Aphasia and Stroke: A Complete Guide for Speech Therapists
Aphasia is an acquired language disorder resulting from a brain injury, most often a stroke (Cerebrovascular Accident). It affects the ability to speak, understand, read, and/or write. The speech therapist plays a central role in the assessment and rehabilitation of aphasia, starting from the acute phase and throughout recovery.
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Communication supports, language exercises, tools for caregivers
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What is Aphasia?
Aphasia is an acquired language disorder resulting from a brain injury. Unlike developmental disorders, aphasia occurs in a person who had mastered language before the injury. It can affect all modalities of language: oral expression, oral comprehension, reading, writing.
What Aphasia Is Not
- It is not an intelligence disorder: cognitive abilities may be preserved
- It is not a psychiatric disorder
- It is not a hearing disorder
- It is not simply "searching for words" like everyone else
Causes of Aphasia
Stroke is the most common cause of aphasia (about 80% of cases). Aphasia usually occurs with damage to the left hemisphere, which is dominant for language in most people.
Types of Stroke
- Ischemic Stroke (80%): blockage of a cerebral artery
- Hemorrhagic Stroke (20%): rupture of a blood vessel
Other Causes
- Traumatic brain injury
- Brain tumor
- Neurodegenerative diseases (primary progressive aphasia)
- Brain infections (encephalitis)
Types of Aphasia
🔴 Broca's Aphasia (Non-fluent)
Expression: very limited, agrammatic, severe word-finding difficulties. Slow, effortful speech. Comprehension: relatively preserved for simple language. The patient is often aware of their difficulties, which can lead to frustration and depression.
🔵 Wernicke's Aphasia (Fluent)
Expression: fluent but meaningless, numerous paraphasias (distorted or replaced words), sometimes jargon. Comprehension: severely impaired. The patient is often unaware of their disorders (anosognosia).
🟣 Global Aphasia
Most severe form: expression and comprehension massively impaired. Often associated with right hemiplegia. May evolve into Broca's aphasia with recovery.
🟢 Conduction Aphasia
Repetition selectively impaired. Fluent expression with phonemic paraphasias. Comprehension preserved. The patient frequently self-corrects (approach behavior).
🟡 Anomic Aphasia
Least severe form: isolated word-finding difficulties with expression and comprehension generally preserved. Often a residual stage after recovery from more severe aphasia.
Assessment of Aphasia
Areas Assessed
- Oral Expression: spontaneous language, naming, verbal fluency, repetition
- Oral Comprehension: words, sentences, texts
- Reading: aloud and comprehension
- Writing: spontaneous, dictation, copying
- Bucco-facial Praxias: looking for associated apraxia
Standardized Tests
- BDAE (Boston Diagnostic Aphasia Examination)
- MT-86
- LAST (Language Screening Test) - quick screening
- Token Test - comprehension
- DO-80 - naming
Speech Therapy Rehabilitation
💡 Principles of Rehabilitation
- Timeliness: start as soon as possible, even in the acute phase
- Intensity: literature shows that intensity improves outcomes
- Personalization: adapt to the needs and goals of the person
- Functionality: aim for communication in daily life
- Involvement of the Surroundings: train caregivers
Rehabilitative Approaches
Linguistic Approaches: analytical work on the components of language (phonology, lexicon, syntax). Naming, repetition, and sentence construction exercises.
Pragmatic/Functional Approaches: focus on effective communication rather than linguistic correction. PACE (Promoting Aphasics' Communicative Effectiveness), role-playing.
Cognitive Approaches: based on neuropsychological models of language. Target the identified deficient processes.
Alternative and Augmentative Communication (AAC): communication boards, applications, pictograms to compensate for deficits.
Phases of Care
- Acute Phase (first days/weeks): assessment, stimulation, AAC if needed
- Subacute Phase (1-6 months): intensive rehabilitation, maximum recovery
- Chronic Phase (>6 months): maintenance, compensation, adaptation
Tips for Caregivers
- Speak Normally: no need to shout, hearing is intact
- Simplify: short sentences, one idea at a time
- Give Time: do not finish sentences for the person
- Use All Channels: gestures, drawings, writing, images
- Check Understanding: ask closed questions
- Avoid Infantilization: intelligence is preserved
- Maintain Communication: continue to include the person
Our Downloadable Tools
💬 Communication Boards
Supports to communicate essential needs when speech is impossible.
Download🖼️ Daily Imagery
Images to facilitate evocation and communication.
Download📚 Semantic Category Cards
For working on vocabulary and evocation.
Download📝 Writing Exercises
Supports for the rehabilitation of written language.
DownloadFrequently Asked Questions
Recovery is variable. Some people recover completely or nearly, while others retain significant sequelae. Favorable factors include: initially less severe aphasia, small stroke size, early and intensive care, younger age, good motivation. Recovery is maximal in the first 6 months but can continue for years.
There is no fixed number. The HAS recommends intensive rehabilitation (ideally 5 hours/week minimum in the subacute phase). In practice, frequency depends on severity, phase, the person's abilities, and the organization of the healthcare system. Rehabilitation can last from a few months to several years.
It depends on the type of aphasia. In Broca's aphasia, comprehension is often relatively preserved for simple language. In Wernicke's aphasia, it is severely impaired. In any case, speak normally but simply, use visual supports, and check understanding with closed questions or gestures.
🧠 Supporting Aphasia
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