Speech and language therapy (SLT) is the main treatment for aphasia. SLT is a general term used to describe different techniques that can help improve a person’s ability to communicate.
SLT for aphasia aims to:
- help the person relearn communication skills that have been lost or damaged (if this is possible)
- make the best use of the person’s remaining communication abilities
- find new ways of communicating
Speech and language therapy
There is no single best way to treat aphasia, however, most experts agree a course of SLT tends to be more successful if it is based on the following:
Dose and intensity
Research has shown one of the most important things affecting the success of SLT is the time spent doing it (the dose). The more hours spent doing SLT, the more successful it is likely to be.
Research also shows that a short-term course of intensive SLT, for example, eight to 10 hours a week over a couple of months, is usually more effective than a longer, less intensive course, for example, one to two hours a week for five or six months.
However, not everyone has the energy to participate in intensive therapy, particularly elderly people recovering from a stroke.
Gradual build up
SLT works best when the therapist sets modest goals and then moves on to more complex goals. For example, they might start with naming a specific person, before describing their relationship with that person.
Personalised
Research shows that people are more engaged when using teaching material and aids with a personal significance.
For example, using photographs of people or situations that a person would remember is more effective than using stock photographs.
Provide alternatives
It is important for a therapist to discuss potential alternative communication methods, such as simple gestures, more complex sign language, or technology, such as electronic speech synthesisers.
This can be particularly useful in primary progressive aphasia, as the person and their loved ones may have time to learn how to use the methods while they are still able to speak fairly well, preparing for a time when they will have more difficulty.
Group work
It can be beneficial for someone with aphasia to work in a group with other people with the condition. As well as providing a good opportunity to practice communication skills, it can also lessen the feelings of loneliness and isolation experienced by many people with aphasia.
SLT can be carried out by trained and supervised volunteers. The Stroke Association provides training for volunteers. See The Stroke Association website for details about volunteering.
SLT techniques
Promoting Aphasics' Communicative Effectiveness (PACE)
Promoting Aphasics' Communicative Effectiveness (PACE) uses conversation to improve a person’s communication skills.
The therapist will use a picture or drawing to stimulate a conversation, while the person with aphasia is encouraged to use any means of communication to respond.
Early PACE sessions focus on simple topics of conversation, such as where the person was born. As the sessions progress, the topics of conversation become more complex and abstract, including for example, the person’s favourite film and why they like it.
Melodic intonation therapy (MIT)
Melodic intonation therapy (MIT) is often used in the treatment of non-fluent forms of Broca's aphasia.
Many people with aphasia do not have difficulties when singing. This may be because the parts of the brain used when singing are different to those used when speaking.
During MIT sessions, a person with non-fluent aphasia is encouraged to hum and to sing words or phrases that they find difficult to recall, while tapping out a rhythm. This technique has been shown to increase the number of words a person can recall.
Computerised script training (CST)
Computerised script training (CST) uses scripts that simulate real-life conversations and social activities, allowing a person with aphasia to practise their communication skills.
This is usually carried out in hospital under the supervision of a speech and language therapist or assistant. However, a recent study has shown that CST may be effective when it is self-managed, with only a small amount of guidance.
Constraint-induced aphasia therapy (CIAT)
Constraint-induced aphasia therapy (CIAT) is a type of SLT designed for people with long-term (chronic) aphasia.
People with chronic aphasia may adopt a number of basic compensatory strategies to help them communicate, for example:
- pointing
- gesturing (but not complex sign language)
- making sound effects, such as saying "brrrrm" for car
These strategies may be useful in the short term, but relying on them can lead to a person with aphasia forgetting previously learnt communication skills and delaying their recovery.
CIAT usually involves a short course of intensive therapy during which a therapist aims to identify these types of compensatory strategies and encourages more complex ways of communicating. This may not necessarily be full speech, but may include methods that force the brain to make use of its language centre, such as drawing or using communication tools, such as a speech synthesiser.
Transcranial stimulation
Transcranial stimulation is a type of painless treatment that may benefit some people with aphasia.
There are two types of transcranial stimulation:
- transcranial direct current stimulation (tDCS) – where electrodes (small metallic discs) are placed on the surface of the scalp and a small electrical current is passed through them
- transcranial magnetic stimulation (TMS) – where magnetic coils are placed above the scalp which create short-lasting electrical currents in the brain below the stimulation site
It has been suggested that both tDCS and TMS may help stimulate parts of the language centre that have been damaged and encourage a certain degree of recovery and repair. Initial research has found these types of treatment may help people to improve their ability to remember names of certain objects, people and places.
As transcranial stimulation is a new method of treatment, access is currently limited to people willing to take part in a clinical trial. Read more about clinical trials and Clinical trials for aphasia.
Medication
Researchers have also been studying the effects of medication for improving the language skills of people with aphasia.
One type of medication that has proved reasonably effective in some people with Broca's aphasia, when used in combination with SLT, is called bromocriptine.
It is thought bromocriptine may help stimulate sections of the brain’s language centre, leading to an improvement in communication skills.
Another medication that has proved effective in improving language skills, particularly the ability to name objects, people and places correctly, is called donepezil.
Donepezil increases levels of a chemical called acetylcholine in the brain. This is thought to lead to an increase in cognitive ability (the ability to think, reason and plan).
Again, it is likely that access to these sorts of treatment will only be available in clinical trials.
Communicating with a person with aphasia
If you live with, or care for, a person with aphasia, you may be unsure about the best way to communicate with them. You may find the following advice helpful.
- After speaking, allow the person plenty of time to respond. If a person with aphasia feels rushed or pressured to speak, they may become anxious, which can affect their ability to communicate.
- Use short, uncomplicated sentences and do not change the topic of conversation too quickly.
- Avoid asking open ended questions. Closed questions that have a yes or no answer are better.
- Avoid finishing a person’s sentences or correcting any errors in their language. This may cause resentment and frustration for the person with aphasia.
- Keep any possible distraction to a minimum, such as background radio or TV noise.
- Use paper and a pen to write down any key words, diagrams or pictures to help reinforce your message.
- If you do not understand something that a person with aphasia is trying to communicate, do not pretend that you do understand. The person may find this type of behaviour patronising and upsetting. It is always best to be honest about your lack of understanding.
- Try to remember that despite their change in speech pattern, the person’s personality is unchanged. They may appear emotionally distant or abrupt, but how they speak to you does not necessarily reflect how they feel about you.
