What does this mean? Where do we go from here?
How can I possibly support my loved one when they are unable to communicate what they need?
What does the term Aphasia mean?
As per the American Speech-Language Hearing Association (ASHA), aphasia is defined as an acquired neurogenic language disorder resulting from an injury to the brain (stroke or head injury), usually in the left hemisphere of the brain. There are different types of aphasia, but most fall into the general categories of nonfluent aphasia or fluent aphasia, depending on the individual’s language characteristics. Are the person’s phrases slow, laborious, broken and effortful, or does the speech flow freely, but perhaps lack meaning or understanding? Aphasia can affect many areas of communication, including a person’s ability to speak, understand others, write and/or read. Aphasia is a language-based disorder and does not affect a person’s intelligence, although many people may make that incorrect assumption if the communicator is not able to effectively expressive him/herself.
But, I’m confused, my loved one doesn’t fit into those categories! They aren’t answering yes/no questions correctly, they’re not following commands, their speech is slurred, or they are not talking at all. On top of that, they are coughing when they drink. What is going on?
Aphasia can be confusing and complicated in its presentation because it often co-occurs with other difficulties that may result from a stroke or brain injury, such as cognitive impairment, apraxia of speech (difficulty getting the “message” from the brain to the speech muscles to produce voluntary speech sounds or words) and dysarthria (impairment in the muscles or physical structures required for speech, which may make the speech sound slurred, strained, nasal or breathy).
So, what do I do next? Now my loved one is home with me and feeling frustrated or depressed. I don’t understand and I am starting to feel stressed!
This week I asked several of my recent younger patients with aphasia to describe their struggles and offer suggestions. They are middle aged adults who have suddenly been jolted into a world where they are unable to speak fluently, and in one case she can’t talk at all. Imagine how they must feel. When I asked these brave individuals what they’ve struggled with, some of the things they listed include:
- Feeling frustrated that others are not being patient with them and giving them time to finish talking- others are jumping in and speaking for them
- Difficulty texting or “whatsapping,” leading to a feeling of social isolation
- Feeling scared about worrying about job security. How could a language impairment affect their ability to work?
- Wondering if anyone else is experiencing the same situation
So what should I do? What can I do to help my loved one?
Reach out to a speech-language pathologist as soon as possible for assessment and intervention. A list of all qualified, licensed therapists in Trinidad and Tobago can be found on the “Occupational Therapy and Speech Language Therapy Board TT” Facebook page or the board can be reached at firstname.lastname@example.org. Additionally, the following tips from NHS (2021) will help you communicate with your loved one:
- After speaking, allow the person plenty of time to respond. If a person with aphasia feels rushed or pressured to speak, they may become anxious, which can affect their ability to communicate.
- Use short, uncomplicated sentences, and don't change the topic of conversation too quickly.
- Avoid asking open-ended questions. Closed questions that have a yes or no answer can be better.
- Avoid finishing a person's sentences or correcting any errors in their language. This may cause resentment and frustration for the person with aphasia.
- Keep distractions to a minimum, such as background radio or TV noise.
- Use paper and a pen to write down key words, or draw diagrams or pictures, to help reinforce your message and support their understanding.
- If you don't understand something a person with aphasia is trying to communicate, don't pretend you understand. The person may find this patronising and upsetting.
- Use visual references, such as pointing, gesturing and objects, to support their understanding.
- If they're having difficulty finding the right word, prompt them – ask them to describe the word, think of a similar word, try to visualise it, think of the sound the word starts with, try to write the word, use gestures, or point to an object.
I hope this information helps. My recent patients told me their best advice to others is to be kind and have patience. We are all in this together!
American Speech-Language Hearing Association. (2021). Aphasia. https://www.asha.org/practice-portal/clinical-topics/aphasia/#collapse_1
National Health Service (UK). (2021, March 23). Treatment: Aphasia. NHS. https://www.nhs.uk/conditions/aphasia/treatment/