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Understanding Expressive Aphasia: Symptoms, Treatment, and Recovery

speech therapist working with patient on expressive aphasia treatment

Expressive aphasia is a communication disorder that can make it difficult to produce speech. It’s also known as Broca’s aphasia, because it usually occurs after damage to an area of the brain called the Broca’s area.

There are many types of aphasia, and it’s possible to have more than one. For this reason, it’s important to get a diagnosis from an expert called a Speech Language Pathologist (SLP). An accurate diagnosis is necessary for treatment because each type of aphasia requires different treatment.

You’re about to learn how expressive aphasia is treated, and why a unique approach for everyone is crucial for recovery.

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Understanding Expressive Aphasia

Aphasia refers to a class of communication disorders that occur when the language center of the brain becomes damaged – often from a left-hemisphere stroke or traumatic brain injury.

When the language center of the brain becomes damaged, the person may have difficulty accessing the information in the brain that helps control various aspects of communication.

There are four primary aspects of communication that can be affected by aphasia, which are:

  • Spoken language expression
  • Spoken language comprehension
  • Written expression
  • Reading comprehension

Expressive aphasia occurs when the primary difficulties involve spoken language expression and written expression. This is where the name comes from.

Expressive aphasia is also known as Broca’s aphasia, because the first scientist that identified this condition was Paul Broca. Later, they named the particular area of the brain that controls speech production Broca’s Area.

Along with expressive aphasia, it’s also possible for someone to overlap with other types of aphasia.

For instance, receptive aphasia involves difficulty with comprehension. If someone with expressive aphasia also overlaps with receptive aphasia, they may have difficulty with expression and some difficulty with comprehension, too. This is why diagnosis by an expert is critical.

Symptoms of Expressive Aphasia

Expressive aphasia often manifests as a difficulty with language production. However, this can look different for everyone.

Here are some symptoms that someone with expressive aphasia may have:

  • Exhibits effortful speech, or can’t speak at all
  • Struggles to find the right words, and may put incorrect strings of words together (“word salad”)
  • Utters short sentences or single words repeatedly
  • Finds difficulty with grammar and using conjunctions
  • Reads just fine but may struggle with writing

Someone with expressive aphasia may not struggle with knowing what to say; but they may struggle putting what they want to say into words. When expressive aphasia is severe, the person may not speak at all or only utter single words repetitively. Sometimes, the single words they do use are not the words they intended to say.

It’s important to know that expressive aphasia is about the cognitive skill of expression, not the motor skill of moving your mouth.

Expressive aphasia is different than dysarthria, a condition that involves difficulty moving the muscles of the tongue and mouth, which often leads to slurred speech. This condition is distinctly different from aphasia, and treatment differs for both. This is another important reason to work with an expert for a diagnosis.

Aphasia Does Not Mean Loss of Intelligence!

If you sit down to have a conversation with someone with expressive aphasia, it helps to remember to be patient. As you can imagine, this can be quite frustrating for the person that wants to express themselves, so patience is key.

People with expressive aphasia can sometimes still comprehend verbal speech and written words. This means they can listen to you, but may struggle with responding.

Due to this delay in, or lack of, response, many people assume that someone with expressive aphasia has reduced intelligence, but this is not true! Aphasia does not affect one’s intelligence. It affects the ability to communicate.

If you encounter someone with aphasia, speak to them like you normally would. If the person has mixed aphasia and also struggles with comprehension, it helps to use simpler words and a slower pace, too.

Most importantly, do not raise your voice if you think someone does not understand you. People with expressive aphasia can hear just fine. Your job is to be patient as their healing brain comes up with the right words to respond to you.

A great way to develop empathy for someone with expressive aphasia is to recall the feeling of having an idea on the tip of your tongue, but you can’t remember it. It can be frustrating if you “rack your brain” trying to remember it, but never do. This might be what expressive aphasia is like.

The person might know what they want to say, but the healing brain is struggling to put it into words. Be patient.

Treatment for Expressive Aphasia

The best way to treat expressive aphasia is to start working with a Speech Language Pathologist. These experts know how to diagnose your type(s) of aphasia and cater a treatment plan for your unique needs.

Almost every speech rehabilitation plan will include speech therapy exercises. They are a staple, because they help heal the brain and improve communication.

When the Broca’s area of the brain has been damaged by stroke, for example, the person cannot access the information once stored in that area of the brain. In order to regain the ability to produce speech, the brain must rewire itself and store that information elsewhere.

This rewiring process is known as neuroplasticity. It allows the brain to create and strengthen new pathways in order to become more efficient.

For example, neuroplasticity is the reason why mathematicians have increased grey matter in the areas of the brain responsible for arithmetic. They have practiced arithmetic regularly, and the brain has adapted in response. The same concept applies to speech rehabilitation.

After damage to the Broca’s area of the brain, a person with expressive aphasia must work diligently with an SLP to practice speech therapy exercises. By practicing the task of speech production, the brain will respond by strengthening new pathways that control speech production.

The process is slow and requires consistency long-term in order to create results. But when patients are diligent, they can often overcome expressive aphasia and regain their voices.

For example, see this video of a stroke patient with expressive aphasia after 4 years:

As you can see, she comprehends the therapist with normal speed. However, her words are slow and calculated because she is still regaining the ability to produce speech. She has come a long way, and proves that recovery is possible when you put in the work.

Why Expressive Aphasia Treatment Should Be Unique for Everyone

It’s important to work with an SLP when beginning treatment for expressive aphasia. All brains are wired differently, which means there are differences in how expressive aphasia manifests between people.

For instance, one person with expressive aphasia might struggle with verbal speech production while another struggles with writing. This is why working with an expert is necessary, especially in the beginning.

After you are diagnosed and begin exercises with your SLP, they may send you home with homework to keep practicing at home. This is essential for feeding the brain the stimulation it needs for recovery.

To improve motivation at home, two SLP’s designed an app called the CT Speech & Cognitive Therapy App. It includes many speech exercises that you can practice on your own. Best of all, your SLP can assign certain exercises for you to work on.

If your insurance no longer covers speech therapy and you’re looking for ways to improve on your own, the app might still be a good fit. It includes an initial assessment test that helps identify areas to improve. However, it works best to get started with the help of an expert, and then take matters into your own hands after you’re confident in your customized rehabilitation plan.

How Long Does It Take to Regain Speech?

Statistically, over one-third of stroke survivors have some type of aphasia after stroke. Of these individuals, 60% still have speech problems more than 6 months post-stroke. This does not mean that aphasia will stop improving after six months, though.

As you saw in the video above, aphasia recovery can be a slow process that takes years. Don’t let this stop you from pursuing recovery. When you put in the work, the brain will respond.

It’s essential to keep recovery going strong at home, because the brain requires stimulation in order to heal. Even putting in ten minutes a day will provide benefits. In a way, this helps tell the brain that speech production is important, and you want to get better at it.

Summary: How to Overcome Expressive Aphasia

Expressive aphasia occurs when there is damage to the part of the brain that controls speech production (Broca’s area). Individuals often exhibit effortful speech and struggle with speaking and writing.

This does not mean the person has lost their intelligence. It simply means their brain needs extra time to retrieve the right words. Fortunately, a steady speech therapy exercise plan can help people improve expressive aphasia.

Recovery requires consistency and diligence, so be sure to stick with it day after day. If necessary, invest in speech therapy apps that help motivate you to practice. Best of luck on the road to recovery.

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