Aphasia is a language disorder that can impact the ability to speak, listen and understand, write, and/or read.

• Speaking: Aphasia impacts the ability to find the right words and put them together in a way that makes sense. Some people with aphasia might say one or two words, often nonsense words, any time they want to answer a question or start a conversation. Others might be able to recall and say only a few words during a conversation. Still others can speak complete sentences easily but their words, or the order in which they are said, do not make sense.
• Listening and Understanding: Many people with aphasia can hear others well but experience difficulty understanding what is being said to them. For some, the difficulty occurs when the question is long or the conversation is complicated. For others, difficulty understanding happens with simple or short messages too.
• Writing: If a person with aphasia has difficulty speaking, he or she may also have difficulty writing. The way a person writes may be similar to how he or she speaks or it may be even more impaired.
• Reading: Problems with reading often reflect difficulties that people with aphasia have with listening and understanding. If someone has a hard time understanding what others say, they may also have a hard time understanding written words and sentences.

Aphasia does not look the same in all people. For some people, aphasia is very mild. For others it is very severe. For some people, only speaking or only listening is impacted. For others, all four areas are impacted.

Aphasia is typically diagnosed and treated by speech-language pathologists. While there is no cure for aphasia, speech therapy can help to restore as many abilities as possible and compensate for.

Aphasia is caused by damage to the areas of the brain that control language. Different types of aphasia are caused by damage to different locations in the brain. Most commonly, aphasia is caused by damage from a Cerebrovascular Accident (CVA) or stroke. Brain injuries, tumors, or other neurological events can also cause aphasia.

It is important to note that not everyone who has a stroke has a diagnosis of aphasia. Henry Evans is one example of an individual who has had a stroke but does not have aphasia.

AAC stands for Augmentative and Alternative Communication. Augmentative communication refers to adding to what someone can say using speech. It helps individuals say more than they could using their speech alone. Alternative communication is refers to substituting for natural speech. It helps individuals who are not able to talk at all be able to express themselves.

AAC takes many forms. These forms include facial expression, body language, gestures, writing, and drawing-tools we all use either to supplement our speech or in as a replacement when we are not able to talk (e.g., we are sick or when we are expected to be silent). While these forms of AAC can be helpful for individuals who are not able to communicate everything they want using speech, they may also need something more. As a result, AAC can also involve tools like sign-language or objects, photographs, drawings, or printed words to which an individual can point to share an idea. Sometimes, a collection of photographs or drawings printed on one page (communication board) or several pages (communication book) is introduced. Finally, AAC tools can involve a computer-like device that speaks when a letter, word, or symbol is selected. We refer to these tools as speech-generating devices.

AAC can help individuals with aphasia in two ways. It can help to build language skills (remediation) and it can help make communication more successful (compensation).

Remediation activities, such as tasks that address finding words, putting them in the right order, and/or understanding what others are saying frequently happen during speech and language therapy. AAC can be a tool for remediation by providing a visual and/or auditory cue that supports what the therapist is saying or how the person with aphasia should respond.

AAC can also be used to compensate when individuals need to communicate but cannot effectively use their speech. Many times, these situations occur outside the therapy room and include the broad categories of daily activities (chatting about current events, ordering food at a restaurant, banking or creating a grocery list), personal narratives (maintaining closeness with family and friends by telling stories), and meeting specific needs (calling for assistance, providing directions or delivering a speech). AAC can provide all or just part of what an individual needs to communicate in these situations.

These FAQs are variations of the same question. Basically, the assumption is that if people can communicate functionally in some situations, or with some people, they don't need AAC. What happens when the situation changes though? For example, what happens when the gentleman who can meet his basic needs discovers that he has run out of coffee beans so he cannot make his own coffee? What happens when he just decides he wants tea instead of coffee in the morning but there isn't any in the cabinet? What happens when his wife goes to visit a new grandchild and he needs to tell his son, who has come to stay with him, how to trim his mustache? In the second situation, what happens when the woman goes to the doctor and the doctor asks her a question? What happens when she watches a show on TV that her husband has never seen and wants to talk about it?

In answering these questions, it is important to consider four things:

1. Familiar communication partners might not always be available. When this happens, is the person with aphasia still able to communicate?
2. Relying on communication partners to interpret communication, or even prevent the need for communication by automatically providing for needs, does not allow for independence. With all of the changes that occur following a stroke, finding ways to maintain some independence is very important.
3. Communication is not always predictable. When we are at home, we sometimes want to talk about things unrelated to home, like friends, community events, or movies. When the number of potential communication topics increases, it can be harder for even the most familiar communication partners to understand.
4. Finally, we all change. Even in familiar settings, we might want a different beverage or a different hair style or a different magazine. If attempts to communicate something different are misunderstood by communication partners, people with aphasia may "give up" and accept the status quo. Think about how frustrating this would be for you.

AAC can be an important addition to the current means of communication for anyone who is not able to express everything he or she might want to. It can support participation and independence in a variety of communication environments and with a variety of communication partners.

There is no set timeline for when AAC can be successfully introduced to someone who has aphasia. However, since AAC is appropriate when people are unable to communicate fully using their speech, it can be an appropriate tool days, weeks, months, and years after a stroke.

Remember, AAC does not refer to one tool. Rather, it includes a variety of different forms that can be useful at different times and in different ways. For example, within days of having a stroke, gestures for specific needs, a rating scale from "not important" to "very important", a communication board for a favorite activity, or a communication device programmed with pictures and information about family members can be introduced as therapy tools to support the restoration of speech and language skills. Over time, different tools might be added or the same tools might be expanded to support communication about different topics or in environments outside the therapy room.

AAC can be introduced successfully at any point in the rehabilitation process provided that the person with aphasia understands both how and why to use it. When this happens, AAC can help decrease frustration with communication and even prevent depression and/or withdrawal from social situations.

Like we said above, there is no set timeline for when AAC can be successfully introduced to someone who has aphasia. However, waiting to introduce AAC until long after a stroke is not recommended. For the person with aphasia, it means many years without a fully functional means of communication-years of frustration, depression, and social isolation. It sends the signal that AAC is a "last resort" and a sign that improvement is no longer possible.

That being said, there is no reason AAC cannot be successfully introduced years after a stroke. As long as someone is unable to communicate fully using his or her speech, it is appropriate to introduce and teach the use of AAC. This can be done days, weeks, months, or years after a stroke.

There is no evidence that using AAC, even a speech-generating device, will hinder the recovery of speech. In fact, research shows that use of AAC may even have a positive effect on the production of speech. Whether or not a person with aphasia eventually regains enough speech to say everything that he or she wants to say, AAC can provide a way to reduce reduce frustration and maintain social interactions while still working on the production of speech.