Aphasia is a major adult language disorder that impairs our ability to speak and comprehend what is said by others. Unusually all methods of language usage are impaired -- speaking, understanding, reading, writing and gesturing. Reasoning and memory are also affected.
Most often, aphasia is the result of a stroke which causes damage to the brain. A stroke is a cerebral-vascular accident (CVA) in which the brain is deprived of oxygen as a result of
a blockage or hemorrhage in a major blood vessel within the brain. Several factors increase the risk of a stroke. These include: high blood pressure, arteriosclerosis, diabetes, high cholesterol levels, alcoholism, smoking, and certain types of medications. Aphasia can also be caused by direct injury to the brain from external trauma.
The elderly are particularly susceptible to suffering a stroke. According to the American Speech-Language-Hearing Association, there are over one million adult aphasics in the United States today.
Types of Aphasia
There are a variety of classifications of aphasia. The language impairments which characterize a particular type of aphasia depend on the location and extent of the damage to the brain.
Wernicke's Aphasia
Patients with Wernicke's Aphasia have great difficulty understanding spoken language and making themselves understood. Although they speak easily, they usually produce jargon such as •bo-bo•, •nuf-nuf•, •garnd•, or strings of recognizable, but unrelated, words such as
•then chair carpet again for that.• These patients rarely recognize their own speech errors.
Broca's Aphasia
Patients with Broca's Aphasia have relatively good understanding of language but very reduced, slow, telegraphic speech, e.g. •food, shop, meat, beans These patients usually know what they want to say, but seem to have lost the ability to •articulate•, or form the words with their mouth. These patients
recognize their errors and struggle to correct them.
This problem is called •apraxia of speech•. Apraxia refers to an inability to voluntarily perform a sequence of movements, although muscle strength and function is normal.
Conduction Aphasia
Patients with Conduction Aphasia have good understanding of language, usually speak fluently, but have occasional instances of slow, effortful speech. Often they substi tute one sound or word for another and have great dif ficulty repeating (imitating) words.
Anomie Aphasia
Patients with Anomie or Amnesic Aphasia have very good understanding of language and speak readily, although with severe word-finding difficulty. These patients
seem to talk a great deal but convey very little· meaning. They are unable to remember the crucial content words which carry the message. For example, •she did that and gave them this before they went there•. Often these patients do not recognize that they have a language problem.
Global Aphasia
Patients with Global Aphasia have such extensive brain damage that they have almost no functional communication skills. They understand very little spoken language and are usually able only to repeat meaningless syllables such as •na, na, na,•.
Problems Associated with Aphasia
Most aphasic patients suffer physical impairments because of their stroke. Damage to one side of the brain affects the opposite side of the body. Usually the damage which causes aphasia occurs in the left side of the brain. Therefore, many aphasics are paralyzed on the right side of the body. Some aphasic patients suffer partial blindness in the right side of
the visual field of each eye. Still others experience dysphagia, which is a disorder of eating and swallowing.
Frequently, aphasic patients suffer from apraxia, which is an inability to carry out a sequence of voluntary movements in the absence of muscle incoordination or weakness. Apraxia impairs the patient's ability to plan and execute a sequence of movements. Patients with apraxia of speech are unable to form speech sounds, those with limb apraxia may be unable to demonstrate how to use scissors, or wave a greeting.
Some aphasic patients experience agnosia which is difficulty recognizing either visual, auditory or tactile information. For example, a patient with normal vision may not recognize common objects or familiar faces. Likewise, a patient with normal hearing may not recognize sounds, and a patient with normal touch sensation may not recognize objects they are able to feel.
Coping with impaired communication as well as physical limitation may cause the patient to feel frustration, isolation and despair. Relationships with family and friends may become strained, because the patient's verbal interaction is limited and confusing. Feelings of dependency lead to loss of self-esteem. Emotional expression is less controlled and appropriate. Many aphasic patients cry easily and swear unintentionally.
Recovery and Rehabilitation
During the first four to six months following the stroke, most aphasic patients experience some degree of spontaneous recovery of speech and language functions. Recovery is reinforced and extended if speech-language therapy is introduced during this time.
Speech-language pathologists are the professionals who evaluate and treat patients with communication disorders. To maximize recovery, therapy should be initiated as soon as the patient is medically stable. After the speech-language pathologist determines the type and severity of aphasia, an appropriate therapy program is designed and implemented.
It is important that the therapy activities are tailored to meet each patient's needs. Patients who have difficulty understanding language may be taught to focus on single words, or short phrases coupled with objects, pictures or gestures. Patients with apraxia of speech are taught in a systematic way, how to organize and perform the various oral movements necessary to produce speech sounds. Patients who have severe word finding problems are taught self-cuing and compensatory techniques. For those patients with good comprehension skills but very limited expression, communication aids are designed to
meet their particular needs.
Communicating with the Aphasic Patient
As a crucial part of the total therapy program, the speech language pathologist counsels with family and nursing staff regarding the most appropriate ways to communicate with the aphasic patient.
It is important to realize the aphasic patient may still be able to communicate in some way. Talking about the patient in his/her presence should be avoided. Speaking slowly, using situational or social gestures, will enhance the patient's understanding. Allowing the patient ample time to process and respond will encourage accuracy and self-correction while maintaining the patient's self-esteem. Accepting all speech attempts reinforces the patient's efforts to speak.Including the aphasic patient in family activities re-affirms his/her position in the family unit.
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