Aphasia
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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.
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.
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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.
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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.
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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.
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- 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.
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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.
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American Academy of Neurology
American Heart Association
American Speech-Language-HearingAssociation (ASHA)
Brain Injury Association, Inc.
Easter Seals
National Aphasia Association
National Stroke Association
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