What is Aphasia? Understanding Bruce Willis’ Diagnosis

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On Wednesday March 30, the family of Bruce Willis announce the actor would retire immediately, at the age of 67, due to a medical condition called Aphasia. This shed light on a rarely covered diagnosis. Aphasia is terrifying as it represents a chilling diagnosis that strikes our ability to communicate.

We have all had those incredibly frustrating moments when we just can’t think of the perfect word that would explain exactly what we mean to say. We may have had an occasional moment of misunderstanding someone who is talking to us. It’s terrifying that our difficulties in speech or understanding could get so bad that others couldn’t understand us or us them.

We spoke to a Speech and Language Pathologist (SLP) to find out more. Aphasia is a language disorder that comes from an injury to the brain, most typically the left hemisphere. “Aphasia can affect speaking, understanding (comprehension), reading and writing. It can impact all or some of these areas in varying degrees,” says Sandra Crawford, MA CCC-SLP.

Types of aphasia

There are three patterns of aphasia: Expressive, Comprehensive, and Global. The expressive type means that you might have trouble finding the right words although you can clearly understand what is being asked and what needs to be said. Imagine knowing exactly what needs to be said, but the words come out wrong.  While this may happen on occasion to all of us that moment when we cannot grasp the right word, consistent inability to communicate can cause extreme frustration.

Comprehensive Aphasia is when incorrect or unnecessary words are used but there is also a weakness in comprehension. This is not a common occurrence that many can relate to, so one can only imagine the horror of increasingly misunderstanding what people are saying to you. Global Aphasia occurs when there is extensive damage to both areas of the brain which control comprehension and speech.

Causes of aphasia

Aphasia usually results from damage to the brain, such as a stroke, tumor, or traumatic injury. However, some patients present with Primary Progressive Aphasia. PPA for short, this aphasia is actually classified as a type of dementia. In this case, the areas of the brain that manage language shrink and decay over time.

“The reasons can really impact the outcome. Like when a patient has a stroke, [in] the first six months, they can have spontaneous recovery,” noted Crawford. “[This] can impact their progress and treatment.”

What does Bruce Willis have?

Although Willis’ family has not released details about his specific diagnosis, we have some clues to go on. There’s no evidence of something sudden like a stroke or physical injury from an accident. In fact, quiet reports of Mr. Willis having trouble with lines on set has been around for a few years, possibly as early as 2017. A number of them have brought up reduced hours from an eight-hour day to four, mistakes in script recall, and lately, just overall confusion as to where he was or what he was supposed to be doing there. It’s shocking that this quick witted actor could become silent with a communication and comprehensive disorder.

This slow progression implies that whatever is causing his aphasia has been building for a while. That points to causes like a growing tumor or Primary Progressive Aphasia. Though a tumor is a possible source, there are usually other accompanying symptoms, and that doesn’t seem to be the case. However, from what we know now (and we don’t know everything yet), it seems like PPA is a possible cause here.

What does Primary Progressive Aphasia look like?

PPA is classified as a rare disease. However, it may be underdiagnosed or misdiagnosed, due to unfamiliarity with PPA. About twice as many men as women develop PPA, and the average age of onset is between 50 and 70.

People with PPA usually initially deal with word finding difficulties and difficulty expressing themselves verbally. They also have trouble understanding what others are saying to them. Through all this, they retain cognitive functioning and the ability to perform complex tasks.

As the disease progresses, speaking and understanding written words become more difficult, and many people with PPA become mute. A few years after the initial diagnosis, PPA goes on to affect memory, cognitive functioning, and behavior.

Treating aphasia

There is no cure for PPA, however, speech therapy helps manage and sometimes slow its progression. Regardless of the cause of someone’s aphasia, speech therapy can help.

“Speech Therapy should be provided by a Speech Language Pathologist that has their certificate of clinical competence (CCC) from the American Speech Language and Hearing Association (ASHA),” Crawford informed us.

What speech therapy looks like

Treatment can be restorative (aimed at regaining impaired function) or compensatory (aimed at working around existing problems). The first type of approach focuses on body functions and vocal structures. In contrast, the second sort of efforts try to modify how the person participates in activities with others.

The patient can receive therapy individually or in a group. Therapy focuses on teaching strategies to help with word finding difficulties. Augmentative and Alternative Communication devices can also be helpful based upon the needs of the patient, especially if they are nonverbal. These tools help people communicate using either spelling, symbols, or pictures.

Additional issues

Patients with aphasia may also present with related issues, such as apraxia (movement problems), dysarthria (trouble moving the mouth), or dysphagia (swallowing difficulties). These conditions can also be treated and managed to improve a patient’s communication and overall quality of life.

It is important to involve the patient’s family. They will be helpful in carrying over strategies and techniques learned within the therapy session into the home.

Those with aphasia require kindness and compassion as they have lost abilities that they once had, such as the ability to express themselves or understand what others are saying. It is very difficult to know what you want to say, but be unable to do so. Just try to practice patience. They surely deserve it.