| The
onset is sudden -- in an instant, one’s life is irrevocably
altered. The effects are generally long-term. “One does not
recover from aphasia, one recovers with aphasia,” notes
National Aphasia Association (NAA) President Emeritus Martha
Taylor Sarno, MA, MD (hon). Because of the disconnect between
their ability to think and their inability to communicate,
people with aphasia often become extremely frustrated,
depressed, and isolated.
What is aphasia?
Aphasia is an impairment of language, affecting the production
or comprehension of speech and the ability to read or write.
Aphasia is always due to injury to the brain-most commonly
from a stroke, particularly in older individuals. But brain
injuries resulting in aphasia may also arise from head trauma,
from brain tumors, or from infections.
Aphasia can be so severe as to make
communication with the patient almost impossible, or it can be
very mild. It may affect mainly a single aspect of language
use, such as the ability to retrieve the names of objects, or
the ability to put words together into sentences, or the
ability to read. More commonly, however, multiple aspects of
communication are impaired, while some channels remain
accessible for a limited exchange of information. It is the
job of the professional to determine the amount of function
available in each of the channels for the comprehension of
language, and to assess the possibility that treatment might
enhance the use of the channels that are available.
How many people have
aphasia?
It has been estimated that about one million people in the
United States have acquired aphasia. The majority are the
result of stroke. About one third of severely head-injured
persons have aphasia.
Who can have aphasia?
Aphasia may occur in persons of any age, sex, race, or
nationality. Vocation and education are not determining
factors.
Can aphasia be temporary?
Yes. Temporary aphasia, called transient aphasia, refers to a
communication problem that lasts only a few hours or days.
More than half of those who initially show symptoms of aphasia
recover completely within the first few days.
Can aphasia be prevented?
There are no definitive steps that can be taken to prevent the
onset of aphasia in the event of a stroke or head trauma. The
condition is determined by the location and size of the area
of damage in the brain.
Can aphasia be cured?
No medicine or drugs have been known to cure aphasia, as yet.
Surgery is successful in those occasions where pressure from a
brain tumor or a hematoma impacts a critical speech center.
Surgery is not useful in cases of aphasia following stroke,
which represent the vast majority of instances. Speech therapy
is often provided to persons with aphasia, but does not
guarantee a "cure". The purpose of speech therapy is
to help the patient to fully utilize remaining skills and to
learn compensatory means of communication.
Varieties and
special features of aphasia
Over a century of experience with the study of aphasia has
taught us that particular components of language may be
particularly damaged in some individuals. We have also learned
to recognize different types or patterns of aphasia that
correspond to the location of the brain injury in the
individual case. Some of the common varieties of aphasia are:
- Global aphasia - This is the most
severe form of aphasia, and is applied to patients who can
produce few recognizable words and understand little or no
spoken language. Global aphasics can neither read nor
write. Global aphasia may often be seen immediately after
the patient has suffered a stroke and it may rapidly
improve if the damage has not been too extensive. However,
with greater brain damage, severe and lasting disability
may result.
- Broca's aphasia - This is a form
of aphasia in which speech output is severely reduced and
is limited mainly to short utterances, of less than four
words. Vocabulary access is limited in persons with
Broca's aphasia, and their formation of sounds is often
laborious and clumsy. The person may understand speech
relatively well and be able to read, but be limited in
writing. Broca's aphasia is often referred to as a 'non
fluent aphasia' because of the halting and effortful
quality of speech.
- Mixed non-fluent aphasia - This
term is applied to patients who have sparse and effortful
speech, resembling severe Broca's aphasia. However, unlike
persons with Broca's aphasia, they remain limited in their
comprehension of speech and do not read or write beyond an
elementary level. Wernicke's aphasia - In this form of
aphasia the ability to grasp the meaning of spoken words
is chiefly impaired, while the ease of producing connected
speech is not much affected. Therefore Wernicke's aphasia
is referred to as a 'fluent aphasia.' However, speech is
far from normal. Sentences do not hang together and
irrelevant words intrude-sometimes to the point of jargon,
in severe cases. Reading and writing are often severely
impaired.
- Anomic aphasia This term is
applied to persons who are left with a persistent
inability to supply the words for the very things they
want to talk about-particularly the significant nouns and
verbs. As a result their speech, while fluent in
grammatical form and output is full of vague
circumlocutions and expressions of frustration. They
understand speech well, and in most cases, read
adequately. Difficulty finding words is as evident in
writing as in speech.
- Other varieties of aphasia In
addition to the foregoing syndromes that are seen
repeatedly by speech clinicians, there are many other
possible combinations of deficits that do not exactly fit
into these categories. Some of the components of a complex
aphasia syndrome may also occur in isolation. This may be
the case for disorders of reading (alexia) or disorders
affecting both reading and writing (alexia and agraphia),
following a stroke. Severe impairments of calculation
often accompany aphasia, yet in some instances patients
retain excellent calculation in spite of the loss of
language.
Disorders that
may accompany or be confused with aphasia
There are a variety of disorders of communication that may be
due to paralysis, weakness, or incoordination of the speech
musculature or to cognitive impairment. Such impairment may
accompany aphasia or occur independently and be confused with
aphasia. It is important to distinguish these disorders from
aphasia because the treatment(s) and prognosis of each
disorder are different.
- Apraxia Apraxia is a collective
term used to describe impairment in carrying out
purposeful movements. People with severe aphasia are
usually extremely limited in explaining themselves by
pantomime or gesture, except for expressions of emotion.
Commonly they will show you something in their wallet, or
lead you to show you something, but this is the extent of
their non-verbal communication. Specific examination
usually shows that they are unable to perform common
expressive gestures on request, such as waving good-bye,
beckoning, or saluting, or to pantomime drinking, brushing
teeth, etc. (limb apraxia). Apraxia may also primarily
affect oral, non-speech movements, like pretending to
cough or blow out a candle (facial apraxia). This disorder
may even extend to the inability to manipulate real
objects. More often, however, apraxia is not very apparent
unless one asks the patient to perform or imitate a
pretended action. For this reason it is almost never
presented as a complaint by the patient or the family.
Nevertheless it may underlie the very limited ability of
people with aphasia to compensate for the speech
impairment by using informative gestures.
- Apraxia of speech This term is
frequently used by speech pathologists to designate an
impairment in the voluntary production of articulation and
prosody (the rhythm and timing) of speech. It is
characterized by highly inconsistent errors.
- Dysarthria Dysarthria refers to a
group of speech disorders resulting from weakness,
slowness, or incoordination of the speech mechanism due to
damage to any of a variety of points in the nervous
system. Dysarthria may involve disorders to some or all of
the basic speech processes: respiration phonation,
resonance, articulation, and prosody. Dysarthria is a
disorder of speech production not language (e.g., use of
vocabulary and/or grammar). Unlike apraxia of speech, the
speech errors that occur in dysarthria are highly
consistent from one occasion to the next.
- Dementia Dementia is a condition
of impairment of memory, intellect, personality, and
insight resulting from brain injury or disease. Some forms
of dementia are progressive, such as Alzheimer's disease,
Picks disease, or some forms of Parkinson's disease.
Language impairments are more or less prominent in
different forms of dementia, but these are usually
overshadowed by more widespread intellectual loss. Since
dementia is so often a progressive disorder, the prognosis
is quite different from aphasia.
For more
information, visit the National
Aphasia Association |
