A few weeks ago, legendary actor Bruce Willis announced that he’ll be taking a step back from acting due to health concerns, including a diagnosis of aphasia.
Ever heard of aphasia? You’re not alone. In this article, we’ll break down what aphasia is, including symptoms, treatment options, how it affects bilingual and multilingual people, and just how common it is (hint: much more than you probably think).
What is aphasia?
The word aphasia comes from the Greek word aphantos, which means “speechless”, or a “without” + phantos “speech.” It is a communication disorder that can impact a person’s ability to speak, read, write, and understand other people.
As human beings, communication is central to nearly every facet of our lives. We use our written and spoken language skills to engage in conversation with friends and family members, tell stories or jokes, and read emails for work or traffic signals while driving. In fact, our unique communication styles – the way that we build-up to the punchline of a joke, the words and tone of voice we use to respond to another person when they’ve confided in us or yelled at us – make up a huge portion of who we are.
When the ability to communicate is impacted, it can therefore have devastating effects on a person’s work life, relationships, and their ability to engage meaningfully with the world.
Signs and symptoms of aphasia
What does aphasia actually look like? There are seven types of aphasia, all of which are caused by damage to the language centres in the brain. These subtypes can be grouped into two overarching categories: expressive and receptive aphasias.
As the name suggests, expressive aphasia is marked by difficulty expressing oneself through speech despite relatively intact comprehension abilities. A person with expressive aphasia knows what they want to say, but has difficulty saying or writing it as they intend.
Most of us have had the experience of having a word on the tip of our tongue, but not being able to get it out. Depending on the severity of their presentation, a person with expressive aphasia may have this experience once every few sentences to nearly every word. They may also use words that are incorrect but related to the word they want to say in meaning (e.g., “daughter” instead of “son”), or sound (“something” instead of “son”), or they may use made-up words (e.g., “locher” instead of “son”).
Receptive aphasia is when your ability to receive information from the outside world is impaired. Much like the experience of visiting a foreign country where a language you don’t know is spoken, people with receptive aphasia can hear voices or see the writing on a page, but they are unable to make sense of what is being said.
People with receptive aphasia also have difficulty speaking. They often speak in long sentences and with regular intonation without realizing that their words and sentences are all scrambled up and do not make sense to the other person.
Expressive and receptive aphasia can both be incredibly frustrating experiences. People with expressive aphasia generally are aware of their difficulties and frustrated by their inability to express themselves as they want. People with receptive aphasia are often unaware of their difficulties, and thus frustration stems from feeling that they are constantly misunderstood despite a belief that they are speaking clearly.
What Causes Aphasia?
Aphasia is caused by injury to the language centres of the brain. Though its most common cause is stroke, it can also be caused by a brain tumor or head injury. In rare cases, it can take the form of a dementia-like progressive disease, as in the case of Bruce Willis. This is known as primary progressive aphasia.
How common is aphasia?
Despite limited public and health professional awareness of aphasia, it occurs in approximately one-third of people who have had a stroke. Currently, one million people in the United States are living with aphasia, and nearly 180,000 people acquire it each year. It is thus more common than either Parkinson’s Disease or Multiple Sclerosis.
What treatment options are available?
Although there is no cure for aphasia, a speech-language pathologist can help a person with aphasia improve their language skills. Therapy may target reading, writing, speaking, and the ability to understand.
Semantic Feature Analysis
Therapy for aphasia differs greatly depending on type and severity. However, one of the most common types of aphasia therapy is known as Semantic Feature Analysis.
To understand how Semantic Feature Analysis works, think about a time when you found your mind wandering from one thing to another. You may have started off thinking about your plans to go swimming over the weekend, and suddenly you’re remembering the time you had an allergic reaction to a bee sting. Though you may wonder how you got from point A to point Q, usually if you retrace your steps, you can find the connections that led you from one topic to another.
The thought of swimming in the ocean reminds you of your favorite seafood dish, grilled octopus. From grilled octopus, you jump to another kind of seafood, softshell crab, which gave you hives when you ate it at Red Lobster during your twenty-first birthday party. Suddenly you’re thinking of allergies, and that time you got stung by a bee and your mother had to drive you to the hospital for an injection of adrenaline. There you have it, from weekend beach plans to childhood hospital visits in four easy steps.
Much as our thoughts often move in chains of related memories or sensations, words are stored in our brains in complex maps, with a variety of connections branching out from every word. The word apple might sit in the middle of a word map with connections to words like ‘fruit,’ ‘red,’ and ‘crunchy,’ as well as more individualized descriptors, such as ‘my favorite kind of pie,’ or ‘the thing that grows on the trees in my backyard.’
When a person has a brain injury, connections between words that have been built and solidified over the course of a lifetime are broken, leaving holes in the language maps in their brain.
Oftentimes, the focus of speech therapy is to try to rebuild those connections. A person with aphasia may be shown a picture of an apple and be unable to name what they see. But by describing its qualities – juicy, sweet, found in orchards, etc. – they begin to rebuild the broken connections. Often, at the end of a therapy session, they may remember the word.
Bilinguals with aphasia
Aphasia can affect the communication abilities of people who speak more than one language in a variety of ways. For some people with aphasia, their communication difficulties may be roughly equivalent across both of the languages they speak. For others, they may have much more difficulty communicating in one language than the other.
Why might one language be more impacted than another?
Researchers have found that the way language is impacted in bilinguals with aphasia is largely determined by the age at which the second language was learned. If a person learned both languages before the age of seven, it is more likely that both languages will be equally impacted by aphasia.
However, if a person learned their second language after the age of seven, that language is likely to be more impaired than their first language.
This is true because people who learn more than one language during early childhood store both of their languages in the same area of the brain. The webs of meaning for words are thus intertwined. For example, a Spanish-English bilingual may have a mental map of the word ‘dog’ that connects it with ‘furry,’ ‘domesticated,’ and ‘cuatro patitas.’ Thus, when damage is done to this area of the brain and the word maps are broken, both languages tend to be equally affected.
In contrast, a person who learns their second language later in life actually stores this language in a separate part of the brain. Generally speaking, the language maps in a person’s first language are also stronger and contain more connections than those of their second language. Thus, when there is damage to the brain, the second language is usually more impacted than the first.
What language should bilinguals do speech therapy in?
Considering that nearly half of the world’s population is now bilingual, choosing the language in which to provide therapy for aphasia is an important consideration for a speech language pathologist.
Interestingly, research has found that rebuilding language maps in a person’s weaker language (usually their second language) can lead to a transfer of regained skills to the stronger language. This is especially true with cognate words, or words that sound similar and have the same meaning across both languages. For example, in a person whose first language is English and second language is Spanish, targeting the Spanish word ‘televisión’ would likely help them to recover the English word ‘television’ as well. However, targeting the word ‘television’ in English may not lead to the same transfer to Spanish.
I know someone with aphasia. What can I do to help?
If one of your friends or family members has aphasia, don’t be a passive bystander. There are many things you can do to help.
Simplify your communication
One of the best things you can do to help is to simplify your communication. Speak in short simple sentences, and use hand gestures and other visual cues to help support their understanding where possible (e.g., gesture as though brushing your teeth when reminding someone to brush their teeth or write down the words ‘brush teeth’ if you find that that helps the person). When giving instructions, break them down into single steps.
Do not speak to a person with aphasia as though they are a child, and don’t shout or yell.
Rather than asking open-ended questions (e.g., What do you want to eat?), try to provide options for them to choose from (e.g., Do you want Italian or Chinese food?)
Finally, provide ample time for your loved ones to think and respond, and do your best to involve them in conversations. You may try gently checking in to see if they have understood, or be sure to ask their opinion.
Keep people with aphasia in your life
It can be challenging to figure out how to maintain a relationship with a person with aphasia. Their personality might have changed, and they may not seem like the same person you once knew. It’s quite common for people with aphasia’s social and even family relationships to fall away. This contributes to high levels of isolation and depression in people with aphasia. So, don’t shy away. You may need to learn new ways to communicate with the person you know with aphasia, but it will be worthwhile for helping support their emotional well-being and keeping an important relationship in your life.
Spread the word!
Finally, spread the word about aphasia! Despite its prevalence, aphasia remains a relatively unknown disorder. Increased public awareness not only helps people to understand and connect with people with aphasia, but it’s also important to increase funding for research into methods of preventing and treating aphasia.
So, if you’ve made it to the end of this article, tell somebody about it. The more people know about aphasia, the better we can help those affected by it.
Curious about other language stories? Check out the ALTA Beyond Words Blog for more.
Janet Barrow holds a B.A. in Written Arts from Bard College, and a Master of Speech-Language Pathology from the University of Sydney. She works as a pediatric speech pathologist and freelance writer, and is currently finishing her first novel.