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Aphasia is slippery and inconsistent



Have you ever had the experience of not being able to recall a word, name, or date? Doesn’t it drive you crazy? Eventually you may be able to say what you were looking for, often when you aren’t thinking about it so hard. The information is somewhere in your head, but you couldn’t access it right away. Now imagine that you have aphasia and this is how your brain works all the time!

Our clients with aphasia can become very frustrated with the inconsistency or ‘slipperiness’ of aphasia. One minute you have the word, the next minute it’s gone. All of the feelings of accomplishments are out the window when that happens. I remind our clients that with a lot of practice (retrieving frequently over time), those words get faster and easier.

When you think about aphasia, remember that a stroke or other head injury has caused some brain damage. Your brain is a neural network, which means that the billions of neurons (brain cells) in your brain are connected to each other. When you have a stroke, some of those brain cells and their connections are destroyed. So the usual connections that produced your thoughts, speech, writing, reading, language, etc. have been severed. It’s as though you’re trying to get somewhere in a car and the road has been closed.

There are no “locations” of information stored in your brain. While some areas of the brain are thought to be responsible for certain functions, all of the areas of the brain work together. Damage to one area of the brain doesn’t usually mean that language is totally gone, it just means that the ability to access that information has changed. Words and ideas are thought to be separate patterns of neuron activation, so we have to train a different pattern. So using the driving example, when the road has been closed, it doesn’t mean that your destination has disappeared. It means that the way you get there has changed.

I’ve had a client say “I can’t say ‘french fries’”. When I pointed out that he’d just said it, he couldn’t purposefully do it again. Paying very close attention to a word often causes it to stop working. The connections have to find new paths to travel to reach the information, and until they’re stronger, you may have mishaps. This is why direct confrontation naming or speaking tends to fail; it isn’t as helpful as producing the same information in a more indirect manner. (An example of direct confrontation is how you’ve seen picture naming tasks done “what is this?” and someone holds up a picture of something”.)

Intensive aphasia therapy is a really good way to get a lot of repetition over time with the perfect type of support to become more independent. Repetition over time is learning (neuroplasticity), but it’s different than how you would teach a child. Our goal is to create new patterns (pathways) to reconnect some of these routes through stimulation and practice.

The person with aphasia isn’t purposefully forgetting words or playing around—the connection routes aren’t stable. They aren’t trying to be frustrating on purpose. Remember to have patience during this process and think “those pathways are under construction right now”. Your loved one with aphasia may appreciate this advice, too.


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About Dr. Bartels

Dr. Bartels is the owner of The Aphasia Center Intensive Aphasia Programs. She helps families with aphasia through communication training, personalized treatment plans and customized home programs.