NEUROSCIENCE AND PSYCHOLOGY

Published: 04 April 2022

doi: 10.3389/frym.2022.626477

APHASIA: HOW OUR LANGUAGE SYSTEM CAN

“BREAK”
Maria V. Ivanova 1* and Nina F. Dronkers 1,2
1
Aphasia Recovery Lab, Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
2
Department of Neurology, University of California, Davis, Davis, CA, United States

Our brains enable us to learn language. We develop it early on in life

YOUNG REVIEWER:
and use it effortlessly every day. It is only when the language system
GIGI breaks down that we fully realize how complicated it is to speak and
AGE: 9 understand. In this article, we will explore what happens when brain
damage leads to a language disorder called aphasia. About 15 million
people worldwide and about 2 million in the U.S. alone are affected
by aphasia. Sadly, many people still do not know what aphasia is.
Here, we will explain different types of aphasia, tell you about the
language difficulties people with this disorder encounter, and provide
information about how language is processed in the brain.
LANGUAGE
A system of spoken, Can you describe what is happening in the picture shown in Figure
manual (signed), and/or 1? Without much effort, you can probably put together a simple
written symbols (words storyline, turning your ideas into words, and those words into neat
and expressions) that
are used and
sentences, much like beads on a thread. Communication is essential
understood by a large for human beings; it has played a crucial role in the evolution of our
group of people species and remains an important part of our society. Language is the
to communicate. most common, efficient, and informative means of communication,

kids.frontiersin.org April 2022 | Volume 10 | Article 626477 | 1

 Ivanova and Dronkers Aphasia—Language Disorder

whether it is by exchanging day-to-day stories with our friends,

learning in the classroom, reading the texts of ancient scholars, or
focusing on one’s thoughts and feelings during a solitary walk in the
park. Our brains enable us to learn language, we develop it early on in
life and use it effortlessly every day. The complex nature of language
only becomes apparent when the system breaks down and we cannot
make sense of what is being said to us or find the right words to express
our thoughts.

WHAT IS APHASIA?
The brain is the organ that makes language possible. Various regions of
the brain work together to process and understand incoming speech
and to respond by turning our thoughts into words, combining them
into phrases, and then producing clear, meaningful sounds that people
around us can easily understand. The brain needs a lot of energy to do
APHASIA its demanding job well. About 20% of the calories that we consume
Is a language disorder daily go directly to fuel the brain, even though the brain is only 3% of
caused by an injury to the body’s weight. The brain also needs a constant supply of oxygen,
the brain. In aphasia,
the ability to talk, to
delivered via the blood, to work properly. Brain cells with reduced or
understand spoken no oxygen supply can survive for a limited time, but if blood flow is
language, to read and not restored quickly, they start to die. If blood cannot reach areas
write are all impaired, of the brain that are responsible for language, and the brain cells
to varying degrees.
there suffer permanent damage, a person can lose the ability to use
IMPAIRMENT/DEFICIT
language normally and is said to have an aphasia (the Ancient Greek
word for “speechlessness”).
Difficulty or loss of
ability to perform a
certain function or task. Aphasia is a communication disorder in which a person’s ability to
For aphasia, the talk, to understand spoken language, and to read and write will all
impairment or deficit is be affected, to varying degrees. These language impairments lead to
a loss of language skills
that happened because
communication problems. Aphasia is not caused by poor hearing or
of the injury. vision problems, or difficulty moving the tongue or jaw. A person is

Figure 1
Can you describe what
is going on in this
picture? Image from
the Comprehensive
Aphasia Test [3].
Reprinted with
permission.

Figure 1

kids.frontiersin.org April 2022 | Volume 10 | Article 626477 | 2

 Ivanova and Dronkers Aphasia—Language Disorder

diagnosed with aphasia when there is observable damage to the brain,

as seen on a brain scan (learn more about brain scans in another FYM
STROKE
article [1]). Stroke is the leading cause of aphasia in adults. A stroke
can happen either when a blood vessel becomes blocked and cannot
When a blood vessel in
the brain gets clogged
deliver oxygen to brain areas down the line, or when a vessel breaks,
or breaks and causes leading to blood spilling out into the brain. You can find out more
the blood to stop about stroke in another FYM article [2]. Aphasia can also be caused
flowing leading to brain by a traumatic brain injury, surgery on the brain, or an infection in
tissue damage.
the brain.

About 15 million people worldwide and about 2 million in the U.S.

alone are affected by aphasia. Roughly 35% of those who have a stroke
will end up with aphasia. Sadly, many people still do not know what
aphasia is. A survey conducted by the National Aphasia Association
in 2016 showed that <10% of the U.S. population has heard about
aphasia and can identify it as a language disorder. This makes social
participation particularly challenging for people with aphasia, as many
people they encounter will not understand the disorder and the person
with aphasia will probably find it difficult to explain the condition.

IS APHASIA THE SAME FOR EVERYONE?

The language impairments observed in aphasia can be strikingly
different in each person. Some people with aphasia will find it more
difficult to understand others, while others will make sound errors and
grammatical mistakes while speaking. Still others will have difficulty
repeating words and sentences. However, certain features of aphasia
are almost universal.

All people with aphasia have problems with retrieving words in a

conversation. However, depending on where the damage is in the
brain, this common deficit will manifest itself in different ways.
Someone might confuse the right word with related words, like
choosing “letter” when meaning to say “envelope.” Someone else
might struggle to retrieve the word, sort of like when you speak in
a foreign language and are limited in your vocabulary. For example,
when asked to name a picture of an Egyptian pyramid, a person with
aphasia said, “Can not think of the word, it is from Hawaii, not Hawaii,
but that part of the world, where someone was buried, I can see it, but
can not name it.” Yet another person will make errors in the sounds
of the words and say “bee” instead of “key.” Observing and describing
these different error patterns has greatly expanded our understanding
of how the language system works and how many distinct brain areas
are required to support the simple act of producing a single word.

To accurately describe the characteristics of aphasia, researchers have

devised numerous language tests, in which patients must match words
and sentences to pictures, name pictures, repeat words and phrases,
read, and write. Remember the picture in Figure 1? It comes from a

kids.frontiersin.org April 2022 | Volume 10 | Article 626477 | 3

 Ivanova and Dronkers Aphasia—Language Disorder

Figure 2
Descriptions of the
picture in Figure 1,
provided by two
patients with different
(Broca’s and
Wernicke’s) types of
aphasia. Their damaged
brain areas are shown
in red on the brain
images. Damage to
different brain areas
causes aphasia to
manifest itself in
different ways. As you
can see, some patients
have a lot of trouble
coming up with even
common words, while
others talk more
effortlessly, though it
might be hard to
understand them.

Figure 2

commonly used aphasia test—the Comprehensive Aphasia Test [3].

This picture description task can tell us a lot about aphasia (Figure
2).
WERNICKE’S AREA
The upper back part of TYPES OF APHASIAS
the left temporal lobe
that was believed to be
important for
Even the first doctors describing aphasias in the 1800s were aware of
understanding the varied nature of the disorder. However, they quickly recognized
language. Currently, that certain symptoms tend to appear together, thus a classification
researchers think that a system for aphasia was born. Originally, it was thought that language
much larger area is
responsible for
depends on two critical brain regions—one in the temporal lobe
understanding language. (Wernicke’s area) for understanding language and one in the frontal
BROCA’S AREA
lobe (Broca’s area) for speaking. However, we know today that the
language system depends on multiple brain regions working together
The lower part of the
left frontal lobe that
in a coordinated fashion (Figure 3). Most aphasias result from damage
was thought to be to the left hemisphere (side) of the brain, since it is the left hemisphere
responsible for that most often processes language. There are many types of aphasia;
language production. the most well-known are explained below.
Today, scientists believe
it is involved in word
selection and some Broca’s aphasia was the first to be described, by a French surgeon, Paul
grammatical processing. Broca, in 1861. The most obvious symptom in this aphasia is trouble
saying words and sentences. In very severe cases, when damage
to the areas responsible for language production is extensive, the
patients’ speech will be limited to 1–2 words or even just a string of
sounds or a meaningless phrase that they repeat in response to any

kids.frontiersin.org April 2022 | Volume 10 | Article 626477 | 4

 Ivanova and Dronkers Aphasia—Language Disorder

Figure 3
Incoming speech is first
processed in the top
temporal area
(Wernicke’s area). Then
the meaning of the
words is accessed in
the middle back
temporal areas, along
with selection of an
appropriate response.
Next, through
connections called the
arcuate fasciculus,
information is sent to
the lower frontal
language areas (Broca’s
area and surrounding Figure 3
regions). There, the
sentence is put
together and the
response is spoken question. In milder cases, individuals tend to produce grammatical
with the help of the
errors in their speech, for instance, leaving out proper verb endings
primary motor cortex.
Additional areas are and using simplified phrases that contain only the most important
recruited depending on content words. People with Broca’s aphasia also have problems with
the type and difficulty comprehension, especially with complex sentences, like, “Put the
of the language task.
Damage to one or
comb on the other side of the pen and turn over the book.” Typically,
more of the language Broca’s aphasia is caused by injury to the lower part of the left frontal
areas can lead to lobe of the brain (called Broca’s area) and nearby brain structures.
aphasia.
Wernicke’s aphasia has a pattern of symptoms that is almost the
opposite of Broca’s aphasia, with comprehension as the main problem.
First described in 1874 by a German doctor, Carl Wernicke, it is
characterized by severe comprehension difficulties combined with
well-pronounced and easy speech that often does not make much
sense. Sometimes the person cannot even understand the simplest
sentences, like, “Point to the door.” They may talk a lot, but often
choose the wrong words or produce meaningless sounds. Their
problem seems to be in matching words to the concepts they want to
describe or understand. Originally, it was thought that damage to a part
of the temporal area (called Wernicke’s area) led to Wernicke’s aphasia.
Today researchers have established that damage to a much larger part
of the left temporal lobe causes lasting Wernicke’s aphasia.

In conduction aphasia, the most common symptom is a problem with

repetition, especially for words that do not have a real meaning, like
“blosh” or meaningless phrases like “waltzing private island.” People
with conduction aphasia can speak quite well and understand most
of what is being said to them but repeating a phrase word-for-word
is very difficult. They often say, “I heard you say it, but the words just
disappeared!” Typically, Conduction aphasia is associated with damage
to lower parietal and top temporal areas.

kids.frontiersin.org April 2022 | Volume 10 | Article 626477 | 5

Ivanova and Dronkers Aphasia—Language Disorder

Global aphasia is the most severe form of aphasia, in which a person

has the symptoms of all the aphasias we have just described. They
have a lot of trouble talking and understand very little. Yet, they can
often communicate through facial expressions and gestures, and can
still “think,” though not with words. Many enjoy working on puzzles,
listening to music, being around other people, and traveling with their
families or friends. Being without language is hard, but other forms of
communication and non-verbal activities can still provide meaningful
social interactions.

Kids can get aphasia too, but childhood aphasia is rare. Strokes can
happen in children born with a heart condition or a blood disorder that
leads to an interruption of normal blood flow to the brain. Most kids
will show good recovery, but some might have language problems for
the remainder of their lives.

HELPING PEOPLE WITH APHASIA

While most people with aphasia can regain a substantial part of their
language, this can take many years after a stroke, and most people say
their language never fully recovers. For almost 150 years, researchers
have been trying to understand how the brain processes language,
how language can be lost due to brain damage, and how to best
help patients recover their language skills. Research with people who
have aphasia has provided valuable insights about the disorder itself
and the language system, in general. This research has led to the
development of language therapies for people with aphasia. Trained
speech-language pathologists work with individuals with aphasia to
help them relearn lost words, understand complex sentences, and
regain the ability to produce words accurately. Some people benefit
more from therapy than others, and researchers still do not fully
understand why. Today, doctors are also testing whether stimulating
brain regions with mild electrical current or magnetic waves might
help brain cells be more active and form new connections. Thanks
to research, we know that it is beneficial to start therapy as soon as
possible and engage the whole family in helping the person regain
their language skills.

Even when recovery of language skills is not fully possible, it

is important to continue to provide people with aphasia with
opportunities for meaningful social participation, so that they do not
feel isolated or depressed. If someone you know has aphasia, speak
slowly, and use simple sentences and words. Make sure there are no
additional distractions in your environment and only one person is
talking at a time. Give the person with aphasia more time to respond
and listen patiently. Be creative in your communication—use writing,
gestures, and/or pictures to facilitate understanding. Remember that,
while the person with aphasia has lost a part of their language,
they have not lost their personality or intelligence. There are many

kids.frontiersin.org April 2022 | Volume 10 | Article 626477 | 6

 Ivanova and Dronkers Aphasia—Language Disorder

resources you can use to learn more about aphasia and how to
1
communicate with those who have it.1
The American
Speech-Language-
Hearing Association: Many mysteries about language and the brain still remain. It will
https://www. take research by kids like you to fully understand how language
asha.org/
works and how we can best help people with aphasia. Acquiring
public/, The
National Aphasia and using language seems easy, but losing it is painful and regaining
Association: language ability is difficult. So, the next time you talk to someone,
https://www. pause for a second and appreciate the enormous complexity of our
aphasia.org/, The
National Institute on
language system and yet how naturally it makes us who we are.
Deafness and Value this fragile human ability and be ready to give a helping hand
Communication to those who are challenged every time they must communicate
Disorders: with another person.
https://www.
nidcd.nih.gov/
health/aphasia,
Aphasia Recovery FUNDING
Lab at the University
of California This work was supported by the NIH/NIDCD grant R01 DC016345.
Berkeley: https://
aphasia. The content is solely the responsibility of the authors and does
berkeley.edu/ not necessarily represent the official views of the National Institutes
resources-for- of Health.
patients/

REFERENCES
1. MacDonald C., Mukherjee, P., and Yuh, E. 2019. How to see into the brain
without surgery! Front. Young Minds. 7:14. doi: 10.3389/frym.2019.00014
2. McCambridge, A. 2019. Recovery after a stroke—five tips for rehabilitation. Front.
Young Minds. 7:21. doi: 10.3389/frym.2019.00021
3. Swinburn, K., Porter, G., and Howard, D. 2004. Comprehensive Aphasia Test.
Routledge: Psychology Press.

SUBMITTED: 05 November 2020; ACCEPTED: 28 February 2022;

PUBLISHED ONLINE: 04 April 2022.

EDITOR: Athina Tzovara, University of California, Berkeley, United States

SCIENCE MENTOR: Vinitha Rangarajan

CITATION: Ivanova MV and Dronkers NF (2022) Aphasia: How Our Language

System Can “Break”. Front. Young Minds 10:626477. doi: 10.3389/frym.2022.626477

CONFLICT OF INTEREST: The authors declare that the research was conducted in
the absence of any commercial or financial relationships that could be construed
as a potential conflict of interest.

COPYRIGHT © 2022 Ivanova and Dronkers. This is an open-access article

distributed under the terms of the Creative Commons Attribution License (CC BY).
The use, distribution or reproduction in other forums is permitted, provided the
original author(s) and the copyright owner(s) are credited and that the original

kids.frontiersin.org April 2022 | Volume 10 | Article 626477 | 7

Ivanova and Dronkers Aphasia—Language Disorder

publication in this journal is cited, in accordance with accepted academic practice.

No use, distribution or reproduction is permitted which does not comply with these
terms.

YOUNG REVIEWER
GIGI, AGE: 9
My name is Gigi. I play piano and like art. My favorite thing to do is art and crafts. I
have a tuxedo cat named Athena. And my favorite color is yellow!

AUTHORS
MARIA V. IVANOVA
I am a neuroscientist at the University of California Berkeley investigating how brain
injuries affect people’s language, memory, and attention abilities. To better identify
the different patterns of deficits in individuals with brain damage, I have developed
several language and memory tests. I hope that my work will lead to a better
understanding of the changes in the brain that lead to recovery. In my free time,
I enjoy talking about language, the brain, and the connection between the two to
kids of all ages. *[email protected]

NINA F. DRONKERS
Nina Dronkers has worked with people with language disorders (aphasia) for over 40
years. She is a neuroscientist who wants to understand how language is processed
in the brain, and how a brain injury can affect the way we speak and understand.
She also uses this information to try and help people with aphasia to recover their
language skills.

kids.frontiersin.org April 2022 | Volume 10 | Article 626477 | 8