There are different types of aphasia, depending on the area of brain damage, and these aphsia's present with different symptoms:

Global Aphasia - with global aphasia there is a more general deficit across many cognitive functions and speech, language and literacy skills are all affected to some extent.  Speech may consist of a few single words or syllables, understanding, reading and writing are all impaired.  

Broca's Aphasia - is more of an expressive aphasia. When only the Broca's area of the brain is affected the individual can understand most spoken words and language, but has difficulties expressing language. The individual may have word finding difficulties (anomia), non-fluent and reduced ungrammatical speech. The word finding difficulties may be particularly prominent, and the individual may often use the wrong words, such as “spoon” instead of “fork”. Others may get “stuck” on a particular word and keep repeating it, or they may just use key words e.g. "arrive 9 o'clock station pick-up".

Wernicke's Aphasia - when only the Wernicke's area is damaged the patient’s understanding of language is effected, and he may also be unable to monitor his own language.  A lack of self-monitoring means that he will not be able to make sure that what he says makes sense or is in context.  Speech will be fluent, but the individual will use a lot of the wrong words.  Writing will also be impaired.

Conduction Aphasia - this type of aphasia produces fluent speech, but the speech is often interrupted with frequent variations of particular words which are produced as self corrections.  Repetition of words is often difficult with different variations of the same word are produced.  Comprehension is generally well preserved.

Transcortical Motor Aphasia - with this aphasia, naming is good, but spontaneous speech is rare. These individuals do not speak much or initiate conversation.

Transcortical Sensory Aphasia - with this type of aphasia the individual has fluent speech, but it is often jargon or repetitions of what others are saying.  There is also a severe impairment of oral and written comprehension.

Anomic Aphasia - word finding difficulties in spontaneous speech or naming tasks is very evident with this aphasia.  However comprehension is usually good, as is repetition.

There are a number of aphasia therapy approaches for Stroke and CVA.  These include trying to stimulate the patient to facilitate a communicative response, or using shaping or fading techniques to train the individual to develop an appropriate response.  Another approach is reorganizing the function of the brain, so the undamaged parts compensate for the damaged.  The Pragmatic approach looks to restore communicative competence by using any modalities available, such as gesture, drawing, writing etc.  Other approaches really breakdown the different areas of function of the brain (using a cognitive neuropsychological model), pinpoint areas of difficulty/impairment and then perform a hierarchy of therapeutic processes to try and increase language and communicative competence.  For instance, naming disorders are often worked on by doing a variety of picture naming tasks to facilitate word retrieval, or refine strategies to aid word retrieval.

The success of these approaches may very well depend on the severity of the stroke, the area of brain damage, and the frequency and intensity of therapy.  Some therapists may use a combination of approaches.  Unfortunately, if the stroke is severe, it is unlikely that any of these approaches will be able to allow an individual to return to normal, full cognitive and communicative functioning.  However, therapy may help an individual make some progress back towards normal functioning and/or give them other compensatory strategies to help with cognitive tasks and communication.

Strategies need to be put in place for the individual, and those around the individual have to be much more aware of their communication.  See our Download Centre for more detailed infromation sheets relating to Stroke, Total Communication, and strategies to facilitate communication. icommunicate will also provide resources such as picture communication charts to the facilitate communication following stroke.