Aphasia

What is Aphasia?

Aphasia is an acquired condition — it comes on after an injury or illness, most commonly stroke, traumatic brain injury (TBI), brain tumour, or progressive neurological disease (such as Primary Progressive Aphasia, or PPA). It affects language: the ability to produce and understand spoken and written words.

Critically, aphasia is a language disorder, not a cognitive disorder. People with aphasia retain their intelligence, knowledge, memories, and personality. They know what they want to say; the neurological damage affects the pathways that convert thoughts into language and language into meaning.

Aphasia affects approximately 2 million people in the United States, with around 180,000 new cases each year — yet it remains far less recognised by the public than conditions it often accompanies, such as stroke.

Types of Aphasia

Aphasia is not one condition. There are many types based on which language functions are affected:

• Broca's aphasia (non-fluent) — effortful, telegraphic speech (short, key-word sentences); relatively preserved comprehension; person knows what they want to say but struggles to produce it
• Wernicke's aphasia (fluent) — speech flows easily but contains errors, made-up words (neologisms), or "word salad"; comprehension is significantly impaired
• Global aphasia — affects all language modalities; most severe form, often following large stroke
• Anomic aphasia — primary difficulty with word-finding; speech is otherwise relatively fluent
• Primary Progressive Aphasia (PPA) — a rare, degenerative form associated with frontotemporal dementia

How It Presents

Depending on type and severity, a person with aphasia may:

• Substitute words (saying "table" when meaning "chair")
• Use made-up words or sounds
• Speak in short, effortful phrases
• Have difficulty finding words (tip-of-the-tongue on most words)
• Struggle to understand long or complex sentences
• Have difficulty reading and/or writing
• Show significantly different abilities across modalities (e.g., better written than spoken output)

Emotional and psychological impact is profound. Many people with aphasia experience depression, social isolation, and loss of identity — particularly if language was central to their professional life or relationships.

Assistive Technology and Communication Supports

AAC is particularly important for people with aphasia:

• Low-tech AAC — communication books and boards with words, phrases, symbols, and photos
• High-tech AAC / Speech Generating Devices (SGDs) — apps (Proloquo4Text, TouchChat, Lingraphica) that support word-finding and message construction
• Word prediction and phrase banks — reduce the effort of typing when written communication is easier than speech
• Partner-Assisted Scanning — a communication technique for people with limited motor control
• Supported Conversation for Adults with Aphasia (SCA) — a framework for training communication partners to support more successful conversations
• Voice banking — capturing a person's voice before disease progression (for PPA) to create a personalised speech output for SGDs

Common Misconceptions

• "People with aphasia are cognitively impaired." Aphasia affects language, not intelligence. This misconception is one of the most damaging — it causes people with aphasia to be systematically underestimated.
• "If they can't talk, they have nothing to say." People with aphasia have full inner lives, opinions, and experiences; they lack reliable access to the linguistic tools to express them.
• "Aphasia only affects speaking." Aphasia typically affects reading, writing, and language comprehension as well.

Language and Identity

Person-first language ("person with aphasia") is standard. The Aphasia Access community has developed the concept of "life participation" as a guiding philosophy — prioritising quality of life, relationships, and meaningful activity, not just speech therapy outcomes.