The Many Voices of Aphasia

By Walt Kilcullen



Sandy had a stroke nine years ago. She was left with paralysis in her right arm, a weakness in her right leg requiring a brace to walk, and expressive aphasia. She understands what people are saying, but can only talk in one word responses and occasionally in short phrases. She cannot read, write, add or subtract. These problems are common for people who have suffered a stroke or other brain injury on the left side of the brain which affects the right side of the body.


Cheinhwa had a stroke four years ago and has similar results as Sandy. He also understands what people are saying. When he speaks, however, he struggles with every word. He speaks in complete sentences, but each sentence takes a great deal of effort. He can also read and write, but this also comes with great effort.


Lucian had a traumatic brain injury six years ago. He was the victim of a violent crime. He was hit over the head with a blunt object and left for dead. He did recover but is cognitively impaired and has expressive aphasia. He also understands what people say, but speaks so rapidly it is difficult to understand him. He can read and write, but like Cheinhwa, he does so slower than normal and with some difficulty.


All of these survivors are people that I have mentored through the Brain Injury Association of New Jersey. They all have aphasia but with different traits. And there are many other traits that I mention below giving aphasia “many voices.” So what exactly is aphasia? If you research the term, aphasia is divided in many ways. The simplest way is to divide the term into “Expressive Aphasia,” which, like the three cases above, have difficulty expressing themselves, and “Receptive Aphasia,” which means you have difficulty understanding what is said. Some survivors have symptoms of both.


Symptoms may include:

             •  difficulty in pronouncing or forming words

             •  difficulty understanding or comprehending language

             •  difficulty or inability to read and write

             •  tendency to repeat words or phrases

             •  difficulty or inability to use complete sentences

             •  difficulty or inability to repeat words or phrases

             •  poor enunciation

             •  difficulty or inability to name objects


The most important point, however, is that any type of language problem as a result of a traumatic brain injury or an acquired brain injury such as a stroke, is considered aphasia.


If you have aphasia and are home after the hospital stay and after the out patient rehab, what do you do? At some point, speech therapists will decide there is little to gain from additional therapy sessions. So now you must get on with your life. Here is what I recommend.


First, join a support group specifically for aphasia. Go to the National Aphasia Association web site ( to find the support group nearest you. Scroll down under “Aphasia Community” to “Aphasia Community Groups.” Click on your state and get a list of support groups. Support groups are wonderful for sharing new techniques, and meeting friends with similar problems. If you cannot find a group close to you, start your own. The NAA web site tells you how.


Second, investigate the use of computer software and speech devices to see if they might be of help. Bungalow Software, Parrott Software, Communication Scripts Inc., and Lingraphica are examples.


Third, investigate clinics and community groups that specialize in Aphasia. Again, go to the National Aphasia web site and scroll down under “Aphasia Community” to “Aphasia Programs and Centers.” This will enable you to see what is available in your state. Be sure you get details such as cost and the success rate before you invest your money.


Hope For The Future


Pharmaceutical companies are testing drugs such as Piracetam, amphetamines, and Bromocriptine to improve speech in aphasia patients Results are encouraging.


Neural Regeneration has also shown some promise. Researchers have used cell transplantation which is designed to restore brain tissue after a brain injury.


Constraint Induced Aphasia Therapy (sometimes called Constraint Induced Language Therapy) has also shown positive results. Many years after a stroke resulting in aphasia, studies have shown that CIAT has improved speech and comprehension in patients. During their therapy, the speech therapist spends three to four hours per day, five days per week, for three weeks giving intensive speech therapy targeting the patient’s specific weaknesses.


I intentionally did not give details of these new advances because none of the studies are yet conclusive. However, if you want more information on these and others new studies, you can find it in an article entitled Aphasia Therapy In The New Millennium found on the NAA web site.



Copyright © June 2009

The Stroke Network, Inc.

P.O. Box 492 Abingdon, Maryland 21009

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