Editors note: May is National Stroke Awareness Month

DEAR MAYO CLINIC: My mom had a stroke recently and is really struggling with her speech. She's in speech therapy, but could you please tell me more about this side effect of a stroke?

ANSWER: Aphasia is a disorder that affects a person's ability to retrieve language. It’s as if their brain's word cabinet has fallen over and mixed their words around, resulting in varying levels and forms of impairment, including auditory comprehension and verbal expression.

Causes

A stroke happens when blood vessels supplying the brain burst or are blocked. This reduces blood flow to the brain, depriving it of the essential nutrients and oxygen needed to support brain cell life. A stroke and its damage to the primary language centers in the left hemisphere of the brain are the most common cause of aphasia. 

Aphasia can also develop due to a brain tumor, infection or degenerative disease. The underlying cause of aphasia and the location of a stroke or tumor determine the severity of a person's language difficulties.

Temporary aphasia can arise during a migraine. It can also occur from a seizure or transient ischemic attack (TIA), sometimes called a mini-stroke. Anyone who experiences a TIA is at an elevated risk for a full-blown stroke in the future.

Symptoms

A person who is affected by aphasia may:

• Experience difficulty understanding conversations or directions.
• Have trouble writing coherent sentences.
• Speak in brief or incomplete sentences.
• Use words or sentences that don’t make sense.
• Have difficulty reading and recognizing letters.

Aphasia can be the first sign of stroke. If you or a loved one experiences these symptoms, seek medical help immediately.

Types of aphasia

Your healthcare team may classify aphasia as:

• Broca's (non-fluent) aphasia. Non-fluent aphasia is marked by decreased language output, difficulty identifying words, and incomplete or short sentences. People with non-fluent aphasia are usually aware of their communication difficulties because their cognition and comprehension are mostly intact.
• Wernicke (fluent) aphasia. Fluent aphasia is identified by incoherent word order, word combination errors, grammar mistakes and incorrect word choices. People with fluent aphasia may have a steady flow of speech filled with jargon and made-up words. They also experience paraphasias — substituting a different sound or word for the intended word. People with fluent aphasia typically have difficulty comprehending spoken and written language.
• Global (mixed) aphasia. Global aphasia results from a major stroke that extensively affects the brain, causing cognition, comprehension and language difficulties. This type of aphasia usually has both receptive and language-expression components.

Testing

A common initial test to determine the cause of aphasia is a CT scan or MRI. In addition, testing usually involves exercises and observations to gauge the person's ability to:

• Explain a situation shown on paper.
• Follow directions.
• Answer questions.
• Have a conversation.
• Read and write.
• Repeat words and sentences.

Treatment and coping

Speech-language therapy is the most common form of treatment. Early intervention and timely treatment are essential for achieving maximum results.

A speech-language pathologist works with patients to regain as many previous language skills as possible or, with certain diseases and conditions, to maintain their communication ability.

Treatment exercises often incorporate activities relevant to the patient to increase motivation and participation. Exercises may include saying their name, address, birth date or family members' names; ordering food from a menu; or writing on a greeting card.

To help someone with aphasia, family and friends can:

• Continue to treat the person as a mature adult and include them in conversations.
• Reduce visual distraction and background noises, such as the TV, radio and other conversations.
• Be sure you have the person's attention before speaking to them.
• Keep messages short and simple. Speak slowly but naturally. Speaking louder doesn't increase understanding.
• Use gestures, facial cues and voice intonation to help the person understand the message.
• Don't assume they understand what you're saying. Your loved one may respond with head nods and sounds of agreement but not understand what's being said.
• When repeating a statement, avoid changing your language around, use simple language and repeat the phrase the same way.
• Recognize that their intelligence has nothing to do with their ability to communicate. 
• Encourage communication and be patient.
• Give your loved one plenty of time to respond, and try not to answer for them.

Support groups can also aid healing and coping for patients and family members.

Delaney Collins and Kinsey Weyer, Speech-Language Pathology, Mayo Clinic Health System, La Crosse, Wisconsin.

Related Articles