Aphasia

What are the different types of aphasia?

There are different types of aphasia. These include expressive aphasia, also called Broca’s or non-fluent aphasia, receptive aphasia, also known as Wernicke’s or fluent aphasia, and anomic aphasia. Someone can have more than one type. They can also have other problems with communication at the same time, such as dysarthria or cognitive problems. Find out more about the different types of aphasia.

What are the signs of aphasia?

While it will be different for everyone, learn about some of the more common signs of aphasia.

Dysarthria

Dysarthria happens when a stroke causes weakness in the muscles of the face, mouth and the vocal cords in the voice box. It can also affect breathing. About one in four people have dysarthria directly after a stroke, and another one in four have dysarthria together with aphasia. Dysarthria is a physical speech difficulty. It doesn’t affect the ability to use language.

What are the signs of dysarthria?

Dysarthria affects people in different ways. For some, their speech may only be a little unclear and people will usually be able to understand them. However, for others it means that they can’t speak clearly at all. They might find it harder to speak if they are feeling stressed.

Some common signs include:

• Not being able to speak clearly.
• Slurred or slow speech.
• Speaking with a quiet or strained voice, or one that doesn’t change its tone.
• Hesitating a lot or speaking in short bursts, rather than full sentences.

Apraxia of speech

Apraxia of speech means the brain has difficulty with planning and coordinating movements in the muscles of the face, mouth and voice box. This can make it difficult to speak clearly.

This is different from muscle weakness (dysarthria). The muscles may not be weak, but the person can’t coordinate the muscle movements in the complex sequence needed for speech. This affects what someone does consciously (when they intend to do something) but it might not affect an automatic response. So someone may not be able to say goodbye when asked to, but they may be able to say it without thinking.

Apraxia of speech is less common than aphasia and dysarthria. It can occur with both. It can be tricky to tell the difference between apraxia of speech and other communication problems, but a speech and language therapist can help with a diagnosis.

Some common signs include:

• Trying to say the word, but the sounds are not in the right order.
• The person is often aware they’re not saying sounds in the right order, but cannot correct themselves, for example, ‘hos-ti-pal’.
• Several attempts are made to say the word correctly.
• Some words in the sentence might be perfect, while others are a challenge.
• The speech errors made can change each time.
• Hesitating between words, and needing several attempts to get the right mouth shape to say a word.
• Sometimes people can manage more automatic speech, for example, listing the days of the week, but can struggle with new sentences.

Although I may look okay at first glance, I am now less confident and people need to be more patient with me.

Graham, stroke survivor

Cognitive communication difficulties

We use social cognition skills to help us interact with other people. These skills include the ability to interpret non-verbal cues, like facial expressions and tone of voice, and taking turns in a conversation.

Problems with social cognition after a stroke may be due to damage in the right side of the brain. Cognitive changes after a stroke can have a wide range of effects on communication, but these are some of the most common:

• Taking things very literally, not understanding jokes or sarcasm, or being unable to interpret figures of speech, such as ‘it’s raining cats and dogs’.
• Having trouble with reasoning and finding it hard to understand someone’s logic or point of view.
• Difficulty processing information can make someone feel overloaded and make it hard to keep up with a conversation.
• Finding it hard to take turns in a conversation, getting stuck on a single topic or talking mainly about themselves.
• Difficulty reading facial expressions and body language.
• Lacking insight into their own behaviour.
• Difficulties with maintaining eye contact and keeping track of the conversation.