Aphasia (patient information)

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 * Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S.

Overview
Aphasia is a disorder that results from damage to portions of the brain that are responsible for language. For most people, these are areas on 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, an infection, or dementia. The disorder impairs 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.

What are the types of Aphasia?
1. Wernicke’s aphasia: Damage to the temporal lobe (the side portion) of the brain may result in a fluent aphasia called Wernicke’s aphasia. In most people, the damage occurs in the left temporal lobe, although it can result from damage to the right lobe as well. People with Wernicke’s aphasia may speak in long sentences that have no meaning, add unnecessary words, and even create made-up 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.” As a result, it is often difficult to follow what the person is trying to say. People with Wernicke’s aphasia usually have great difficulty understanding speech, and they are 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.

2. Broca’s aphasia: A type of non-fluent aphasia is Broca’s aphasia. People with Broca’s aphasia have damage to the frontal lobe of the brain. They frequently speak in short phrases that make sense but are produced with great effort. They 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,” or “book book two table,” for “There are two books on the table.” People with Broca’s aphasia typically understand the speech of others fairly well. Because of this, they are often aware of their difficulties and can become easily frustrated. People with Broca’s aphasia often have right-sided weakness or paralysis of the arm and leg because the frontal lobe is also important for motor movements.

3. Global aphasia: Another type of non-fluent 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.

What are the symptoms of Aphasia?
Any of the following can be considered symptoms of aphasia:
 * inability to comprehend language
 * inability to pronounce, not due to muscle paralysis or weakness
 * inability to speak spontaneously
 * inability to form words
 * inability to name objects
 * poor enunciation
 * excessive creation and use of personal neologisms
 * inability to repeat a phrase
 * persistent repetition of phrases
 * paraphasia (substituting letters, syllables or words)
 * agrammatism (inability to speak in a grammatically correct fashion)
 * dysprosody (alterations in inflexion, stress, and rhythm)
 * uncompleted sentences
 * inability to read
 * inability to write

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 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 that affect the brain.

Who is at highest risk?
Anyone can acquire aphasia, including children, but most people who have aphasia are middle-aged or older. Men and women are equally affected. According to the National Aphasia Association, approximately 80,000 individuals acquire aphasia each year from strokes. About one million people in the United States currently have aphasia.

Diagnosis
Aphasia is usually first recognized by the physician who treats the person for his or her brain injury.Frequently this is a neurologist. The physician typically performs tests that require the person to follow commands, answer questions, name objects, and carry on a conversation. If the physician suspects aphasia, the patient is often referred to a speech-language pathologist, who performs a comprehensive examination of the person’s communication abilities. The examination includes the person’s ability to speak, express ideas, converse socially, understand language, read, and write, as well as the ability to swallow and to use alternative and augmentative communication.

Treatment options
In some cases, a person will completely recover from aphasia without treatment. This type of spontaneous recovery usually occurs following a type of stroke in which blood flow to the brain is temporarily interrupted but quickly restored, called a transient ischemic attack. In these circumstances, language abilities may return in a few hours or a few days.

For most cases, however, language recovery is not as quick or as complete. While many people with aphasia experience partial spontaneous recovery, in which some language abilities return 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 two-year period. Many health professionals 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 aims to improve a person’s ability to communicate by helping him or her to use remaining language abilities, restore language abilities as much as possible, compensate for language problems, and learn other methods of communicating. Individual therapy focuses on the specific needs of the person, while group therapy offers the opportunity to use new communication skills in a small-group setting. Stroke clubs, regional support groups formed by people who have had a stroke, are available in most major cities. These clubs also offer the opportunity for people with aphasia to try new communication skills. In addition, stroke clubs can help a person 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 loud radio or TV, 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 person’s speech.
 * Allow the person plenty of time to talk.
 * Help the person become involved outside the home. Seek out support groups such as stroke clubs.

Other treatment approaches involve the use of computers to improve the language abilities of people with aphasia. Studies have shown that computer-assisted therapy can help people with aphasia retrieve certain parts of speech, such as the use of verbs. Computers can also provide an alternative system of communication for people with difficulty expressing language. Lastly, computers can help people who have problems perceiving the difference between phonemes (the sounds from which words are formed) by providing auditory discrimination exercises.

Where to find medical care for Aphasia?
Directions to Hospitals Treating Aphasia