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Posted Feb 24 2010 12:00am

          Aphasia is a disorder that results from damage to portions of the brain that are responsible for language.  For most people, these are areas on the left side (hemisphere) of the brain.  Aphasia usually occurs suddenly, often as the result of a stroke or head injury, but it may also develop slowly, as in the case of a brain tumor, an infection or dementia.  The disorder impairs the expression and understanding of language as well as reading and writing. As nurses, we need to take a full assessment of the disease process in caring for the patient with aphasia, particularly in learning ways to sharpen our communication skills to provide for their specific needs.   

          Anyone can acquire aphasia, including children, but most people who have aphasia are middle-aged or older.  Men and women are equally affected.  According to the National Aphasia Association, approximately 80,000 individuals acquire aphasia each year from strokes.  About one million people in the United States currently have aphasia.  Aphasia is caused by damage to one or more of the language areas of the brain.  Many times, the cause of the brain injury is a stroke. A stroke occurs when blood is unable to reach a part of the brain.  Brain cells die when they do not receive their normal supply of blood, which carries oxygen and important nutrients.  Other causes of brain injury are severe blows to the head, brain tumors, brain infections and other conditions that affect the brain.

          Common characteristics displayed by a person who has aphasia may include decreased attention, decreased memory, inability to recall specific words, poor auditory comprehension, lack of ability to use words or gestures to make needs known, and high levels of frustration.  Some areas will be affected greater than others.  The person with aphasia will most likely have weakness or paralysis of the right side of their body.  This is because the left hemisphere of the brain is usually where language is located and the left side of the brain controls the right side of the body.  Although it is rare, a person may have aphasia resulting from a stroke in the right hemisphere of their brain.  In this case, the person would experience weakness or paralysis on the left side of their body.

          A nurse is normally the first person to see a patient just after admission to the floor.  There are several things we must do and not do as nurses caring for the patient with aphasia:  

Do talk simply and naturally and encourage the patient to respond in whatever way he/she can.

Do include him/her in the daily affairs. Consult the individual for their decisions in matters.

Do explain what has happened to the patient.  Reassurance may be provided by an intelligent, simple explanation.

Do encourage gestures and talking with hands.

Do tactfully change the subject when the patient is frustrated in trying to explain something.

Do keep any instructions and explanations simple.  Try to keep your conversation geared to the patient’s immediate needs or surrounding.

Do encourage the use of greetings and social exchanges such as “Hello” and “Thank You”.

Do utilize routine activities for speaking.  Let the patient ask for what is needed regarding dressing or mealtime issues.  If he/she is unable, say the word for them.

Do ask direct questions requiring a simple “yes” or “no” rather than those requiring complex answers.

Do educate family members on the tips for communicating at home.      

Do speak as if he/she were a child, deaf or retarded. Treat the individual like an adult and simplify or rephrase your wording without shouting.

Do discuss the patient’s emotional reactions and problems in his presence.

Do give false optimism; reassure and be empathetic instead.

Do confuse the patient with too much idle chatter or too many people/distractions in the room.

Do answer for the patient if they are capable of speaking. 

          The effects of a patient dealing with aphasia can be devastating for everyone related to an individual who suffers from the disorder. From the onset of a stroke, or any type of brain injury, many families have questions about the rehabilitation process and how to deal with the communication impairments that are left behind.  Hopefully these tips will help the nurse in caring for the patient with aphasia. 


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