Since his stroke, your father knows what he wants to say but the words come out wrong, or not at all. He calls a fork a 'thing' and gets frustrated when you guess. Sometimes he nods as if he understands, but you're not sure he does.
This is aphasia, and it's common after a stroke. With therapy and support, many people improve. Here's what families should know.
What aphasia is
Aphasia is a disorder that results from damage to the parts of the brain that handle language1. It can affect speaking, understanding speech, reading and writing. It does not affect intelligence1. A person with aphasia may know exactly what they want to say but be unable to find or say the words, or may speak fluently but say things that don't make sense.
Stroke is the most common cause, and about one-third of stroke survivors have aphasia1. It can also result from head injury, brain tumors or infections, and some forms come on gradually with certain kinds of dementia1. See stroke recovery in the elderly for the bigger picture of recovery.
Types of aphasia
| Type | What it looks like |
|---|---|
| Broca's (non-fluent) | Short, effortful phrases; often understands better than speaks |
| Wernicke's (fluent) | Long sentences that may not make sense; trouble understanding |
| Global | Severe trouble speaking and understanding |
| Primary progressive | Language slowly gets worse over time; not caused by stroke |
These types are described by the National Institute on Deafness and Other Communication Disorders1. Many people have a mix of features. A speech-language pathologist can assess your parent's strengths and difficulties in detail.
Non-fluent aphasia
People with Broca's aphasia often speak in short phrases with great effort, sometimes leaving out small words like 'is' and 'the'1. They may say 'Walk dog' to mean 'I'll take the dog for a walk.' They often understand speech fairly well and know their speech is difficult, which can be very frustrating. Weakness or paralysis on the right side of the body is common because the same brain area controls movement there1.
Fluent aphasia
People with Wernicke's aphasia may speak in long, complete sentences that have no meaning, add unnecessary words, or make up words1. They often have trouble understanding speech and may not realize their own speech doesn't make sense1. This can be confusing for families, who may think the person is confused rather than having a language problem.
Global aphasia
Global aphasia results from damage to large parts of the brain's language areas1. People with it have severe difficulty speaking and understanding. They may say only a few words and understand little. Even so, many can still communicate through facial expression, gestures, tone of voice and touch. Some improvement often happens with time and therapy.
What recovery looks like
Some people recover fully from aphasia without treatment, especially if the damage is mild. But most people have some lasting difficulty1. The greatest gains usually come in the first months, but improvement can continue for years1. Recovery depends on the cause, the size and location of brain damage, the person's age and health, and therapy. Many people return to meaningful conversation and activities even if their speech isn't the same as before.
Be patient. Progress may come slowly, and there will be good and bad days. Fatigue, illness and stress can make communication harder for a while.
Speech-language therapy
Speech-language therapy is the main treatment for aphasia. It aims to improve communication by restoring as much language as possible, teaching ways to compensate, and finding other ways to communicate1. Therapy may happen in the hospital, at a rehab facility, at home or in an outpatient clinic. Group therapy and support groups give people a chance to practice in a supportive setting1.
Therapists may also teach the use of communication boards, apps, writing, drawing or gestures. Family involvement is part of good therapy, since the people your parent talks to most can learn how to help1. Ask the therapist to show you exercises to practice between sessions.
Medicare coverage for therapy
Medicare covers speech-language pathology services that are medically necessary to regain and strengthen speech and language skills2. Part A covers therapy during a hospital stay or in a skilled nursing facility, and Part B covers outpatient therapy and therapy at home through home health2. Your parent may pay coinsurance after the deductible for outpatient therapy.
Coverage depends on medical need, not on whether your parent is still improving quickly. If therapy is cut off and you think it's still needed, ask for the reasons in writing and about appeal rights. See inpatient rehab vs. skilled nursing and does Medicare pay for home health care for how rehab settings differ.
How to talk with a parent who has aphasia
Small changes make conversations easier. Get your parent's attention before you start. Reduce background noise like the TV or radio1. Use short, simple sentences, but speak in an adult tone, not as if to a child1. Give your parent time to speak, and don't finish their sentences or correct every mistake1. Ask yes-or-no questions when possible. Use gestures, pictures, writing and pointing to support what you say.
Include your parent in conversations with others, and ask their opinion on decisions, even if responding takes time1. Being left out of family talk is one of the most painful parts of aphasia for many people.
Communication tools
Simple tools can help. Keep a notebook and pen handy. Make a communication board with pictures or words for common needs, like water, bathroom, pain, tired and family names. Tablet apps designed for aphasia can speak words when your parent taps a picture. A list of key personal information on a card helps in emergencies and doctor visits. Ask the speech-language pathologist which tools fit your parent.
Frustration, depression and isolation
Losing the ability to communicate easily is hard. Many people with aphasia feel frustrated, embarrassed, angry or sad, and some pull away from friends. Depression is common after a stroke; watch for it and talk to the doctor if your parent seems withdrawn or hopeless. See depression in the elderly. Stroke clubs and aphasia groups help people practice in a safe setting and feel less alone1. See loneliness in the elderly for ways to stay connected.
Other stroke effects to watch
The same stroke that causes aphasia can affect swallowing, movement, vision and memory. Trouble swallowing can raise the risk of choking and pneumonia; see dysphagia in the elderly. Weakness on one side raises fall risk. Speech-language pathologists also treat swallowing problems, so mention any coughing during meals.
Doctor visits and decisions
At medical appointments, a parent with aphasia may struggle to explain symptoms or understand instructions. Go with them if you can. Tell the doctor about the aphasia at the start, and ask them to speak to your parent directly, slowly and simply. Bring a written list of questions and medicines. Aphasia doesn't by itself mean a person can't make decisions, but it can make it harder to express them. Plan ahead with legal documents while your parent can communicate their wishes; see power of attorney.
Support for caregivers
Caring for a parent with aphasia takes patience and energy. It's normal to feel frustrated or sad about the conversations you used to have. Ask the speech therapist to teach you strategies, connect with other families through aphasia groups, and take breaks. See caregiver burnout and respite care for help.
Making home life easier
Daily routines can reduce the number of things your parent has to explain. Keep items in the same places, post a simple daily schedule with pictures, and label drawers and cupboards with words and pictures. Agree on a few gestures or signals for urgent needs, like pain or needing the bathroom. Let your parent do as much as possible on their own, such as choosing clothes or meals by pointing, which keeps independence and dignity.
Reading and writing may also be affected, so mail, bills and medicine labels can become hard to manage. Offer help without taking over, and check that your parent still understands instructions on prescriptions. If your parent lives alone, think about safety: can they call for help and explain an emergency? A medical alert button can help when words don't come; see medical alert systems. Talking openly about what's hard, and what your parent still wants to handle, keeps the relationship on equal footing.
Helping friends and visitors
Friends may stop visiting because they don't know what to say. Give them a few simple tips: speak normally but slowly, ask one question at a time, wait for answers, and don't pretend to understand. A short visit with a shared activity, like looking at photos or watching a game, takes pressure off talking.
An example
After a stroke, Jorge's mother had Broca's aphasia. She understood most of what was said but could only get out a few words. Her speech therapist worked with her three times a week and taught Jorge to ask yes-or-no questions and wait. Jorge made a picture board for the kitchen and turned off the TV during conversations. A year later, his mother could say short sentences and joined a weekly aphasia group at the local hospital. This is an illustration; every person's recovery is different.
