All About Aphasia: Aphasia Awareness Month

Talking is simply something we take for granted until it’s suddenly gone without warning. We don’t think it could happen to us, until it becomes our story. Aphasia is often the culprit, so let’s shed some light.

“Why can’t I talk?,” “What is Aphasia?,” “When will the Aphasia go away?” are often questions raised by our patients and their families after they have suffered trauma, leaving them with the inability to speak.

You may be a daughter like myself caring for a parent, or a spouse who suffers from aphasia. You may be faced with hospital visits, doctors’ appointments, household chores, financial burdens, and role reversals. You may be a parent to a child whose high school or college comes to a halt, or a friend without your bestie for social support. We are all victim when aphasia strikes and need a means of healing.

As a Speech-Language Pathologist here at Helen Hayes Hospital, and also a daughter who has a mother with aphasia and apraxia (a coexisting speech disorder), I know the challenges that communication breakdown brings both personally and professionally and the obstacles in helping those who suffer to navigate the world of speech therapy and recovery. As part of a Speech Team at HHH working with seasoned experts in the field of speech and language rehabilitation, we are here to serve your communication needs.

What is Aphasia? Simply put, aphasia is an acquired language disorder resulting from damage to the brain that affects the production and/or comprehension of spoken or written words and the ability to read or write. It is not the result of sensory or motor deficits to the speech system, but can co-exist with other neurologic impairments including motor speech disorders such as a dysarthria or apraxia, as well as other comorbidities.

What Are the Types of Aphasia? There are various types of aphasia. Expressive Aphasia is often thought of as a nonfluent aphasia in which there is great struggle for language output at the single word level or word retrieval within conversational speech. With an expressive aphasia, a person may experience difficulty retrieving the names of objects or pictures and there may be struggle in constructing sentences. The names of people, things, and/or places are words that often get “stuck” feeling like they are “on the tip of your tongue.”  It also compromises more complex language production such as the ability to describe something in detail or elaborate on a topic. Receptive Aphasia depends upon the comprehension or ability to grasp the meaning of spoken words, questions, directives, or identification of objects, but the ease of connected speech is often spared. Receptive aphasia is considered a fluent aphasia because connected speech resembles something like jargon or “nonsense” words stringed together.  An assessment of repetition skills is an important area of evaluation for differential diagnosis to be made across the varying types of aphasia. Some common types of aphasia include Global Aphasia, Mixed, Motor or Sensory Transcortical Aphasia, Broca’s Aphasia, Wernicke’s Aphasia, Conduction Aphasia, and Anomia to name a few.

How Does Someone Get Aphasia? Aphasia occurs as a result of neurologic insult, or injury to the brain, most commonly from a stroke or a CVA, but can also occur as a result of brain trauma including brain tumors, infections, falls, and even dementia from frontotemporal degeneration. It is important to note that not all persons who suffer such trauma will have aphasia.

Who Is Affected by Aphasia? Aphasia occurs most commonly in the aging, but children and young adults can even acquire aphasia, depending upon the injury.

How Severe is Aphasia? Aphasia can range from mild to very severe, with subtle changes in speaking or word-retrieval to near total inability to talk. Severity depends upon a variety of factors including the cause of injury, location in the brain that the injury occurred, duration of acute trauma, the presence of pre-existing conditions, and even educational background, mental health status, and compliance with medical care.

What is a Speech-Language Pathologist? After trauma has occurred, a doctor may refer you to a Speech-Language Pathologist if he/she suspects communication impairment is present. A Speech-Language Pathologist, also known as an SLP, is a professional who is an expert in communication with a minimum of a Master’s Degree earned to practice independently as a clinician. Speech-Language Pathologists can work in various settings including academic and healthcare settings, or private practices, and even corporate businesses for things like accent reduction.

Here at HHH, our inpatient team of SLPs work with various adult populations who have suffered acute trauma to conduct comprehensive evaluations, diagnose communication breakdown, and devise individualized treatment plans to provide you with both traditional and innovative approaches toward therapy in achieving your personal communication goals. SLPs also treat coexisting disorders of motor speech, cognitive-linguistic skills, voice, and dysphagia or swallowing problems, and even rehabilitate tracheostomy and ventilator dependency while you work through your aphasia.

Traditional Approaches to Aphasia Therapy:  There are a variety of exercises designed to stimulate your language needs. Some examples of expressive type aphasia stimulation involve the following: reciting serials or Melodic Intonation Therapy (MIT), reading, writing or spelling single words or sentences, naming objects and pictures found in the household or community, generating items belonging in a category, and/or describing objects or picture scenes with inclusion of specific features. More complex naming tasks involve things like generating synonyms, retrieving words for analogies, and/or chaining together opened ended sentences to form a narrative.

Receptive type aphasia stimulation tasks involve the following: matching objects and pictures to their corresponding words, identifying objects, pictures, words, or sentences, answering questions or responding to statements appropriately that display comprehension, and/or following a set of progressively complex instruction.

Your SLP can even construct a therapy binder housing various handouts individually selected for your needs and assign “homework” for practice. This is an extension of your therapy and is an impressive way to “show off” your independence, while continuing to be under the care of a skilled clinician.

Innovative Adjuncts to Traditional Aphasia Therapy: In addition to the traditional aphasia interventions, there are a variety of technology-forward options that can be incorporated into your therapy program with a market that is continually expanding, including augmentative and alternative communication devices (AAC) for your tablet or laptop, which are speech-generating devices (SGD) to help someone with speech or language impairment communicate through a built-in system of words and images. These devices have dual purpose of being both a communication aide and training tool with specially designed therapy exercises and native language options. Some examples of these devices include apps such as Tactus Therapy Language-4-in-1, Lingraphica Small Talk, Constant Therapy, iName It, Proloquo2Go, and Tapgram (cell phone assist). Communication boards can also be constructed by our SLPs or our very own Assistive Technology Specialist (Center for Rehabilitation Technology “CRT” Department) can evaluate you for a communication technology device.

Our Speech Team can incorporate materials brought from home or within the community to bridge the gap between therapy practice and functional carry-over. You can also explore aphasia communication groups and support groups, such as our HHH Stroke Club, aphasia centers such as the Adler Aphasia Center, or aphasia blogs, podcasts, websites, and webinars that are dedicated to aphasia recovery. These are useful outlets in building positive attitude and social networks through your communication journey. Some examples are as follows:

Communication and Support Groups:
Aphasia Group Lessons at HHH
Brain Injury Support Group at HHH
Stroke Club at HHH

Facebook:
Adler Aphasia Center
Aphasia and Aphasia Caregivers Exclusive (ACE) Group
Aphasia Awareness Art to Share
Aphasia Communication Group
Primary Progressive Aphasia Support Group
S.A.Y. Younger Aphasia Group

Aphasia Center:
Adler Aphasia Center www.adleraphasiacenter.org

Blogs:
Aphasia Will Not Be Silent
Faces of Aphasia
Instagram.com/stroke.mama
Mindpop.net
The Blue Banana Diaries

Podcasts:
Aphasia Access Conversations
A Stroke of Luck
Brain Science
Caregiver Dave
Listen for Life
Say Aphasia
Say What? Living with Aphasia
The Slow Road to Better

Websites/Webinars:
American Speech-Language and Hearing Association www.ASHA.org
American Stroke Association www.stroke.org
Aphasia Hope Foundation www.aphasiahope.org
Institute for Music and Neurologic Function www.imnf.org
National Aphasia Association www.aphasia.org

How Long Does it Take To Recover from Aphasia? Recovery means different things to different people and is often the most emotional question a clinician can answer for a patient. The recovery process depends upon a variety of factors including qualification for services, social and family support, accessibility of services, carry-over, comorbidities, and even socio-economic status for out-of-pocket expenses that may be incurred. Some persons with aphasia make a full recovery, while others may experience residual, long-lasting effects. Some don’t expect a full recovery but want to be as functional as possible or simply return to a hobby they enjoy. There is extensive research supporting neuroplasticity, the process of the brain to change and reorganize neural networks and synaptic connections, for continued neuro-recovery occurring through our lifespan. There is NO CAP for Aphasia Recovery and this gives HOPE!

Our Promise: The dedicated team of Speech-Language Pathologists in the HHH acute rehabilitation program thrive on helping you achieve your best possible self and will work tirelessly to find your words. We love you. We advocate for you. YOU are the very reason for our day. We fight together!

Empowerment: Therapy is grueling, but you are a warrior! Stare the beast in the eye and take it down! Aphasia does not define you; you are so much more. You may feel failure at times, and its ok to be sad, but remember those people in your life that need you—they are your reason for fighting. HAVE PATIENCE! KEEP TALKING! DON’T GIVE UP! 

 

Meet our loving team of Speech-Language Pathologists at HHH:

Inpatient:
Shana McGann (Lead SLP)
Laura Teetz (Assistive Technology Specialist)
Sarah Ficucello
Karl Holmstrom
Kimberly Lehn
Cara Kovarik
Nicole Accetturi
Alexandra Chisick
Maria Heffinger

Outpatient:
Rebecca Finch (Lead SLP)
Lisa Modell
Christina Farrell
Nadia Moger
Kristen Coseo
Danielle Ladas

Thank you from the bottom of our hearts,
Tara da Rosa, M.S., CCC-SLP (Inpatient)