What is Aphasia?

Earlier this spring, a social media posting about actor Bruce Willis yielded an outpouring of support from fans. The post, written by Willis' former wife Demi Moore, indicated that “...Bruce has been experiencing some health issues and has recently been diagnosed with aphasia, which is impacting his cognitive abilities..”. Moore went on to say that Willis would be stepping away from his career in acting as a result of the diagnosis. 

The notion that anyone must step away from their life’s work to manage medical needs would prompt support and words of encouragement from most people, and meaningfully so. But few individuals actually know what aphasia is, how it manifests itself, and its impact on daily living.

The National Aphasia Association (NAA) conducted a survey in 2016 to assess how much the public knew about aphasia. The NAA found that only 8.8% of those surveyed knew that aphasia was an acquired disorder of language. Although a few years have passed since the administration of the survey, the likelihood is that few people still fully know and understand what such a diagnosis actually means. 

The American Speech-Language-Hearing Association (ASHA) defines aphasia as “...a language disorder that happens when you have brain damage…Damage [to the left] side of your brain may lead to language problems…”. As a result of the language centers of the brain being impacted, “aphasia may make it hard for you to understand, speak, read, or write.” Aphasia can differ in its level of severity and can showcase itself as different “types” dependent upon if 1) speech is fluent and uninterrupted, 2) if a person can comprehend spoken messages, and 3) if a person can repeat words/phrases. 

Aphasia is acquired - it is not present developmentally or following birth - and can typically accompany the diagnosis of stroke. Aphasia can also occur as a result of other types of brain damage (e.g., traumatic brain injury, brain tumor, meningitis, seizures, encephalopathy) or be the sign of the onset of neurodegenerative disease (e.g., dementia). Generally, aphasia does not impact a person’s level of intellect, but rather how a person processes, understands, and uses language to interact with their environment. 

Language skills may be impacted in isolation or several may be impacted at once. Initiating, maintaining, and closing communication with individuals with aphasia can at times be frustrating for the speaker and the listener. If communicating with a person who has aphasia, consider implementing the following tips:

1. Secure the attention of the person with aphasia before you start speaking.
2. Maintain eye contact. Watch body language and gestures that are used.
3. Talk in a quiet place. Turn off the TV or radio.
4. Keep your voice at a normal level. You do not need to talk louder unless asked.
5. Keep the words you use simple but adult. Don't "talk down" to the person with aphasia.
6. Use shorter sentences. Repeat key words that you want understood.
7. Slow down your speech.
8. Give the person with aphasia time to speak. It may take longer. Try not to finish sentences for them.
9. Try using drawings, gestures, writing, and facial expressions. Sometimes, they may be easier to understand than words. 
10. Ask the person with aphasia to draw, write, or point when they are having trouble talking.
11. Ask "yes" and "no" questions. Those are easier to answer. 
12. Let mistakes happen sometimes. The person with aphasia may not be able to say everything perfectly all the time.
13. Let the person with aphasia try things for themselves. They may need multiple times to try. Provide help when asked. 

There is much that we do not know about Bruce Willis’ diagnosis, such as what the primary cause of his diagnosis is, what components of language (speaking, understanding, reading, writing) have been impacted most, and how long he has been dealing with the impact(s) of aphasia. Although there are many unanswered questions, what we do know is that this revelation has placed aphasia in the spotlight. It is a diagnosis that more of the general public should be aware of given its high prevalence - it’s estimated that 1 in every 250 people in the US is living with aphasia. Persons with aphasia should be afforded the same opportunities to engage socially and maintain strong connections with others. The more the public understands about aphasia, the more support can be offered for persons with aphasia. 
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June is Aphasia Awareness Month. If you are looking for resources specific to all things aphasia, consider the following websites: 

• American Speech-Language-Hearing Association (https://www.asha.org/)
• National Aphasia Association (https://www.aphasia.org/) 
• American Stroke Association (https://www.stroke.org/en/about-stroke/effects-of-stroke/cognitive-and-communication-effects-of-stroke/stroke-and-aphasia)