can become depressed. Feelings of sadness, isolation and loneliness are common.

It is important for people with aphasia, as well as their families and caregivers, to know that there are resources to help them cope. People with aphasia, their family members, and those who care for them, can learn techniques to make communicating easier, improve their coping skills, and restore their confidence. There is help out there and there are exercises – and books of these exercises - available.

Excellent and unique speech therapy workbook for high functioning adults: 'What I Mean Is'

In some cities, there are aphasia groups or institutes. Speech language therapists can be found in hospitals, clinics or private practice. You can find speech therapists in the RBY directory and if you know of a good therapist, please let us know so that we can share this information with others.

How Common Is Aphasia?

It is estimated that there are over 100.000 people living with aphasia in Canada. Many stroke survivors have some degree of aphasia. According to The Aphasia Institute there are nearly twice as many people with aphasia as with Parkinson’s Disease. However, most people know little or nothing about aphasia.

How does stroke cause aphasia?

The left side of the brain controls the ability to do many things, including speaking, understanding spoken language, reading, writing, and doing math. If a stroke has occurred in the left side of the brain, it can cause communication problems. These communication problems are called aphasia.

The left side of the brain also controls the ability to feel things and move you muscles on the right side of the body. If a stroke has occurred in the left side of the brain, it can also cause movement problems that can affect the stroke survivor’s ability to communicate. These types of movement problems (also called motor deficits) that can affect communications are:

• Apraxia (sometimes referred to dyspraxia), is trouble making purposeful or skilled movements with accuracy. It can affect all or some of the complex movements involved in speaking. Apraxia can limit the stroke survivor’s ability to gesture, such as waving good-bye, beckoning, or saluting. It can also make it difficult for the stroke survivor to pantomime or pretend movements, such as pretending to cough or blow a kiss.

• Dysarthria is a speech disorder due to weakness, slowness, or incoordination of the muscles that are used for speech. A person with dysarthria will typically have slurred speech.

• Dysphagia means difficulty swallowing. It may be caused by weakness or a lack of sensation in the mouth. Because dysphagia involves many of the same muscles involved in speech, it is usually diagnosed and treated by speech language pathologists. Dysphagia increases the risk the stroke survivor may choke on food or beverages.

What are the warning signs of a stroke?

Fast and appropriate treatment are key factors in achieving the best outcome for stroke survivors. It is vital that everyone know the warning signs of stroke. If you or someone you know experiences any of the following symptoms, don’t wait! Call 911 or your local emergency number right away.                                                     

• Sudden weakness, numbness or tingling in the face, arm or leg
• Sudden temporary loss of speech or trouble understanding speech
• Sudden loss of vision, particularly in one eye, or double vision
• Sudden severe and unusual headache
• Sudden loss of balance, especially with any of the above

What you can do to help

“Human beings can adapt themselves to any situation if they can communicate with others about it. People with aphasia however are very unique in they have lost the very capability for hearing conversations with others which might help them with their disorder. Their disease is essentially cruel because it interferes with the major vehicle of its own treatment.”

“Thoughts and intelligence are often intact and suddenly there’s this inability to express yourself.  It’s like being a prisoner in your own head. “

You can put your language back together again with brilliant and unique workbook 'What I Mean Is' by top speech therapists Hilary Dibben and Anita Kess