Identifying expressive aphasia
He speaks in short, effortful phrases and becomes frustrated, yet he correctly follows a two-step spoken request. This combination, impaired speech production with preserved comprehension, is expressive (Broca) aphasia. It results from damage to the language production area in the frontal lobe of the dominant hemisphere, which is usually the left hemisphere, consistent with his left-sided ischemic stroke and right-sided weakness. Because his understanding is intact, communication should reduce the demand on word production rather than on comprehension.
The best communication approach
Asking one yes-or-no question at a time and waiting for his reply allows him to answer with a single word, a nod, or a gesture. It respects his intact understanding, lowers frustration, and still gives him practice. The nurse speaks normally rather than loudly or in a childish way, gives him time, avoids interrupting, and may use communication boards or writing if helpful. Speech-language therapy guides further rehabilitation.
| Feature | Expressive (Broca) aphasia | Receptive (Wernicke) aphasia |
|---|
| Speech | Slow, effortful, short phrases | Fluent but often meaningless |
| Comprehension | Largely intact | Impaired |
| Awareness of errors | Usually aware, frustrated | Often unaware |
| Helpful approach | Yes-or-no questions, time to answer | Gestures, pictures, simple cues |
Why the other approaches are wrong
Finishing his sentences may seem kind but removes his opportunity to practice and may misstate what he wants. Repeating words slowly to strengthen the lips and tongue targets dysarthria, a motor speech problem, not a language disorder. Relying mainly on gestures and pictures because words confuse him suits receptive aphasia; he clearly understood the spoken request. Watch out! Distinguish aphasia (language) from dysarthria (speech muscles), and expressive from receptive aphasia, by checking comprehension.
Exam takeaway
Assess both expression and comprehension before choosing a communication strategy. Key point! For expressive aphasia, ask simple yes-or-no questions one at a time, allow time, and avoid finishing the client's sentences.