Most cases of aphasia can be improved with treatment, even severe cases of global aphasia. However, a complete return to pre-aphasia communication levels is not always possible.
Speech and language therapy (SLT) is the main treatment for aphasia. SLT is a general term that is used to describe a number of different techniques that can help improve a person’s ability to communicate.
Aims of SLT
SLT for people with aphasia has three main goals:
- to help the person to relearn any communication skills that have been lost or damaged (if this is possible)
- to make the best use of the person’s remaining communication abilities
- to find new ways of communicating
Principles of SLT
There is no single way to treat aphasia, but most experts agree that a course of SLT tends to be more successful if it is based on the principles that are described below.
Intensive
Research has found that a short-term course of intensive SLT, for example, eight to ten hours a week over the course of two months, is usually more effective than a longer, less intensive course, for example, one to two hours a day for five or six months. However, not everyone has the energy to participate in intensive therapy, particularly elderly people who are recovering from a stroke.
Cumulative
SLT works best when the therapist sets relatively modest goals and then moves on to more complex goals. For example, they might start with naming a specific person, before describing their relationship with that person.
Personalised
Research has found that using teaching material and aids that have a personal significance to the person being treated produces a more engaged response than using generic materials.
For example, using photographs of people or situations that a person would remember is more effective than using stock photographs.
Provide alternatives
Spoken and written language is not the only way that a person with aphasia can communicate. Therefore, it is important that a therapist discusses potential alternative communication methods, such as simple gestures, more complex sign language, or technology, such as electronic speech synthesisers.
Group work
It can be beneficial for someone with aphasia to work in a group with other people with the condition. As well as providing a non-threatening opportunity to practise communication skills, it can also lessen the feelings of loneliness and isolation experienced by many people with aphasia.
In addition, research carried out in 2010 suggested that SLT does not always have to be provided by a fully qualified therapist to be successful. Trained and supervised volunteers can also provide effective treatment or they can work with professional therapists to improve the effects of therapy.
The Stroke Association provides training for volunteers. See The Stroke Association website for details about how to volunteer.
SLT techniques
Promoting Aphasics' Communicative Effectiveness (PACE)
Promoting Aphasics' Communicative Effectiveness (PACE) is a type of SLT that uses conversation to improve a person’s communication skills.
The therapist will use a picture or drawing to stimulate a conversation, while the person with aphasia is encouraged to use any means of communication to respond.
Early PACE sessions will focus on relatively simple topics of conversation, such as where the person was born. As the sessions progress, the topics of conversation become more complex and abstract, including, for example, the person’s favourite film and why they like it.
Melodic intonation therapy (MIT)
Melodic intonation therapy (MIT) is a type of SLT that is often used in the treatment of non-fluent forms of Broca's aphasia.
MIT is based on a common observation that many people with aphasia who have speaking difficulties do not have similar difficulties when singing. This may be because the parts of the brain that are used when singing are different to those that are used when speaking, so the singing areas of the brain and the associated ability may remain undamaged.
During MIT sessions, a person with non-fluent aphasia is encouraged to hum and to sing words or phrases that they find difficult to recall, while tapping out a rhythm. This technique has been shown to increase the number of words a person can recall.
Computerised script training (CST)
Computerised script training (CST) is a type of SLT that involves using a computer. CST uses scripts that simulate real-life conversations and social activities, allowing a person with aphasia to practise their communication skills and to relearn abilities.
Constraint-induced aphasia therapy (CIAT)
Constraint-induced aphasia therapy (CIAT) is a type of SLT that is designed for people with chronic (long-term) aphasia (usually defined as aphasia that lasts longer than two years).
CIAT is based on a type of physical therapy, known as constraint-induced motor therapy (CIMT), which is sometimes used to help people recovering from a stroke.
People recovering from a stroke often have weakness on one side of their body. This causes them to use the other side of their body more. CIMT uses equipment, such as splints, to prevent them from relying on the stronger side of their body, and forces them to make use of the weakened side in an effort to get them to relearn how to use it.
CIAT is based on a similar premise. People with chronic aphasia may adopt a number of basic compensatory strategies to help them to communicate, for example:
- pointing
- gesturing (but not complex sign language)
- making sound effects, such as saying "brrrrm" for car
These strategies may be useful in the short to medium term, but relying on them can cause a person with aphasia to forget previously learnt communication skills and delay their recovery.
Therefore, CIAT usually involves a short course of intensive therapy where the therapist will work with the person with aphasia to identify these types of basic compensatory strategies and encourage them to adopt more complex ways of communicating. This may not necessarily be full speech, but may include methods that force the person’s brain to make use of its language centre, such as drawing or using communication tools, such as a speech synthesiser.
Transcranial stimulation
Transcranial stimulation is a type of painless treatment that may benefit some people with aphasia.
There are two types of transcranial stimulation:
- transcranial direct current stimulation (tDCS), which is where electrodes (small metallic discs) are placed on the surface of the scalp and a small electrical current is passed through them
- transcranial magnetic stimulation (TMS), which is where magnetic coils are placed above the scalp and used to generate magnetic fields, which create short-lasting electrical currents in the brain below the stimulation site
It has been suggested that both tDCS and TMS may help to stimulate parts of the language centre that have been damaged and encourage a certain degree of recovery and repair. For example, initial research has found that these types of treatment may help people to improve their ability to remember the names of certain objects, people and places.
As transcranial stimulation is a new method of treatment, access is currently limited to people who are willing to take part in a clinical trial. A clinical trial is where researchers compare a new treatment against an existing treatment or a dummy treatment (placebo) to see whether the new treatment is effective and safe.
See the Health A-Z topic about Clinical trials and Aphasia - clinical trials for more information.
Medication
Researchers have also been studying the effects of medication for improving the language skills of people with aphasia.
One type of medication that has proved reasonably effective in some people with Broca's aphasia, when used in combination with SLT, is called bromocriptine.
It is thought that bromocriptine may help stimulate some sections of the brain’s language centre, leading to an improvement in communication skills.
Another medication that has proved reasonably effective in improving language skills, particularly the ability to name objects, people and places correctly, is called donepezil.
Donepezil increases the levels of a chemical called acetylcholine in the brain. This is thought to lead to an increase in cognitive ability (the ability to think, reason and plan).
Again, it is likely that access to these sorts of treatment will only be available in clinical trials.
Communicating with a person with aphasia
If you live with, or care for, a person with aphasia, you may be unsure about the best way to communicate with them. You may find the advice listed below helpful.
- After speaking, allow the person plenty of time to respond. If a person with aphasia feels rushed or pressured to speak, they may become anxious, which can affect their ability to communicate.
- Use short, uncomplicated sentences and do not change the topic of conversation too quickly.
- Avoid asking open ended questions. Closed questions that have a yes or no answer are better.
- Avoid finishing a person’s sentences or correcting any errors in their language. This may cause resentment and frustration for the person with aphasia.
- Keep any possible distraction to a minimum, such as background radio or TV noise.
- Use paper and a pen to write down any key words, diagrams or pictures to help reinforce your message.
- If you do not understand something that a person with aphasia is trying to communicate, do not pretend that you do understand. The person may find this type of behaviour patronising and upsetting. It is always best to be honest about your lack of understanding.
- Try to remember that despite their change in speech pattern, the person’s personality is unchanged. They may appear emotionally distant or abrupt, but how they speak to you does not necessarily reflect how they feel about you.
