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Aphasia is
a language disorder that results from damage to portions
of the brain that are responsible for language. For most
people, these are parts of the left side (hemisphere) of
the brain. Aphasia usually occurs suddenly, often as the
result of a stroke or head injury, but it may also develop
slowly, as in the case of a brain tumor. The disorder impairs
both the expression and understanding of language as well
as reading and writing. Aphasia may co-occur with speech
disorders such as dysarthria or apraxia
of speech, which also result from brain damage.
Who has aphasia?
Anyone can acquire aphasia, but most people who have aphasia
are in their middle to late years. Men and women are equally
affected. It is estimated that approximately 80,000 individuals
acquire aphasia each year. About one million persons in the
United States currently have aphasia.
What causes aphasia?
Aphasia is caused by damage to one or more of the language
areas of the brain. Many times, the cause of the brain injury
is a stroke. A stroke occurs when, for some reason, blood
is unable to reach a part of the brain. Brain cells die when
they do not receive their normal supply of blood, which carries
oxygen and important nutrients. Other causes of brain injury
are severe blows to the head, brain tumors, brain infections,
and other conditions of the brain.
Individuals with Broca's aphasia have damage to the frontal
lobe of the brain. These individuals frequently speak in
short, meaningful phrases that are produced with great effort.
Broca's aphasia is thus characterized as a nonfluent aphasia.
Affected people often omit small words such as "is," "and," and "the." For
example, a person with Broca's aphasia may say, "Walk dog" meaning, "I
will take the dog for a walk." The same sentence could also
mean "You take the dog for a walk," or "The dog walked out
of the yard," depending on the circumstances. Individuals
with Broca's aphasia are able to understand the speech of
others to varying degrees. Because of this, they are often
aware of their difficulties and can become easily frustrated
by their speaking problems. Individuals with Broca's aphasia
often have right-sided weakness or paralysis of the arm and
leg because the frontal lobe is also important for body movement.
In contrast to Broca's aphasia, damage to the temporal lobe
may result in a fluent aphasia that is called Wernicke's
aphasia. Individuals with Wernicke's aphasia may speak in
long sentences that have no meaning, add unnecessary words,
and even create new "words." For example, someone with Wernicke's
aphasia may say, "You know that smoodle pinkered and that
I want to get him round and take care of him like you want
before," meaning "The dog needs to go out so I will take
him for a walk." Individuals with Wernicke's aphasia usually
have great difficulty understanding speech and are therefore
often unaware of their mistakes. These individuals usually
have no body weakness because their brain injury is not near
the parts of the brain that control movement.
A third type of aphasia, global aphasia, results from damage
to extensive portions of the language areas of the brain.
Individuals with global aphasia have severe communication
difficulties and may be extremely limited in their ability
to speak or comprehend language.
How is aphasia diagnosed?
Aphasia is usually first recognized by the physician who
treats the individual for his or her brain injury. Frequently
this is a neurologist. The physician typically performs tests
that require the individual to follow commands, answer questions,
name objects, and converse. If the physician suspects aphasia,
the individual is often referred to a speech-language
pathologist, who performs a comprehensive examination
of the person's ability to understand, speak, read, and write.
How is aphasia treated?
In some instances an individual will completely recover
from aphasia without treatment. This type of "spontaneous
recovery" usually occurs following a transient ischemic attack
(TIA), a kind of stroke in which the blood flow to the brain
is temporarily interrupted but quickly restored. In these
circumstances, language abilities may return in a few hours
or a few days. For most cases of aphasia, however, language
recovery is not as quick or as complete. While many individuals
with aphasia also experience a period of partial spontaneous
recovery (in which some language abilities return over a
period of a few days to a month after the brain injury),
some amount of aphasia typically remains. In these instances,
speech-language therapy is often helpful. Recovery usually
continues over a 2-year period. Most people believe that
the most effective treatment begins early in the recovery
process. Some of the factors that influence the amount of
improvement include the cause of the brain damage, the area
of the brain that was damaged, the extent of the brain injury,
and the age and health of the individual. Additional factors
include motivation, handedness, and educational level.
Aphasia therapy strives to improve an individual's ability
to communicate by helping the person to use remaining abilities,
to restore language abilities as much as possible, to compensate
for language problems, and to learn other methods of communicating.
Treatment may be offered in individual or group settings.
Individual therapy focuses on the specific needs of the person.
Group therapy offers the opportunity to use new communication
skills in a comfortable setting. Stroke clubs, which are
regional support groups formed by individuals who have had
a stroke, are available in most major cities. These clubs
also offer the opportunity for individuals with aphasia to
try new communication skills. In addition, stroke clubs can
help the individual and his or her family adjust to the life
changes that accompany stroke and aphasia. Family involvement
is often a crucial component of aphasia treatment so that
family members can learn the best way to communicate with
their loved one.
Family members are encouraged to:
- Simplify language by using short, uncomplicated sentences.
- Repeat the content words or write down key words to clarify
meaning as needed.
- Maintain a natural conversational manner appropriate
for an adult.
- Minimize distractions, such as a blaring radio, whenever
possible.
- Include the person with aphasia in conversations.
- Ask for and value the opinion of the person with aphasia,
especially regarding family matters.
- Encourage any type of communication, whether it is speech,
gesture, pointing, or drawing.
- Avoid correcting the individual's speech.
- Allow the individual plenty of time to talk.
- Help the individual become involved outside the home.
Seek out support groups such as stroke clubs.
What research is being done for aphasia?
Aphasia research is exploring new ways to evaluate and treat
aphasia as well as to further understanding of the function
of the brain. Brain imaging techniques are helping to define
brain function, determine the severity of brain damage, and
predict the severity of the aphasia. These procedures include
PET (positron emission tomography), CT (computed tomography),
and MRI (magnetic resonance imaging) as well as the new functional
magnetic resonance (fMRI), which identifies areas of the
brain that are used during activities such as speaking or
listening. In-depth testing of the language ability of individuals
with the various aphasic syndromes is helping to design effective
treatment strategies. The use of computers in aphasia treatment
is being studied. Promising new drugs administered shortly
after some types of stroke are being investigated as ways
to reduce the severity of aphasia.
To read more about this topic from the National Institute
on Deafness and Other Communication Disorders, please click
here: http://www.nidcd.nih.gov/health/voice/aphasia.htm
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