After a brain injury, a person may find communicating more challenging. This includes speaking, listening, reading, writing, and understanding language.
Aphasia
Aphasia is the term used to describe a language disorder. It is a common language problem that occurs after a stroke (which is a non-traumatic brain injury), but can occur from other causes such as traumatic brain injury and tumours [1]. Aphasia can impact a person’s ability to talk, understand conversation, and read and write, which are all important aspects of communication. Someone with aphasia is often able to understand others or know what they want to say, but has difficulty putting thoughts into words or grammatical sentences.
Difficulty communicating because of aphasia can lead to social isolation and be associated with a lower quality of life [2].
Aphasia can range from mild to severe and can be categorized into several types. The person with aphasia should work with a speech-language pathologist to understand their specific pattern of impairments and areas of strength is important. This can help create therapy goals and find the most effective ways to communicate with others.
This chart from the National Aphasia Association demonstrates common types of aphasia based on patterns of impairments.
Please note that this diagram only shows a selection of types of aphasia. Since there are so many different combinations of language impairments, it’s important to work with a speech-language pathologist to address your specific needs. Speech-language pathologists are experts in the assessment and treatment of all different types of aphasia [3].
Tips for improving and supporting communication
No matter the severity of aphasia, communication challenges can be incredibly frustrating. Communication and social interaction are important parts of maintaining relationships and supporting mental health and well-being. The way you communicate with your friend or family member will have to change. Here are some tips on how you can help the person with aphasia communicate.
- A speech-language pathologist (SLP)
- A speech-language pathologist (SLP) specializes in helping people with language, speech, cognitive-communication, and swallowing difficulties. A speech-language pathologist can be consulted during the acute stage of recovery or at a later point in rehabilitation. Some people have even benefitted from working with a speech-language pathologist many years after their injury. Speech-language pathologists complete a comprehensive assessment, work with the person to create a therapy plan and help them work towards specific communication goals. It’s important to remember that recovery is different for everyone: while communication skills can improve over time, long-term difficulty communicating may persist [4].
- Augmentative and alternative communication (AAC)
- Augmentative and alternative communication (AAC) devices and technology can help people communicate more effectively. There are both low-tech (e.g. paper or communication boards) and high-tech (e.g. electronic devices) options. There are several applications for computers, tablets and smartphones that generate sentences, translate text to speech, and more. Speech-language pathologists and occupational therapists on the recovery team will be able to determine if an AAC device is appropriate for your friend or family member (taking into consideration any physical impairments, such as reduced movement of one arm).
- Be patient
- It’s incredibly frustrating to struggle with communication. Both of you are going to be feeling impatient, especially if you haven’t had communication problems in the past. Be patient with the person and with yourself. It’s going to take some getting used to, and it won’t always go smoothly. Communication often improves over time with practice and patience
- Focus on one task at a time
- Multi-tasking can be tiring, and it can divide a person’s concentration. Divided attention can make it harder to find the right words. When the person wants to read, write, or speak with someone, try to reduce distractions for them so they can focus on one task at a time.
- Join a conversation group, participate in activities and volunteer
- The more someone practices a skill, the stronger it gets. Communication is a big part of recreational activities and volunteering. There are conversation groups offered by different community centres, hospitals, and programs to help people practice communicating. Often times these groups can be facilitated by an SLP or a trained volunteer. Encourage your friend or family member to try a group. They get an opportunity to practice their communication skills and socialize with others.
- Use notecards or picture cards
- Someone who has difficulty communicating may benefit from using notecards or picture cards to help communicate. They can be used by the person with the brain injury to communicate with you. Written aids or pictures can also be used to communicate important information (such as phone numbers and addresses), answer yes/no questions and communicate frequently used phrases.
Reading
Reading skills are a component of language. People with aphasia may have difficulty understanding words they are trying to read. Reading plays a large role in activities of daily living (ADLs), and aphasia-related reading challenges can impact a person’s abilities to enjoy hobbies, understand medical forms, and more. A speech-language pathologist (SLP) can assess reading skills and make recommendations for therapy to improve the person’s reading ability. Some people find that increasing text size, reading slowly, reviewing what they have read, and using a line guide can help with reading. Following a stroke, visual deficits or impaired physical movement of the hand can also impact a person’s ability to read and write, for these concerns, you can also work with an occupational therapist [5].
You can help the person with a brain injury by reading to them and doing reading exercises with them.
Writing
People with aphasia may have difficulty with written language, including spelling words incorrectly; making grammar mistakes or writing the wrong word. These impairments can make communication, hobbies, and other activities challenging. A speech-language pathologist (SLP) can help with assessing writing skills, focusing on various evidence-based therapy activities to target these skills [6]. You can also help with writing exercises.
Dysarthria
Dysarthria is the term used to describe a speech impairment where the nerves controlling muscles for speech are damaged. Just like aphasia, there are many different types of dysarthrias. One of the most common ways used to describe dysarthria is “slurred speech”. People with dysarthria may have muscular weakness, a smaller range of motion with their lips and tongues, difficulty controlling volume and tone, and problems controlling airflow. While dysarthria can happen on its own, it is common for people with dysarthria to also have some form of aphasia.
Apraxia of speech
Apraxia of speech is another motor speech impairment that can occur following an acquired brain injury (or may be related to another neurological condition). Apraxia of speech is related to problems with motor planning or organizing speech. People with apraxia of speech make errors in the sounds of the words they say and can have difficulty with their rate and rhythm of speech. Apraxia of speech commonly occurs along with aphasia [7].
A speech-language pathologist (SLP) can help by creating an individualized therapy program specific to your friend or family member’s impairments. An example of what this could include is completing speech drill-based activities or completing strength-based exercises. Their speech may not be exactly the way it was before the injury, but with time and practice, many people see improvements.
