Bridging Silence with Technology: How AI Could Transform Counselling for People with Aphasia

By Cynthia Crosse

Two years ago, I met a wonderful woman living with aphasia after a stroke. She’d moved into a retirement village and decided to try counselling. Six months of sessions passed - filled with repeated guesses, pointing at pictures, and gentle attempts to “get” each other. My biggest question: Was she truly understanding me? And was I truly understanding her?

Last month, she returned, asking to revisit painful family wounds. I paused. I realized we didn’t have the communication tools in place to navigate such deep emotional terrain safely.

This moment sparked my exploration: Can artificial intelligence help counsellors work more effectively with people with aphasia?

What Is Aphasia - and Why Does It Matter?

Aphasia isn’t a loss of intelligence - but a language barrier. It's typically caused by stroke, brain injury, tumors, or neurodegenerative disease. Over two million people in the U.S. and around 26,000 in New Zealand live with it (though these numbers are likely higher).

Aphasia comes in different forms - Broca’s, Wernicke’s, Global, Anomic, and more - each affecting speech, comprehension, reading, or writing, in unique ways. Some people might speak fluently but produce garbled sentences, while others speak slowly but understand well. In severe cases, both expression and comprehension are deeply impaired.

Communicating with someone with aphasia is more than asking for clarity - it involves patience, humility, and creativity. As AphasiaNZ says: “Until you’ve met it, you just don’t get it.”

The Emotional and Social Toll

Aphasia isn’t just about lost words. It strips away independence - making day-to-day tasks exhausting and isolating. Many lose the freedom to drive, consent to decisions, or express themselves fully. Unsurprisingly, rates of depression, anxiety, and social withdrawal are high.

Speech-language pathologists often act as informal counsellors, but most aren’t trained in the grief, identity loss, and deep emotional work required. Meanwhile, counsellors often lack the tools and training to communicate effectively with people with aphasia. So how do we connect? 

Looking Beyond Words: Strategies in Practice

Right now, no AI tool is robust or ethically sound enough to fully support counselling with people with aphasia. Yet the urgent need remains. Many people with aphasia want and deserve access to emotional support - and counsellors need better tools to meet them. So, how do we prepare?

In Proloquo2Go, the boards could be organized to work with counselling-specific concepts

Augmentative and Alternative Communication (AAC) Tools

Some counselling professionals are experimenting with communication boards, symbol-based apps like Proloquo2Go, and creative therapies like art, sand tray, or music. These approaches help bypass traditional language, tapping into meaning through gesture, image, and metaphor.

Still, most AAC systems are not designed with adult counselling in mind. Emotional nuance, relational depth, and cultural values are difficult to convey through symbols alone. And while digital boards can now “speak” pre-programmed phrases, they don't adapt well to the unpredictable flow of real therapeutic dialogue.

Screenshot of the Aphasia-GPT system interface, which provides selectable corrected phrases

AI-Assisted Speech Tools: Promise and Caution

Early prototypes like Aphasia-GPT show what’s technically possible. Designed by a computer science student for his mother, this tool uses GPT to offer clearer paraphrases of disordered speech, giving users choices over how their message is expressed. But its use has only been tested with three people. It's not yet validated for clinical or counselling contexts.

Virtual Reality and Simulators

VR platforms like EVA Park offer simulated environments for speech practice. AI simulations could, in theory, help train counsellors to interact more effectively with PWA. But these technologies remain largely experimental, with limited research focused on deep emotional processing or therapeutic alliance. They’re not yet ready to step into the counselling room.

Real-Time Transcription and Interfaces

Platforms like Zoom now offer live transcription and AI assistants. While promising, these tools struggle with atypical speech patterns - and are not designed with aphasia in mind. Their potential remains mostly untapped in this field.

Ethical and Practical Challenges

The counselling profession must tread carefully. AI companies aren’t bound by the ethical codes we uphold. They collect sensitive data, can’t be held accountable for harm, and often design with profit - not relational care - in mind.

Moreover, many people with aphasia are older, may have lower incomes, and may face barriers accessing the very tools being designed for them. If AI is to support inclusion, we must address these inequities head-on - and involve people with aphasia in co-design from the start.

Where to From Here?

Right now, the most important step is not adoption, but attention. Counsellors, designers, researchers, and disability advocates must come together to imagine, test, and shape AI tools with people with aphasia, not just for them.

With care, creativity, and ethical commitment, technology may one day help bridge communication gaps in counselling. But for now, it remains a field of hope and hypothesis, not a ready-made solution.