Aphasia

Aphasia is a breakdown in the brain's ability to plan, produce or understand language. It appears as difficulty finding words, speech that others cannot follow, slow or broken sentences, or trouble understanding what is said. The person knows what they want to say — the route from thought to word is damaged.

This distinction is the single most important thing for families to understand, because the most common and most damaging mistake is talking about someone in their presence on the assumption that they are not following.

Most often stroke, particularly affecting the left side of the brain where language sits in the majority of people. It also occurs after traumatic brain injury, and in Parkinson's disease, multiple sclerosis and other neurodegenerative conditions, where the pattern of difficulty differs.

Speech is produced by several brain regions working together, so the type of aphasia depends on which of them was affected. Assessment identifies the pattern before any therapy starts.

Word retrieval and sentence construction. Comprehension. The muscles of speech where articulation rather than language is the problem. Alternative and augmentative communication — writing, gesture, picture boards, apps — introduced early rather than as an admission of defeat.

Social communication is trained deliberately: managing a conversation, repairing a misunderstanding, participating in a group. These are the skills that determine whether someone re-enters their own social life.

Speech and language therapy must be delivered in the patient's own language. Interpreting works for physician review and for physiotherapy; it does not work for language therapy, because the therapy is the language.

We confirm availability for your language before including it in a plan rather than after you arrive. If we cannot provide it, we say so and structure the programme around what we can deliver.

Evidence points towards higher intensity over a shorter period producing better outcomes than the same total spread thinly over months. This is why therapy is delivered in blocks rather than as a weekly appointment.

It is balanced against fatigue, which is severe early after stroke. The plan states the intended intensity and adjusts to tolerance rather than following a template.

Allow time and do not finish sentences. Use writing, drawing and gesture alongside speech. Ask questions that can be answered with yes or no when fluency is poor, and open questions when it is better. Reduce background noise.

These are taught deliberately, because most of a person’s communication happens outside therapy and the people around them determine whether it succeeds.