What is aphasia?

Definition of Aphasia

Aphasia is a disorder of language resulting in the loss of ability to communicate orally, through signs, or in writing, or the inability to understand such communications. 1

Key Characteristics of Aphasia

Aphasia is a common consequence of stroke, particularly with left hemispheric lesions, affecting approximately 21-38% of acute stroke patients 1, 2. It manifests as impairment of various verbal abilities, including:

• Abnormal verbal expression
• Difficulties in understanding spoken or written language
• Impaired repetition
• Naming difficulties
• Reading and writing problems 2

Types of Aphasia

Aphasia can be classified according to fluency, comprehension, and naming abilities:

• Nonfluent aphasias:

  • Broca's aphasia
  • Transcortical motor aphasia
  • Global aphasia
  • Mixed transcortical aphasia

• Fluent aphasias:

  • Anomic aphasia
  • Conduction aphasia
  • Wernicke's aphasia
  • Transcortical sensory aphasia
  • Subcortical aphasia 2

Impact on Health Outcomes

The presence of aphasia has significant implications for health outcomes:

• Associated with decreased response to stroke rehabilitation interventions
• Increased risk for mortality
• Substantial impact on quality of life, relationships, vocation, and leisure activities 1
• High short- and long-term morbidity and healthcare expenditure 3

Recovery Patterns

Spontaneous recovery from aphasia often occurs but varies based on several factors:

• Most remarkable in the first three months after stroke onset
• Recovery from aphasia caused by ischemic stroke occurs earlier and is most intensive in the first two weeks
• In hemorrhagic stroke, spontaneous recovery is slower, occurring from the fourth to eighth week
• The course and outcome depend greatly on the type of aphasia 2

Assessment and Management

Assessment

1. All stroke patients should be screened for communication disorders using simple, reliable, validated tools 1

2. Patients with suspected communication deficits should be referred to a Speech-Language Pathologist (SLP) for comprehensive assessment of:

   • Comprehension
   • Speaking
   • Reading and writing
   • Gesturing
   • Use of technology
   • Pragmatics (social cues, turn-taking, body language)
   • Conversation 1

Treatment Approaches

1. Early intervention: Treatment should be offered as early as tolerated 1

2. Intensity of therapy:

   • For acute phase (first 6 weeks): 30-45 minutes of direct language therapy, 2-3 days per week 1
   • For early recovery: At least 45 minutes of direct language therapy, five days a week 1
   • For chronic aphasia (>6 months): Intensive therapy of at least 10 hours/week of therapist-led individual or group therapy for 3 weeks, plus 5+ hours/week of self-managed training 1

3. Therapeutic modalities:

   • Speech and language therapy focusing on production and comprehension of words, sentences, and discourse 1
   • Conversational treatment and constraint-induced language therapy 1
   • Use of non-verbal strategies, assistive devices, and technology 1
   • Group therapy and conversation groups 1
   • Communication partner training for family members and caregivers 1

4. Supplementary approaches:

   • Computerized language therapy to enhance benefits of other therapies 1
   • Alternative means of communication (gesture, drawing, writing, augmentative and alternative communication devices) 1

5. Support and education:

   • Information should be available in aphasia-friendly formats 1
   • Family engagement in the entire process from screening through intervention 1
   • Training in supported conversation techniques for communication partners 1

Emerging Treatments

Research is exploring additional interventions to augment traditional speech and language therapy:

• Transcranial brain stimulation shows promise in boosting aphasia therapy outcomes 4
• Pharmacological agents (piracetam, bromocriptine, dexamfetamine, donepezil) have shown varying degrees of efficacy in different studies 3

Important Considerations

• Aphasia often co-occurs with non-language cognitive deficits, particularly executive functions and verbal working memory, which may impact recovery 5
• Treatment should address the impact of aphasia on functional activities, participation, and quality of life 1
• Cultural and linguistic diversity should be considered, with assessment and information provided in the patient's preferred language 1

Early identification and aggressive management of aphasia through appropriate therapy helps to improve both language function and broader recovery outcomes 1.