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Aphasia is a communication disorder caused by damage to one or more regions of the brain that control language skills. People with aphasia may not be able to express themselves verbally or in writing, or they may not understand spoken or written language.

An estimated 1 million people in the United States have aphasia, and approximately 80,000 people are diagnosed with the disorder each year. The most common brain injury leading to aphasia is stroke.

The primary treatment for aphasia is speech-language therapy that focuses on relearning and practicing language skills and using alternative or complementary communication methods. Family members often participate in the therapy process and function as communication partners of the person with aphasia.

A person with aphasia may:

• Speak in short abbreviated sentences
• Speak in sentences that don't make sense
• Make up words
• Have difficulty finding the right word
• Not comprehend other people's conversation
• Interpret figurative language literally
• Not understand written words
• Write sentences that don't make sense
• Make significant spelling errors

The language problems of aphasia can be understood as deficits in saying or writing something (expressive language) or in comprehending either spoken or written communication (receptive language). The severity and scope of the problems depend on the extent of damage and the area of the brain affected. Some people may, for example, comprehend what others say relatively well but struggle to find words to speak. Other people may speak more clearly than they can write.

Your doctor may refer to one of three broad categories of aphasia (nonfluent, fluent and global) that describe what region of the brain was damaged and how communication is usually affected. The two primary language networks for most people are located in the brain's left hemisphere.

• Nonfluent aphasia. Damage to the language network toward the front of the brain usually results in Broca's aphasia. It's also called nonfluent aphasia. People with this disorder struggle to get words out, speak in very short sentences and leave out words. A person might say, "Want food" or "Walk park today." Although the sentences aren't complete, a listener can more or less decipher the meaning. A person with Broca's aphasia may comprehend what other people say to some degree. They're often aware of their own difficulty in communicating and may get frustrated with these limitations.
• Fluent aphasia. Wernicke's aphasia is the result of damage to the language network in the middle left side of the brain. It's often called fluent aphasia. People with this form of aphasia may speak fluently in long, complex sentences that don't make sense or include made-up, incorrect or unnecessary words. They usually don't comprehend spoken language well and often aren't aware of their own difficulty communicating.
• Global aphasia. Global aphasia results from extensive damage to the brain's language networks. People with global aphasia have severe disabilities with expression and comprehension.

The most common cause of aphasia is stroke — the blockage or rupture of a blood vessel in the brain. This disruption of the blood supply leads to brain cell death or damage in areas of the brain controlling language. Aphasia may also be caused by a severe head injury, a brain tumor or an infection.

A relatively rare form of dementia called primary progressive aphasia is a disease that causes the gradual degeneration of cells primarily located in the brain's language networks. Although other dementia symptoms may eventually appear, aphasia is generally the first and most pronounced symptom. The aphasia symptoms progressively worsen over time.

Because most cases of aphasia result from stroke, your doctor or a neurologist is most likely to identify the symptoms during assessment.

You should see a doctor if you or someone you know has trouble speaking, comprehending speech, recalling words, reading or writing. You'll most likely be referred to a speech-language pathologist for an assessment of language problems, and you may need to see a neurologist to determine possible causes of the symptoms.

A speech-language pathologist will conduct tests and informal observations to assess your speech-language skills, such as your ability to:

• Engage in a conversation
• Understand and use words correctly
• Answer questions about something you've read or heard
• Follow instructions
• Explain steps of a process
• Answer yes-no questions and respond to open-ended questions about common subjects
• Tell a story or explain the plot of a story
• Explain a joke or a figurative phrase, such as "I need to unwind"
• Read and write letters, words and sentences

People who have had a stroke or other brain injury often face a number of rehabilitative challenges. In particular, an individual may have difficulty with motor skills needed to speak or write. These complications may exacerbate the communication challenges of aphasia.

Aphasia can create psychological and interpersonal complications for the affected individual, as well as for family and friends. People with aphasia may be aware of their limitations for communicating. The language barriers may lead to embarrassment, depression and relationship problems.

Family members and friends are usually aware of a person's difficulty with expression, but it's hard to gauge how well someone comprehends. The challenges of aphasia require patience and often change the nature of relationships. The normal method of dealing with problems — talking about them — often isn't possible or requires more effort than usual. Family members may experience feelings of resentment, depression or grief.

If damage to the language networks is mild, a person may recover language skills without treatment. However, most people undergo speech-language therapy to rehabilitate their language skills and supplement their communication experiences. Recovery of language skills is usually a relatively slow process, and few people regain pre-injury communication levels.

Therapy is most effective when it begins as soon as possible after the brain injury. Work with a speech-language pathologist for the first three to six months will be intense, most likely taking five or more hours a week. Additional, less intense therapy may continue for up to two or more years.

The speech-language pathologist uses exercises to improve and practice communication skills. These may begin with simpler tasks such as naming objects and evolve into more complex exercises of explaining the purpose of an object.

The speech-language pathologist helps people take advantage of their stronger communication skills in order to augment those that are weaker. The therapist might teach the person to communicate more clearly with gestures or drawings. Some people with aphasia may use a book or board with pictures and words to help them recall commonly used words or help them when they're stuck. Although they may not be of value to everyone with aphasia, some computer programs enable people to practice word recall and other skills.

Group treatment also is common and can be very beneficial. In a group setting, people with aphasia can try out their communication skills in a safe environment. The setting provides people an opportunity to practice clarifying ideas when they're not understood, taking turns, initiating conversations and fixing conversations that have completely broken down. Group participants may also do role-playing activities to practice using language in common daily activities and social situations.

A speech-language pathologist may take an individual or group on outings to practice such activities as going to a restaurant or shopping.

For individuals who improve significantly, there may be additional therapy focusing on communication strategies that enable them to return to work, school or other activities that require sophisticated or flexible communication skills.

People with aphasia
If you have aphasia, the following tips may help you communicate with others:

• Carry a card explaining that you have aphasia.
• Carry paper and pencils or pens with you at all times.
• Use drawings, diagrams or photos.
• Use gestures or point to objects.
• Tell or show people what communication style works for you.

Family and friends
Family members and friends can use the following tips when communicating with a person with aphasia:

• Simplify your sentences and slow down your pace.
• Allow the person time to talk.
• Don't finish sentences or correct errors.
• Keep conversations focused on one topic at a time.
• Avoid distracting noises.
• Keep paper and pencils or pens readily available.
• Help the person with aphasia create a book of words, pictures and photos to assist with conversations.
• Use drawings or gestures when you aren't understood.
• Involve the person with aphasia in conversations as much as possible.
• Check for comprehension or summarize what you've discussed.
• Talk about the frustrations that the person with aphasia is experiencing.
• When conversations break down, decide together whether to continue or return to the topic later.

Support groups
Local chapters of such organizations as the National Aphasia Association and the American Stroke Association and some medical centers offer support groups for people with aphasia and others affected by the disorder. These groups provide people with a sense of community, a place to air frustrations and coping strategies.