Must-Know Tips For Working With Aphasia As An Occupational Therapist
Brain damage, no matter what the cause is, can have devastating consequences on an individual’s daily function and quality of life.
Movement restrictions, emotional changes, behavioral problems, and communication deficits differ in severity but if present, drastically reshape a person’s life as well as those of their close family and friends.
In this post, you’ll learn about one of the most frustrating disorders that can occur from brain damage. It can be a challenge for the patient/client and for the occupational therapist.
The disorder is called aphasia.
What is Aphasia?
Aphasia is a communication disorder that occurs when the language parts of the brain sustain damage or injury. Roughly 25-40% of stroke survivors get some form of aphasia (NAA, 2017).
Aside from stroke, aphasia is also associated with epilepsy, brain tumors, traumatic brain injury, dementia, and infection of the brain tissue. There are several types of aphasia:
Expressive Aphasia (Non-fluent)
This is also referred to as Broca’s aphasia. The affected person knows, in their mind, what they want or what they want to say but when it is communicated the words (verbal and written) come out in shards. Commonly, the patient will utter single syllable sounds/words or sometimes nothing at all.
Receptive Aphasia (Fluent)
Also referred to as Wernicke’s aphasia because of the area of the brain affected, receptive aphasia is demonstrated when the person can hear or read a language but is unable to comprehend the meaning behind it. Sometimes their own speech gets churned into non-sense sentence structures or they take speech very literally (Web MD).
With anomic aphasia, the person struggles or is unable to find the right words for speaking or for writing. Typically, they can’t seem to find nouns and verbs and frequently use vague, filler words (“thing,” “stuff,” etc.). The person will sometimes demonstrate circumlocution, in which they start describing the word they are trying to identify (ASHA.org).
The affected person has a severely limited capacity for reading, writing, and speaking. The damage is extensive and often occurs to both Wernicke’s and Broca’s area of the brain. Although people with global aphasia can improve, the rate and extent of improvement really depend on the severity of the brain damage (NAA, 2017).
Primary Progressive Aphasia
Primary progressive aphasia is an extremely rare disorder where the affected individual loses the ability to read, write, talk, and understand language over time. Unlike other types of aphasia, there is no treatment to reverse the progressively worsening damage of PPA (NAA, 2017).
It is thought to be caused by the atrophy of certain lobes (frontal, temporal or parietal) due to abnormal proteins. The biggest risk factors for PPD are learning disabilities and certain rare gene mutations (Mayo Clinic).
Check out this short and helpful Ted-Ed video explaining aphasia:
Not only is the above video helpful for therapists, but it is also a great video to share with patients and their family members new to aphasia.
How to Approach Treatment as an OT
Occupational therapists working with the adult population will inevitably have run-ins with patients post-stroke or brain injury exhibiting the symptoms of aphasia.
Unfortunately, aphasia is not something the you as the therapist can simply ignore during the session going about your typical intervention.
Aphasia changes everything about treatment including delivery, comprehension of instruction, and application of functional tasks.
Here are two different scenarios for comparison:
Sally is a 57-year-old female who was recently admitted to a skilled nursing facility to undergo treatment post-stroke. She demonstrates right-side hemiplegia throughout her right lower and upper extremities. She tells her occupational therapist that her primary goal is to shower safely at home with the assist of her husband. When she initially arrived, she required Maximum assist using a 3-in-1 wheeled shower chair. Now, with the help of her OT, she can complete her showering with Contact-guard assist from her husband using a walker and a shower chair at home.
Now, let’s add aphasic symptoms into the mix.
Sally is a 57-year-old female who was recently admitted to a skilled nursing facility to undergo treatment post-stroke. She demonstrates right-side hemiplegia throughout her right lower and upper extremities as well as global aphasia. She is unable to communicate her primary goals to therapy. Although she recognizes her husband, she frequently gets frustrated with him because she can’t understand him when he’s trying to help her with hygiene tasks. She often refuses showers from nursing staff by trying to pull away from them when they are directing her into the bathroom. If too many people are talking to her or around her at once, she shuts down or lashes out.
Tailoring Your Approach
Aphasia can affect Sally’s situation in more ways than one but the second scenario captures just a few of the possibilities. Without typical, adult-level language, her occupational therapist is presented with some inescapable challenges. So, what would occupational therapy be doing to promote a patient’s progress?
Focus on the Cognitive Deficits
Without neglecting other impairments, the OT needs to make the cognitive deficits a priority.
Pull out relevant standardized tests that you are comfortable with administering to your patient. Bring out compensatory strategies such as picture books, communication boards, and auditory aids.
If you’re uncomfortable or unfamiliar with how to provide treatment for your patients experiencing aphasia, then seek out continuing education courses that will help you start to build confidence with these patients.
Recruit Assistance from SLP
Speech-language pathologists make their living working with patients with language and communication impairments.
Their educational background and continuing training are insightful and incredibly relevant for patients with aphasia. If you are having difficulty working with your patient with aphasia, you can seek out training and tips from SLPs as well as incorporate cotreatments during the course of the patient’s therapy.
Consulting my SLP coworkers on patients with aphasia has been incredibly helpful for me personally in my inpatient rehab setting.
Modify Your Own Communication Style
Occupational therapy practitioners need to be 100% mindful of how they are communicating with their patient as well as how the patient is attempting to communicate back.
Note whether or not verbal instruction is affirmed by the patient or alternatively frustrates the patient. Progress through 1-step, 2-step, or 3-step commands according to what the patient can tolerate. If anything, start relying on silence and tactile/visual cues more than verbal cues (Communication Tips, Aphasia.org).
Provide Education to Caregivers and Family Members
Family members and staff who are unfamiliar with aphasia should also be provided with education on how to communicate more effectively with the patient. You as the OT should be letting relevant family and staff know what communication strategies are working during their sessions and as well as what types to avoid.
We hope these tips help you get a good grasp on working with this difficult condition and also helps you and your patients with aphasia succeed in working towards their goals.
What would you add to this list that has helped you when working with clients with aphasia? Please share your experiences and thoughts in the comments below.
This post was originally published on December 5, 2017 and updated on June 23, 2021.
References and Resources
Mary V. Radomski. (1983). Sourcebook For Aphasia. A Guide to Family Activities and Community Resources.
American Language-Speech-Hearing Association: www.asha.org
An Overview of Aphasia: http://www.webmd.com/brain/aphasia-causes-symptoms-types-treatments#1.
National Aphasia Association: www.aphasia.org.
Nice post, Sarah!
An addition that i dont think is discussed often enough (although i do think your post implies it!): it is important to discuss the likely prognosis of the client’s issues, as well as the patience required of the client’s loved ones. Too often have i witnessed the hopeful gleam in the eyes of friends and family that see OT’s as their last line of hope, just to see their disillusionment after months with seemingly little progress.
One of the many unfortunate side effects of low exposure of OT to the general public is that their high expectations in situations like these are too often met with relatively poor outcomes. That is, what seems like major strides to us can seem like inconsequential differences to them, which is why it is important we discuss with them these possibilities.
Either way, great tips! Just found your blog but Im lovin it. Keep up the good work 🙂
The reason why I would use this resource is because it is relatable for what I am going in to and it is great to help me answer questions for this assignment.
I’m so glad it’s helpful for you!