Patients with post-tumor removal aphasia face intense isolation. It’s time we recognized this silent struggle and acted decisively to expand access to speech therapy
By Dr. Sathyanarayana L.D, Consultant Neurosurgeon, Narayana Health, Bengaluru.
A common but neglected complication
Language is central to how we think, relate, and exist in the world. Speech involves the ability to use movements of the tongue, lips, jaw muscles, and vocal tract to produce sounds. Aphasia (sometimes called dysphasia) is a broad-spectrum acquired language disorder affecting a person’s ability to process, use, and/or understand language. It can affect all forms of language – speaking, listening, reading, and writing. Aphasia can cause frustration and stress for an individual living with it, as well as for their caregiver. Research indicates that about 30 percent of patients who undergo brain tumor surgery in the language-dominant hemisphere (typically the left side) develop some form of aphasia. Yet, despite its prevalence and impact, aphasia remains an under-addressed concern in post-operative care across India.
Aphasia can vary from mild degree wherein there is trouble understanding long messages and needing a little extra time to understand and respond to spoken messages and difficulty finding words to express or explain an idea to severe degree in which there is little to no ability to speak, read or write or using a combination of words and jargon that is not understood by others and being unaware of own errors.
Location of the tumour
Whether and how a brain tumor affects a person depends on where it is in the brain. Each section or lobe of the brain is responsible for different functions, some of which are involved in communication. For example, the frontal lobe is involved in language production (how we express ourselves), and the temporal lobe is involved in understanding what others are saying to us and how our thought processes work. As a result, pressure from a tumor in one of these areas of the brain can affect the ability to speak and understand what others are saying. Areas of the brain controlling language are generally found in the left hemisphere, so if this is where the tumor is, a person is more likely to experience language and speech difficulties.
However, in some cases speech centre is found in the right hemisphere, for instance, especially with left-handed people. Because our brains are responsible for controlling the muscles needed to produce speech, a brain tumor can also cause difficulty speaking by interrupting some signals being sent to the mouth, dysarthria. Brain tumors can either be benign (non-cancerous) or malignant (cancerous). A tumor can cause aphasia if it impacts the brain’s language centers. Aphasia due to cancer is called neoplastic aphasia.
The most common type of aphasia due to a brain tumor is anomic aphasia. Aphasia due to brain tumors is more likely to be short-term and milder than post-stroke aphasia. The outcome and prognosis for cancer-related aphasia are also dependent on the success of the medical treatment. If the tumor is treated successfully, the aphasia is likely to resolve.
Types of aphasia:
- Expressive aphasia: Difficulty speaking or finding the right words
- Receptive aphasia: Difficulty understanding spoken language or written words
- Global aphasia: A severe form of aphasia affecting both speech production and language comprehension
Why Early Therapy Matters
Slow-growing brain tumors in the left cerebral hemisphere can impact the brain. For patients recovering from brain tumour surgery, this vital faculty is sometimes the most painful loss. Timely and individualized speech therapy plays a critical role in helping the brain reorganize and compensate for lost function — a process known as neuroplasticity. This could mean that if the tumor is impacting a language center, the brain can shift language processing to another part of the brain. The first three to six months after surgery are a golden window for recovery. There are dozens of ways that speech-language pathologists (SLPs) treat aphasia. The type of treatment a person receives is generally determined by the type of aphasia he or she has, as well as the severity of it. However, it can also be guided by the needs of individual patients and their families as it relates to activities of daily living.
What can be done
- Integrate speech therapy into standard post-operative protocols
- Strengthen the workforce and training
- Harness teletherapy and digital health tools
- Support families and caregivers
- Include rehabilitation under insurance and public health schemes
Giving Voice to Recovery
Aphasia doesn’t kill, but it can erase identity, self-worth, and connection. In a society where verbal communication dominates, losing language means losing participation. Yet, with appropriate therapy and support, many patients make remarkable recoveries. The challenge is not healthcare possibility, but access and awareness.
The time has come to treat rehabilitation as essential, not optional. In India’s expanding neurosurgical landscape, we cannot afford to let patients survive surgery only to live in silence. They deserve more than survival; they deserve to be heard. I advocate a multidisciplinary, integrated approach to neuro-rehabilitation and particularly speech therapy. Speech-language therapy is to be initiated during inpatient recovery for at-risk patients and continued via outpatient or tele-rehabilitation pathways.