Socializing with Aphasia

About 795,000 people in the United States have a stroke each year, according to the Centers for Disease Control and Prevention. It is one of the most common causes of disability. One such potential after effect is aphasia, which affects the way stroke survivors communicate.

A stroke, sometimes called a brain attack, happens when a clot blocks the blood supply to the brain or when a blood vessel in the brain bursts. During a stroke, the brain cells are deprived of oxygen and they begin to die. This can cause aphasia, a condition that impairs the expression and understanding of language and which may co-occur with speech disorders.

After acquiring aphasia, many adults are left unable to interact as they did before, which can take a toll on their happiness and emotional health. Aphasia survivors are able to pursue some social activities that don’t require a lot of talking, such as art classes, gardening, and exercise. But for others, finding a new normal can be overwhelming without a speech-language pathologist (SLP) to help guide them as they regain the ability to communicate and the confidence to do so in social settings.

Infographic with three bar charts illustrating selected 2016 Aphasia Awareness survey results.

According to the 2016 Aphasia Awareness Survey, 85 percent of adults have not heard of the term aphasia. Ten percent of adults believe that if a person has difficulty with speech, it means they also have intellectual deficiencies. Eighty-four percent of adults know that it is common for a person who has had a stroke or brain injury to have difficulties with speech and communication. Go to the selected results from the 2016 Aphasia Awareness survey.

What Is Aphasia?

Aphasia is one of the most common disabilities resulting from stroke. The National Aphasia Association defines the condition as an impairment of language affecting the production or comprehension of speech and the ability to read or write.

There are several types of aphasia that often affect how people engage with others, said Darlene Monda, clinical assistant professor at NYU Steinhardt.

“One of the biggest problems people have is that they lose their social network,” she said. “They lose their friends who often don’t have the skills or knowledge to know how to interact, especially when someone has comprehension challenges, in addition to expressive language challenges.”

Strokes aren’t the only source of aphasia. Other causes include brain injuries, head trauma, brain tumors, and infections. About 180,000 people acquire aphasia every year, according to the National Aphasia Association.

Monda explained that the role of the SLP is critical in recovery; they are “not just mechanics who try to fix language, but [they] encourage someone to go out there and communicate at whatever level the stroke survivor can. And the only way to do that is to be sure that you’re talking on their level and about the things they want to be talking about.”

National Aphasia Association president Darlene S. Williamson said she emphasizes that someone with aphasia remains the person they always were.

“So many times family members will say, ‘He still likes music,’ or ‘He still likes to watch football,’” she said. “Well, of course — he’s still the same person. He’s still your loved one. All of the same personality idiosyncrasies or traits, good and bad, are still there. It’s just compounded by their difficulty communicating, so accept that this is still the person you loved and that person is entitled to your love and respect unquestionably.”

How Does Aphasia Affect a Stroke Survivor?

Because there is no cure for aphasia, said Williamson, it becomes a part of life for those who have it.

“You live with aphasia for the rest of your life, so the thrust is to live successfully with aphasia rather than talking in terms of fixing or curing anyone or ever saying ‘I’m all done. I don’t have aphasia anymore,’” she said. “It’s always a piece of you.”

There are two broad categories of aphasia: expressive or non-fluent and receptive or fluent. Expressive, or Broca’s aphasia, is experienced by people who may understand speech and know what they want to say but struggle to do so. Receptive, or Wernicke’s aphasia, is characterized by someone who has difficulty understanding speech and who can sometimes show signs of memory loss, although cognitive ability remains unchanged.

Illustration showing which parts of the brain, when damaged, can cause expressive and receptive aphasia.

Expressive aphasia results from damage to the brain’s frontal lobe, while receptive aphasia results from damage to the temporal part of the brain.

According to Williamson, what appears to be memory loss could be that the individual with receptive aphasia simply wasn’t following the conversation. “Could you follow a conversation in Chinese? No. So if you are not processing the language, it might look like you have a deficit in cognition,” even though that might not be the case, she said. Because breakdowns occur when people don’t understand that they might be experiencing a comprehension problem, it becomes challenging to communicate, and patience is required.

How to Help Individuals with Aphasia Socialize

There are ways to help those with aphasia socialize after their brain attack, tumor, or infection; however, health professionals, caregivers, and family members should be aware that for a person with aphasia, comprehension is variable. Someone with aphasia might have good comprehension and communicate with simple answers. But, according to Monda, “when a person with aphasia has difficulty with comprehension, they often are having difficulty realizing they’re not understanding.”

How to Communicate with People Who Have Aphasia

Monda said it’s important that the client drive the conversation and discuss things they are interested in, “so that we can encourage them back into those activities, or talk about those activities with others who might have like interests and make the exchange as functional as we possibly can.”

Here’s some advice from the National Aphasia Association on how to communicate with people with aphasia.

Ask simple questions.

Are you asking a question? Are you telling me something?

Provide choices.

Are we talking about a person? A friend? A family member?

Help communicate if asked.

OK, here’s what I heard: You’re angry because of something your sister did yesterday, and it has to do with eating. Am I correct? Did I understand you?

Acknowledge frustration.

I know how frustrating this is for you. It’s frustrating for me to see you work so hard.

Speak slowly and clearly.

Ask questions that can be answered with yes or no.

If you don’t understand, say so.

Give me some information. Talk around it. Give me all the words you can that can be put into context.

Allow extra time.

Don’t rush, so you can validate what you heard by asking questions such as: Am I understanding you correctly? 

Source: The Stroke Comeback Center, courtesy of National Aphasia Association. “Tips for Communicating With People With Aphasia,” NAA. Accessed Sept. 25, 2018. https://strokecomebackcenter.org/resources/information/

There are tools available to help people with aphasia communicate, depending on how receptive the individual is to utilizing them. Such tools include:

  • Visual aids, such as magazines: Let the person with aphasia comment or point to what they are referring to so that you have a common point of reference.
  • Augmentative and alternative communication devices: The devices are either electronic or non-electronic and are used to transmit or receive messages.
  • Communication boards: These single-page boards involve organizing images with categories at the top to create sentences that have meaning.

Still, an SLP does more than routine exercises with their client. In addition to using visual aids in conversations, Monda said, “From day one, we’re asking: ‘What are your interests? What are the things that you want to communicate about? Do you really need to say the name of this fruit, or would you rather be talking about art or the boat you used to own and sail out on the bay?’” 

The goal, Monda said, is “to give people a chance to achieve the best outcome possible. That outcome can be a very small gain, and it can be an enormous, near-return to their original functional capability.”

The following section includes tabular data from the graphics in this post.

Selected Results From the 2016 Aphasia Awareness Survey 

Have you ever heard the term aphasia?

AgeNoYes
25 to 3484%16%
35 to 4486%14%
45 to 5486%14%
55 to 6484%16%
65 and over85%15%

To what extent do you agree with this statement? If a person has difficulty with speech, it means they also have intellectual deficiencies.

AgeStrongly DisagreeSomewhat DisagreeNeutralSomewhat AgreeStrongly Agree
25 to 3439%25%24%8%5%
35 to 4444%23%23%5%5%
45 to 5449%20%24%6%2%
55 to 6456%24%14%3%3%
65 and over55%22%15%5%3%
65 and over55%22%15%5%3%
TOTAL39%25%24%8%5%

Is it common for a person who has had a stroke or brain injury to have difficulties with speech and communication?

AgeI don’t knowNoYes
25 to 3411%4%85%
35 to 449%7%84%
45 to 5410%5%85%
55 to 6412%6%81%
65 and over11%5%84%
TOTAL10%6%84%

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Citation for this content: Speech@NYU, the online master’s in speech-language pathology from NYU Steinhardt.