Understanding Aphasia for Student Nurses
Learn how aphasia can affect a patient's ability to speak, understand, read or write, and why a sudden new language problem requires urgent neurological assessment.
What is aphasia?
Aphasia occurs when areas of the brain involved in language are damaged or disrupted. The pattern varies between patients and can affect spoken language, understanding, reading and writing.
Difficulty expressing words
The patient may know what they want to say but struggle to produce the words.
Difficulty processing language
Spoken words may be heard normally but become difficult for the patient to understand.
Language extends beyond speech
Reading and writing can also be affected because they depend on language processing.
What might aphasia look like?
Searching for words
The patient may pause repeatedly or be unable to name familiar objects.
Short or effortful speech
Speech may become slow, limited or difficult to produce.
Words may be substituted
The patient may unintentionally use a different word from the one they intended.
Difficulty following conversation
The patient may struggle to understand questions or instructions.
Written information becomes difficult
Previously familiar written words may become difficult to process.
Written language changes
The patient's ability to write words or sentences may also be affected.
Aphasia is not the same as dysarthria
Both can affect communication, but they describe different problems. Distinguishing what you observe helps you communicate neurological changes more accurately.
Language problem
The difficulty involves producing or understanding language itself.
Speech production problem
Language may remain intact, but weakness or impaired control of the muscles used for speech makes words sound slurred or unclear.
Can occur together
A patient may have more than one communication problem following a neurological event.
“Unable to name a cup” or “speech suddenly slurred” communicates more useful information than simply writing “speech abnormal”.
New aphasia can be a neurological emergency
Sudden language difficulty can occur during an acute stroke or another neurological event. The onset and associated neurological findings are therefore important.
- Sudden inability to find or produce familiar words.
- Sudden difficulty understanding spoken language.
- New language change accompanied by facial weakness.
- New language change with unilateral arm or leg weakness.
- New language change with altered vision or sensation.
- New communication difficulty with reduced consciousness.
- Any rapidly developing focal neurological deficit.
Look at the whole neurological picture
Establish baseline
Determine whether the communication problem is new or previously documented.
Observe communication
Notice speaking, understanding and the patient's ability to respond appropriately.
Look for associated deficits
Assess facial movement, limb movement, consciousness, pupils and other neurological changes as appropriate.
Establish timing
If the problem is acute, establish when symptoms began or when the patient was last known to be at their normal baseline.
Keep neurological assessment within ABCDE
Airway
Assess airway patency and respond immediately to any airway compromise.
Breathing
Assess respiratory rate, pattern, oxygen saturation and work of breathing.
Circulation
Assess pulse, blood pressure, perfusion and the wider cardiovascular picture.
Disability
Assess consciousness, pupils, speech and language, limb movement and blood glucose according to local practice.
Exposure
Look for injury, illness or other findings that may help explain the deterioration.
Escalate
Sudden focal neurological changes require prompt clinical review and the appropriate local emergency pathway.
How can you communicate with a patient who has aphasia?
Communication difficulties can be frustrating and frightening. Adapting how you communicate can help the patient participate more effectively.
Do not rush
Give the patient additional time to process information and respond.
Keep communication clear
Use straightforward language and avoid unnecessarily complicated questions.
Reduce distractions
A quieter environment may make communication easier.
Use communication aids
Writing, pictures, gestures or communication tools may help, depending on the patient's abilities.
Speak to the patient
Do not automatically direct conversation to relatives or carers because communication is difficult.
Use specialist advice
Follow the communication strategies recommended by the wider multidisciplinary team, including speech and language therapy.
Recognising acute language change
Example
Earlier in the shift, a patient was speaking normally and answering questions appropriately.
You later ask what they would like to drink. They appear to understand that you are speaking but repeatedly struggle to produce the words they want.
When you assess them further, you also notice new weakness in their right arm.
You recognise the pattern: sudden language difficulty + new unilateral weakness.
You immediately escalate the neurological change according to the local emergency pathway and establish when the patient was last known to be at their normal neurological baseline.
Describe what has changed
Example escalation
“I'm concerned about Mrs Green. She was speaking normally earlier in the shift. She has now developed sudden difficulty finding words and cannot name familiar objects. She also has new right arm weakness.”
This communicates the baseline, new language problem and associated focal neurological deficit.
Aphasia recognition errors to avoid
- Calling every language problem “confusion”.
- Assuming aphasia means the patient lacks intelligence.
- Confusing aphasia with slurred speech alone.
- Speaking only to relatives instead of including the patient.
- Rushing the patient to answer.
- Failing to establish whether the language problem is new.
- Ignoring associated facial or limb weakness.
- Waiting for communication to improve before escalating sudden symptoms.
Recognise → compare → connect → escalate
Identify language change
Notice changes in speaking, understanding, reading or writing.
Establish baseline
Determine whether the problem is new and look for other focal neurological findings.
Report sudden change
Clearly describe the language problem, associated neurological findings and timing.
Build confidence recognising neurological communication changes
Understanding the difference between language, speech and cognition helps you describe neurological deterioration more accurately and communicate concerns more effectively.
Explore Clinical Confidence →