Aphasia: Learning to communicate again after a stroke

  • Post-stroke aphasia can occur even in young adults.
  • There are different subtypes of this language disorder, but with proper treatment, it can be cured.
  • A speech-language pathologist and a neurologist tell us more.

Imagine living a life struggling to connect with others. Unfortunately, this is a reality for many people with aphasia.

Aphasia, an acquired language disorder, often occurs after a stroke, but it can also result from traumatic brain injury, brain tumor, or brain infection.

About a third of stroke survivors are affected by some form of aphasia, which affects their ability to speak, read, write, and understand what others say to them.

“Aphasia indicates difficulty in understanding language and/or using language,” explains Nasreen Alli, a speech-language pathologist and assistant director of the Department of Speech Therapy, Western Cape Government.

She adds: “Language is a broad term that refers to the system of symbols that people use to communicate, the rules that govern how sounds and words are used to form sentences, and the rules used, including pragmatic skills or nonverbal communication skills such as eye contact, taking turns and appropriateness of speech.”

For some stroke survivors, it is an experience equivalent to going back to preschool, where they have to relearn language and communication skills. Such was the case for Thatto, 43, who had a stroke nearly a decade ago and developed aphasia – the most severe form of aphasia.

She told Health24 in 2019:

I was learning the verbal difference between ‘d’, ‘t’, ‘b’, ‘p’, ‘r’, ‘v’ etc. Not “show”, “hair” is not “left”.

Professor Andre Moshan, a neurologist at the University of the Witwatersrand explains: “When everything is affected, both in expression and understanding, we call it global aphasia. It is the most disabling form of aphasia.

“If someone talks to someone with aphasia, it seems like nonsense to them and they can’t understand it, so they can’t carry on any conversation. They are also not able to express themselves or name anything, like things.”

Broca, Wernicke, and Global aphasia are some of the subtypes of aphasia, says Allie, but there are others. She broke down these three subgenres:

  • International aphasia It is considered the most severe form of aphasia, as it affects an individual’s ability to understand and speak. A person may struggle to understand simple instructions and use of words, but may be able to communicate using facial expressions, intonation, and gestures.
  • Broca’s aphasia It is a non-fluent aphasia. One’s ability to comprehend is generally intact, but their speech is strained, and grammar is weak. The person may know what they want to say but may have difficulty finding the words.
  • Wernicke’s aphasia It is a fluent aphasia. One’s ability to understand is weak but one is able to speak fluently, which, however, does not always make sense.


Alli added that for patients with post-stroke aphasia, early intervention in speech therapy is vital.

The process begins with an initial assessment to identify the person’s communication strengths and challenges. Treatment can be provided on an individual basis or in a group. This depends on the individual’s needs,” she explains, and emphasizes the importance of family involvement as it aids recovery. “Treatment not only focuses on the individual with aphasia but also helps the communication partners of the individual.”


Mochan added that recovery from aphasia after stroke varies and depends on the severity of the stroke, but most survivors achieve some form of ability to communicate again.

“It can sometimes include what we call the AAC (Augmentative and Alternative Communication) method. So, for example, an iPad could be given or slides with pictures of the person who might not be able to say the words, and they could point out something they wanted. If they They want food, they can point to a picture of the food, for example.

Likewise, Alli explains that the success rate of recovering from aphasia depends on the severity of the stroke, the patient’s health, as well as the support available to them.

She says aphasia can be chronic and lifelong. “Even after intensive speech therapy, the individual may experience residual, invisible communication difficulties.”

That’s why speech therapists may work with clients throughout their lives. If any difficulties persist, the therapist will suggest certain strategies to enhance the patient’s communication at each stage, she explains.

Stroke and aphasia in adults under 45

If a stroke occurs in someone younger than 45, there are many factors that may play a role in their recovery, says Alli. These include:

  • The severity of the damage to the brain. Time is a major factor in stroke. Arriving at the hospital within the window period (3-4 hours) to receive treatment may reduce the severity of a stroke.
  • The health status of the individual
  • Comorbidities (such as high blood pressure, diabetes, obesity) and how well they manage their lifestyle
  • Stick to a healthy diet and regular exercise schedule
  • Age: Younger people have a greater chance of recovering and returning to work than older people.
  • Motivation and determination
  • Support from family and friends

All of these factors affect recovery. With good support and appropriate lifestyle changes, the chances of a young individual’s recovery increase.

Knowing the risk factors for stroke

While there are some known risk factors for stroke, including smoking, high blood pressure, high cholesterol, and diabetes, Mokann says, stroke can occur in some people, even young adults, completely without any apparent cause, which is known as Stroke “coded”, or unexplained.

He adds:

But many people, even after severe strokes, show improvement, so there is always hope for improvement and, in some cases, a fairly good recovery.

For example, Thato received intensive speech therapy, neuro-functional therapy, and occupational therapy for many years after her stroke, but that ended in 2019. Today, she is the co-director of the Stroke Survivors Foundation, and she will soon receive an LLM.

Allie adds that support from family and friends is vital for a person with aphasia. “Aphasia not only affects an individual’s ability to communicate, but it affects an individual’s sense of who they are.”

And she adds:

The way we communicate is rooted in our identity as people, and each person’s communication style is unique to them. It is important to have the support of family and friends. Family and friends are part of an individual’s healing journey…Making them a part of therapy only helps in the process.

Alli asserts, that a person has difficulty speaking, this does not mean that his intelligence has been affected. “It’s important to remember that people with aphasia are still adults and we should treat them with the same respect and dignity as they were before the stroke.”

The best thing you can do, says Alli, is to take the time to listen to the aphasia’s message and not rush it. “It is very important to continue to involve the individual in regular daily activities,” she says.

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