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Does Your Senior Loved One Have Aphasia?

Is your older family member or friend having trouble expressing and understanding language? He or she could be struggling with aphasia.

Aphasia has recently been in the news, with actor Bruce Willis’ diagnosis last year. However, the condition isn’t new. Over 2 million people in the United States live with aphasia, and 100,000 to 180,000 individuals develop aphasia every year.

Depending on type and severity, aphasia can be as simple as an inconvenience or dramatically impact a person’s independence. Your loved one with aphasia may live independently or in a specialized care community. Regardless, he or she will benefit from understanding the condition, and you will.

What Aphasia Is and Is Not

Aphasia is an acquired language disorder caused by damage to the brain.

People with aphasia have trouble expressing or comprehending spoken and written language. They don’t necessarily have problems with muscle strength or coordination, memory, or other cognitive skills like attention and decision-making. However, aphasia can co-occur with these issues.

Language impairments associated with aphasia do not reflect a person’s intelligence. Individuals still have meaningful thoughts and ideas but may have difficulty communicating them.

Aphasia is most often caused by a stroke in the brain’s left hemisphere, where the language center is located. Other causes of aphasia include traumatic brain injury (TBI), brain tumors and infections, and neurodegenerative diseases such as dementia (as in the case of Bruce Willis).

Aphasia Symptoms

While people with aphasia experience different issues with expressing and understanding language, the one universal symptom across types is the word-finding difficulty, called anomia. If the older adult in your life has aphasia, you have most likely seen them struggle to find the right word for the person, object, or action they’re trying to talk about.

Speaking impairments can include:

• Substituting sounds (e.g., “tephelone” instead of “telephone”), called phonemic paraphasia
• Substituting words (e.g., “dog” instead of “cat”), called semantic paraphasia
• Creating new, unfamiliar, unmeaningful words, called neologisms
• Speaking smoothly but producing sentences that don’t make sense to the listener, called jargon
• Omitting articles and other function words (e.g., “the,” “in,” and “of”), called telegraphic speech
• Having difficulty speaking smoothly and easily; speech is effortful and halting
• Using as little as a single word to communicate
• Making errors in grammar or word order
• Similar errors when writing – including letter substitutions, grammar and spelling mistakes, and using single or very few words – called agraphia

Impairments in language comprehension can include:

• Trouble understanding what someone else says and requiring extra time to process it
• Trouble understanding complex grammar and long sentences
• Trouble understanding figurative language
• Trouble with reading – including trouble recognizing or sounding out words, understanding function words like articles and pronouns, and interpreting word meaning – called alexia

Aphasia Types

There are eight types of aphasia, each with a unique profile of strengths and weaknesses. Types are separated into “fluent” and “non-fluent” aphasias, the main difference being whether a person can produce smooth, effortless speech.

Of course, no diagnosis is the same; everyone experiences aphasia differently.

You may know about one type of aphasia based on your personal experience or that of your loved one. Here are the eight aphasia types:

• Anomic aphasia
• Conduction aphasia
• Transcortical sensory aphasia
• Wernicke’s aphasia
• Transcortical motor aphasia
• Broca’s aphasia
• Mixed transcortical aphasia
• Global aphasia

Primary Progressive Aphasia (PPA) is seen in certain subtypes of dementia. The first observed symptom is language difficulty, though other deficits (such as memory) typically develop.

Aphasia Treatment

As each aphasia type and individual experience differs, various treatment options may be appropriate for the older adult in your life.

A certified Speech-Language Pathologist (SLP) should provide speech and language therapy. An SLP will consider your loved one’s communication needs for daily interactions, work responsibilities, social engagement, relationship maintenance, and more.

Determining treatment goals should be a collaborative process between you, your loved one, the SLP, and the staff at the assisted living community if that’s where your loved one with aphasia is living. The person’s needs, interests, and priorities are all important factors when deciding what to target in therapy.

A person-centered approach:

• Capitalizes on your loved one’s strengths
• Address weaknesses by strengthening skills and teaching strategies
• Identifies barriers to meaningful participation and communication and modifies the environment to reduce the barriers (e.g., including pictures with text to increase understanding)

Several therapy methods exist for treating different aspects of aphasia, and specific therapy approaches vary based on individual needs. You might see the Speech-Language Pathologist using one or more of the following:

• Semantic Feature Analysis to strengthen vocabulary networks in your loved one’s brain and improve word-finding skills
• Response Elaboration Training to increase content words (nouns, adjectives, etc.) and to help your loved one participate more in conversations with others.
•  Verb Network Strengthening Treatment using verbs to activate vocabulary networks and improve basic sentence production.

How to Support Your Senior Loved One with Aphasia

As a communication partner for a person with aphasia, you can take steps to ensure communication is as easy and stress-free as possible.

• Reduce distractions in the environment. Turn off the TV or radio, close the door, and only talk to one person at a time.
• Start your conversation by stating the topic to help increase understanding.
• Talk about familiar topics, using visual aids (like family pictures) when appropriate.
• Speak naturally and slowly, using short, simple sentences. Rephrase or repeat yourself if the person does not understand. Make your comments clearer with gestures and facial expressions.
• Avoid open-ended questions. Give choices or ask yes-no questions.
• During conversations, summarize what the person has told you to ensure you understand and allow them to clarify.
• It’s okay to say you don’t understand. Ask if you can guess what the person is trying to say, or use a whiteboard that you can both write or draw on.
• Be patient and give the person plenty of time to express themselves. Avoid correcting grammar and words if you’ve understood what was said.
• Suggest taking a break or talking about something else if you notice the person becoming frustrated.

Wrapping It Up

Life with aphasia is complex and can be frustrating for the people struggling with the condition and their families and caregivers. However, speech and language therapy can help people strengthen their skills and learn strategies to compensate for communication difficulties. Friends, family members, and caregivers can help create a positive and supportive communication environment to decrease stress and increase success.

Resources

These websites and organizations provide excellent resources for individuals living with aphasia as well as for their loved ones, caregivers, and support staff:

• American Speech-Language-Hearing Association: https://www.asha.org/public/speech/disorders/aphasia/
• Aphasia Hope: http://www.aphasiahope.org
• Aphasia Institute: http://www.aphasia.ca
• National Aphasia Association: https://www.aphasia.org/
• Tactus Therapy: https://tactustherapy.com/

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