Open Access Open Access  Restricted Access Subscription or Fee Access

Exploring Experiences of Expressive Aphasia in Brain Injury Patients: A Qualitative Study

Heena Narotam, Helen E. Sammons


Background: Aphasia affects 0.37% of South Africans. Expressive aphasic patients’ ability to react appropriately to the environment contributes to their hospital experience, and ultimately their mental health and recovery. The challenge of communication for these patients makes it important to anticipate their experiences.

Objectives: The purpose of the present study was to explore the patterns of patient experiences in relation to expressive aphasia following brain injuries in order to identify helpful recommendations for alternative communication and for promoting mental health and well-being.

Methods: A qualitative case series study was completed with the participation of seven adults who had recovered from expressive aphasia. Participants had received their acute care at Worcester Provincial Hospital, South Africa and at the time of the study were able to communicate effectively concerning their experiences and perspectives. Interviews were transcribed and transcripts analysed by two independent researchers. A thematic analysis method, within a constructionist framework, and at a latent level, was applied.

Results: Participants were generally satisfied with the services of health professionals. All participants described their families as being supportive. However, even though most participants had attempted to initiate alternative forms of communication, their families had not reciprocated this. Participants experienced sadness, frustration and anger following the onset of expressive aphasia. They reported gaining insight into the way their lives might change in the near future, such as their roles within the community, as well as into their experiences of introspection and self-reflection.

Conclusions: Persons with new onset expressive aphasia during acute care at a large South African hospital experience negative emotions (such as feelings of frustration, entrapment and sadness) as well as inadequate responses to their desire to use alternative forms of communication. Anticipation of such negative experiences may substantially help communication. Formal training in this regard is recommended for health care professionals. Also, visitors to patients with expressive aphasia require basic instruction on the use of alternative communication.



Expressive Aphasia; Alternative Communication; Communication Rehabilitation and Mental Well-being; Communication Rehabilitation and Prognosis

Full Text:



CureResearch. Statistics by Country for Aphasia. (accessed 12 February 2017).

Davis, G.A. (2016) American Speech-Language-Hearing Association, Available at: 18th July 2016).

Worrall, L., Ryan, B., Hudson, K., Kneebone, I., Simmons-Mackie, N., Khan, A., Hoffmann, T., Power, E., Togher, L., Rose, M. (2016 March) Reducing the psychosocial impact of aphasia on mood and quality of life in people with aphasia and the impact of caregiving in family members through the Aphasia Action Success Knowledge (Aphasia ASK) program: study protocol for a randomized controlled trial, : BioMed Central.

Centro de Investigaciones Médico-Sanitarias (CIMES), Departamento de Medicina, Universidad de Málaga, Campus Universitario Teatinos, University of Málaga, Málaga, Spain. (2005) ' Poststroke aphasia: epidemiology, pathophysiology and treatment',Drugs Ageing , 22(2), pp. 163-82 [Online]. Available at: 8 March 2014).

Gil M., Cohen M., Korn C., Groswasser Z. (1996) 'Vocational outcome of aphasic patients following severe traumatic brain injury', Brain Injury , 10(1), pp. 39-45 [Onl ine]. Available at: (Accessed: 8 March 2014).

Hier, D.B., Yoon, W.B., Mohr, J.P., Price, T.R., Wolf, P.A. (1994 July) 'Gender and aphasia in the Stroke Data Bank. ', Brain Language, 1(47), pp. 155-67 [Online]. Available at: (Accessed: 18th July 2016).

Lauren Burns. Introduction to Traumatic Brain Injury. Continuing Medical Education February 2008; 26(2): (accessed 12 February 2017).

Executive Overview: District Health Plan Cape Winelands District 2016/2017. Western Cape Government Health 2016/2017;

Robinson R.G., Kubos K.L., Starr L.B., Rao K., Price T.R. (1984) 'Mood disorders in stroke patients. Importance of location of lesion', Brain: A journal of neurology , 107(1), pp. [Online]. Available at: (Accessed: 15 August 2015).

Carota, A., Staub, F., Bogousslavsky, J. (2002 February) 'Emotions, behaviours and mood changes in stroke. ', Current Opinion in Neurology, 1(15), pp. 57-69 [Online]. Available at: (Accessed: 17th July 2016).

Ropper AH, Samuels MA, Klein JP. Principles of Neurology, 10 ed. : McGraw-Hill education; 2014.

Greenwald B, Bell K. Sleep and Traumatic Brain Injury. (accessed 11 April 2017).

National Collaborating Centre for Mental Health (UK). (2010) Depression in Adults with a Chronic Physical Health Problem. NICE Clinical Guidelines, Leicester (UK): British Psychological Society [Online]. Available at: (Accessed 15 August 2015).

Spaccavento S., Craca A., Del Prete M., Falcone R., Colucci A., Di Palma A., Loverre A. (2014) 'Quality of life measurement and outcome in aphasia', Neuropyschiatry Disease and Treatment , 10(), pp. 27-37 [Online]. Available at: 8 March 2014).

Fann J, Hart T.. Depression after Traumatic Brain Injury. (accessed 11 April 2017).

Silverman M.E. (2011) 'Community: the key to building and extending engagement for individuals with aphasia', Seminars in speech and language , 32(3), pp. 260-261 [Online]. Available at: (Accessed: 22 July 2015).

Robey RR. (1998) 'A meta-analysis of clinical outcomes in the treatment of aphasia',Journal of Speech, Language and Hearing Research, 41(1), pp. 172-87 [Online]. Available at: (Accessed: 8 March 2014).

Mattioli F, Ambrosi C., Mascaro L., Scarpazza C., Pasquali P., Frugoni M., et al. (2014) 'Early aphasia rehabilitation is associated with functional reactivation of the left inferior frontal gyrus: a pilot study', Stroke , 45(2), pp. 145-52 [Online]. Available at: (Accessed: 10 January 2014).

Godecke E., Rai T., Ciccone N., Armstrong E., Granger A., Hankey G.J. (2013) ' Amount of therapy matters in very early aphasia rehabilitation after stroke: a clinical prognostic model', Seminars in Speech and Language , 34(3), pp. 129-41 [Online]. Available at: (Accessed: 8 March 2014).

Laska A.C., Kahan T., Hellblom A., Murray V., von Arbin M. (2011) 'A randomized controlled trial on very early speech and language therapy in acute stroke patients with aphasia', Cerebrovascular Disease Extra , 1(1), pp. 66-74 [Online]. Available at: (Accessed: 8 March 2014).

Poslawsky, I.E., Schuurmans, M.J., Lindeman, E., Hafsteinsdóttir, T.B. (2010 January) 'A systematic review of nursing rehabilitation of stroke patients with aphasia. ', Journal of Clinical Nursing, 1-2(19), pp. 17-32 [Online]. Available at: (Accessed: 17th July 2016).

Bryer A., Connor M.D., Haug P., Cheyip B., Staub H., Tipping B., Duim W., Pinkney-Atkinson V. (2010) 'South African guideline for management of ischaemic stroke and transient ischaemic attack 2010: A guideline from the South African Stroke Society (SASS) and the SASS Writing Committee ', SAMJ, 100(11), pp. 24-25 [Online]. Available at: (Accessed: 13 August 2015).

McColl, M.A., Bickenbach, J., Johnston, J., Nishihama, S., Schumaker, M., Smith, K., Smith, M., Yealland, B. (2000 August) 'Spiritual issues associated with traumatic-onset disability ', Disability and Rehabilitation, 12(22), pp. 555-64 [Online]. Available at: (Accessed: 20th July 2016).

Sevinç, S., Ajghif, M., Uzun, Ö., Gülbil, U. (2016 June) 'Expectations of relatives of Syrian patients in intensive care units in a state hospital in Turkey', Journal of Clinical Nursing, 10(11), pp. [Online]. Available at: (Accessed: 15th July 2016).

Andersson, S., Fridlund, B. (2002 June) 'The aphasic person's views of the encounter with other people: a grounded theory analysis.', Journal of Psychiatric and Mental Health Nursing, 3(9), pp. 285-92 [Online]. Available at: (Accessed: 17th July 2016).

Toronto C.E., Weatherford B. (2016 Jan-Feb) 'Registered Nurses' Experiences With Individuals With Low Health Literacy: A Qualitative Descriptive Study.', Journal for Nurses in Professional Development, 1(32), pp. 8-14 [Online]. Available at: (Accessed: 15th July 2016).

McCabe, C. (2004 January) 'Nurse-patient communication: an exploration of patients' experiences.', Journal of Clinical Nursing, 1(13), pp. 41-9 [Online]. Available at: (Accessed: 15th July 2016).

Holland, A.L., Halper, A.S., Cherney, L.R. (2010 August) 'Tell me your story: analysis of script topics selected by persons with aphasia.', American Journal of Speech and Language Pathology, 3(19), pp. 198-203 [Online]. Available at: (Accessed: 17th July 2016).

Tami, J., Howea (2008) 'The ICF Contextual Factors related to speech-language pathology', International Journal of Speech-Language Pathology , 10(1-2), pp. 27-37 [Online]. Available at: 18th July 2016).

(2016) International Classification of Functioning, Disability and Health (ICF), Available at: (Accessed: 18th July 2016).

World Health Organisation. (accessed 3 January 2017).

Disabil Rehabil. 2016 Jun 27:1-16. [Epub ahead of print] Wallace, S.J., Worrall, L., Rose, T., Le Dorze, G., Cruice, M., Isaksen, J., Kong, A.P., Simmons-Mackie, N., Scarinci, N., Gauvreau, C.A. (2016 June) 'Which outcomes are most important to people with aphasia and their families? an international nominal group technique study framed within the ICF.', Disability and Rehabilitation, (1-16), pp. [Online]. Available at: (Accessed: 18th July 2016).

Grawburg, M., Howe, T., Worrall, L., Scarinci, N. (2014) ' Describing the impact of aphasia on close family members using the ICF framework. ', Disability and Rehabilitation, 14(36), pp. 1184-95 [Online]. Available at: (Accessed: 18th July 2016).

Meesters, J., Pont, W., Beaart-Van De Voorde, L., Stamm, T., Vliet Vlieland, T. (2014 April) 'Do rehabilitation tools cover the perspective of patients with rheumatoid arthritis? A focus group study using the ICF as a reference. ', European Journal of Physical and Rehabilitation Medicine, 2(50), pp. 171-84 [Online]. Available at: (Accessed: 18th July 2016).

Glässel, A., Finger, M.E., Cieza, A., Treitler, C., Coenen, M., Escorpizo, R. (2011 June) 'Vocational rehabilitation from the client's perspective using the International Classification of Functioning, Disability and Health (ICF) as a reference.', Journal of Occupational Rehabilitation, 2(21), pp. 167-78 [Online]. Available at: (Accessed: 18th July 2016).

Simkiss DE, Blackburn CM, Mukoro FO, Read JM, Spencer NJ. Childhood disability and socio-economic circumstances in low and middle income countries: systematic review. BMC Paediatrics2011; 11(119): . (accessed 30 May 2017).

Centre for Rehabilitation Studies. Lecture notes. (January 2012) 'Rehabilitation An Introduction', in Centre for Rehabilitation Studies. (ed.) Lecture notes: Rehabilitation an introduction. Stellenbosch University: , pp. 5-12.

Tenchini, M.P. () Reporting Gesture and Voice in Reporting Speech: Co-verbal Language in Literature, Available at: 20th July 2016).

Hadar, U. (1991) 'Speech-related body movement in aphasia: period analysis of upper arms and head movement', Brain Language, 41(3), pp. [Online]. Available at: (Accessed: 13 August 2015).

Braun, V., Clarke, V. (2006) 'Using thematic analysis in psychology', Qualitative Research in Psychology , 3(2), pp. 77-101 [Online]. Available at: (Accessed: 22nd July 2016).

Lincoln, Y.S., & Guba, E.G. (1985) Naturalistic Inquiry, Newbury Park, CA: Sage Publications.

Kubler-Ross E, Axelrod, J. The 5 Stages of Grief and Loss. (accessed 17 April 2017).

Coyle J(2002) 'Spirituality and health: towards a framework for exploring the relationship between spirituality and health', Journal of Advanced Nursing , 37(6), pp. 1365-2648 [Online]. Available at: (Accessed: 16 August 2015).



  • There are currently no refbacks.