Case Study - Severe Brocas Aphasia Mild Apraxia

Age: 46

Time since stroke/injury: 15 months post-onset


  • Experienced a stroke during skydiving with a subsequent TBI from failure to land on target
  • Sustained visual and hearing loss from his injury
  • Limited interaction with others, could not initiate or participate in conversation
  • Long processing time to understand and answer questions
  • Speech mostly "yeah"
  • very limited reading and writing

He delivered a menu to another client and initiated "order lunch?"

Assessment: Warren was very guarded and did not trust what he did not understand. While his cognitive abilities were very good, he could not initiate speech other than "yeah". His comprehension was limited. He often refused to do some therapy tasks and wanted his therapy materials put into his bag immediately after each use. He did not want anyone helping him. His wife took care of him full-time and just wanted to be able to have a conversation with him. A practical joker before his injury, she missed his sense of humor. Warren's comprehension did not allow for joking at this point.

Treatment: 8 week program including physical and occupational therapies. Warren's goals were to speak in sentences, to use other methods of communication when needed, use technology, compensatory strategies and communication aids to help him express himself. He also worked on reading and writing information about himself and his life.

Results: Despite his demeanor, Warren was very motivated, often getting up in the middle of the night to do his homework by himself. At first, he did not want to do homework with his caregiver or use any aids to help him. He had an Ipad but considered it "cheating" –for the first few weeks he would not use it or allow it out of the backpack.

As his comprehension improved, he began to allow help, work with his wife, use his Ipad, and even ask for help when needed. His delayed responses to auditory information—questions and greetings—became faster. The best part of all—his joking sense of humor came back. He began to use sarcasm and prank therapists and other clients. He became more like his old self to the delight of his family.

At the beginning of therapy, he wrote some of his address and copied a sentence. By the end of his session, his writing scores increased by 30-55%. He wrote write words and sentences we'd practiced as well as new words. He could use a personal book to help him find a word he needed. He could consistently speak in 2-3 word sentences and even longer sentences by reading aloud.