Aphasia

WHAT IS APHASIA?

Aphasia is a language impairment, where the individual is unable to comprehend the use of speech and language, affecting the ability to read or write.  Aphasia occurs as a direct result of brain injury - most usually from a stroke, (especially in older individuals). Other  brain injuries resulting in Aphasia, include head trauma, brain tumors, and infections.

Aphasia is most likely the result of damaging the language centres of the brain, which are almost always located in the left hemisphere. This is the location for most people’s ability to produce and comprehend language. Damage can be caused by a stroke, traumatic brain injury or other head injury. In the case of a brain tumor, Aphasia can develop slowly. Aphasia can also occur with speech disorders which also result in brain damage such as  Dysarthria or Apraxia of speech.
In the UK, there are around 250,000 people who have Aphasia, many of them under the age of retirement.

TYPES OF APHASIA

Generally, Aphasia can be divided into four broad categories:
(1) Expressive Aphasia  is where the individual has difficulty conveying thoughts through speech or writing. Although the individual knows what he wants to say, he cannot find the words he needs.
(2) Receptive Aphasia is where the individual has difficulty understanding spoken or written language. Although the individual is able to hear the voice or see the print , he is unable to make sense of the words.
(3) Individuals with Anomic or Amnesia Aphasia, (the least severe form of Aphasia), find using the correct names for particular objects, people, places, or events difficult.
(4) Global Aphasia, (the most severe form of Aphasia), results from severe damage to the language areas of the brain. Almost all language function, both comprehension and expression is lost. Also lost are speech (speaking or understanding), reading and writing.

Aphasia can also be defined in another two ways:
Broca’s Aphasia (‘Non-Fluent Aphasia’): This is where speech is severely reduced and is mainly limited to short utterances of less than four words. Access to vocabulary is limited and the formation of sounds by persons with is often laborious and clumsy. The person may understand speech relatively well and be able to read, but be limited in writing.                                                                                                            
Wernicke’s aphasia ('Fluent Aphasia')  – This is where the ease of producing connected speech is hardly affected, affecting instead  the  ability to understand spoken words.  However, speech is far from normal. Sentences do not hang together and irrelevant words intrude - sometimes to the point of jargon, in severe cases. Reading and writing are often severely impaired.  

CAUSES OF APHASIA

Aphasia is a symptom and not a disease; it can occur in a variety of brain injuries.

• In stroke, the deficit is usually sudden and obvious.

• In substantial head trauma, the deficits may be unrecognized.

• In Dementia, the language problem may be tricky and require elicitation with the assistance of a speech pathologist or neuropsychologist.

• In Multiple Sclerosis and Parkinson disease, no language abnormality should be present.

• A special situation exists in the case of the rare Landau-Kleffner Syndrome, a syndrome of acquired epileptic aphasia.

• Symptoms begin in childhood and progress; electroencephalographic (EEG) findings confirm the diagnosis.

• The syndrome is treatable; however, in some patients, the seizures are controlled more than the Aphasia is.

• Aphasia is diagnosed on the basis of localisation (involvement of the left hemisphere or thalamus); therefore, careful, thorough mental-state examination is essential.

WHAT CAN BE DONE?

It is possible for an individual to completely recover from Aphasia without treatment (e.g Temporary (Transient) aphasia). More than half of those symptoms showing Aphasia recover completely within the first few days.
 
No medicine or drugs have been known to cure Aphasia, as yet. Surgery has been successful in those occasions where pressure from a brain tumor or a haematoma impacts a critical speech centre. However, surgery is not useful in cases of Aphasia following a stroke, which represent the vast majority of instances.

In most cases, however, language therapy should begin as soon as possible and be tailored to the individual needs of the patient. Speech therapy is often provided to persons with Aphasia, but does not guarantee a "cure". The purpose of speech and language therapy is to help the patient to fully utilize remaining skills and to learn compensatory means of communication.

Rehabilitation with a speech pathologist involves extensive exercises in which patients read, write, follow directions, and repeat what they hear. Computer-aided therapy may supplement standard language therapy.

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.

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