Common Speech Errors in Aphasia

If you know someone with aphasia – or perhaps if you have aphasia, you’ve probably noticed that words don’t always come out as planned. Someone might mean to say the word “desk” but instead say “chair” or “tesk” or even a nonsense word like “joom.”

It can help to know some common errors for people with aphasia.

Semantic Paraphasia

Saying one word in place of another

Example: saying “hammer” for “flashlight”

Phonemic Paraphasia

Saying something that sounds similar to the intended word

Example: saying “knike” for “knife”

Neologism

Using an invented word or a non-real word

Example: saying “fibble” for “horse”

Circumlocution

When a person has difficulty thinking of the word, so they describe it instead

Example: “it’s a thing that flies up in the air on a string… you know, it’s a toy” for “kite”

Perseveration

Getting stuck on a previous word after attempting to move on

Example: A person correctly names “socks,” but the next item is a coat, and they say “socks” again

Conduit d'approche

When a person has difficulty saying a word and repeatedly attempts to self-correct

Example: “frigalator, frigigator, frigaliterlater, refrigetator” for “refrigerator”

These are all common errors for people with aphasia. If you know someone who has had a stroke or brain tumor that affects their language, you may have noticed some of these speech problems. You may have also read some of these words in a speech therapy evaluation or progress report.

There are also other “tricky concepts.” This is a generalization,

but many people with aphasia have problems with the following categories:

Tricky Concepts:

- Opposites (yes/no, right/left, up/down)

- Letters/Numbers

- Months/Days

- Colors

- Shapes

- Body parts

- Family relationships

- Pronouns

Of note, these “tricky concepts” are often some of the very last language problems to resolve. Even very high level people with aphasia will commonly have difficulty saying or listening to dates and times, or may accidentally say “he” when they mean “she.”

As a conversation partner, it can help to be aware of these patterns, because you might offer extra support (ex: visual aids) when dealing with any of these tricky concepts. You can use calendars, pictures of family members, write key words, or draw pictures. It can also help to confirm what was said to double check that the right word came out.

Remember, speech errors can be very frustrating for people with aphasia. Be patient and give them time!

Tips for Talking to People with Aphasia

Many family members, friends, and caregivers report difficulty talking to their loved ones with aphasia. But when you have aphasia, it’s more important than ever to have conversations!

Here are a few tips for how to talk to a stroke survivor with communication difficulties.

Be Patient

Patience is everything – this is the most important tip! People with aphasia often need extra time to think of the right words or process what you’ve said. Stay engaged, keep eye contact, but stay quiet. Make sure you’re talking with the person, rather than for them. If you try to finish their sentences, it can be very frustrating and make it even more difficult for them to get their words out. Be comfortable with silence and be patient.

Use Visual Cues

Since comprehension can be affected, visual cues are extremely helpful to add context to the conversation. Some examples of visual cues are facial expressions, gestures, pointing, using pictures, actual objects, and writing down key words. This will help connect the visual information (what they see) to the auditory information (what they hear).

Face-to-Face is Best

If possible, talk in a quiet environment where you can see each other face-to-face. This way, you can use facial expressions, gestures, and other visual cues to facilitate conversation. Talking on the phone tends to be difficult, but a video call or FaceTime can be easier. Reduce distractions by turning off the TV, closing doors, and keeping background noise to a minimum.

Don’t Talk Loudly (unless the person is hard of hearing)

Stroke survivors may have trouble understanding, but talking louder doesn’t help. It’s not that the person has difficulty hearing you – their ears are fine! The problem is that their brain has difficulty interpreting auditory information. Allow extra time for processing instead. It can also help to break up your long thoughts into shorter, more direct statements.

Talk About the Here and Now

Talking about the “here and now” tends to be easiest because the immediate environment often provides more context for your conversation. You are also looking at the same things and can point or gesture to objects in the room. It is more cognitively demanding to discuss abstract concepts (ex: past/future, hypothetical situations). However, visual cues – such as a calendar, a picture, or writing key words can help.

Don’t Pretend

Don’t pretend to understand what your loved one is saying if you aren’t quite getting it. Acknowledge their attempt, but tell them you haven’t quite figured out what they’re trying to say. Confirm the parts that you do understand, and ask if they can give you any more information. If they’re having trouble, you can ask questions (remember to pause and be patient after each one) or offer multiple choice options. When you think you understand, confirm with your loved one.

The National Aphasia Association and the American Heart Association teamed up to make a great one-page poster with communication tips. Print this out and put it on your fridge to help you remember how to talk to your loved one after a stroke.

Source: https://www.aphasia.org/aphasia-resources/communication-poster/

Do you have more tips? Let us know!

Types of Aphasia

There are many different types of aphasia. Language is stored in several areas of the brain, so the type of language difficulty someone has depends on the part of the brain that was affected.

In reality, everyone’s brain is different, and each aphasia is slightly different too. Sometimes people will have aphasia that does not fit neatly into one of these categories. This is especially true for people who are multilingual, or people who are left-handed. Nonetheless, learning about common types of aphasia can be helpful.

Blumenfeld’s “Neuroanatomy Through Clinical Cases” has a diagram that illustrates some of the most common types of aphasia.

Types of aphasia, found in Blumenfeld’s “Neuroanatomy Through Clinical Cases”

Global Aphasia

Global aphasia is very severe. People with global aphasia will have difficulty with all language domains: talking, understanding, reading, and writing. They will say very few words, or they may say no recognizable words at all. They will understand very few words, or no words at all. They are unable to read or write. People with global aphasia can often evolve toward a different subtype of aphasia with time and/or speech therapy, but prognosis depends on the extent of the damage that caused the aphasia.

Mixed Transcortical Aphasia

Mixed transcortical aphasia is similar to global aphasia, but with the ability to repeat. A person with this type of aphasia will likely have very little voluntary speech, poor comprehension, and difficulty reading and writing. However, they will quasi-automatically repeat back words that they hear. The main areas of language are typically not damaged, but the brain tissue nearby is, which leaves the language areas isolated from the rest of the brain.

Broca’s Aphasia

Broca’s aphasia is a very common type of aphasia. People with Broca’s aphasia know what they want to say, but have difficulty getting their words out. Speech is slow and effortful. They can often understand most of what is said – especially clear, direct sentences, but may struggle to understand more complex grammar and/or longer sentences. Concrete nouns and verbs are easier to say than small grammatical words.

Transcortical Motor Aphasia

People with transcortical motor aphasia have significant difficulty producing spontaneous speech, but they can repeat phrases and sentences. Comprehension is largely preserved, but writing is difficult and often mirrors their spoken language. People with transcortical motor aphasia have a very hard time initiating speech, and sometimes, difficulty initiating other motor movements too.

Wernicke’s Aphasia

Wernicke’s aphasia is characterized by difficulty with auditory comprehension. This aphasia occurs when the area of the brain responsible for processing spoken words and attaching meaning to them is damaged. People with Wernicke’s aphasia are typically unaware that they are having difficulty. They can talk at a normal rate and rhythm. However, they often string together words that don’t make sense and include seemingly random or made up words.

Transcortical Sensory Aphasia

People with transcortical sensory aphasia also have significant difficulty with auditory comprehension. They can talk at a normal rate and rhythm, but typically have lots of errors in their speech. They are able to repeat words and phrases, sometimes repeating a question or part of a question back to the listener. They may have visual field deficits, or difficulty recognizing visually presented objects. They may have difficulty copying a line drawing.

Conduction Aphasia

Conduction aphasia is a type of aphasia where people can typically understand most of what’s being said and speak at a normal rate and rhythm. They still have errors in their speech, but have a high level of awareness of these errors. A hallmark of conduction aphasia is to attempt to fix errors in their speech, often getting closer and closer to the target word with repeated attempts. They have difficulty repeating, but can typically paraphrase what they’ve heard.

Anomic Aphasia

Anomic aphasia is the most mild form of aphasia. A person with this type of aphasia is relatively functional with speaking, understanding, reading, and writing. However, they have difficulty with word finding. Their speech is fluent, but with frequent pauses for word finding. When they have difficulty thinking of words, they tend to use vague language, such as “those things” and “the stuff over there” or attempt to describe the object they are thinking of. This also occurs in writing.

There is one more type of aphasia that is different from those mentioned above.

Primary Progressive Aphasia (PPA)

Despite its name, Primary Progressive Aphasia (PPA) is a type of frontotemporal dementia. It is caused by a deterioration of the areas of the brain that are involved in speech and language. This condition progresses slowly. People with PPA can lose the ability to speak and write and, eventually, to understand written or spoken language. There are also various subtypes of PPA.