Aphasia and Communication Difficulties

Communication difficulties are often caused by a stroke and include:

• Aphasia – a form of brain damage which affects your ability to understand or produce words
• Dysarthria – a physical issue where the muscles you use to speak are weak or not working properly
• Apraxia of speech – difficulty controlling and coordinating the movements that are needed to talk normally.
• Cognitive difficulties – changes in how you think may make it more difficult to communicate.

You may also experience communication difficulties as a result of fatigue or brain fog, which can be caused by Long Covid as well as other conditions. Breathlessness can also make it difficult to speak clearly, and vision issues can make it difficult to read or write.

It is important to remember that people with communication difficulties like aphasia, dysarthria, or apraxia:

• Know what they want to say.
• Are intelligent.
• May need additional time to speak or write.

What is aphasia?

Aphasia is a common effect of stroke, affecting around one in three people who have had a stroke.

Aphasia means that a part of your brain which controls language has been damaged. There are two main parts of the brain which may be affected:

• Broca’s area – This part of the brain controls how you produce language and speech. If it is damaged, it may be more difficult to speak or write.
• Wernicke’s area – This part of the brain controls how you understand language. If it is damaged, it may be more difficult to understand spoken or written language.

Either or both of these parts of the brain may be affected by a stroke or head injury.

People with aphasia may find that they:

• Find it difficult to think of the right words
• Use the wrong word, or put words in the wrong order
• Struggle to understand what people are saying
• Slur or mumble
• Spell words wrong, or mix up similar words

In extreme cases, people with aphasia may be unable to speak at all.

Some people who speak more than one language find that aphasia only affects one language, or affects one language more than others.

People with aphasia may not be aware that what they say is not what they mean to say.

Managing aphasia

Aphasia can improve over time, especially with support from speech and language therapists and with conversation practice. Even if your aphasia does not improve, you can learn other ways to communicate.

Aids like a conversation support book or a communication app may help if you are struggling to find words. These use images or videos to prompt you to find the word you’re looking for. CHSS offers a conversation support book, which you can order.

You may find it easier to communicate in person if you:

• Avoid background noise. Turn off TVs, radios, etc.
• Face the person you are speaking to, and make sure you can see their face.
• Consider gestures and facial expressions.
• Ask people to speak slowly
• Ask people if you need them to repeat or rephrase something
• Write down words, or the first letters of words, if you are having trouble saying them.
• Describe things if you cannot remember the word for them.

If you have a conversation planned, such as a doctor’s appointment or interview, it can help to write down what you may need to say.

If you struggle to speak, writing may be easier. If you struggle to write, but can speak clearly, there are apps available which will take dictation for you.

When reading or writing, look for images near the text which may help you to understand.

Helping someone with aphasia

If your friend or loved one has aphasia, you can make it easier when communicating with them by:

• Reducing background noise. Turn off any TVs, radios, or music.
• Being patient and waiting for the person to finish.
• Not interrupting or assuming you know what the person intends to say.
• Making sure that your face is clear and that you are looking at the person you’re talking to.
• Speaking slowly and clearly, and being prepared to repeat yourself if asked.
• Using facial expressions and gestures to help give context.
• Drawing pictures to illustrate what you are saying, if they seem to be having trouble understanding you.

Always remember that difficulty communicating does not mean difficulty thinking.

What is dysarthria?

Dysarthria is a physical condition where the muscles of the mouth, throat, or face are not working properly. This is often the result of a stroke, but can also be a result of other problems like: nervous dysfunction, brain injuries, or muscle damage.

People with dysarthria may slur, mumble, or otherwise struggle to speak clearly. This is not a problem with language (as aphasia is), but the physical act of speaking.

If you are struggling with dysarthria, it can be helpful to practice speech exercises with a speech and language therapist. You may have to repeat yourself when speaking.

It can be helpful to use gestures, writing, or small drawings to help you get your point across.

It may also be easier to communicate in writing. Consider asking people whether they can email instead of telephoning, for example, or whether they would like you to write a note.

What is apraxia of speech?

Apraxia of speech (also called ‘Dyspraxia’) is caused by damage to the speech control centres in the brain that are used for planning and forming sounds and words into speech. This results in an inability to control and coordinate the movements that are needed to talk normally. It is different to dysarthria because it is not caused by muscle weakness.

Apraxia of speech may result in:

• Difficulty finding the correct mouth position to make /coordinate sounds
• Difficulty making smooth transitions between sounds and words

It is important to remember that individuals with apraxia:

• Have difficulty coordinating the lips, tongue and other facial muscles to produce a word or sentence
• May try to say a word or sound and make repeated attempts but be unable to pronounce it
• May experience both apraxia and aphasia