Supporting an Aphasic Patient: Approaches and Practical Tools
Aphasia disrupts the patient's communication and identity. Discover rehabilitative approaches and tools to restore language abilities and support the recovery journey.
Aphasia, an acquired language disorder following a brain injury, affects about 30% of patients who suffer from strokes. Beyond the loss of words, it often shakes the entire identity. The speech therapist supports the patient in this reconstruction journey, mobilizing various approaches to restore communication in all its forms.
🧠 Definition and Mechanisms
Aphasia is an acquired language disorder resulting from a brain injury, most often vascular (stroke), but also traumatic, tumor-related, or degenerative. It affects the abilities to produce and/or understand spoken and written language, to varying degrees depending on the location and extent of the injury.
Oral Expression
Word-finding difficulties, paraphasias, reduced fluency, agrammatism, or jargon
Comprehension
Variable difficulties, from contextual understanding to severe impairments
Written Language
Reading and writing often impacted, sometimes partially preserved
📊 Types of Aphasia
The classification of aphasias is based on the analysis of different language components. This distinction guides the priority rehabilitation axes.
🔴 Broca's Aphasia
Reduced, non-fluent expression. Major word-finding difficulties. Agrammatism (telegraphic style). Relatively preserved comprehension. Awareness of difficulties. Left frontal lesion.
🟠 Wernicke's Aphasia
Fluent, logorrheic expression. Jargon, numerous paraphasias. Severely impaired comprehension. Frequent anosognosia. Left temporal lesion.
🟡 Conduction Aphasia
Fluent expression with phonemic paraphasias. Severely impaired repetition. Preserved comprehension. Awareness of errors and self-corrections.
🟣 Global Aphasia
Severe impairment of all modalities. Massively affected expression and comprehension. Reserved prognosis. Extensive lesion.
💡 Beyond Classifications
"Pure" clinical profiles are rare. Most patients present mixed profiles that evolve over time. Regular assessment allows for adjustments to objectives and approaches based on the patient's current profile.
🔍 Initial Assessment
The aphasiological assessment systematically explores all language modalities to create a precise profile of preserved and deficient abilities. It forms the basis of the therapeutic project.
Assessment Batteries
- BDAE (Boston): International reference, semiological classification
- MT-86 (Montreal-Toulouse): Complete Francophone battery
- LAST: Rapid screening test in the acute phase
- TLC: Lille Communication Test, functional approach
- ECVB: Bordeaux Verbal Communication Scale
Evaluated Dimensions
- Oral expression: spontaneous, naming, repetition, fluency
- Oral comprehension: words, sentences, texts, complex commands
- Reading: aloud, written comprehension
- Writing: spontaneous, dictation, copying
- Functional communication abilities
📈 Recovery Phases
Recovery after aphasia generally follows three distinct phases, each requiring specific objectives and intervention modalities.
Acute Phase (0-3 months)
Maximum spontaneous recovery. Intensive early management. Regular evaluation of progress. Support for the patient and family. Alternative communication if necessary.
Subacute Phase (3-12 months)
Still significant brain plasticity. Intensive and targeted rehabilitation. Consolidation of gains. Generalization work. Environmental adaptation.
Chronic Phase (>12 months)
Relative stabilization. Maintenance of gains. Optimization of functional communication. Compensatory strategies. Long-term support.
🎯 Tailored Tools for Rehabilitation
JOE by DYNSEO offers cognitive and language stimulation exercises tailored for adult patients, usable in sessions and at home to extend therapeutic work.
Discover JOE →🎯 Rehabilitative Approaches
Classic Linguistic Approach
Systematic work on deficient components: phonology, lexicon, syntax, discourse. Structured exercises progressing from simple to complex. Repetition and reinforcement.
Melodic and Rhythmic Therapy (MIT)
Use of singing and prosody to facilitate verbal production. Particularly indicated in severe non-fluent aphasias. Engages the right hemisphere.
Constraint-Induced Therapy (CIAT)
Intensive rehabilitation (several hours/day) requiring the use of spoken language. Prohibition of gestural compensations. Significant results demonstrated.
Pragmatic and Functional Approach
Focus on communicative effectiveness rather than linguistic correction. Ecological situational practices. Development of compensatory strategies.
Semantic Therapy (SFA)
Semantic Feature Analysis: activation of the semantic network around the target word. Effective for word-finding difficulties. Strengthens lexical connections.
💬 Alternative and Augmented Communication
When oral language remains very limited, alternative communication tools allow for maintaining exchanges and the patient's autonomy.
✅ AAC Tools for Aphasic Patients
- Communication notebooks: Images, photos, personalized pictograms
- Communication boards: Thematic supports (needs, emotions, places)
- Tablet applications: Proloquo2Go, TD Snap, personalized solutions
- Gestures and mime: Non-verbal communication to be developed
- Drawing: Expressive support sometimes preserved
⚠️ AAC and Rehabilitation: Complementary
Alternative communication does not hinder the recovery of oral language. On the contrary, it reduces frustration, maintains social interaction, and can serve as support for rehabilitation. It should be offered without waiting for a hypothetical recovery.
👨👩👧 Supporting the Family
Aphasia disrupts family balance. Relatives need to be informed, guided, and supported to adapt their communication and best accompany their loved one.
Inform
Explain aphasia, its mechanisms, preserved abilities, and expected evolution
Train
Convey communication strategies tailored to the patient's profile
Support
Welcome emotions, guide towards caregiver support resources
💡 Tips for Relatives
- Speak normally, without infantilizing or shouting
- Allow time to respond
- Ask closed questions if necessary
- Accept all modes of communication
- Do not pretend to understand
- Maintain adapted social activities
🛠️ Tools and Resources
Rehabilitation Materials
- Thematic photographic picture books
- Graduated naming supports
- Exercises for syntactic comprehension
- Texts adapted by complexity level
- Digital stimulation applications
Resources for Patients and Families
- National Federation of Aphasic Individuals of France (FNAF)
- Support and discussion groups
- Adapted documentation (simplified booklets)
🎯 Conclusion
Supporting the aphasic patient requires technical expertise, creativity, and humanity. Beyond restoring language functions, the goal is to enable the patient to regain their place as a communicating subject, regardless of the modality used.
Brain plasticity offers sometimes surprising recovery possibilities, provided there is early, intensive, and prolonged management. The involvement of the family and adaptation of the environment complement the therapeutic framework.
Restoring communication, rebuilding identity:
DYNSEO supports every step of the journey.
