Aphasia Therapy

Do you ever get that tip of the tongue feeling, you know the one where you know what words you want to say, but it's just not coming out the way you want it to? Or maybe you look at the headlines of the morning newspaper, but you're just not able to recognize or process the words. Well, for those living with aphasia, things as simple as finishing a sentence or reading the newspaper can become monumental challenges after having a stroke. More importantly, the frustration and isolation that people with aphasia experience can be just as difficult to manage.

June is National Aphasia Awareness Month and as a result, we wanted to highlight a podcast Q and A with Alison Finkelstein, MA, CCC-SLP, clinical educator at the Speech-Language Institute (SLI). According to the National Aphasia Association, 2 million people in the United States have the communication disorder, but 84.5% of Americans state they’ve never heard the term aphasia before. Read through the Q and A below to learn more.

Q: Could you tell us a little bit about what aphasia is?
A: Aphasia is an acquired communication disorder, meaning you're not born with it. It may occur after a stroke or a brain injury or another type of neurological disease. It's an impairment of language, so it may affect verbal expression, auditory comprehension, written expression, or reading comprehension, or a combination of those modalities. But the important thing is that it's a loss of language, not intellect.

Q: I've seen it written a few ways as aphasia and dysphasia. Are they related? Are they similar?
A: Those are two totally different things. Aphasia is the language disorder that I've just mentioned. Dysphagia is a swallowing disorder. I think the confusion sometimes comes when somebody sees dysphasia, D-Y-S-P-H-A-S-I-A, instead of D-Y-S-P-H-A-G-I-A. The S-I-A is another way to say aphasia, but aphasia's the term that's used now.

A person with aphasia may present with only one modality of language impairment. As I mentioned, it could be just verbal expression that's impaired. But typically aphasia affects several modalities at the same time.

The level of impairment is based on the severity of the stroke itself and the brain lesion itself. A person with mild aphasia may have only slight difficulty retrieving the names of objects, whereas somebody with a more severe aphasia may be unable to put words together to form a sentence or to indicate their needs. Others may speak fluently, but their sentences don't make sense, and they have difficulty understanding others and recognizing their own errors.

Q: Obviously it sounds like every case of aphasia is very specific to the client or patient that you're seeing.
A: Exactly. As no two individuals are alike, no two cases of aphasia are alike. We typically classify aphasias according to different categories. But you can have two people that have the same type of aphasia, but they're going to still present differently. The two general classifications are expressive or receptive aphasia.

Expressive aphasia is also known as fluent aphasia. With that, you're going to see maybe poor comprehension. Their words may lack meaning. Their speech might have a normal vocal inflection, but as I mentioned, they have difficulty understanding the speech of others, and they don't recognize their own speech errors.

Somebody with the other type of classification, which is the expressive aphasia or non-fluent aphasia, they generally have good comprehension, but there may be long hesitations between words when they're trying to express themselves, and they may make grammatical errors.
You know that tip of the tongue feeling that we all get from time to time when we're trying to think of a word or say the word's name? We all have that, especially as we get older, but a person with aphasia who has that tip of the tongue feeling, it's more severe. They can't maybe even name objects in their environment, or simple labels, and sometimes family members' names. That's what's very frustrating to them.

Q: Do patients normally come to you knowing already that they have aphasia, or do you diagnose someone with aphasia?
A: That's a great question. Here at Salus University, in our Speech-Language Institute, they typically have been given the diagnosis of aphasia because they've received treatment in an acute care hospital, and then maybe have gone to a rehab facility, or have received home care. They've typically seen a speech pathologist before coming to the Institute, or maybe very limited treatment, but still they've heard that diagnosis.

But sometimes they don't really fully understand that, or their family members or caregivers don't fully understand it. So we do a complete evaluation, and then give them more information on aphasia, and what our treatment goals would be.

Q: Could you describe what an aphasia evaluation is like?
A: Sure. Typically, we conduct a very thorough interview, not just with the person with aphasia, but whoever is important in their life. Typically, it will be a caregiver or a spouse, another parent it could be. We want to find out what the needs of the whole unit is - not just the person with aphasia, but what were they typically like? How do they function now? What's their daily routine like? We get a lot of that information on that first meeting with them.

Then we conduct some formal testing that involves all those language modalities that I just mentioned. We'll look at their auditory comprehension, their reading comprehension, their ability to express themselves verbally, and their ability to write. We'll see which modalities we want to target, and which are most important for that individual. But we try to make it very functional. The whole goal is communication. It's not just being able to speak.

Q: I know you mentioned it normally happens in adults who had a stroke, but do you ever see aphasia in more childhood cases or pediatric cases?
A: No. It's an acquired ...I shouldn't say no. There have been children and adolescents who have the rare instance of a stroke, but most typically it's adults. Following a stroke is probably the most common that we see, but it could be any brain injury. But depending on where that lesion is, there's going to be different levels of impairment.

One of the primary language centers in the brain is in the left hemisphere. It's called Broca's area. This is more in the frontal area of the brain. It controls language production and speech gestures. But that's just one area. Another primary area that controls language comprehension would be Wernicke's area, which is a little bit more posterior in the brain. One or more of those areas can be affected.

But fortunately there are other areas of the brain that support those primary language centers that can assist with communication. That's what our goal is. Then of course there's brain plasticity. We want to make sure that we're using any modality that we can to build those compensatory strategies up.

Q: What types of therapy or treatment can clients expect when they come to the Speech-Language Institute?
A: It's going to be based on their needs, obviously, and which modalities are most impaired. We typically have goals that work on word retrieval and being able to communicate basic needs with their families. We work on them being able to label their family members. That's a very important one. A lot of times we'll involve family as well, and train them how to do some things at home that will promote communication.

Q: Right, so it's not just when you're in SLI. It's all day, every day.
A: Oh, yeah. We don't want the family members to do therapy at home per se, but we give the clients homework. We show them different things that they might do on their computers. Patients who are more severely impaired might use augmentative devices.

Q: Right. I've seen, I think once, there was an iPad sort of thing.
A: Yes. That's very common. It's used not just for communication, but you can make it a therapy tool as well. You're building the lexical retrieval or ability to think of words, say words, and write words. You might do reading comprehension on that - we try to hit every modality, but make it life participatory too.

Q: What do you find your clients struggle with the most when they experience aphasia?
A: I would say frustration. They feel isolated. Part of breaking through that is to have them join a support group so that they can meet others with aphasia. It's also for their caregivers and loved ones, so that they can get support and education and resources. It reduces that feeling of isolation. It's an important part of therapy, because it engages them in a social setting that they might otherwise not go to.
Aphasia Support Group
Q: You run the support group here at the Speech-Language Institute. Could you talk more about that?
A: It's one of the things I love the most about being here. I actually supervise two graduate students who run the meetings, but we collaborate on how we're going to plan each meeting. Our aphasia support group meets the second Thursday of each month from 2:00 to 3:00 p.m. We've grown. We started it in July of 2017 where we had maybe two or three members. Then most recently we're averaging between 12 and 14.

Q: Are they all clients of SLI, or have they come from other places?
A: Most of them are. We've had some caregivers and others who just want to attend for education. They might not have aphasia, but they have a loved one who maybe doesn't feel like coming to the meeting yet. They'll come and get the education there. Yeah, it's been very successful.

We typically do different topics each month. The students had been great about planning topics of interest that the clients have expressed an interest in. They usually have a little PowerPoint up there, but they'll use it as a visual aid, which is important for folks with aphasia. We're really happy with it.

Q: What would you say your favorite…not your favorite part of aphasia, but working as an SLP, what's your favorite part of it?
A: Well, I feel like I've learned so much from our aphasia clients, or any of our clients that have a communication disorder, but specifically those with aphasia. That population tends to be middle aged or older. I just learned their resilience and their perseverance. I have a lot of respect for that. That's probably my favorite part is interacting with them and their families.

Q: That's great. Is there anything else you would want to mention or talk about just about SLP or SLI in general?
A: We're trying to increase aphasia awareness overall through the support group, but also we're going to be training some PA (Physician Assistant) students in terms of informing them, when they are doing patient interviews with somebody with aphasia and their family members. That's a project that one of the capstone groups is working on.

Just in terms of tips for communicating with somebody with aphasia, be patient, allow plenty of time for a response, and speak with them rather than for them. Use simple short sentences, speak face to face, try to minimize distractions, and maybe use a quiet environment when you really want them to get the most from the conversation.

If they have an augmentative device, encourage them to use that. Even just a pen and paper sometimes. Not everybody can use that, if they have a lot of writing issues, but we have several clients that carry a little notebook and pencil, and they use it consistently. I would say to encourage that, or maybe they just gesture, encourage the gesture, because the goal is communication.