Aphasia: what it is, symptoms, causes and therapy

Aphasia is a language disorder that results from damage to the areas of the brain responsible for language. The Royal College of Speech and Language Therapists (RCSLT) says it may affect a person’s ability to talk, write and understand spoken and written language. A person with aphasia may find answering the telephone, watching television or listening to the radio hard, and everyday tasks can become impossible, which can lead to frustration, social isolation and difficulties in close relationships.

The Stroke Association explains that aphasia is a communication difficulty that affects language. Other communication difficulties after stroke can come from problems moving or coordinating the muscles of the mouth and vocal cords, such as dysarthria and apraxia of speech, and some people have more than one.

The NHS says aphasia affects people in different ways, but symptoms may include the following. It can affect speaking, understanding, reading and writing to different degrees.

• Not being able to say the right words, speaking very slowly or with long pauses.

• Finding it very difficult to speak, or speaking in very short or incomplete sentences.

• Repeating, mixing up or missing out words.

• Making up words or sounds.

• Not being able to understand what other people are saying, particularly if you cannot see them.

• Difficulty reading or writing.

The NHS says aphasia is caused by damage to the parts of the brain that deal with language. Common causes are stroke, which is the most common cause, severe head injury, a brain tumour, bleeding or an infection in the brain, and conditions that cause the brain to become damaged over time, like dementia, or alcohol or drug-related brain damage.

Anyone can get aphasia, but it is more common in people over 65, because the risk of stroke and conditions like dementia is higher for older people. The RCSLT says it is most commonly a disorder of older adults, but can appear in children as a developmental disorder. There are different types of aphasia depending on which part of the brain has been affected, and the Stroke Association names Broca’s aphasia, Wernicke’s aphasia and anomic aphasia as the most common.

The NHS says aphasia is treated with speech and language therapy. A speech and language therapist assesses your symptoms and works with you to improve your speaking, reading and writing and to find different ways to communicate. Therapy may be individual or in a group, face to face or online, and usually involves the people around you.

• Matching words to pictures and categorising or sorting words.

• Repeating words or rhyming tasks.

• Practising ways of communicating without words, like drawing, body language, hand movements and facial expressions.

• Using technology, for example setting your phone to be voice-activated or taking pictures of things you struggle to name.

• Speech and language therapy apps or computer programs to practise.

The NHS says there is currently no cure for aphasia, and how much it affects life varies from person to person, depending on the cause and the amount of brain damage. If aphasia was caused by a stroke, head injury or brain tumour, most people improve with treatment, especially in the first few months. People can still improve months or years later, and some do recover fully.

If aphasia is caused by a condition that gets worse over time, like dementia, the symptoms are likely to get worse, and treatment may focus on learning and practising other ways of communicating. The RCSLT describes aphasia as a long-term and life-changing condition, and says that the person with aphasia, their family and friends and wider society all need to adapt to facilitate communication.

Sudden speech problems can be a sign of stroke. The NHS says to call 999 if you or someone you are with suddenly has face weakness (one side of the face may droop), weakness or numbness in one arm or down one side of the body, speech problems such as slurring words, sounding confused or finding it difficult to find the right words, or blurred vision or loss of sight in one or both eyes. These can be signs of a stroke, which needs to be treated immediately. Do not drive yourself to A&E.

If aphasia has developed gradually, over weeks or months, see a GP, who can arrange assessment and referral to a speech and language therapist or specialist.

The NHS says aphasia can be very frustrating, confusing and difficult. It can affect relationships and independence in daily life and cause anxiety, low mood and depression, loneliness or isolation. Talking therapies and support from your care team can help.

The NHS signposts the Stroke Association, Say Aphasia, Aphasia Reconnect and The Brain Charity for support, local groups and online groups, and the Aphasia Alliance for tips on aphasia-friendlier communication. The Stroke Association also provides communication tools, therapy apps and a free communication support pack.

After a stroke, speech and language therapy is part of NHS stroke rehabilitation, and the NHS says you can find a speech and language therapist through the RCSLT. In other situations a GP can refer you to NHS speech and language therapy or to neurology.

Independent speech and language therapists also work privately and may offer more frequent sessions. Whichever route you use, ask for a therapist with experience of aphasia, and whether family members can join sessions.