Speech Therapy for Aphasia: How Can Adults Rebuild Communication After Stroke
Written by Mariya Kika, M.H.Sc., Reg. CASLPO, Speech-Language Pathologist
Table of Contents
What are the symptoms of aphasia?
Are there different types of aphasia?
Does aphasia look the same in everyone?
How does speech therapy help aphasia?
What is aphasia
Aphasia is a language disorder caused by damage to the parts of the brain responsible for communication. It is one of the most misunderstood conditions that speech therapists treat. It can affect an individual’s ability to speak, understand language, read, or write.
Importantly, it does not affect intelligence. It disrupts language.
The thoughts are still there; it’s the connection between thought and word that has changed. That distinction matters, because it means the person one was before is still present, even when communication feels frustrating or out of reach.
What Causes Aphasia?
Aphasia is most often caused by stroke, but it can also result from:
Traumatic brain injury
Brain tumor
Progressive neurological conditions, such as dementia
What are the symptoms of Aphasia?
Individuals with aphasia may:
Have trouble finding the right words
Have the words, but have trouble saying them
Have difficulty understanding what others are saying
Experience writing challenges, such as missing letters or creating sentences
Experience reading challenges
Speak well, but lack meaning in their sentences
These symptoms can lead individuals to:
Experience frustration in conversation
Feel isolated due to communication barriers
It’s important to re-iterate that intelligence and cognition are not affected by aphasia. Often these individuals have a thought they’d like to share, but experience difficulties getting it across.
Are there different types of aphasia?
Broadly, there are two main types of aphasia:
Expressive Aphasia: Difficulty speaking and/or writing
Receptive Aphasia: Difficulty understanding and/or reading language
In other words, expressive aphasia is about getting a message out where receptive aphasia is about getting a message in. Other terms that are often used are Broca’s aphasia and Wernicke’s aphasia; these refer to the regions in the brain that are impacted. Broca’s aphasia refers to expressive aphasia difficulties and Wernicke’s aphasia refers to receptive aphasia.
These are the two main aphasia types, and each encompasses sub-types of aphasia that are dependent on the location of the injury or stroke, as well as the presenting symptoms. They may also co-occur, leaving individuals with difficulties in both expressing themselves and understanding what was said to them.
Does Aphasia look the same in everyone?
The specific effects on speaking, understanding, reading, or writing will depend on which parts of the brain were affected. The severity of these effects are also dependent on the part of the brain that was affected and the severity of the cause, such as a stroke or brain injury.
What’s more, the degree to which these effects impact individuals will vary. It will depend on their own strengths and challenges, as well as their daily functioning.
No two people will experience aphasia exactly the same way.
For example, two individuals may have had the same type of stroke and now both experience an expressive aphasia. One may have difficulty with apraxia, motor planning for speech, where the other may have difficulties writing and they both have difficulties finding words. Identifying this difference is important because it directly impacts what speech therapy will target.
How does speech therapy help aphasia?
Speech therapy beyond the hospital is a key factor in aphasia recovery. A speech therapist will evaluate an individual’s current language abilities, their specific patterns of aphasia, and incorporate their communication goals into therapy. These might be reading to grandchildren, ordering at a restaurant, or returning to work.
Speech therapy for aphasia can include:
Restorative exercises rebuild word retrieval and sentence structure
Compensatory strategies for getting a message across when the exact words aren't available
Communication aids and apps that provide in-the-moment support
Training for family members and communication partners
The Life Participation Approach to Aphasia (LPAA) to ensure that an individual’s re-engagement with life and community is central to therapy and goals
Do you need a diagnosis before starting speech therapy?
No, a formal diagnosis isn't required to start speech therapy for aphasia. While it does often occur after inciting events or diagnoses, a formal diagnosis of “aphasia” is not required from a physician to be eligible for speech therapy. And speech therapy does not have to be a last resort after having “tried everything else first”.
Whether symptoms started recently or have been present for a while, progress is still possible. Aphasia recovery can continue well beyond the initial months after a stroke or injury. A speech therapy assessment will provide the guidance needed to identify symptoms, goals, and treatment planning.
Common Questions About Aphasia
Is aphasia a sign of low intelligence?
No. Aphasia is a language disorder, not a cognitive or intelligence disorder. It disrupts the connection between thought and word, but the underlying thoughts and intelligence remain intact.
What is the most common cause of aphasia?
Stroke is the most common cause of aphasia. It can also result from traumatic brain injury, brain tumors, or progressive neurological conditions like dementia.
Can aphasia improve years after a stroke?
Yes. While the most rapid recovery often happens in the first few months, many adults continue to make meaningful progress with speech therapy well beyond that window.
How long does speech therapy for aphasia take?
There is no fixed timeline. Treatment length depends on the type and severity of aphasia, the person's goals, and how they respond to therapy. Progress is typically measured against personal, daily-life communication goals rather than a set schedule.
Do I need a doctor's referral to start aphasia therapy?
No. Speech therapy can be accessed and initiated at any time by anyone, including caregivers and family. You don't need to have completed other treatments first, and it's worth reaching out directly to ask what's needed to get started.
About the author
Mariya Kika is a registered speech-language pathologist and the founder of Cognicare Speech Therapy, operating virtually across Ontario. She holds a Master of Health Science from the University of Toronto. She previously worked as the sole speech-language pathologist at Altum Health, part of Toronto's University Health Network, providing outpatient neurorehabilitation that centered return-to-work care. She is a member of the Canadian Concussion Network, Ontario Brain Injury Association, Toronto Brain Injury Association, and Canadian Telerehab Community of Practice.
For more on specific conditions, see Stroke & Aphasia, Brain Injury & Concussion, and Speech Disorders.