Break the Silence of Aphasia with Specialized Speech-language Rehab

In March 2022, the family of action movie hero Bruce Willis announced he had been diagnosed with aphasia – a neurological disorder that robs patients of verbal communication abilities – and that he would be stepping away from acting.

Aphasia occurs as a result of damage to the speech centers of the brain; approximately 180,000 people are diagnosed each year in the U.S. – three times the rate of Parkinson’s disease diagnoses.

Though aphasia is less common as a standalone diagnosis, it is widely recognized as a side effect of Alzheimer’s disease, brain injury, or stroke. Indeed, the “S” in the “BE FAST” mnemonic for identifying signs of stroke stands for slurred or lack of speech.

I heard about Willis’ aphasia diagnosis while I was making rounds with my patients in our stroke program. Losing some or all of your communications skills is difficult for anyone. For an actor who made his mark with edgy banter in films like Die Hard, Pulp Fiction, and Look Who’s Talking, not to mention the TV show Moonlighting, seems almost tragic.

Since the announcement, several peers and patients have reached out to me with questions due to my specialization in treating aphasia, particularly the four main types:

1. Broca’s: Patients have trouble speaking but retain comprehension (nonfluent aphasia). It is caused by brain injury or lesions. "Broca's area" is in the frontal lobe of the brain, usually on the left side, and connected to production of speech.
2. Wernicke’s: Patients have trouble understanding spoken words (fluent aphasia). This form is caused by brain injury or lesions. "Wernicke's area" is in the temporal lobe on the left side of the brain and is responsible for understanding speech.
3. Global: With this most severe form, patients struggle to speak and understand language. It is also caused by brain injury or lesions.
4. Primary progressive aphasia (PPA): Speaking, writing, reading, and comprehension get worse over time It is caused by gradual degeneration of communication centers in the brain.

Some forms of aphasia can be treated and controlled. However, PPA is a lifelong, progressive condition that requires swift, specialized neurorehabilitation. Patients need personalized care – and patience – as they learn new skills to replace those that aphasia robs them of, such as self-expression, some cognitive abilities, swallowing, and even breathing automatically.

At UT Southwestern’s Peter O’Donnell Jr. Brain Institute, our neuro-trained speech-language therapists provide acute aphasia treatments. UT Southwestern’s William P. Clements Jr. University Hospital, which in December 2020 opened its third tower, is equipped with the most advanced technology and specially designed quiet spaces for our patients to hone their speech-language skills.

Rehab and treatment for aphasia

Aphasia occurs when there are changes in either the left- or right-side speech centers in the brain: the left controls conversational speech and the right controls creative speech, such as singing. During neurorehabilitation, we focus on practicing activities that stimulate the unaffected side of the brain to take over some of the lost speech faculties.

For PPA, which gets worse over time, we focus on adaptive communication strategies to achieve a new normal. Though speech may not return fully, a speech-language therapist can teach you to use manual and digital tools to express yourself. Patients with neurodegenerative aphasia also learn techniques to reduce the risk of complications, such as choking on or aspirating food when the brain becomes uncoordinated.

Depending on the type of aphasia, treatment may include a combination of proven methods to reduce risks and restore some or all communication abilities.

Speech-language therapy (SLT): Our neuro-trained speech therapists initiate adaptive strategies as well as strengthening exercises for the unaffected speech center of the brain. For example, you might practice a series of vocalizations over and over, and we’ll increase the challenge with each session. With our leading-edge equipment and specialized training, we can adapt the treatment plan to best suit each patient’s specific communication deficits.

Melodic intonation therapy: It’s not uncommon to hear patients singing in our aphasia clinic – singing activates the right side of the brain, allowing us to retrain that speech center to take over more left-brained communication. Patients can sing along with their favorite tunes from home or chant to our metronome as they work to regain speech.

Medications: While there are no medications that specifically target speech centers of the brain, certain drugs for progressive dementia can increase the level of acetylcholine, a neurotransmitter that helps conduct brain signals associated with communication.

Mental health support: Aphasia dramatically changes a patient’s role at home, work, and in the community, and because of that some struggle with anger, frustration, isolation, and depression. Our specialists are trained to screen patients for anxiety and depression throughout the course of care.

For example, we ask patients to return to the hospital within 30 days after a stroke that causes aphasia to identify emotional concerns. Our rehabilitation psychologists can help patients and caregivers access individual and group mental health support here and in their local community.

Stepping up stroke rehab

“Stroke recovery is a combination of hard work, faith, and hope, all of which we provide and believe in as part of an integrated team,” says Nneka Ifejika, M.D., M.P.H., Chief of Stroke Rehabilitation at UT Southwestern. Meet Dr. Ifejika and some of the stroke recovery team as they highlight the care and rehabilitative therapy patients can expect at UT Southwestern.

The future of neurorehabilitation

As Mr. Willis’s case shows, even the most “Unbreakable” people can lose the ability to communicate. UT Southwestern is launching a study to determine whether quicker implementation of rehab might reduce devastation from aphasia and perhaps recover more of a patient’s speech and comprehension.

After a stroke, the current protocol is to start rehab the following day. In our study, we are examining whether specific blood biomarkers that indicate brain inflammation and nerve damage can pinpoint which patients might benefit earlier rehab, within 24 hours after a stroke. We can assess whether positive change occurred by measuring these biomarkers incrementally during treatment. Our goal is to enroll hundreds of patients in this study, giving us data to potentially help more patients, more quickly.

Future studies will explore the role of brain stimulation and neuromodulation to treat patients with neurological symptoms, such as aphasia occurring after stroke. We hope that combining stimulation with rehabilitation can maximize patients’ neurological function and quality of life.

Vocal expression and communication make up a huge part of our personalities. Losing that ability makes life more challenging for patients and their families. If you or a loved one are concerned about a waning ability to speak, read, or process language, connect with a specialist. With a precise diagnosis and personalized treatment, we can help recover part or all of your communication deficits.

To meet with an aphasia expert, contact us a 214-645-8300 or request an appointment online.