Aphasia Dysphasia
Alexia Dyslexia
Agraphia Dysgraphia
- What is aphasia?
- Who has aphasia?
- What causes aphasia?
- What types of aphasia are there?
- How is aphasia diagnosed?
- How is aphasia treated?
- What research is being done for aphasia?
- Where can I get additional information?
What
is aphasia?
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.
Who
has aphasia?
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.
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.
What
types of aphasia are there?
There are two broad categories of
aphasia: fluent and non-fluent.
Damage to the temporal lobe (the
side portion) of the brain may result in a fluent aphasia called Wernicke’s
aphasia (see figure). 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.
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.
Another type of non-fluent 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.
There are other types of aphasia,
each of which results from damage to different language areas in the brain.
Some people may have difficulty repeating words and sentences even though they
can speak and they understand the meaning of the word or sentence. Others may
have difficulty naming objects even though they know what the object is and
what it may be used for.
How
is aphasia diagnosed?
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.
How
is aphasia treated?
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 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.
What
research is being done for aphasia?
Scientists are attempting to reveal
the underlying problems that cause certain symptoms of aphasia. The goal is to
understand how injury to a particular part of the brain impairs a person’s
ability to convey and understand language. The results could be useful in
treating various types of aphasia, since the treatment may change depending
upon the cause of the language problem.
Other research is attempting to
understand the parts of the language process that contribute to sentence
comprehension and production and how these parts may break down in aphasia. In
this way, it may be possible to pinpoint where the breakdown occurs and help in
the development of more focused treatment programs.
Although different languages have many
things in common when specific portions of the brain are injured, there are
also differences. Scientists are trying to understand the common (or universal)
symptoms of aphasia and the language-specific symptoms of the disorder. Other
researchers are examining whether people with aphasia may still know their
language but have difficulty accessing that knowledge. These studies may help
with the development of tests and rehabilitation strategies that focus on
specific characteristics of one language or multiple languages.
Researchers are exploring drug
therapy as an experimental approach to treating aphasia. Some studies are
testing how drugs can be used in combination with speech therapy to improve
recovery of various language functions.
Researchers are also looking at how
treatment of other cognitive deficits involving attention and memory can
improve communication abilities.
To understand recovery processes in
the brain, some researchers are using functional magnetic resonance imaging
(fMRI) to better understand the human brain regions involved in speaking and
understanding language. This type of research may improve understanding of how
these areas reorganize after brain injury. The results could have implications
for both the basic understanding of brain function and the diagnosis and
treatment of neurological diseases.
Where
can I get more information?
NIDCD maintains a directory of
organizations that can answer questions and provide printed or electronic
information on aphasia. Please see the list of organizations at www.nidcd.nih.gov/directory.
Use the following keywords to help
you search for organizations that are relevant to aphasia:
For more information, additional
addresses and phone numbers, or a printed list of organizations, contact:
Jargon aphasia is a fluent or receptive aphasia in which the patient's speech is incomprehensible, but appears to
make sense to them. Speech is fluent and effortless with intact syntax and grammar, but the patient has
problems with the selection of nouns. They will either replace the desired word with another
that sounds or looks like the original one, or has some other connection, or
they will replace it with sounds. Accordingly, patients with jargon aphasia often use neologisms,
and may perseverate if they try to replace the words they can't
find with sounds.
Commonly, substitutions involve picking another (actual) word starting with
the same sound (e.g. clocktower - colander), picking another semantically
related to the first (e.g. letter - scroll), or picking one phonetically
similar to the intended one (e.g. lane - late).
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