Aphasia is a communication disorder that can make it more difficult to speak to and understand others, and it can occur after TBI.
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 may 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)
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 words (although they know what they want to say) and sometimes speak in short, fragmented sentences. For example, instead of saying “I want to go out to dinner” they may simply say “eat…food.” In extreme cases, individuals with expressive aphasia may not be able to speak at all.
Because of the proximity of Broca’s area to the primary motor cortex, expressive aphasia is usually associated with physical impairments such as difficulty walking, a weak or paralyzed arm, and/or slurred speech.
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)
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 with ease. However, they often speak in long, convoluted sentences and use words in the wrong way, without realizing it. Sometimes, their sentences are jumbled up and do not make sense, which they typically do not realize.
Treating 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 and/or comprehend language. 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
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 usually treatable to some degree, 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.