Understanding Aphasia After Stroke

By: Mark Ostrowski CCC-SLP

Your loved one just suffered a stroke. You rush to the hospital to be by their side and find you are at a loss for words when you realize the road to recovery that lies ahead. 

After a stroke, your loved one may also be at a loss for words. While difficulty communicating is a common and immediate symptom of stroke, it’s also one that can continue in the future. Communication challenges – including how fluently and clearly a stroke patient can speak and how well they can comprehend others – can persist long after the stroke. This is called aphasia.

If you have a loved one who is struggling with aphasia, you can play an important role in improving their quality of life.

What leads to aphasia?

For most individuals, expression and comprehension of language occurs in the left hemisphere of the brain. When injury occurs to this area, it can result in struggles to communicate and/or understand language. The severity of language impairment to expression and comprehension can depend upon where the injury occurred and the severity of the injury. Stroke is the most common cause of aphasia, however, other causes include traumatic brain injuries, tumors and degenerative diseases.

What does aphasia feel like?

We’ve probably all heard or even said at some point, “The words are on the tip of my tongue.”

Individuals with aphasia often say that is what it feels like. They know what they want to say but have difficulty finding the words. Even simple and familiar words can be difficult, leaving the person feeling frustrated, confused and even embarrassed because they know what they are trying to communicate. They may not understand why others aren’t comprehending, or they may not comprehend what others are saying to them. They may understand pieces of a conversation – or nothing at all.

Not being able to understand and communicate with their doctors and care team, in particular, can leave individuals with aphasia feeling vulnerable and out of the loop in their own care plan.

Diagnosing aphasia

Typically, when a patient has persistent language challenges following a stroke, a physician will conduct imaging – usually magnetic resonance imaging (MRI) or computed tomography (CT) scan – and an initial assessment. This is often followed by a referral to a speech-language pathologist for a more comprehensive assessment of language capabilities including expression, comprehension, reading and writing to determine the degree of impairment.

Common misconceptions of aphasia

It’s important to know the common misconceptions about aphasia, as they can hinder recovery.

Intelligence: One misconception you may have about your loved one is that they have reduced intelligence. Aphasia affects language, and while your loved one may have cognitive deficits from the stroke itself, those deficits are not part of aphasia. It is quite possible for your loved one to suffer a stroke resulting in aphasia and have no cognitive deficits at all.

Hearing: Aphasia affects the processing of language, not the ability to hear. Hearing loss can accompany aphasia, further adding to the difficulties in processing language. Just because your loved one has aphasia does not mean that they can't hear you.

Effort: Those with aphasia may be perceived as being unfriendly or not “trying hard enough” to communicate. Aphasia can make even basic communication extremely difficult. In most cases, they are trying even harder than those around them to communicate.

Many with aphasia who have regained communication say they were further frustrated by the impatience of those around them and the misunderstandings that happen as a result of that.

Stroke rehabilitation and aphasia recovery

Recovering from a stroke can be one of the greatest challenges your loved one will face, and where they go for treatment can make a difference. The American Heart Association and American Stroke Association recommend that, whenever possible, patients recovering from a stroke be treated in an inpatient rehabilitation hospital rather than a skilled nursing facility.¹

Inpatient rehabilitation for stroke recovery is carefully tailored to each patient’s specific needs. While helping to restore physical functions and gain strength, inpatient rehabilitation can also help those with aphasia overcome related speech and communication deficits.

Individuals with aphasia receive intensive, evidence-based treatment from a speech-language pathologist, while also providing family members with tools and strategies to aid in recovery. You may find that technology including tablets and speech-generating software are integrated into therapy sessions and personal smartphones can also be used to complement sessions and allow practice between visits. These tools bridge the gap in communication between patients and their loved ones and can help in settings outside of inpatient rehabilitation.

Participating in your loved one’s therapy can go a long way toward encouraging them and working through frustration.

Can my loved one recover from aphasia?

Full recovery is possible for individuals with less severe aphasia, however, those with more significant limitations may have persistent symptoms requiring the indefinite use of strategies to communicate. Stroke patients typically continue to improve well after the 2-3 week average inpatient rehabilitation stay. This means it is important to continue therapy with a speech-language pathologist after discharge and you can do that through outpatient physical therapy.

Prior to leaving inpatient rehabilitation, individuals with aphasia and their caregivers receive a comprehensive list of local, regional and even national resources.

Tips for helping your loved one cope with aphasia

Additionally, there are things you can do to help your loved one cope with aphasia.

• Talk simply and slow your pace.
• Ask “yes or “no” questions.
• Allow your loved one time to respond, and resist the urge to finish sentences.
• Remove background noise around you.
• In addition to speech, use gestures, writing, drawings, or facial expressions.
• Encourage independence and continue to involve them in group conversations.

View resources from The National Aphasia Association.

Contact us to learn if inpatient rehabilitation is right for your loved one. 

1 Guidelines for Adult Stroke Rehabilitation and Recovery. American Heart Association, Inc. 2016.