Aphasia

Also called Dysphasia, Expressive aphasia, Receptive aphasia, Broca's aphasia, Wernicke's aphasia

After a stroke or brain injury the words are still in there; aphasia damages the routes to them, and partners can build new ones.

What it is

Aphasia is a language difficulty caused by damage to the language areas of the brain, most often after a stroke, and it sits in the Health A-Z as aphasia. This entry is about what it does to conversation.

The crucial fact: aphasia affects language, not intelligence. The person knows what they want to say, who you are and what happened this morning. What has gone is the reliable route from a thought to the word, and often the route back from your words to their meaning. It can touch speaking, understanding, reading and writing in any mix, and the mix changes from hour to hour with fatigue.

Who it can help

The approaches here help anyone with aphasia at any stage, from the first days on a stroke ward to years later. They help partners at least as much, because in aphasia the partner's behaviour changes what the person can do.

They aren't for unclear speech with intact language, which is dysarthria, nor for the word-finding of dementia, which follows a different course and needs a different plan.

How it works

Broadly, expressive aphasia means the person understands well but produces halting, effortful speech with words missing; receptive aphasia means fluent speech that may not make sense, with understanding affected. Most people have some of both. Word-finding difficulty is nearly universal: the word is on the tip of the tongue and a related one comes out instead, or a sound-alike, or nothing.

Supported conversation is the partner-side technique with the best evidence. You write key words as you say them, draw, gesture, offer written choices and check back by summarising. The person points, draws, ranks, nods. Meaning gets built between you. Written key words matter because reading a single word is often easier than hearing a sentence.

Recovery is real and slow. Most change happens in the first months, but people keep improving for years with the right practice, and there's no cut-off after which therapy stops being worth having.

Getting started

This week: keep a pen and pad in every room and use them. Write the topic word before you start a conversation. Ask yes and no questions when the open question stalls, and give ten seconds of wait time before you rescue.

Cut the background noise and talk one to one. Say one idea per sentence. Don't finish the person's sentences unless they've asked you to, and don't pretend you understood when you didn't: "I've lost you, can we go back?" respects them more than nodding does.

Try a picture board for the topics that come up daily. A communication book with photographs of family, places and the routine gives the person a way to steer the conversation rather than only answer. A symbol board on a phone does the same job on the move.

Where to get help

Ask the stroke team for speech and language therapy and keep asking after discharge; community teams exist and referral is by the GP if nobody else has done it. The Stroke Association runs communication support groups and a helpline, Say Aphasia runs peer drop-ins run by people with aphasia, and Different Strokes is for younger stroke survivors. The RCSLT explains what a therapist can offer.