Treating aphasia

Most cases of aphasia can be improved with treatment, even severe cases of global aphasia. However, a
complete return to pre-aphasia communication levels is not always possible.
Speech and language therapy (SLT is the main treatment for aphasia. SLT is a general term that is used to
describe a number of different techni!ues that can help improve a person"s ability to communicate.
Aims of SLT
SLT for people with aphasia has three main goals#
to help the person to relearn any communication s$ills that have been lost or damaged (if this is
possible
to ma$e the best use of the person"s remaining communication abilities
to find new ways of communicating
Principles of SLT
There is no single way to treat aphasia, but most e%perts agree that a course of SLT tends to be more
successful if it is based on the principles that are described below.
Intensive
&esearch has found that a short-term course of intensive SLT, for e%ample, eight to ten hours a wee$ over the
course of two months, is usually more effective than a longer, less intensive course, for e%ample, one to two
hours a day for five or si% months. However, not everyone has the energy to participate in intensive therapy,
particularly elderly people who are recovering from a stro$e.
Cumulative
SLT wor$s best when the therapist sets relatively modest goals and then moves on to more comple% goals. 'or
e%ample, they might start with naming a specific person, before describing their relationship with that person.
Personalised
&esearch has found that using teaching material and aids that have a personal significance to the person being
treated produces a more engaged response than using generic materials.
'or e%ample, using photographs of people or situations that a person would remember is more effective than
using stoc$ photographs.
Provide alternatives
Spo$en and written language is not the only way that a person with aphasia can communicate. Therefore, it is
important that a therapist discusses potential alternative communication methods, such as simple gestures,
more comple% sign language, or technology, such as electronic speech synthesisers.
Group work
(t can be beneficial for someone with aphasia to wor$ in a group with other people with the condition. )s well as
providing a non-threatening opportunity to practise communication s$ills, it can also lessen the feelings of
loneliness and isolation e%perienced by many people with aphasia.
(n addition, research carried out in *+,+ suggested that SLT does not always have to be provided by a fully
!ualified therapist to be successful. Trained and supervised volunteers can also provide effective treatment or
they can wor$ with professional therapists to improve the effects of therapy.
The Stro$e )ssociation provides training for volunteers. See The Stro$e )ssociation website for details
about how to volunteer.
SLT techniques
Promoting Aphasics' Communicative ffectiveness !PAC"
-romoting )phasics. /ommunicative 0ffectiveness (-)/0 is a type of SLT that uses conversation to improve a
person"s communication s$ills.
The therapist will use a picture or drawing to stimulate a conversation, while the person with aphasia is
encouraged to use any means of communication to respond.
0arly -)/0 sessions will focus on relatively simple topics of conversation, such as where the person was born.
)s the sessions progress, the topics of conversation become more comple% and abstract, including, for
e%ample, the person"s favourite film and why they li$e it.
#elodic intonation therap$ !#IT"
Melodic intonation therapy (M(T is a type of SLT that is often used in the treatment of non-fluent forms of
1roca.s aphasia.
M(T is based on a common observation that many people with aphasia who have spea$ing difficulties do not
have similar difficulties when singing. This may be because the parts of the brain that are used when singing are
different to those that are used when spea$ing, so the singing areas of the brain and the associated ability may
remain undamaged.
2uring M(T sessions, a person with non-fluent aphasia is encouraged to hum and to sing words or phrases that
they find difficult to recall, while tapping out a rhythm. This techni!ue has been shown to increase the number of
words a person can recall.
Computerised script training !CST"
/omputerised script training (/ST is a type of SLT that involves using a computer. /ST uses scripts that
simulate real-life conversations and social activities, allowing a person with aphasia to practise their
communication s$ills and to relearn abilities.
Constraint%induced aphasia therap$ !CIAT"
/onstraint-induced aphasia therapy (/()T is a type of SLT that is designed for people with chronic (long-term
aphasia (usually defined as aphasia that lasts longer than two years.
/()T is based on a type of physical therapy, $nown as constraint-induced motor therapy (/(MT, which is
sometimes used to help people recovering from a stro$e.
-eople recovering from a stro$e often have wea$ness on one side of their body. This causes them to use the
other side of their body more. /(MT uses e!uipment, such as splints, to prevent them from relying on
the stronger side of their body, and forces them to ma$e use of the wea$ened side in an effort to get them to
relearn how to use it.
/()T is based on a similar premise. -eople with chronic aphasia may adopt a number of basic compensatory
strategies to help them to communicate, for e%ample#
pointing
gesturing (but not comple% sign language
ma$ing sound effects, such as saying 3brrrrm3 for car
These strategies may be useful in the short to medium term, but relying on them can cause a person with
aphasia to forget previously learnt communication s$ills and delay their recovery.
Therefore, /()T usually involves a short course of intensive therapy where the therapist will wor$ with the
person with aphasia to identify these types of basic compensatory strategies and encourage them to adopt more
comple% ways of communicating. This may not necessarily be full speech, but may include methods that force
the person"s brain to ma$e use of its language centre, such as drawing or using communication tools, such as
a speech synthesiser.
Transcranial stimulation
Transcranial stimulation is a type of painless treatment that may benefit some people with aphasia.
There are two types of transcranial stimulation#
transcranial direct current stimulation (t2/S, which is where electrodes (small metallic discs
are placed on the surface of the scalp and a small electrical current is passed through them
transcranial magnetic stimulation (TMS, which is where magnetic coils are placed above the
scalp and used to generate magnetic fields, which create short-lasting electrical currents in the
brain below the stimulation site
(t has been suggested that both t2/S and TMS may help to stimulate parts of the language centre that have
been damaged and encourage a certain degree of recovery and repair. 'or e%ample, initial research has found
that these types of treatment may help people to improve their ability to remember the names of certain ob4ects,
people and places.
)s transcranial stimulation is a new method of treatment, access is currently limited to people who are willing to
ta$e part in a clinical trial. ) clinical trial is where researchers compare a new treatment against an e%isting
treatment or a dummy treatment (placebo to see whether the new treatment is effective and safe.
See the Health )-5 topic about /linical trials and )phasia - clinical trials for more information.
#edication
&esearchers have also been studying the effects of medication for improving the language s$ills of people with
aphasia.
6ne type of medication that has proved reasonably effective in some people with 1roca.s aphasia, when used in
combination with SLT, is called bromocriptine.
(t is thought that bromocriptine may help stimulate some sections of the brain"s language centre, leading to an
improvement in communication s$ills.
)nother medication that has proved reasonably effective in improving language s$ills, particularly the ability to
name ob4ects, people and places correctly, is called donepe7il.
2onepe7il increases the levels of a chemical called acetylcholine in the brain. This is thought to lead to an
increase in cognitive ability (the ability to thin$, reason and plan.
)gain, it is li$ely that access to these sorts of treatment will only be available in clinical trials.
Communicating with a person with aphasia
(f you live with, or care for, a person with aphasia, you may be unsure about the best way to communicate with
them. 8ou may find the advice listed below helpful.
)fter spea$ing, allow the person plenty of time to respond. (f a person with aphasia feels rushed
or pressured to spea$, they may become an%ious, which can affect their ability to communicate.
9se short, uncomplicated sentences and do not change the topic of conversation too !uic$ly.
)void as$ing open ended !uestions. /losed !uestions that have a yes or no answer are better.
)void finishing a person"s sentences or correcting any errors in their language. This may cause
resentment and frustration for the person with aphasia.
:eep any possible distraction to a minimum, such as bac$ground radio or T; noise.
9se paper and a pen to write down any $ey words, diagrams or pictures to help reinforce your
message.
(f you do not understand something that a person with aphasia is trying to communicate, do not
pretend that you do understand. The person may find this type of behaviour patronising and
upsetting. (t is always best to be honest about your lac$ of understanding.
Try to remember that despite their change in speech pattern, the person"s personality is
unchanged. They may appear emotionally distant or abrupt, but how they spea$ to you does not
necessarily reflect how they feel about you.