A person being prepared to be put in a MRI
By Rawan Tarawneh, MD

The Loudest Silence: How Aphasia Complicates Communication After Brain Injury

Aphasia is a common neurological condition that impacts a person’s ability to communicate with the world around them. Here at UNM Health, research is underway that could demonstrate a new way to help the brain relearn communication after a stroke or brain injury.

Speech and language communication is how humans navigate the world, share their needs and wants and work together to accomplish amazing things. Aphasia can rob a person of that precious ability.

Aphasia is a neurological condition caused by damage to the portions of the brain responsible for speech and language. This damage can happen over time due to a condition such as dementia or suddenly as with a head injury or a stroke.

Stroke is the most common cause of aphasia, and 25-40% of stroke survivors will develop the condition. According to the National Aphasia Association, at least 2 million people in the U.S. have aphasia, and another 180,000 develop it each year.

Though it is more common than cerebral palsy, multiple sclerosis and Parkinson’s disease, 85% of people surveyed in 2016 had never heard the term “aphasia.” The condition was brought into the national spotlight in spring 2022 when the family of popular Hollywood actor Bruce Willis announced he would step away from his career following an aphasia diagnosis.

Willis’s wife, Emma Hemming, recently shared a social media update about how the actor and his family are coping with his diagnosis. She said the family has pulled together to support Willis and one another, and the burden of caretaking and grief while creating a new sense of normalcy is significant.

As the only academic medical center in New Mexico, we are accustomed to helping people with aphasia and their families understand and adapt to this difficult condition.

As the only academic medical center in New Mexico, we’re accustomed to helping people with aphasia and their families understand and adapt to this difficult condition
Rawan Tarawneh, MD

Family Matters with Aphasia

Family involvement is an important part of aphasia treatment. Willis’ family and many others like them learn the best way to communicate with their loved one by participating in therapy sessions, minimizing distractions and including the person in natural adult conversations while allowing them plenty of time to speak and avoiding correcting them.

However, caring for a person with aphasia can be challenging. According to a 2020 study, caretakers of family members with aphasia report worsening:

  • Stress (89%)
  • Emotional well-being (79%)
  • Sleep quality (68%)
  • Physical discomfort (43%)

They said they have trouble maintaining relationships with friends and family and adapting to the dependence of the person for whom they care. Yet 90% of caregivers surveyed also said they work through these challenges because they are invested in the quality of life of the person under their care, and 78% said they want to aid in their recovery.

Caretakers and people with aphasia are also to get involved in activities and support groups outside the home to maintain an active lifestyle. Sites such as and The American Heart Association list aphasia and stroke support groups, which can help caregivers find comfort and ideas to improve their family’s quality of life.

Just as every caretaker experience is different, so is each patient’s aphasia symptoms. In some cases, the type of symptoms a patient has may indicate which type of aphasia is present.

Understanding Types of Aphasia

Aphasia is typically diagnosed by the physician who treats a patient’s brain injury. Using MRI and CT imaging, they can examine the specific part of the brain that is injured. The physician usually also tests a patient’s ability to understand and express language.

There are four general categories of aphasia, categorized by their symptoms and, often, the injured portion of the brain.

  • Expressive (non-fluent) aphasia: Patients with Broca’s aphasia have difficulty making their thoughts known in speech or writing. They know what they want to communicate but can’t find the words. The most common type, it is usually associated with damage to the brain’s frontal lobe.
  • Receptive (fluent) aphasia: Difficulty understanding spoken or written language is common with this type of aphasia. The patient can hear or see spoken or written words, but they’re unable to make sense of them. Wernicke’s aphasia is often the result of brain damage in the temporal lobe.
  • Global aphasia: This most severe type of aphasia involves the loss of all language comprehension and expression. Patients with global aphasia cannot speak, understand speech, read or write. Usually this is a result of severe and extensive brain damage.
  • Anomic or Amnesia aphasia: Patients with these less severe forms of aphasia have difficulty using the correct names for objects, people, places or events.

How well a person might recover is often difficult to predict because aphasia is different for everyone. Generally, patients who are younger or who have less severe brain damage can recover more communication abilities. The affected region of the brain is key, as people tend to recover language comprehension skills more thoroughly than expression skills.

If the doctor suspects a person has aphasia, they are referred to a speech-language pathologist who will examine the person’s communication abilities and determine a treatment plan.

Treatments for People With Aphasia

In some cases, such as following a stroke, the brain can recover from aphasia without specific treatment due to its ability to adapt and change. Some people with aphasia notice significant improvements in the first few months after diagnosis.

For most people, individualized language therapy should begin as soon as possible. Working with a speech pathologist, people with aphasia practice exercises that involve reading, writing, following directions and repeating what they hear. Some patients use computers and tablets at home to continue these exercises and to help them communicate with family members.

The goal of aphasia therapy is to improve a person’s ability to communicate using their remaining language abilities and to restore as much of what was lost as possible. Patients with aphasia also learn other ways of communicating such as using gestures, pictures and electronic devices.

While there are no medications designed to treat aphasia, there are drugs that can slow down symptoms and address the root cause such as Alzheimer’s disease or frontotemporal dementia. These medications work by boosting the amount of acetylcholine in the brain, which helps transmit communication signals.

Recently, music therapy has gained attention as a potential strategy to improve communication and word-finding in individuals with non-fluent aphasias. This notion was conceived when physicians and speech-pathologists noticed that, although aphasia patients are not able to speak or read a sentence, they are able to sing it.

Music therapy sessions with a speech pathologist or music therapist involve repetition of simple phrases in music that gradually transition into more complex phrases and train the brain to re-learn speech through music. Eventually, aphasia patients can turn their sing-song speech into regular speech and maintain these new speech abilities over time.

The Future of Aphasia Treatment

New technologies are beginning to shape the way patients and their families access treatment for aphasia.

University of New Mexico researcher Jessica Richardson, SLP, associate professor of Speech and Hearing Sciences, hopes to find opportunities to maximize the brain’s adaptability. Funded by a $2M grant from the NIH National Institute on Deafness and Other Communication Disorders, Richardson is investigating a non-invasive treatment called transcranial direct current stimulation (tDCS).

In combination with therapy, the application of electrical current through the scalp during tDCS may help “interest” nerve cells near injured portions of the brain to take up communication tasks and quiet others that might be interfering.

With repeated exposure to this electricity, Richardson hopes to demonstrate that patients’ brains change the way they process language. Unlike some treatments that focus on a narrow scope of language like naming objects in a picture, Richardson’s research is aiming to help patients’ recover their ability to access narrative language they can use in everyday life to tell stories, give descriptions and discuss projects.

Aphasia is a difficult condition for patients and for their families. It often results in restructuring daily routines and developing a “new normal,” much like Bruce Willis and his family.

Here at UNM Health Sciences Center, we are honored to treat patients from across the Southwest with all types of aphasia. Our residents and fellows work closely with expert faculty to ensure all patients get care and support as they manage their health.

To discuss aphasia diagnosis and treatment options, call 505-272-4866.

To find out whether you or a loved one might benefit from neurology care
Categories: Neurology