Aphasia therapy: recovering from loss of speech

Aphasia is a condition that limits a person's ability to understand spoken and written speech, and their ability to speak. Aphasia does not mean impairment in intelligence. Aphasia can develop after a stroke, or as a result of a head injury or a brain tumour. There are different levels of aphasia: from the mild and hardly noticeable, to severe. Recovery is possible; however, if aphasia symptoms persist for two or three months, aphasia can become permanent.

People diagnosed with aphasia find it difficult or impossible to express their thoughts through language. They can mix up words in the same category, for instance: "tall" and "short". Aphasia can make it impossible for a person to understand a word, even if they can read it. People with aphasia can speak slowly, searching for correct words. Some people affected can speak, but would sometimes get a word or a sound wrong. In people with aphasia, comprehension of spoken speech is impeded, especially if the conversation takes place between several people or if he speech is very fast. Furthermore, people with aphasia find it difficult to understand numbers.

Aphasia therapy involves two approaches: first, working on the patient's impaired functions, and second, improving the practical side of their communication with people around them. The former one is called impairment-based therapy. A health professional works with the patient to stimulate particular skills, such as speaking, listening, writing and reading. The other aspect of aphasia therapy is communication-based, or consequence-based therapy. It involves solutions to everyday communication challenges that the patient faces.

When impairment-based aphasia therapy is used, a patient spends some time with a therapist focusing on particular aspects of speech. For instance, the patient might be re-learning sentence structure. Computer programmes that encourage comprehension and word finding may be part of this therapy and the patient can work on those at home.

An example of an impairment-based aphasia therapy is asking the patient not to use the speaking or comprehending abilities of which the patient is still in control. Instead, the therapy aims to recover those functions that are lost. Another therapy that can be used is melodic intonation therapy, whereby the patient is supposed to sing, rather than say, sentences.

Family members are encouraged to get involved in the patient's communication-based aphasia therapy. Here the person with aphasia and people in their communication circle work out the most effective ways to communicate. Alternative means of expressing the patient's thoughts and preferences need to be found. One of the strategies in this therapy is for the patient to use as much of their intact functions as possible. This is the social, or participation-based approach to dealing with aphasia.

In this approach, people around the person who has aphasia create optimal conditions for communication. For instance, background noises are removed. The patient and their family can use whichever means of communication are available to them: pictures, simple or incomplete sentences, gestures and facial expressions. A technique called "supported" or "scaffolded conversation" is used in community groups, whereby volunteers support an aphasia patient throughout the conversation.