What is aphasia?

Aphasia is a language or communication disorder that is a result of damage to parts of the brain responsible for language.

Facts about aphasia

The most common cause of aphasia is stroke but it can also be a result of a brain injury, tumour, dementia or a progressive brain disease.

• Speech problems are the most recognized sign of stroke onset, yet aphasia is not well recognized or understood during recovery.
  • Approximately one-third of people who have a stroke experience aphasia (Laska et al., 2001).
  • 60% of patients with aphasia post-stroke have ongoing communication difficulties one-year post-stroke (Pederson et al., 2004).
  • 43% of patients who initially present with aphasia post-stroke are still significantly aphasic 18 months later (Laska et al., 2001).
• There are more than 100,000 Canadians living with mild to severe aphasia.

Impact of aphasia on healthcare

• Incidence of stroke and prevalence of aphasia is increasing due to our aging population.
  • In the next 20 years, the number of Canadians living with the effects of stroke will almost double (2017 Stroke Report, Heart and Stroke).
• The presence of aphasia has been associated with:
  • General decreased response to stroke rehabilitation interventions
  • Increased risk for mortality
  • Longer hospital stays
  • Increased use of rehabilitation services
  • More frequent discharge to long term care facilities (Dickey et al., 2010)

• Conversation is an important part of healthcare, even the technical side of medicine depends on being able to talk to the affected person.
  • Aggressive management of aphasia through therapy helps to improve both language and broader recovery.

• Increasing communicative access to healthcare for the person with aphasia will affect:
  • Quality of life after stroke
  • Compliance with treatment
  • Knowing signs of stroke and prevention of secondary stroke

The most current Canadian Stroke Best Practice Recommendations: Stroke rehabilitation practice guidelines includes:

1.  All health care providers working with persons with stroke across the continuum of care be trained about aphasia, including the recognition of the impact of aphasia and methods to support communication such as Supported Conversation for Adults with Aphasia (SCA™)
2. Treatment for aphasia should include group therapy and conversation groups
3. Treatment to improve functional communication should include supported conversation techniques for potential communication partners of the person with aphasia
4. Families of persons with aphasia should be engaged in the entire process from screening through intervention, including family support and education, and training in supported communication

Impact of aphasia on quality of life

Although aphasia is defined as a language disorder, emotional and psychosocial changes commonly occur in the individual with aphasia and in their families. Aphasia is reported to be a significant predictor of a negative effect on quality of life after stroke. (Lee et al., 2015). This negative effect can include:

• High risk of social and emotional isolation
• Depression
• Aphasia-related abuse
• Reduced functional recovery
• Caregiver stress and illness
• Reduced access to healthcare information and social services

Aphasia is a family problem

People with aphasia and their families want:

• on-going therapy and support
• information
• other people to understand aphasia
• to help others
• hope and positivity from healthcare professionals

References & Resources

1. 2017 Stroke Report. Heart and Stroke
   https://www.heartandstroke.ca/-/media/pdf-files/canada/stroke-report/strokereport2017en.ashx
2. Canadian Stroke Best Practice Recommendations: Stroke rehabilitation practice guidelines, update 2015, International Journal of Stroke 2016. Vol. 11(4) 459-484 Retrieved from:
   https://journals.sagepub.com/doi/full/10.1177/1747493016643553
3. Dickey, Laura et al. Incidence and Profile of Inpatient Stroke-Induced Aphasia in Ontario, Canada. Archives of Physical Medicine and Rehabilitation, Feb, 2010 Volume 91, Issue 2, 196 – 202
   https://www.archives-pmr.org/article/S0003-9993(09)00870-3/fulltex
4. Laska AC, et al. Aphasia in acute stroke and relation to outcome. J Intern Med. 2001;249:413–422
   https://www.ncbi.nlm.nih.gov/pubmed/11350565
5. Laska AC, Kahan T, Hellblom A, Murray V, von Arbin M. A randomized controlled trial on very early speech and language therapy in acute stroke patients with aphasia. Cerebrovasc Dis Extra. 2011;1:66–74.
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3343759/
6. Lee H, Lee Y, Choi H, Pyun SB. Community integration and quality of life in aphasia after stroke. Yonsei Med J. 2015;56:1694–1702
   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630062/
7. Pedersen, P. M., Vinter, K., & Olsen, T. S. (2004). Aphasia after stroke: type, severity and prognosis. The Copenhagen aphasia study. Cerebrovasc.Dis., 17(1), 35-43
   https://www.ncbi.nlm.nih.gov/pubmed/14530636