Aphasia is a problem with language. It can affect the ability to understand or express spoken language, and often reading and writing as well. It usually results from damage to the areas of the brain responsible for producing or understanding language. Other speech problems, such as slurred speech (dysarthria) or trouble planning the movements of speech (apraxia of speech), can also occur alongside aphasia (1).
Sudden trouble speaking or understanding speech can be a sign of a stroke. Call 911 right away, even if the symptoms go away.
How Common Is Aphasia?
About 1 million people in the U.S. live with aphasia, and about 180,000 Americans develop it each year. An estimated 40% to 60% of stroke survivors have aphasia (2). It most often affects middle-aged and older adults, but children can develop it too.
What Causes Aphasia?
Aphasia is usually caused by a stroke or traumatic brain injury, but it can also result from a brain tumor or a progressive neurological disease that affects the language areas of the brain. Language problems can also happen briefly during a transient ischemic attack (TIA), sometimes called a mini-stroke, and usually clear within minutes to hours (1, 3). A TIA is a warning sign of a possible future stroke and needs emergency care.
What Are the Symptoms of Aphasia?
Aphasia is grouped into two broad categories, fluent and nonfluent, with several types in each, depending on where the brain is damaged (1).
Wernicke’s aphasia. This fluent aphasia comes from damage to the back of the upper temporal lobe. People may speak in long sentences that have little or no meaning, sometimes using made-up words. They often don’t realize what they’re saying doesn’t make sense, and they usually have trouble understanding speech.
Broca’s aphasia. This is the most common nonfluent aphasia and comes from damage to the left frontal lobe. Because this area also helps control movement, it often comes with weakness or paralysis of the right arm or leg. People may understand speech and know what they want to say, but have great difficulty saying it. They often leave out small words and speak in short phrases that take a lot of effort.
Global aphasia. This results from widespread damage to the brain’s language areas. People have trouble both understanding and expressing language. They may struggle to say even simple words, repeat words or phrases, and have trouble understanding even simple spoken or written language.
Recognizing a Stroke
Most aphasia is caused by a stroke. Because there is a short window of time to treat a stroke, it’s important to recognize the warning signs. The American Stroke Association uses the letters FAST (4):
Face drooping. Ask the person to smile and see if one side droops.
Arm weakness. Ask the person to raise both arms and see if one drifts down.
Speech difficulty. Is speech slurred, hard to understand or absent?
Time to call 911. If any of these signs appear, even if they go away, call 911 and get to the hospital right away.
Other sudden signs of stroke include:
Numbness or weakness of the face, arm or leg, especially on one side of the body
Confusion, trouble speaking or trouble understanding speech
Trouble seeing in one or both eyes, or in part of the field of vision
Trouble walking, dizziness, or loss of balance or coordination
A severe headache with no known cause
Any of these should be treated as a medical emergency. Call 911 (4).
Getting help for aphasia matters. Communication ability is linked to independence, social participation, rehabilitation results and quality of life over the long term (2).
What Happens in the Brain With Aphasia?
The brain is made of many types of cells. The ones we usually think of as brain cells are neurons. To survive, neurons need a constant blood supply to deliver oxygen and glucose.
A stroke or other brain injury can disrupt this blood supply. This can set off a chain reaction called the ischemic cascade. Without enough oxygen, the cell’s energy production fails, and a flood of a brain chemical called glutamate pushes neurons to fire faster than they can keep up with. This produces damaging molecules called free radicals and lets calcium rush into the cell, breaking down its proteins and eventually killing the neuron (5).
The walls of blood vessels can also break down from enzymes released by damaged cells. This can damage the blood-brain barrier and cause brain swelling, which can lead to further injury (6).
The brain’s language areas can be affected in this way, and the injury may be mild or involve the whole area. In Wernicke’s aphasia, the back of the upper temporal lobe is injured, while in Broca’s aphasia, the left frontal lobe is injured. Both are usually caused by problems in the left middle cerebral artery, with Broca’s aphasia linked to its upper branch and Wernicke’s aphasia to its lower branch. In many cases of long-term aphasia, both areas are affected.
Broca’s and Wernicke’s areas are connected by a pathway called the arcuate fasciculus, and damage to it can also cause language problems. This pathway can be affected in some brain injuries.
Language involves many areas of the brain beyond Broca’s and Wernicke’s areas. Research has identified two main language networks: a dorsal stream involved in producing language and a ventral stream involved in understanding it. How much each is affected helps shape the type of aphasia a person has (7).
How Is Aphasia Diagnosed?
A physical and neurological exam can reveal signs of a stroke, such as changes in walking or speech. MRI and CT scans help identify the area of injury and the blood vessel involved (8). A physician will also test the person’s ability to understand and use language by asking them to follow commands, answer questions, name objects and carry on a conversation. Lab tests, such as cholesterol levels and markers of inflammation, are also commonly used.
How Is Aphasia Usually Treated?
People with aphasia usually see a speech-language pathologist, who does a detailed evaluation of their communication strengths and challenges. Some people regain language on their own in the months after an injury. Speech-language therapy is the main treatment to help people regain their communication abilities (1).
How the NeuroRescue Program Can Help
Our care is designed to work alongside your physician, neurologist, speech-language pathologist and stroke rehabilitation team, never in place of them. Speech-language therapy is the foundation of aphasia rehabilitation, and our care is meant to support it. Please don’t change or stop any medication, including blood thinners or blood pressure medication, without talking with your prescriber.
One important idea in stroke recovery is called diaschisis. Nerve cells need three main things to stay healthy: glucose, oxygen and activity. They need ongoing stimulation to keep making the proteins and other parts they need to stay healthy and work well. In a stroke, nerve cells supplied by the blocked or burst blood vessel lose their supply of glucose and oxygen, and many are lost unless blood flow is restored quickly.
No one can bring back nerve cells that have been lost. But the lost cells usually aren’t the only reason for the symptoms after a stroke.
That’s where diaschisis comes in. Each nerve cell receives signals from thousands of other nerve cells, and that input helps keep it active and healthy. When nerve cells are lost in a stroke, other nerve cells they connected to, even in areas with a normal blood supply, can lose that input. Those cells may become less active, lose endurance and tire easily, even though they still get plenty of glucose and oxygen (9).
These weakened but still-living nerve cells need the right amount of activity. Too little activity can leave them underused, while too much can overwhelm them. But if we can find another pathway that feeds into these cells, and activate it at a level they can handle, it may help rebuild function in the affected areas.
This idea guides our approach to stroke rehabilitation. We use detailed testing to look not only at which areas are damaged, but also at which systems are still working but weakened. We look for pathways we can use to support those weakened systems, and we adjust how much and how often we stimulate them so they’re challenged without being overwhelmed. Then we choose therapies based on what your nervous system needs, with the goal of helping you recover as much function as possible.
Electrical stimulation. Gentle electrical stimulation of the nerves through the skin, called repetitive peripheral sensory stimulation, can stimulate the brain through the nerves of the body. It has been studied in people with aphasia after stroke (10).
Light therapy. Photobiomodulation uses low-level laser and LED light. It has been studied as a way to support nerve cell energy and function after a stroke and other blood vessel injuries (11, 12).
Transcranial magnetic stimulation. TMS uses magnetic pulses to stimulate specific areas of the brain. It has been studied as a way to support language recovery in people with aphasia after a stroke or brain injury (2, 13). TMS is generally safe and well tolerated. At our clinic, TMS is provided by our psychiatric mental health nurse practitioner, who will evaluate whether it may be appropriate for you.
Balance and vestibular therapy. Balance problems are very common after a stroke and raise the risk of falls, including head injuries. Reducing fall risk is a priority in our care. Vestibular therapy has been shown to help improve balance after a stroke (14).
Vision and eye movements. Vision is often affected after a stroke. People may have trouble mapping their surroundings and their body, keeping their eyes steady on a target, following moving objects or handling busy visual environments, and some lose part of their field of vision. We use visual exercises and rehabilitation tailored to your needs, an approach supported by research (15). Certain eye movement exercises have also been studied for supporting thinking and executive function (16), and one study found improvements in brain wave activity and symptom scores after stroke (17).
Constraint-induced therapy. In constraint-induced movement therapy, use of the stronger arm is limited while the weaker arm gets intensive practice. The same idea has been adapted for aphasia, encouraging intensive spoken practice rather than relying on gestures or other workarounds (18). The brain’s maps of the arm and hand also sit close to those for the face, tongue and throat, which is one reason movement therapies may be part of the picture.
Mirror therapy. Mirror therapy uses a mirror image of your stronger limb to give your brain a different picture of the weaker limb during movement exercises (19). It has also been studied in a virtual reality environment (20), and we use our Virtualis system for this.
Spinal adjustments. Research suggests spinal adjustments may do more than move a joint. Studies using EEG, brain stimulation and brain imaging have found that adjustments can produce short-term changes in how the brain processes sensory and movement information, including in the prefrontal cortex and the areas that plan and control movement (21, 22, 23, 24). One study in people with chronic stroke found that a single adjustment session increased the brain’s drive to a weakened leg muscle compared with a control, though it didn’t measure whether strength or walking improved (25), and joint manipulation has also been studied for movement after stroke (26). Researchers are still working to understand how long these changes last and how they relate to symptoms, but they help explain why we look at how your whole nervous system is working, not just your spine. Chiropractic adjustments are used when appropriate and safe for you, along with physical exercise and soft tissue therapies.
Some of these therapies may seem unrelated to language. But one idea behind our approach is that supporting the brain areas around and connected to the injured area may help reduce the effects of diaschisis, which may in turn support the brain’s ability to adapt in the areas involved in language.
Some programs include mild hyperbaric therapy as a structured recovery option between more demanding therapy sessions. The therapies we recommend are always chosen based on your testing and exam findings.
How the NeuroRescue Program Works
Your NeuroRescue Program begins with your Discovery Day. We start with a detailed history of your condition and your life on a timeline. This helps us understand the factors that may have contributed to where you are now, and identify related conditions that may be making it harder to move forward.
We measure how your visual, vestibular and balance systems are working through computerized analysis of your eye movements, inner ear reflexes and balance under different conditions. Our testing includes videonystagmography and saccadometry to measure several types of eye movements, the video head impulse test to measure inner ear reflexes, and CAPS computerized posturography to assess your balance under different sensory conditions. We also use NeuroSensoryMotor Integration testing to evaluate hand-eye coordination and cognition, and Virtualis testing to assess dynamic eye tracking and your perception of vertical in a virtual reality environment.
We combine this with a thorough physical and neurological exam of your sensory, motor, autonomic and cognitive systems. We also review any relevant lab work, imaging and prior testing, and integrate it with our findings.
Together, this helps us understand which parts of your nervous system are working well, which are struggling, and how quickly they tire. We use that information to design your personal NeuroRescue Program, aimed at improving function in the systems that need support and helping them work together. Our testing also helps us decide when to push and when to let you rest.
Our goal is to support your recovery so you can connect, communicate and take part in your life as fully as possible.
Your Next Step
Living with aphasia can be isolating and frustrating, for you and the people who love you. Recovery can continue long after the hospital, and you don’t have to do it alone. To find out if the NeuroRescue Program is right for you, contact one of our patient care coordinators to schedule your Discovery Day.
