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Aphasia After TBI: Causes, Types, and Treatments

woman covering her mouth to symbolize that she cannot speak because she has aphasia after TBI

Aphasia after TBI is a communication disorder that can make it more difficult to speak to and understand others.

Today you will learn the different types of aphasia that a person can develop after brain injury, plus effective ways to treat them.

Understanding Aphasia After TBI

Aphasia occurs after damage to the language centers of the brain, known as Wernicke’s area and Broca’s area.

Wernicke’s area and Broca’s area are regions that play a pivotal role in understanding and producing language. They are found in the dominant side of the brain which, for most people, is the left hemisphere.

Damage to either Wernicke’s or Broca’s area can lead to the two most common forms of aphasia: receptive aphasia and expressive aphasia.

We’ll examine these and other types of aphasia in the sections below.

Types of Aphasia  

There are several types of aphasia that a person can develop after TBI, depending on where the damage occurred.

Unlike stroke victims, who usually experience only one form of aphasia, brain injury patients tend to experience multiple types of aphasia at once. That’s because stroke damage is usually limited to very specific areas of the brain, whereas brain injuries often affect several regions.

The following are the most common forms of aphasia after brain injury:

Expressive Aphasia (Broca’s Aphasia)

man in blue shirt covering mouth with hand because he has expressive aphasia after tbi

Expressive aphasia affects the ability to produce meaningful words. It is caused by damage to Broca’s area and is therefore also known as Broca’s aphasia.

Patients with expressive aphasia have difficulty finding common words and usually speak in short, fragmented sentences.

For example, instead of saying “I want to go out to dinner” they may simply say “eat…food.”

Because of the proximity of Broca’s area to the primary motor cortex, expressive aphasia is usually associated with physical impairments such as slurred speech.

Anomic Aphasia

This type of aphasia is a milder form of expressive aphasia that causes word retrieval failure.

People with anomic aphasia can understand what others say, and in most cases, their speech is fluent and grammatically correct. But their sentences are full of vague words and circumlocutions. For example, instead of saying “zebra” they may say something like “a black and white animal that looks like a horse.”

Anomic aphasia can make people feel like every word is just on the tip of their tongue. While many people without aphasia feel like this sometimes, with anomic aphasia, it happens persistently.

Receptive Aphasia (Wernicke’s Aphasia)

colorful watercolor drawing of two people speaking, the speech bubble is a blend of multiple colors

Receptive aphasia impairs a person’s ability to understand language. It occurs after damage to Wernicke’s area, the brain region responsible for language comprehension.  

Severe forms of receptive aphasia can cause the person to not recognize spoken and/or written words. They cannot read sentences or understand what another person is saying. To them, it is as though everyone is speaking another language.

However, most people with receptive aphasia retain some understanding of language. They can usually read and understand simple words and phrases, but cannot follow complex sentences.

Finally, receptive aphasia also affects the way a person speaks.

Unlike expressive aphasia, the patient can produce words. However, they often speak in long, convoluted sentences and use words in the wrong way, without realizing it. Most of the time, their sentences are jumbled up and do not make sense.

Treating Aphasia After TBI

senior woman smiling at speech therapist who will help her overcome aphasia after TBI

Treatment for aphasia will typically involve training sessions with a speech-language pathologist.

A speech therapist will walk you through various exercises to help you relearn how to speak. The goal of these exercises is to activate your brain’s natural repair mechanism, neuroplasticity.

Neuroplasticity refers to the brain’s ability to rewire itself and create new neural pathways. These pathways allow undamaged portions of the brain to take control of functions that were previously controlled by damaged ones.

Therefore, even if the parts of the brain that normally control language skills are damaged, it’s still possible for other areas to compensate.

The best way to activate neuroplasticity is through repetitive use of speech therapy activities. The most effective speech therapies for treating aphasia are listed below.

1. Constraint-Induced Language Therapy

Constraint-Induced Language Therapy was designed to help people with more severe aphasia regain speaking skills.

This therapy forces a person to speak by eliminating any compensatory tactics that they might rely on.

For example, during a session, the patient would have to:

  • Avoid using gestures, drawings, or writing
  • Communicate only by speaking
  • Practice heavily for at least one hour per day.

With enough practice, you can activate neuroplasticity and regain your ability to speak again.

2. Melodic Intonation Therapy

man playing guitar while his wife sings during music therapy, an effective treatment for aphasia after TBI

For patients with such severe expressive aphasia that they can’t utter a single word, music therapy (or melodic intonation therapy) is a great option.

Melodic intonation therapy involves singing simple words or phrases to the tune of familiar melodies. With enough repetition, patients eventually turn their singing speech into normal speech.

Music therapy is based on the fact that even if a person cannot speak, they can usually still sing an entire song fluently.

That’s because singing engages the right side of the brain, whereas speaking utilizes the left side.

Therefore, if the right hemisphere remains intact, the person will still be able to sing.

Most patients permanently maintain the improvements that they gain through music therapy. This makes it a very effective way to treat aphasia after TBI.

3. Speech Therapy Drills

For people with mild aphasia, practicing TBI speech therapy exercises is often the best approach.

Some examples of speech therapy drills your therapist might show you include:

  • Lip and tongue strengthening exercises
  • Coordination exercises
  • Articulation exercises

To ensure that you keep making progress, it’s important that you do these activities every day. To help you remember to do your exercises, mobile apps like the CT Speech & Cognitive Therapy App can walk you through each activity from the comfort of your own home.

Managing Aphasia after TBI

While aphasia is treatable, it’s not an instant fix. In the meantime, you are going to need to learn how to manage it and communicate effectively with others.

Here are some tips that both patients and their loved ones can use to make communication easier.

  • Ask yes or no questions. Family members and friends should try to use yes or no questions as often as possible. This puts less strain on the person with aphasia.
  • Listen. Even when the person is struggling to find the right words, it’s important to listen patiently. Don’t try to put words in their mouth. The best way to beat aphasia is to practice speaking, so let them speak as much as possible, even if it is difficult.
  • Keep groups small. A small group puts less pressure on the person with aphasia to do all the talking and allows them to respond when they feel like it. Be sure to include your loved one in conversation and keep them involved, but don’t push them too hard.
  • Use pictures and drawings. If communication is especially difficult, try drawing. You might even consider creating a book full of words and pictures that can assist you during conversations.

These tips should help you successfully manage aphasia after TBI.

How Long Does Aphasia After Brain Injury Last?

The length of time that aphasia lasts depends on the severity of the TBI.

Every brain injury is different. Some people recover from their aphasia quickly, while others need years of therapy.

However, since there is no way to accurately predict how long your aphasia will last, the best option is to begin speech therapy immediately. The sooner you engage neuroplasticity, the more progress you will make in your recovery.

Your journey to overcome aphasia might be a long one, but with enough therapy and persistence, you can have a real hope of recovering your voice again after brain injury.

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Get Inspired with This TBI Recovery Story

Independance, motivation and hope!

“My son Sharat suffered a severe traumatic brain injury 23 years ago leaving him with Aphasia and right sided weakness from his vision,hearing to his limbs. The lockdown in June was a great challenge for him as his caregivers stopped coming, no gym workouts and no outings for a coffee.

Being his mother and primary carer I feared that this was a hotbed for depression. I scoured the net and chanced upon FlintRehab. As there was a trial period it was safe for us to risk getting it across to Auckland.

His OT checked it out and felt that it was ideal. I can honestly second this.

He enjoys working on it and now after three months can do it on his own. His left hand helps his right hand. The FitMi video explains and shows him what to do, it gives him marks and applauds him too!!

He has to use both sides of his brain. The caregivers are OT students who returned enjoy working on it with him.

In three months there motivation built up in him with a drive to use his right hand. There is definitely a slight improvement in his right hand.

This encourages him as well as the caregivers to try harder.His overall mood is upbeat. He enjoys it, so much so, that it doesn’t matter if his caregiver is away.

FitMi is a blessing.”

Sharat’s review of FitMi home therapy, 10/10/2020

5 stars

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