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Aphasia
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, frequently 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.
Who
has aphasia?
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.
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, 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 and brain infections as well
as other conditions of the brain.
What are the characteristics of aphasia?
The characteristics
of aphasia depend on the portion of the brain that is injured.
There are many types of aphasia, each of which has unique characteristics.
Broca's aphasia and Wernicke's aphasia are frequently recognized
aphasic syndromes.
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 and is thus characterized
as a nonfluent aphasia. 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."
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 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, often 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.
How is aphasia diagnosed?
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.
How is aphasia treated?
In some instances
an individual will completely recover from aphasia without treatment.
This type of "spontaneous recovery" usually occurs following
strokes which are called transient ischemic attacks (TIA) in
which the blood flow to the brain is temporarily interrupted
but is quickly restored. In these circumstances, language abilities
may return in a few hours to 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 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
two-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 individual to utilize 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. 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 that is 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 be 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.
What research is being done for aphasia?
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 utilized 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.
Where
can I get additional information?
Agency
for Health Care Policy and Research Publications Clearinghouse
P.O. Box 8547
Silver Spring, MD 20907
Voice: (800) 358-9295
Request publication number 95-0662
American Academy
of Neurology
2221 University Avenue, S.E., Suite 335
Minneapolis, MN 55414
Voice: (612) 623-8115
Internet: www.aan.com
American Heart
Association
7272 Greenville Avenue
Dallas, TX 75231
Voice: (214) 373-6300
Internet: www.amhrt.org
American Speech-Language-Hearing
Association
10801 Rockville Pike
Rockville, MD 20852
Voice/TTY: (301) 897-5700
Voice: (800) 638-8255
Fax: (301) 571-0457
Internet: www.asha.org
National Aphasia
Association
156 Fifth Avenue, Suite 707
New York, NY 10010
Voice: (800) 922-4622
Internet: www.aphasia.org
National Brain
Injury Association
1776 Massachusetts Avenue, N.W., Suite 100
Washington, DC 20036
Voice: (202) 296-6443
Internet: www.biausa.org
National Easter
Seal Society
230 West Monroe, Suite 1800
Chicago, IL 60606
Voice: (800) 221-6827
Internet: www.seals.com
National Stroke
Association
8480 E. Orchard Road, Suite 1000
Englewood, CO 80111-5015
Voice: (800) 787-6537
Internet: www.stroke.org
August 1997
NIH Pub. No. 97-4257
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