Living with expressive aphasia can be overwhelming. Adjusting to your new reality and finding new ways to communicate is often exhausting.

Like most medical conditions, expressive aphasia can be treated. These treatments are often tailored to help you improve your speech and language skills or help you find alternative ways to communicate. However, these treatments take time to produce results, and sometimes, you may feel like you’re failing at treatment. On the other hand, your treatment for expressive aphasia may truly fail.

Here, we will explore some reasons why your expressive aphasia treatment is failing and how you can address them.

Key Takeaways

• Expressive aphasia, also known as Broca’s aphasia, is one of the most common types of aphasia.
• The primary treatment for expressive aphasia is speech therapy, however, your speech-language pathologist can offer other treatment options, such as medications.
• Some of the reasons your expressive aphasia treatment may fail include wrong treatment, extensive brain damage, and poor compliance.
• Comprehensive re-assessments, group therapy, and seeking second opinions can help address treatment failure.

Understanding Expressive Aphasia; What Happens to Someone with Aphasia?

Expressive aphasia, also called Broca’s Aphasia or non-fluent aphasia, is a speech or language disorder that affects your ability to speak and write while preserving comprehension. It usually occurs following injury or damage to the frontal aspect of your left brain. This injury or damage can be caused by strokes, tumors, trauma, or degenerative diseases.

What Is The Treatment For Expressive Aphasia?

Treatment for expressive aphasia will typically commence after extensive examination and assessment. This will help your physician and speech-language pathologist to determine the extent of brain damage and the severity of expressive aphasia. It will also influence your personalized treatment plan.

The primary treatment for expressive aphasia is speech and language therapy. (1) This is primarily guided by your speech-language pathologist (SLP). According to the American Speech-Language-Hearing Association (ASHA), evidence-based speech therapy treatment for expressive aphasia typically includes the following:

1. Melodic Intonation therapy: This therapy uses intoning and components of music such as pitch and rhythm to improve your speech.
2. Constraint-induced Language therapy: It primarily involves focusing on using only speech to communicate.
3. Word Retrieval Therapy: This therapy is divided into two major types – Semantic feature analysis and Phonological component analysis. These subtypes work using the same principle which includes using cues to help you remember words and your ability to say them by linking them to similar sounds or answering systematic questions.

Other treatment options include

1. Brain Stimulation (2)
2. Augmentative and Alternative Communication, such as gestures and drawings.
3. Medications, e.g, bromocriptine, galantamine.

4 Reasons Why your Treatment for Expressive Aphasia is Failing

Recovery from expressive aphasia can be painfully slow, especially in severe cases. However, although these treatments often take time to produce significant results, you should notice gradual changes in your speech after weeks to months of intensive and consistent speech therapy sessions.

If you don’t notice any improvements, your treatment may be failing. Here are a few reasons why.

1.    Extent of Brain Damage

Injuries to certain areas of your brain, such as the insula and Broca’s area, are related to poorer outcomes. Additionally, the more severe your aphasia and the larger the extent of damage, the more difficult recovery is.

2.    Poor Compliance

As with most medical conditions, you need to be compliant with your treatment if you want to see any progress. How often do you do therapy weekly? Are you consistent with it? Do you practice with friends and family?

Research (3) shows that intensive therapy done at least 5 hours weekly will yield better results. Poor compliance with your speech therapy may be the reason you’re failing treatment for expressive aphasia.

3.    Wrong Treatment

Treatment for expressive aphasia usually involves a combination of different treatment options to get significant results. These treatments are often tailored based on your specific needs, extent of brain damage, underlying cause, and severity of aphasia. Studies show that combining speech-language therapy techniques may yield better results than a single approach. (4)

Your treatment may fail if there’s a mismatch between the type of treatment and your specific needs. Simply put, your treatment is unlikely to yield results if it isn’t tailored to address your speech and language needs.

4.    Co-existing Conditions

Expressive aphasia can co-exist with other neurological or speech conditions such as apraxia of speech, dementia, or depression, depending on the underlying cause. This can impact progress, preventing you from recovering after treatment.

How to Ensure Your Treatment for Expressive Aphasia Works?

Most times, people with expressive aphasia notice rapid improvement within the first few weeks of treatment, then a gradual decline in progress – this is normal. However, in very few cases, some individuals may not see any improvements despite treatment. If you fall into this category, here are a few things you can do to address this.

1.    Talk to your Therapist

The first step you want to take is to communicate your concerns to your speech-language pathologist. Your therapist may need to conduct another comprehensive assessment of your language, motor speech, and cognition to identify any missed impairments that may be affecting your progress. Depending on the new findings, they will adjust your treatment goals and plans. For instance, your SLP can reduce or increase the treatment types or replace treatments that are not beneficial. They may also increase your therapy hours and adjust the treatment approach.

2.    Try Group Therapy or Support Groups

Group therapy involves speech-language therapy sessions with small groups of participants under the guidance of an SLP. These individuals often share the same communication struggles and treatment goals. As such, participating in group therapy serves as a form of motivation, allows you to engage in conversations, improves your speech and communication skills, and also provides a supportive environment.

3.    Leverage on Technology

Several assistive devices and apps can help to improve your communication and supplement your therapy, whether individualized or group therapies. Apps like the Constant Therapy app can provide language exercises and also aid communication while your speech improves.

4.    Seek a Second Opinion

If you’ve tried all of these and still fail at treatment, you can seek a second opinion from another SLP or ask your therapist to refer you to a specialist. A fresh perspective from another healthcare professional may help improve your chances of recovering.

Conclusion

Remember that the recovery process for expressive aphasia is not always linear, and it may take weeks to years of therapy to recover or develop alternative means of communication. If you don’t see any improvement despite speech therapy treatment for expressive aphasia, don’t panic or feel stuck. Instead, explore the tips listed above, seek family support, and stay consistent and positive.

Written by: Dr. Ori Otokpa, MBBS

Medically Reviewed by: Dr. Danielle Kelvas, MD

References

1. Brady, M. C., Kelly, H., Godwin, J., Enderby, P., & Campbell, P. (2016). Speech and language therapy for aphasia following stroke. The Cochrane database of systematic reviews, 2016(6), CD000425. https://doi.org/10.1002/14651858.CD000425.pub4
2. Elsner, B., Kugler, J., Pohl, M., & Mehrholz, J. (2019). Transcranial direct current stimulation (tDCS) for improving aphasia in adults with aphasia after stroke. The Cochrane database of systematic reviews, 5(5), CD009760. https://doi.org/10.1002/14651858.CD009760.pub4
3. PulvermüLler, F., Neininger, B., Elbert, T., Mohr, B., Rockstroh, B., Koebbel, P., & Taub, E. (2001). Constraint-Induced therapy of Chronic aphasia after stroke. Stroke, 32(7), 1621–1626. https://doi.org/10.1161/01.str.32.7.1621
4. Kiran, S., & Thompson, C. K. (2019). Neuroplasticity of Language Networks in Aphasia: Advances, Updates, and Future Challenges. Frontiers in neurology, 10, 295. https://doi.org/10.3389/fneur.2019.00295