June is National Aphasia Awareness Month. Aphasia is a neurological disorder caused by damage to the portions of the brain that are responsible for language. The most common cause of aphasia is a stroke, but brain tumors, blows to the head, or trauma may also cause aphasia.

As a result, individuals who were previously able to communicate through speaking, listening, reading, and writing become more limited in their ability to do so. Jean Gordon, PhD, an assistant professor and speech-language pathologist in the Wendell Johnson Speech and Hearing Center at The University of Iowa says how a person is affected by aphasia depends on what part of the brain has sustained damage.

"If the front part of the left hemisphere is affected, speech tends to be non-fluent. That is, there are frequent pauses and sentence fragments, and it is a struggle to get words or sounds out. Sometimes sentences sound like a telegram, just strings of single words.

"On the other hand, if the back part of the left hemisphere is damaged, speech is usually more fluent and sentences are grammatical, but with lots of errors, which can be real words (like calling a table a 'chair') or made-up words. It can even sound like an aphasic speaker is speaking a foreign language. Most people with aphasia have a lot of difficulty remembering words," she says.

Aphasia is classified by the area of brain damage and the resulting language impairments (how well the person with aphasia can produce and understand language), like the fluent and non-fluent types just described. The pattern of aphasia depends on many other individual factors and every person with aphasia is different. That is an important consideration in designing therapy for aphasia.

Aphasia can vary from being able to say or understand almost nothing to occasional difficulty retrieving words. Aphasia is most severe right after the stroke, but can improve a lot in the first few weeks.

There are two main purposes of aphasia treatment by speech-language pathologists says Gordon. "In the early stages of therapy, the main goal is to facilitate the recovery of as much language functioning as possible. We do this in tasks that work on individual language abilities (like naming pictures, answering questions, reading and writing words), and in more real-life tasks (like telling stories, answering the phone, ordering in a restaurant).

"In later stages, when improvement begins to slow down, the main goal is to help the person with aphasia to find ways to compensate for, or adapt to, the remaining language impairment. For example, we teach them effective ways to use gesture, drawing, or writing as an alternative or a supplement to spoken language."

Speech-language pathologists work with people with aphasia to restore language function, and compensate for language impairments. "First, we assess the individual's language functioning in all modalities -- speaking, listening, reading, and writing -- and diagnose the aphasia. Then we set goals, and devise a therapy program to address the language impairments in a systematic way.

"Often, in the beginning, therapy is conducted in structured tasks, one-on-one with the therapist, then progresses to more real-life situations with other people being involved. We also work with family members of people with aphasia, to help them learn techniques to communicate with someone with aphasia.

"In the first months following a stroke, the brain goes through a healing process, and this is when the most rapid recovery happens. After about three months, someone who still has aphasia (about 20 to 30 percent of stroke victims) will probably have aphasia for life," she says. "However, research has shown that, even after this healing process is over, speech-language therapy can still help the person with aphasia to make improvements.

"I am involved in research on how people retrieve words -- young adults, older adults, and people with aphasia, and how we can help aphasic speakers retrieve words. There are also people in the neuroscience program who conduct research on aphasia and the brain.

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