Aphasia

Language is damaged. Intelligence is not. Confusing the two is the injury people notice most.

What it is

Here is the thing everybody gets wrong, and it costs people dearly: aphasia damages language, not intellect. The person in front of you knows exactly what they mean. The route from the thought to the word has been cut.

It usually follows a stroke. Around a third of stroke survivors have some aphasia. It can also follow a head injury, a brain tumour or a progressive neurological condition.

It affects any combination of speaking, understanding, reading and writing. Someone might read fluently and be unable to say their own name. Someone else might talk in confident sentences that contain no meaning, and not realise it.

Signs you might notice

Words that will not come, or the wrong word arriving with total confidence. "Pass me the, the, you know, the thing."

Sentences that shrink to key words. "Cup. Tea. No."

Understanding that falls apart when people speak quickly, or when two of them speak at once.

Writing and numbers affected alongside speech, which surprises families.

And frustration. Enormous, entirely rational frustration.

How it can affect day-to-day life

Aphasia is isolating in a specific way. Conversation is how people stay in each other's lives, and when it becomes effortful, others visit less. Not deliberately. They just find it awkward and stop.

Then come the assumptions. People raise their voices, or talk to the relative instead of the person, or explain things slowly as if to a child. Every one of those is a small insult delivered by somebody who meant well.

Depression is common after a stroke, and aphasia makes it far harder to detect, because the usual way somebody tells you they are struggling has been taken away.

Supporting someone well

Speak normally. Not louder, not slower to the point of parody. Short sentences, one idea at a time, then wait. The pause you find uncomfortable is the pause the person needs.

Give them the time. Do not finish their sentence unless they ask you to.

Use everything else: writing, drawing, pointing, photographs, gesture. Communication is the goal, speech is only one route to it.

Ask yes or no questions when someone is tired, and open ones when they are not.

Never talk about the person over their head. They understand more than the conversation is assuming.

Fiducia Talk is free and made for exactly this: 308 symbol cards, a phonics keyboard using the full UK grapheme set, a big-key layout and switch scanning. For somebody who can point but not yet speak, it is the difference between being asked what they want and being told what they are having.

Where to get help

Speech and language therapy is the treatment, and the evidence supports intensive work rather than occasional sessions. Ask for a referral and ask how much therapy is actually being offered, in hours.

The Stroke Association runs communication support groups, which help with the isolation in a way therapy alone does not.

If speech changes suddenly, treat it as a stroke and call 999.