speech therapy

Communication Strategies and Primary Progressive Aphasia

The Capital Gazette had a question about primary progressive aphasia in this week’s Caregiver Corner. The writer expresses frustration that they live far away from their siblings and parents, but they don’t believe the family is doing enough to treat their father’s PPA.

The advice giver gently explains the difference between aphasia brought on from a stroke and the progressive nature of PPA. PPA is a neurological condition. The language loss worsens as brain tissue deteriorates. It is a slow, instead of sudden, decline. The advice giver lets the reader know:

While individuals who develop aphasia as a result of a stroke or head trauma may benefit from speech therapy, those with PPA will not. Some, however, may learn new communication strategies from speech-language pathologists and families may also benefit from strategies learned in aphasia support/community groups.

It’s not the advice anyone wants to hear, but as the columnist points out, there are things people can do to learn new communication strategies.

Communication Strategies

Tactus Therapy points out the major difference between PPA and other forms of dementia, such as Alzheimer’s: “With PPA, difficulty with language is the first sign, while memory and reasoning are usually not affected in the early stages.”

They give plenty of useful tips including focusing on priority vocabulary. Rather than trying to hold onto all speech, focus on the most important, useful words for the individual. “Practice only what’s important to your client. For example, if the client loves pineapple, then use the word in your program. If they don’t care for or need to talk about pineapple, then leave the word out of treatment.”

In addition, it can be helpful to create “PPA cards,” a card the person can carry in their pocket with an explanation to hand others as well as common phrases they may need to remember while interacting with other people. It’s also helpful to start working early with non-verbal cues and gestures.

Want to learn more about PPA? Watch our brief video for an overview of this neurological condition.



  • Fred Raymond
    March 28, 2019 at 10:38 pm

    My wife was diagnosed with PPA 3 years ago. She also has significant balance issues and has experienced a number of falls. The last two falls resulted in broken hips (first the left, then after rehab and home health therapy, fell again and broke right hip) and partial hip replacements. She has been on a walker for 2 years and her mobility is very limited. Part of her PPA is probably AOS as she appears to fully understand verbal communication from others. But her limited ability to respond is frustrating both to her and to her significant others (principally myself and our son, who assists me in caregiving). Her responses to questions, requiring simply yes or no answers are usually dyslexic(??) in that she will answer “yeah” or “yes” initially when she means “no” and vice versa. I printed out the info on Managing PPA and read it aloud to her and she nodded emphatically that she understood it. Once an avid reader, she doesn’t read books at all now, does a little on her Nook, but admits that she has trouble trying to read. My major concerns are, “does the progression eventually manifest in aspects of Alzheimer-type detioration?” and “what is the time span of progression until she loses language altogether.”

  • Anonymous
    July 17, 2019 at 9:42 am

    My husband was diagnosed April 2013 with Primary Progressive Non Fluent Aphasia, not the result of a stroke. We spent many, many hours in speech therapy, and me helping with his reading and writing. We managed to delay the loss of his speech and writing skills, but sadly in the end he lost these skills. When I ask a question he now communicates by shaking his head yes or no.
    After almost 40 years of marriage, I am fortunate I can tell how he may be feeling by watching his facial expressions.
    For the past 2.5 years he has been in long term care. I struggle every day watching him lose the ability to do the simplest of things, the things we all take for granted. He now is in a wheel chair. It is a difficult journey……watching him deteriorate…and not being able to help him…..I can not fix it….makes me so sad…….breaks my ❤️

  • Pat Humphrey
    July 17, 2019 at 6:50 pm

    I was diagnosed with receptive and expressive aphasia, altered mental status and I do not remember what else. This was due to being poisoned by petroleum hydrocarbons at work. At first just being physically sick for months while my body got rid of the toxins was enough to deal with. I remember thinking I might not be able to read anymore. I pulled Shakespeare’s Henry V off the shelf, opened it up, looked at the pages and could make not sense of it. Tactile things became very important to me. I mended clothes, cleaned out closets, worked in the yard. I was on the phone with my son one day and just gave up on being able to talk and hung up the phone. I could not follow the plot of a TV show or movie. A friend suggested I take a look at the old Disney and kid’s movies from the 50’s and 60’s. I started using the juvenile section at the library. No one at the library ever made fun of me. And sometimes when I would go home I would realize I had been out with my clothes put on inside out or things buttoned up goofy. Insead of friends at work I have library friends. I am at the library now. If I have to read anything now, and sometime it is legal stuff. I make a second copy and do what I call decoding the stuff and sometimes rewrite it so I can understand it. You can make the second print smaller so you have bigger margins to write your notes. My handwriting is terrible, but I just realized I have been gripping pens so hard like I had to do when I first got sick and was dropping everything. Trying to think of my writing as flowing now. I go to a little communications/speech group at a local hospital. I need to do this. I am learning things from others that have worked stuff out. I have some balance problems and wear those rubber bottomed river/water shoes that you see in the summer. They help me feel more grounded and less tippy. It is a long journey. I am always learning from others.

  • Beverly Stewart
    July 18, 2019 at 10:37 am

    My husband was diagnosed with PPA this past November. We did go to speech therapy for a couple of months but his speech was not getting better. It does get frustrating when he cannot understand what I ask him to do or go. I have learned different ways to communicate with him. I am always looking for support groups and and so happy to found this community.

    I know how frustrated he gets and how unhappy he is not being able to Express himself. I now do the things he use to do and I know it will only be getting harder as time goes on. I love him and will do whatever I can to help him with this disease.

  • Debbie Herman
    December 10, 2019 at 12:28 am

    My 88 year old mother was diagnosed with PPA in 2011 after she told me she had “trouble talking” which was not apparent to me; however, she was having a myriad of other symptoms – personality changes, delusions, falls, difficulty with higher executive thinking and other signs of dementia. Over the course of 4-5 years, she lost all language skills – speaking and writing. She has had aphasia for 3-4 years now and no ability to communicate. In 2015, she fell and broke has hip – had rehab and then i moved her to my home. At this point, she is total care – for all of her needs. I am constantly trying to determine her wishes with facial expressions. My husband and I are a team – he lifts her and I provide the caregiving which has been an exhaustive process for over 4 years. My heart is so broken. I despise dementia and PPA with a passion. I pray that someday there will be a treatment for this heartbreaking disease.

  • Linda Shumway
    July 12, 2020 at 7:53 pm

    My husband has been diagnosed with PPA 8 years ago. Has been on disability for 2 1/2 yrs. He is in the late phase of PPA. He is very smart and an engineering, so to see him go through this is heart breaking. He (we) have had a great attitude going into this. I think since he keeps himself busy all the time has helped slowed down the process (I wish to think this!). He uses a marker board all time for the past year. We actually have marker boards everywhere in the house and in the cars and he even takes along a small one with him when we go out. He also uses his phone a lot to show words/phrases that he prewritten that he can show. But it has been very frustrating these past few months were we have seen a decline in his PPA where he is starting the late stage of this. I actually miss hearing his voice. He does not understand words now and even hard for him to understand when I write on the marker board. It’s been 3 years since all of his doctors has said there is nothing they can do and he does not need to be seen again unless we needed to. There are no support groups around that are just for PPA. The ones we have gone to are for aphasia patients that were caused by strokes . I feel that we were told he has PPA and had help early on but upset that I feel I am on my own now and have to do my own research for help. He did the speech therapy in the early stage but now I do not know what to do on ways to commutate with him now. Looking for ideas/suggestions. Someone suggested sign-language but I feel it may be too late to learn that. Appreciate any thoughts! We have been married 40 years this year and I love him so much and it is just hard to see him at this stage but I will do whatever I can to get him though this and where he does not feel like he is not smart anymore or sad. And as some of you that as mentioned it is truly heartbreaking.

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