We spoke with Melinda Corwin, PhD, CCC-SLP, about the causes of stroke, how stroke can lead to aphasia, and treatment options that are available for survivors. Corwin is the director of the Stroke & Aphasia Recovery Program (STAR) and is a professor in the TTUHSC Department of Speech, Language & Hearing Services.
“Aphasia is defined as loss of language due to any kind of damage to the brain,” Corwin explains.
While stroke is the most common cause of aphasia, it can also be acquired through any traumatic brain injury (TBI), such as a gunshot wound or car accident.
“Anything that damages the left hemisphere of the brain can lead to aphasia,” Corwin says.
Aphasia caused by traumatic brain injury trends differently based on age and mobility.
“The most common cause (of TBI) in children under five and adults over 65 is falls,” she says. For teenagers and young adults, the most common cause of TBI is car accidents.
A stroke does not always lead to aphasia, as a stroke may not affect the left hemisphere of the brain that houses our language center. But if the left hemisphere is damaged, Corwin says there is a high likelihood of ensuing aphasia.
What Does Aphasia Look Like?
Have you ever felt lost for words, or had a word on the tip of your tongue but couldn’t quite retrieve it?
Patients with aphasia feel this loss regularly, because they have trouble processing language. It feels as if the letters available to them are too jumbled to form the words they want to say. Similarly, they often experience difficulty reading and writing. They can have trouble pronouncing multisyllabic words, and they can have trouble processing what people are saying to them.
Misconceptions About Aphasia
One common misconception is that aphasia is tied to intelligence. Corwin is quick to stress that aphasia is not a loss of intellect.
“It has nothing to do with intelligence,” she explains. “It’s not dementia, and it’s not an intellectual disability.”
Corwin has patients with aphasia who are accused of being drunk, confused or demented.
“Imagine waking up and being transported to another country,” she challenges. “Letters now mean nothing on the keyboard. Words are really mixed up. Imagine the frustration. People with aphasia are continuing to think like you and I think; it’s just a loss of access to the language.”
Another misconception is that patients won’t improve with therapy after six to 12 months.
“Without further injury, they will continue to get better and better over time,” she says encouragingly.
Unfortunately, some patients are unable to get all the therapy they need due to cost and insurance.
“We luckily don’t have to dismiss them because we’re not having to deal with health insurance,” she says, because the TTUHSC Stroke & Aphasia Recovery Program is a community outreach program that doesn’t have to bill for services because of endowment grants and donations. “People can make progress for years after their brain injury or stroke.”
Corwin exudes admiration and respect for her patients.
“To me, they’ve been through something that would be so devastating,” she says. “These individuals have taught me a lot about resilience, working hard, fighting back and surviving.”
Corwin is adamant that her patients are survivors, not victims.
Offering Support for Aphasia Patients
There are ways to support stroke survivors with aphasia and their friends or family members. Providing supplemental ways to communicate is an important step. For instance, we can communicate via body language and universal signs.
“If you were transplanted to Russia, you wouldn’t be able to read the signs or talk to people, but you can still read body language and understand expressions and universal pictures,” Corwin advises.
She also suggests slowing down your rate of speech and giving the person time to communicate. Having pen and paper available is helpful.
“Sometimes they can write part of the word or draw something,” she says.
Social isolation is a problem for people with aphasia. Losing the ability to speak clearly and intentionally is frightening and frustrating. It’s important for persons with aphasia to continue to socialize. Loved ones can help by being present and patient and always remembering it’s not a loss of intellect.
Causes and Signs of Stroke to Watch For
As we have discussed, stroke can be a major cause of aphasia. So, let’s point out the signs of stroke to be aware of.
The most common causes of stroke are high blood pressure and heart disease.
“Heart disease is the No. 1 killer right now,” Corwin warns. “Not managing high blood pressure is a major risk for stroke.”
Corwin recommends the term “brain attack” to describe a stroke, as a way to help people understand the similarities of a heart attack, which results in a lack of blood supply to the heart. With stroke, the problems arise due to lack of blood supply to the brain. And just like a heart attack, time is of the essence for a person experiencing a stroke.
Corwin suggests the acronym “FAST” to quickly ascertain if a person is having a stroke.
- Face: Ask the person to smile. If their smile is lopsided, that is a red flag.
- Arms: The person should be able to raise their arms symmetrically.
- Speech: Ask them to say the names of the days of the week and listen for slurring, confusion or a change in speech pattern.
- Time: If these signs are present, it’s time to call 911. Every minute lost equates to a loss of brain cells from the “brain attack.”
Treatment for Persons with Aphasia and Stroke Survivors
Corwin beams about the success stories she’s witnessed during her career, including a man who had lost all language skills due to aphasia. Using the arts (choir, theater and visual arts) as therapies, he was able to regain much of what he’d lost. At arts camp, and during choir this man was singing every word!
Corwin’s goal is to help stroke survivors with aphasia to live normal lives and effectively communicate with others. Within the Stroke and Aphasia Recovery (STAR) Program, they use a life participation approach to treatment.
“People with aphasia can still love and be loved, find comfortable things to do and live a successful life,” Corwin says. “We can’t always cure aphasia; however, it does get better over time, especially with therapy.”