Aphasia: A Disorder More Common Than You Realize

Imagine that your ability to speak, read or write was suddenly impaired. Communicating with family, friends and colleagues would be challenging and stressful if not impossible. How would you re-learn these skills or cope with the loss of abilities that once came naturally?

For thousands of people who experience aphasia each year as the result of a stroke, brain injury or neurological condition, the disorder and the months of rehabilitation that follow are life-changing. Specialists say a focus on intensive rehabilitation immediately after a stroke or injury is critical, along with lifestyle changes that can help eliminate some of the risk factors.

Every year close to 180,000 people experience aphasia, an acquired communication disorder caused by damage or injury to the left side of the brain which controls language. About 25 to 40 percent of stroke survivors acquire aphasia. While aphasia affects the ability to process language, it does not impact intelligence.

More common than Parkinson’s, muscular dystrophy or cerebral palsy, aphasia affects about two million people, according to the National Aphasia Association. However, the term “aphasia,” is unknown to most Americans.

Risk Factors

“Aphasia is very common in my practice,” said Luis Orengo, M.D., a physiatrist with the Neuro-Rehabilitation Program at the Baptist Heath Neuroscience Center (a physiatrist specializes in physical medicine and rehabilitation). “About 50 to 60 percent of my patients have suffered a stroke, but you can also see aphasia in patients who suffer from traumatic brain injury, patients with brain tumors and neurological disorders,” Dr. Orengo said.

Stroke, traumatic brain injury and brain tumors account for the vast majority of cases, he said. Aphasia patients are typically older, and at high risk of developing a stroke, but strokes also occur in younger people. Risk factors for stroke include diabetes, hypertension, hyperlipidemia (high lipid or fat levels in the blood) and heart disease. An unhealthy diet, smoking and excessive alcohol use are also risk factors.

“Other risk factors include genetics, family history of stroke and race. We also know that African-Americans and Hispanics are typically more likely to suffer a stroke because of high rates of hypertension, diabetes and other risk factors,” Dr. Orengo said.

Effects of Aphasia    

Patients may experience one of three types of aphasia:

• Expressive – impaired speech and articulation but complete comprehension.
• Receptive ‒ fluid speech but impaired comprehension.
• Global – combination of expressive and receptive including both deficits of expression and comprehension or brain injury.

“The main purpose of my specialty is to improve the patient’s functional status and return that patient to the community as soon as possible,” Dr. Orengo said.

In addition to communication deficits, aphasia is typically compounded by motor or sensory challenges, particularly in stroke patients. Following a stroke patients typically experience motor and sensory weakness on the right side of the body. Their ability to walk or use their arms may be impaired, and they may experience numbness or decreased sensation.

Treatment and Recovery

How much a patient recovers and how long it takes depends on the location of the brain injury, how much of the brain is affected and how quickly they receive intervention. Some patients recover completely, but many have lifelong communication challenges. Dr. Orengo sees most patients in the hospital in the “acute” phase of treatment, right after the event that caused aphasia.

“If the patients have deficits of language communication and some sensory and motor deficits, I bring them to the rehab unit we have here at Baptist Hospital. I lead a team of therapists, which includes physical therapists, occupational therapists, speech therapists, and we provide acute intense therapy,” he said.

“A lot of patients can return to normal activities. Some of them will have to develop compensatory strategies to overcome their deficit. Others need adaptive equipment.”

Primary treatment for aphasia is speech and language pathology. A therapist completes a thorough assessment of the patient’s communications skills and deficits, and develops an individualized treatment plan. Depending upon the severity of aphasia, therapy may include teaching the patient, family members and care givers alternative forms of communication.

After they are released from the hospital, Dr. Orengo said, many of his patients continue outpatient therapy at the Intensive Brain Injury Outpatient Program, part of the Neuro-Rehabilitation Program, or with a private therapist. While specialized care is essential to recovery and a return to community and family life, Dr. Orengo said, so is family support.

“Family support is extremely important,” he said. “It’s important for family members to take them to therapy and be involved in their treatment.”

Tags: Baptist Health Neuroscience Center, brain injury, stroke