Dysphasia Matters

An Introduction to DysphasiaAn Acquired Language Processing Impairment.

Julianna Little
Clinical Specialist Speech & Language Therapist
National Rehabilitation Hospital
Rochestown Avenue
Dun Laoghaire
Co. Dublin
February 10 2015

Aims:

To explore the nature of dysphasia-What is it exactly?

To increase your awareness of how best to help both
you & the person with dysphasia communicate more
effectively.

What is Communication?

What is Language ?

What is Speech?

What is Communication?

Exchange of information/feelings/wishes

2 parties both with responsibility for exchange

Speech/Reading/Writing = the main channels

Words are used to convey messages

Many messages also conveyed without words/nonverbally through gestures, sign language & body
language

What is Language?

A symbol system used to communicate

The words we speak, read & write are symbols

The primary use of language is to communicate i.e. to

listen & understand others & to formulate what we
want to say to others

What is Speech?

The production of sounds that make up words or

sentences

Speech is highly complex- it involves the rapid

co-ordinated movements of the lips, tongue, soft
palate, vocal cords & breathing to articulate sounds.

waking one day to find you could not speak or

understand what was being said to you, read the newspaper or
even write your own name, but you are thinking normally! How
frustrating and restricting it would be to have your
communication suddenly taken away?
This is the experience of people with APHASIA/DYSPHASIA

Aphasia is a communication
disability which occurs when the
language centres of the brain are
damaged.

Aphasia/Dysphasia
Q. What do these terms mean?
Ans. Both terms are often used interchangeably. They both refer to
difficulties with Language
A
DYS

= without, total loss (Greek)

= somewhat, degree of loss

N.B. Dysphasia often confused with Dysphagia

Language
Swallowing

What is Aphasia?

The Aphasia Alliance, a group of 11 organisations in the UK,

asked 1,000 people whether they had heard of aphasia;

more than 90 per cent had not.

Asked whether it might be
a long period of time
a fruit or
a communication disability
79 per cent had no idea.
Most people have not heard about aphasia, nor do they
understand the term until someone in their family or a
friend acquires aphasia.

Youtube Clip-The Treasure Hunt

What is Aphasia?
Aphasia is a communication disability which occurs when the
language centres of the brain are damaged.
The person loses the ability to use & understand language.
The person knows what s/he wants to say but cannot find the
words
S/he may also have problems with reading & writing
People who have aphasia can find it hard to understand what others
are saying, even though hearing & thought processes are
unaffected.
Aphasia does not affect intelligence.

What is Aphasia?
For people with aphasia it is the ability to access ideas and thoughts
through language not the ideas and thought themselves-that is
disrupted
BUT
Because people with aphasia have difficulty communicating, others
may mistakenly assume they are mentally ill or have some kind of
learning disability.
Aphasia can vary in severity
Each individual experiences aphasia in different waysSome people regain quite a lot of language others regain very little
In some cases its their reading and writing that is primarily affected
In other cases the ability to grasp the meaning of spoken words is the
main impairment.

Impact of Aphasia Daily Activities

Language forms the basis of most things we do. Many everyday
practical tasks can be difficult for someone with aphasia:

Talking to friends & family

Ordering food in a cafe
Asking for directions
Talking to their doctor
Understanding explanations & instructions
Making a phone call
Checking and paying bills
Filling in forms
Using a cash or using an ATM
Making appointments
Following recipes
Following maps and signs
Buying tickets and using public transport
Reading a book for pleasure

What is Aphasia/Dysphasia?
DVD Presentation

What Causes Aphasia?

An individual may present with Aphasia when any condition or injury
causes structural damage to any of the language areas or tracts
in the brain.

The type & severity of aphasia varies with the site & size of lesion.

What Causes Aphasia?

Usually caused by Stroke
Can also be caused by Subarachnoid Haemorrhage
Traumatic Brain Injury
Multiple Sclerosis
Encephalitis-brain infection
Cerebral Tumour
Neurosurgery
Other Neurological Condition

How common is Aphasia?

Irish Heart Foundation-INASC April 2008
Interesting Facts

Stroke is the 3rd leading cause of death & disability worldwide.

Approximately 10,000 people are admitted to hospital in the Republic of Ireland

each year with stroke disease as a primary diagnosis (ESRI, 2007)

Aphasia is a communication disability experienced by a third of people who

survive stroke.

It is estimated that over 40,000 people in Ireland are survivors of stroke many of
whom have significant residual disability including communication impairment.

Aphasia affects approx. one third of all people who have a stroke. It often
becomes a long term problem with individuals their carers and families facing
different needs at different times.

Aphasia is as common as Parkinson's disease & MS, yet most people have
never heard of it!

Who Acquires Aphasia?

Anyone

While aphasia is most common among older people, it can occur in

people of all ages, races, nationalities and gender.

Aphasia & Physical Disability

Q. Can a person have aphasia without having a physical disability?

Ans: Yes, but many people with aphasia also have weakness or
paralysis of their right leg & right arm. When a person acquires
aphasia it is usually due to damage on the left side of the brain,
which controls movements on the right side of the body.

Aphasia: An acquired disorder of

language processing

Can occur in many different forms/patterns

Breakdowns may occur at any level in language processing

Different symptoms will be seen according to the level of

breakdown

Comprehension( understanding) and expression (use) of

language may be affected to different degrees in the same
person

Processing of spoken & written language may be affected quite

differently in the same person

Dysphasia can change over time

Different Types of Aphasia

Different types or patterns of aphasia correspond to the location of
the brain injury in the individual case. Some of the common
varieties of aphasia are:

Global aphasia
Broca's aphasia (non-fluent aphasia)
Wernicke's aphasia ('fluent aphasia'):
Anomic aphasia
Note: In addition to these main types of Aphasia, there are many
other possible combinations of deficits that do not exactly fit into
the categories mentioned above.

Detecting symptoms of
Aphasia/Dysphasia?

Begin with simple social conversation

Observe responses carefully
Try more complex questions or instructions
Ask person to write things
Any difficulties with understanding or expression of language
could suggest dysphasia and indicate that a full Speech &
Language (SLT) assessment required

Aphasia/DysphasiaThe Role of the SLT

Differentially to diagnose aphasia from other communication

impairments
To assess the type and degree of aphasia
To identify retained abilities
To reduce language impairment
To assist the person with aphasia and those around them to
develop strategies for maintaining communication
To assist the person with aphasia & their family to understand the
condition
To advise the multidisciplinary team on how to communicate most
effectively with the person with aphasia
To assist the persons reintegration into the community

Stroke
Stroke may result in various types of
communication difficulties

The 3 most common problems are

Dysphasia
Dyspraxia
Dysarthria

Dysphasia & Differential Diagnosis

Dysphasia: A disorder of language processing

Dyspraxia: A disorder of speech motorprogramming

Dysarthria: A neuromuscular disorder of speech

Complicating Factors with Aphasia

Other communication impairments

Cognitive Impairments
Perceptual Difficulties
Fatigue
Physical Disabilities
Other Medical Conditions
Social & personal circumstances

World Health Organisation ICF

Framework & Aphasia
Impairment: Abnormality of function
-difficulty understanding basic instructions
-difficulty recognising speech sounds and letters

Disability/Activities: Functional consequences. Any restriction

in the ability to perform an activity as result of impairment
-Difficulty understanding conversations
-difficulty explaining own thoughts & ideas to others

Handicap/Participation: Social consequences. A disadvantage

resulting from the impairment or disability that limits or prevents
the fulfilment of a role.
-difficulties in personal relationships
-loss of employment opportunities & financial insecurity

How does Aphasia affect the persons

life?

Hidden -may be no outward sign of disability

May be unable to show through language that intelligence &

personality are still intact

It may affect all areas of a persons life

Daily activities may be difficult or impossible

Social Changes Commonly

Experienced

Role changes in the family

Relationship difficulties

Social Isolation

Unemployment

Limited leisure activities

Difficulty accessing information & services

Psychological Changes Commonly

Experienced
In the person with DYSPHASIA:
-depression
-loneliness
-negative self-image
-strong emotional reactions:
*anger

*anxiety
*frustration

-increased dependency
-boredom
-reduced motivation
In the Family:
-depression
-minor psychiatric disorders

What can YOU do to help?

Facilitating Communication
Unless appropriately facilitated, Aphasia can mask the
active mind from others.
Communication is a two-way process

Success in communication is the responsibility of both

people
Communication breakdown is also the responsibility of
both people

Facilitating Communication

Facilitating Communication
Successful Communication depends onSkill of person with aphasia
+
Skill of the doctor
+
Materials used to support exchange of
messages

Revealing Competence
Skilled Conversation partners play an important role by
demonstrating attitudes that acknowledge
competence and by applying strategies that allow this

competence to be revealed

Revealing underlying Competence This means being

able to capitalise on pre-morbid cognitive & social abilities if
given the opportunity e.g. by using communication
ramps/strategies

Facilitating Communication Access

In the same way that a wheelchair user may need a
physical ramp to enable them to access their physical
environment i.e. buildings

A person with dysphasia may need communication

ramps/strategies to enable them to access their
language environment i.e. conversation

Facilitating Communication Access

As it is for any of us, the person with aphasia has to
function in a physical environment but also in a
language environment.
The Language Environment = the written and spoken
language that surrounds the person with aphasia.
The Language may be
too fast
too complex
too abstract to be understood

Communication Ramps/Strategies
Allow the person to take IN & give OUT information with
greater ease.
Requires a change in attitude & style.
Requires greater levels of patience & tolerance
Facilitating communication can be demanding yet very
rewarding when you make the right connection!

Facilitating Communication

Effective Communication
& Medical Practice

Successful Communication is important in:

-reducing consultation time

-taking an accurate case history
-ensuring medical advice is followed accurately
-obtaining informed consent to treatment
-gaining your patients confidence
-reducing frustration for you and your patient

Strategies to Facilitate Communication

Dont rush-allow as much time as possible

Make eye contact & listen carefully
Have pen & paper handy
Communicate using any means possible:
speaking
writing key words
drawing
gesturing
pointing
If the person does not understand you try putting the message
another way
Check that important information has been correctly understood

Strategies to Facilitate Understanding

-Reduce background noise
-Find out which strategies help the patient
-Make eye contact & listen carefully
-Slow down but use normal adult language & tone of voice
-Use plain English & avoid medical terms which are unfamiliar to lay
people
-Say one thing at a time, pause in between
-Make clear when you are changing the topic
-Use non-verbal communication to support what you say: Gesture,
drawing, writing down key words, pointing
-Rephrase, if not understood
-Use examples to illustrate
-Ask questions to check that you have been correctly understood

Strategies to Facilitate Expression

-Give the patient time to respond

-Encourage any form of response: The patient may be able to write
the word or first letter, draw, gesture, say another word which
gives a clue
-Ask further questions to clarify the message conveyed
-Structure questions carefully: Yes/ No questions, multiple choice
questions, open questions
-Feedback to check that you have understood correctly

Dos & Donts

Do

Dont

Keep it natural
Keep listening and watching
Explicitly acknowledge a
persons life skills/experience
and competencies
Give plenty of time to respond
Value nonverbal turns as much
as verbal e.g. a dialogue of
facial expression or gesture

Make assumptions
Dont talk too much
Dont reinforce the impairment
and
take the easy way out Ill ask
your wife
Dont use childish language or
tone of voice
Dont invade personal space
Dont rush

Aphasia/Dysphasia & Recovery

No one can predict how much recovery will be made or at what

rate after a brain injury.

If the symptoms of aphasia last longer than 2-3 months after a

stroke, a complete recovery is unlikely.

It is important to note that some people continue to improve over

a period of years and even decades.

Recovery is usually a gradual process that usually involves

both helping the individual & family understand the nature of
aphasia & learning compensatory strategies for communicating

Aphasia/Dysphasia & Recovery

Recovery can depend on site & size of the brain injury, age,
support available, therapy and motivation.

The extent of the recovery varies from person to person and

ranges from those who are left with minimal disability to those
with varied levels of continuing impairment.

Everyone is different-it is important to stay optimistic and never

give up, while also being realistic about recovery!

Some people say that they have been recovering for 10 or more
years because as they gain more experience of living with
aphasia & glean more information, their confidence develops.

Useful Websites
www.aphasia.ie
www.aphasia.org
www.ukconnect.org
www. speakability.org.uk
www.aphasia.org.au
Also: Youtube Clip-Marc Black Heart to Heart