What Is Aphasia? What Causes Aphasia?

Editor's Choice
Main Category: Stroke
Also Included In: Neurology / Neuroscience;  Rehabilitation / Physical Therapy;  Alzheimer's / Dementia
Article Date: 25 Feb 2011 - 0:00 PDT


Aphasia is a language disorder that negatively affects a person's ability to talk, understand the spoken word and also their reading and writing. Originating from the Greek word "aphatos" which means speechless, aphasia is a symptom resultant of pre-existing brain damage, such as Alzheimer's disease or stroke (with over 30% of stroke victims suffering aphasia to some degree).

Originally, aphasia was a term used only to describe complete impairment of the person's communication and language. At the time the term dysphasia was used to describe partial language impairment, but it has been frequently mistaken for a swallowing disorder, dysphagia. Because of this, the term aphasia has taken on the meaning of both degrees of language impairment.

There are three major kinds of aphasia. These are:

• Fluent aphasia
• Non-Fluent aphasia
• Global aphasia

According to Medilexicon's medical dictionary aphasia is:

Impaired or absent comprehension or production of, or communication by, speech, reading, writing, or signs, caused by an acquired lesion of the dominant cerebral hemisphere.

What are the Signs and Symptoms of Aphasia?

A symptom is something the patient feels or reports, while a sign is something that other people, including the doctor detects. A headache may be an example of a symptom, while a rash may be an example of a sign.

As there are three types of aphasia, the symptoms can differ for each type. Details of these differences are:

• Global aphasia - All parts of vocal and written interaction are affected. Both writing and reading is impaired, as well as speech and listening.
• Fluent aphasia - Speech is hard/not possible to understand. The ability to speak is not impaired, but the words spoken make no sense. Writing ability is usually effected in the same way, the writing is flowing but what is actually written is nonsense.
  
  The person suffering from fluent aphasia may become annoyed and irritated if someone has trouble understanding them as they don't always realize they have a language disorder. As for understanding, people with fluent aphasia more commonly have problems with speech than writing.


• Non-fluent aphasia - With this type, speech is slower and hesitant, the patient also struggles to get their words out. Sentences are rarely completed, and even though some words are missing, what they are saying can be made sense of. Again writing ability is usually the same as speech.
  
  Someone with non-fluent aphasia has more problems with grammar than words alone. People with this kind of aphasia are more aware of their disorder and may get annoyed when they struggle with words.

The visible signs that can be noticed on someone with aphasia are weakness or paralysis on one side of the face or body.

What Causes Aphasia?

The part of the brain that controls speech and language recognition is referred to as the language center. It is normally in the part of the brain opposite to side of the hand you write with (e.g. left side of brain for the right handed). These parts of the brain are known as Broca's area and Wernicke's area. Aphasia is caused when any of these parts of the brain or the neural pathways connecting them are damaged. This can be a result of the following:

• Stroke
• Traumatic brain injury
• Epilepsy
• Migraine
• Brain tumor
• Alzheimer's
• Parkinson's

The type of aphasia is dependent on which part of the brain is damaged. The causes of each type of aphasia are:

• Global aphasia - caused by widespread damage right through the language center.
• Fluent aphasia - usually caused by damage to the temporal lobe (side of brain).
• Non-fluent aphasia - mostly the result of frontal lobe (front of brain) damage.

How is Aphasia Diagnosed?

As the number of people that have aphasia after suffering a stroke is high, a test for aphasia is usually carried out soon after the stroke.

The test is normally carried out by a language therapist and would include some basic exercises to help them asses the patient's language skills, such as:

• Naming objects that begin with a certain letter
• Reading or writing
• Holding a conversation
• Understanding directions and commands

A common test used is the Boston Diagnostic Aphasia Examination test, which incorporates exercises that extensively review the patient's language skills.

After aphasia is diagnosed it is usual practice that the patient undergoes a CT (Computerized Tomography) or MRI (Magnetic Resonance Imaging) scan. This will help determine the location and degree of brain damage that has caused the aphasia.

What are the Treatment Options for Aphasia?

The only way to really treat aphasia is with SLT (Speech and Language Therapy). It is not usually viable for someone with aphasia to completely regain the level of communication they had before the disorder, nevertheless SLT can lead to a massive improvement, even with global aphasia.

The results aimed to be achieved from SLT are:

• Better use of the residual language abilities.
• Improved language skills, by relearning them
• Ability to communicate in a different way, making up for missing words in speech

As there are different levels of aphasia and people don't all learn in the same way, there are a few variations of speech language therapy. These are:

• MIT (Melodic Intonation Therapy) - this is mostly used to treat non-fluent aphasia. It involves the use of humming or singing in rhythm (melodic intonation) while repeating phrases and words the patient has been struggling with. This process stimulates brain activity in the right hemisphere. MIT is effective at increasing how many words the patient can remember.
• Group therapy - this is where a small group of people with aphasia get together with a therapist and communicate. This gives the patients a chance to practice and improve their language skills by interacting with a group of people in a comfortable and helpful environment.
• PACE (Promoting Aphasic's Communicative Effectiveness) - a kind of SLT that improves the patient's communication skills by engaging them in conversation. The patient would be shown a picture or a drawing and asked to respond in any way that they can. The level of conversation will start off simple but through time it will become more involved.
• CST (Computerized Script Training) - as suggested in the title, this involves a computer delivered script based on day-to-day conversations. It gives the patient an opportunity to practice their communication skills using realistic situations.

How do you communicate with someone that has Aphasia?

The following are some tips on how to communicate with someone that has aphasia:

• Try to keep sentences short and simple and avoid questions that require a complicated answer.
• Do not change the subject of conversation too quickly.
• Minimise distracting background noises.
• When the person with aphasia is replying, try not to pressure them for a response and give them plenty of time to answer.
• Try not to correct their language as they may find this frustrating.
• Remember that their disorder is affecting the way they communicate, their tone may not necessarily reflect their mood.
• Try to keep a notepad/some paper and a pen to hand, this may help you or them to communicate.

What are the Complications associated with Aphasia?

Aphasia can have a negative effect on a number of aspects of life, as communication is fundamental to day to day living. It can affect things such as personal relationships and work and can result in the patient suffering frustration and distress.

All of these can contribute to heavy psychological stress which can then lead to depression. Research has proven this to be a common complication of aphasia with approximately 25% of people diagnosed suffering depression at some point.

It is advised that someone with aphasia suffering from depression go to support groups or see their doctor about treatment.

How can Aphasia be prevented?

With the main cause of aphasia being a stroke, taking measures to avoid having one would lower the risk of aphasia. Precautions that can be taken to reduce stroke risk are:

• regular exercise
• eating healthily
• monitoring and controlling blood pressure
• avoiding tobacco use
• keeping alcohol consumption low
• managing stress

If someone is suffering a stroke, getting them medical attention as soon as possible is crucial to recovery. There are certain signs to look out for that can determine if someone is suffering or about to suffer a stroke, these are:

• Blurred, blackened, or double vision
• Dizziness, trouble walking, loss of balance and coordination
• Numbness, weakness, or paralysis on one side of the body
• Speech problems
• Sudden severe headache

Further reading: "What is a stroke?"

Written by Mike Paddock

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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