What is Expressive Aphasia?

Imagine having an interesting conversation with family or friends where everyone is contributing freely, but you can’t. You understand what they say, and know what to say, but you struggle when you try to speak. You can only produce some incomplete phrases or sentences with much effort, and if it’s that bad, not at all. This is what people with expressive aphasia go through.

Expressive aphasia, also known as Broca’s aphasia (1) or non-fluent aphasia was discovered by a French physician and scientist, Pierre Paul Broca, in 1961, after he cared for a patient who could only say one word – Tan. This article explores expressive aphasia, its causes, signs and symptoms, treatment options, and what to expect during recovery.

Key Takeaways

• Expressive aphasia is also referred to as non-fluent or Broca’s aphasia.
• It is characterized by difficulty producing complete sentences and omission of linking words such as “the” “and” and “is.”
• Expressive aphasia is caused by damage or injury to the language processing area of the brain – Broca’s area- which is located on the frontal lobe of the left hemisphere.
• The mainstay of treatment for this condition is expressive speech therapy.
• Recovery may take months to years depending on the underlying cause, overall health condition, and the extent of brain injury and damage.

What is Expressive Aphasia?

Expressive aphasia (2) or Non-fluent aphasia is one of the most common types of aphasia. As the name implies, expressive aphasia affects your ability to express your thoughts and ideas through speech and writing.

In this condition, you may know what you want to say but may not be able to say it or have a hard time saying it. Finding the right words can be difficult, and this can limit your sentences to two to four words.

Expressive aphasia often follows damage to the frontal aspect of your left brain – the Broca’s area. Although it doesn’t typically affect your comprehension, it can significantly impair your communication, depending on the level of damage.

What are the Symptoms of Expressive Aphasia?

Living with Broca’s aphasia can be upsetting, especially because you understand what others are saying (3) and want to communicate but cannot do so effectively. These communication difficulties can manifest in the following ways.

• You may speak in short, fragmented, or incomplete sentences
• Difficulty repeating words or sentences
• Poor grammar and difficulty using linking words, conjunctions, and prepositions like “the,” “is,” and “and.”
• Problems with writing
• Lack of spontaneous speech
• Effortful or energy-intensive speaking
• Inability to speak

Although expressive aphasia often occurs alone, it can overlap with other types of aphasia or other neurological deficits such as apraxia or paralysis, depending on the type and extent of brain damage.

Causes of Expressive Aphasia

The Broca’s area, located on the frontal lobe of your left brain, is responsible for speech and articulation. When this part of your brain experiences injuries or damage that lead to cell death, you will develop expressive aphasia. Some possible causes of non-fluent aphasia include.

• Traumatic brain injury from falls, gunshots, or blows to the head
• Stroke, commonly ischemic stroke
• Brain tumors
• Brain infections
• Neurodegenerative disorders such as Alzheimer’s disease

What Next? – Diagnosis of Broca’s Aphasia

Identifying your symptoms and speaking to your physician or healthcare professional early is key to faster recovery and better prognosis. Your healthcare provider will ask some questions and conduct some physical and neurological examinations. They may also include neuroimaging scans like MRI and CT.

If you have a stroke or a traumatic brain injury, your doctor will stabilize you before assessing your understanding, language, and speech to determine if you have aphasia. MRI or CT scans may also be ordered to view the affected part of your brain and the extent of damage. If the underlying cause is a stroke, your physician will also take you through the steps on how to recover from a stroke quickly and curate an individualized rehabilitation program.

Afterward, you’ll be referred to a speech-language pathologist for further evaluation and treatment.

How do you Treat Expressive Aphasia?

After a comprehensive assessment and diagnosis by your speech-language pathologist (SLP), a personalized treatment plan is curated for you based on the severity of your symptoms. The primary treatment for expressive aphasia is expressive speech therapy. (4)

But what is expressive speech therapy?

Expressive speech therapy aims to improve your language and communication. In simple words, it helps you talk and express yourself better. Speech-language pathologists often recommend speech therapy for adults after a stroke. However, this therapy is also useful for children with language or speech disorders.

It often involves several activities, such as tongue and mouth exercises, breathing exercises, playing with language-based board games, and problem-solving and memory activities. The activities are selected based on age and individual needs, and these may be done during group or individual therapy. Interestingly, you can also do online speech therapy through speech therapy apps and platforms.

Your speech pathologist may also employ some other expressive aphasia treatment options including

• Melodic Intonation Therapy (MIT)
• Constraint-induced language therapy
• Conversation therapy
• Word retrieval therapy
• Transcranial stimulation

Through consistent practice and speech production during and outside therapy hours, your brain can strengthen new pathways that help with communication.

Recovery Journey: Can Someone Recover from Aphasia?

Yes. However, the recovery process and duration differ for everyone. For some, recovery may be quick, lasting only months. On the other hand, others may spend years recovering. This is primarily determined by the extent of injury or damage to your brain’s language processing area, the cause, and the severity of speech impairment or disorder.

For instance, for expressive aphasia caused by stroke, speech recovery may take about 2 to 6 months.

Unfortunately, not everyone with expressive aphasia will make a full recovery. However, with diligence, support, and consistency, your communication and language skills will improve over time.

Preventing Broca’s Aphasia: Is it Possible?

There’s no clear-cut way to prevent Broca’s aphasia. However, you can reduce your likelihood of developing aphasia by preventing some of the conditions that cause it. You can prevent these conditions by.

• Increasing physical activity and exercise
• Quitting smoking and excessive drinking
• Cutting down on junk food and adopting a healthy eating plan
• Ensuring regular follow-up visits and taking your medications if you have underlying chronic conditions such as hypertension and diabetes
• Following safety measures during sports and while riding a bike or car, e.g., wearing a seatbelt or putting on a helmet.

While these steps do not directly prevent expressive aphasia, they significantly reduce your risk of developing the conditions that lead to it.

Conclusion

Expressive aphasia is one of the most common types of aphasia that occurs due to damage to the Broca’s area. Although comprehension is preserved, affected individuals can only say short and incomplete phrases or sentences and may have some writing difficulties.

This condition can be frustrating and is often accompanied by mental health issues like depression. If you or a loved one are experiencing symptoms of expressive aphasia, especially after a recent head trauma or stroke, do not hesitate to see your healthcare provider.

Once you start treatment, join support groups, stay consistent, and appreciate your progress, no matter how little.

Reference

1. Acharya, A. B., & Wroten, M. (2023, February 13). Broca aphasia. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK436010/
2. Expressive Aphasia – an overview | ScienceDirect Topics. (n.d.). Www.sciencedirect.com. https://www.sciencedirect.com/topics/neuroscience/expressive-aphasia
3. National Aphasia Association. (2024). Broca’s (Expressive) Aphasia. The National Aphasia Association. https://aphasia.org/aphasia-resources/brocas-aphasia/

‌Altmann, R. F., Da Silveira, A. B., & Pagliarin, K. C. (2019). Intervenção fonoaudiológica na afasia expressiva: revisão integrativa. Audiology – Communication Research, 24. https://doi.org/10.1590/2317-6431-2018-2100