How to recognize and treat expressive aphasia, a communication disorder that can happen after brain damage

• Expressive aphasia can happen after brain damage and may affect your ability to speak or write.
• A few signs include using short phrases and substituting words with similar sounds or meanings.

After a stroke or brain injury, many people have trouble talking.

One type of communication disorder that's common after brain damage is expressive aphasia. With this condition, you generally understand what people say to you, but you may find it difficult to produce the right words to respond.

For example, a person who intends to say "son" might make a sound-based substitution and say "bun." Or they might make a meaning-based substitution and say "daughter", says Jennifer Hicks, a speech-language pathologist who specializes in aphasia.

Expressive aphasia, also called Broca's aphasia or non-fluent aphasia, is one of the six types of aphasia — a form of language impairment that often relates to a brain injury.

While aphasia is fairly uncommon in the general population, it's very common with certain conditions, such as stroke. In fact, about a third of people who have a stroke will develop aphasia.

Without a doubt, struggling with speech can be frustrating, but treatment may help you recover some language ability. You can also use assistive technologies like speech generators to fill in the gaps.

Read on to learn why expressive aphasia happens, your options for treatment, and how loved ones can offer support.

Signs and symptoms

People with expressive aphasia have trouble speaking fluently, but usually they can still understand spoken words, says Gary Seale, researcher and psychologist specializing in brain injury at the Centre for Neuro Skills. Likewise, someone may struggle with writing but remain able to read fairly well.

Intellectual abilities outside of language, like math or pattern recognition, may remain intact.

Common signs of expressive aphasia include:

• Using short phrases: Someone with this condition may speak in simple sentences of just three to four words. For instance, "Give me shoes," instead of "Could you pass me my sneakers from under that bench there?"
• Speech with missing words or poor grammar: Someone might say, "Child run woods," instead of "A child is running into the woods."
• Pauses in speech: Someone may pause mid-sentence, often to mentally search for the right word. For example, "I need (pause) headphones."
• Sound-based word substitutions: Another sign of expressive aphasia is using the wrong word with the same sound. For example, saying "fridge" instead of "bridge."
• Meaning-based word substitutions: People with aphasia may also use a word that has a similar meaning but isn't quite right for the context, such as "sack" instead of "purse."

Note: Expressive aphasia doesn't affect speech on its own. But the part of your brain that controls motor skills sits close to the Broca's area. So, a stroke or brain injury may cause nerve damage that leads to weakness and affects movement, especially on the right side of your body. It's this nerve damage that can restrict your ability to talk.

Causes

The most common cause of expressive aphasia is an ischemic stroke, which happens when a blood clot or fatty tissue blocks blood flow to your brain, starving it of the oxygen it needs to function. This condition can also stem from brain injury, tumors, or viral brain infections like cat scratch disease.

Note: Some people have developed expressive aphasia after COVID-19 infections. According to one theory, the virus causes your blood to clot excessively, and clots formed in the brain may lead to a stroke. In fact, some evidence suggests your risk of having a stroke in the next year increases by 52% after a COVID-19 infection.

Strokes, injuries, and other types of brain trauma can damage a part of your brain called the Broca's area, which controls several aspects of language.

One important function of the Broca's area is helping you translate your thoughts into words. When you want to say "puppy," for example, this area helps you transform the image of a four-legged fluffball into the correct sounds and letters. But an injury to the Broca's area can make it hard to find the word you need in a given moment.

The Broca's area also helps organize information into understandable sentences. An injury to this area, then, could make it difficult to fully express a complicated idea like "I don't need to buy a ticket today."

Instead, you might boil down the thought to "No buy ticket now." Your sentence is still understandable, but it doesn't capture the full meaning of what you wanted to say.

Expressive aphasia is considered a language disorder, not a speech disorder. That's because it doesn't affect your mouth's ability to physically make sounds. Rather, it damages your brain's internal teleprompter, mixing up your mental script before your mouth can read it off.

Diagnosis

If you or a loved one shows signs of expressive aphasia, you may want to seek out an assessment from a speech-language pathologist. These professionals treat speech, language, and communication disorders. They can give you tests that check your ability to:

• Name objects
• Repeat short phrases
• Follow simple or complex commands
• Read
• Write

These tests can help determine the cause of your symptoms, whether that's expressive aphasia or another condition entirely.

You may also find it helpful to visit a neurologist. These specialists can order imaging scans to assess your level of brain damage. They can then recommend treatment options, based on the areas of your brain injured.

Treatment

A number of different treatments can help improve symptoms of expressive aphasia, including speech and language therapy.

In speech and language therapy for expressive aphasia, you may practice exercises like:

In addition to speech and language therapy, you may also find it helpful to try other approaches, including:

• Medications: Drugs called cholinergic agents mimic the effects of the neurotransmitter acetylcholine, which supports language skills like naming objects. Cholinergic agents like donepezil (Aricept) may improve your ability to produce spontaneous speech.
• Psychotherapy: Between 30%-60% of stroke survivors go on to develop depression, which can itself interfere with language performance.
• Non-invasive brain stimulation: This treatment sends a low electric current to your brain to "wake up" neurons in your language centers. Some smaller studies suggest brain stimulation may boost your outcomes in speech and language therapy.

Note: Types of brain stimulation include transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS). However, experts generally prefer tDCS since TMS has a small chance of causing seizures.

Outlook

Hicks has seen a wide variety of outcomes with aphasia treatment in her 25 years of practice.

For instance, she's worked with people who started therapy nonverbal and ended treatment able to comfortably hold conversations. Other people she's worked with have made more subtle verbal gains — but learned to use alternative methods of communication successfully.

Hicks says many factors can play a part in treatment outcomes, including:

• Your age and pre-existing health
• Your language skills before the injury
• The size and location of the damaged area in your brain
• Whether your injury affected other cognitive abilities, like maintaining focus
• Co-occurring nerve damage
• How quickly you start getting treatment after your injury
• The frequency and intensity of treatment sessions

It's difficult to predict the extent you may recover your speech, but improvements can continue for up to a year and beyond, according to Dr. Alison Caruana, neurologist and clinical assistant professor at Stony Brook Medicine.

Sticking with treatment, then, may lead to greater improvement over time.

How to support a loved one

Living with expressive aphasia can feel overwhelming and isolating at times. If you have a loved one with this condition, your support is essential — not just for emotional connection, but also to help them practice and maintain their language skills.

Seale offers several tips to improve your communication with a loved one who has expressive aphasia:

• Reduce background noise and distractions: For example, turn off the TV or move to a quieter room when you're talking about your plans for the weekend.
• Speak slowly and clearly: You likely don't want to switch to "baby talk," but it can help to make sure you're not going full motor mouth, either.
• Give the person time to process what you've said and form a response: Peppering them with question after question may overwhelm them.
• Offer choices rather than open-ended questions: A yes-no question like "Would you like to play checkers with me?" is easier to answer than "What do you want to do today?"
• Pay attention when they point or gesture: Visual aids can be a powerful conversational tool.

Your loved one's care team can offer additional advice for your unique circumstances.

Insider's takeaway

Expressive aphasia disrupts your ability to transform your thoughts into words. You may understand what you read or hear but find it tough to fully express your own ideas. This condition is typically caused by damage to your Broca's area, a part of your brain that affects language.

Speech-language pathologists typically diagnose and treat this condition, although your care team may also include neurologists and other specialists. Treatment can help you regain language abilities like word retrieval and sentence construction. That said, your level of recovery depends on many factors, including your language ability before your injury.

Support from friends and family can be very valuable during this time. Above all, have patience with yourself — recovering from brain damage can be a trial in its own right. But no matter your situation, you have a variety of tools and treatment options to help you live your best quality of life.