After a brain injury, many people find it difficult to communicate with others. They may have difficulty forming sounds, understanding what others say, remembering specific words, or forming understandable sentences. They may also have difficulty reading or writing. This condition is aphasia and can take many different forms. It usually occurs after a stroke, but can also be caused by other brain injuries.
Aphasia can be a disabling problem that limits the patient's ability to communicate with others. This condition affects all areas of a person's life, including personal relationships and professional opportunities. If someone in your life has an aphasia diagnosis, it's important to understand the disorder: its definition, causes, variations, and most effective treatments. Understanding aphasia can help you work together to overcome it.
What is the definition of aphasia?
Aphasia is a language disorder that affects a person's ability to produce or understand language through speech or writing. A patient may lose speaking skills, the ability to understand speech, or the ability to repeat words or sentences. They may also have reading or writing problems. The impact of aphasia varies from person to person depending on the severity of the cause. In most cases it affects various aspects of communication.
Aphasia can be temporary or permanent. The symptoms are often greatest immediately after a brain injury. With proper treatment, side effects can decrease and communication skills can improve. Although learning to communicate through aphasia can be frustrating, many patients live full lives. Overcoming aphasia requires patience, consistent effort and the right strategies.
What causes aphasia?
Aphasia is almost always caused by brain damage, but the causes of that damage can vary. Anything that affects language production or understanding of brain areas can lead to aphasia. Possible causes include:
- Snails:Stroke is the most common cause of aphasia. Stroke is also the fifth leading cause of death in the United States and often results in long-term disability. Annual,There are 750,000 strokesin the United States, about a third of them cause aphasia. The link between aphasia and stroke is more widespread than many realize.
- Head trauma:Injury-related trauma can damage areas of the brain important for speech and language. Traumatic brain injury can be short or long lasting, depending on its severity. If a traumatic brain injury causes aphasia, it will likely cause other cognitive problems as well. Although trauma is a less common cause than stroke, aphasia and head injury often go hand in hand.
- Brain tumors:Because tumors are masses of growing cells, a brain tumor can damage the language centers of the brain. Resolution of aphasia will depend on the success of cancer treatment, although some people may experience communication problems in the long term. In slow-growing tumors, the brain may shift language processing to another area; the brain has a remarkable ability to adapt.
- Infections:In some cases, an infection can cause aphasia, although this is less common. Those with compromised immune systems are much more likely to develop brain infections. An infection can lead to further cognitive problems.
- Degenerative disorders:Degenerative disorders, including Alzheimer's disease, can cause aphasia-like symptoms in language processing and communication.
- Migraines or attacks:Aphasia caused by migraines or seizures is temporary and lasts only the duration of the episode.
What are the different types of aphasia?
Aphasia comes inmany different shapes, all with unique symptoms. Patients often retain all other cognitive skills in addition to speech and language processing. The type and severity of aphasia will influence rehabilitation and treatment. To understand the different forms of aphasia, it is important to know how the brain's language processing and production works.
Language centers in the brain
Different types of aphasia affect different language-related areas of the brain. When trying to understand the disorder, it is helpful to understand the language centers of the brain. The most important are Broca's and Wernicke's areas. Broca's area is an area in the frontal lobe of the dominant hemisphere that is responsible for language production. Wernicke's area is an area in the temporal lobe on the left side of the brain, responsible for understanding language.
Damage to Broca's area impairs production capacity, while damage to Wernicke's area impairs comprehension. For this reason, the different types of aphasia fall into two main categories: fluent or receptive and non-fluent or expressive. When diagnosing aphasia, the doctor will determine whether the main problem is understanding or expressing language.
Non-fluent or expressive forms of aphasia
A patient with disfluent or expressive aphasia may maintain comprehension but have difficulty finding or forming words. The patient knows what he wants to say, but has difficulty expressing this to others through oral or written communication. Non-fluent forms of aphasia include global, mixed transcortical, Brocas', and transcortical motor aphasia:
1. Global
Global aphasia is the most severe form of the condition. It is both receptive and expressive and affects the person's linguistic input and output. A patient has global aphasia if he has difficulty forming recognizable words and understanding and repeating speech. They will also have difficulty reading and writing. This condition is likely temporary and is most severe immediately after the brain injury. With treatment, global aphasia may resolve into a less serious diagnosis. If the brain damage is extensive, global aphasia can persist for a long time.
Skills vary from case to case, but some patients with global aphasia can answer basic 'yes or no' questions. They may also be able to say automatic phrases such as "excuse me" or "thank you." They struggle with all forms of communication, including speaking, understanding others, reading and writing. Because this is the most severe form of the condition, it can damage the patient's relationships, professional career and social life. However, the lack of relationships can lead to feelings of isolation or depressionintensive communication therapycan help reduce depression.
2. Mixed transcortical
Mixed transcortical aphasia, also called mixed disfluent aphasia, describes patients who can produce sparse speech with great difficulty. They also have limited comprehension and difficulty reading or writing. They have the least difficulty with repetition skills; in most cases they can repeat words or sentences. This version of the condition involves damage near Broca's and Wernicke's areas, the language production and comprehension centers of the brain. The damage is indirect and separates language skills from other parts of the brain.
The exact opposite of mixed transcortical aphasia is conduction aphasia: patients have intact language comprehension and production, but struggle with repetition. You can read more about conduction aphasia below.
3. Broca's
Those with Broca's aphasia, another non-fluent form, have limited access to vocabulary and sound formation, including repetition. What distinguishes mixed transcortical aphasia and Broca's aphasia is that patients with Broca's aphasia have a higher level of comprehension. Despite improved comprehension, they may have difficulty understanding complex sentence structures.
Broca's aphasia gets its name from the French scientist Paul Broca, who linked these language production deficits to an area of the frontal lobe of the dominant hemisphere: Broca's area. This part of the brain regulates breathing patterns and vocalizations necessary for speech.
4. Transcorticale motor
Transcortical motor aphasia causes problems with speaking or writing, but has less impact on comprehension. It is similar to Broca's aphasia - the main difference is the ability to repeat. Those with transcortical motor aphasia can often repeat speech. This form of aphasia may represent the recovery phase of Broca's aphasia.
The biggest problem is finding the right words or creating complex sentence structures when speaking or writing. A person may feel that the right word is often 'on the tip of the tongue'. Their grammar may suffer if they miss articles or prepositions, focusing on the main nouns and verbs. There may be tension.
Fluent or receptive forms of aphasia
Patients with fluent or receptive forms of aphasia have impaired comprehension but can form words or sentences. They may speak in sentences that mimic normal speech, but use incorrect sounds or words, or have difficulty remembering certain words. They are often unaware of their speech errors. Fluent forms of aphasia include Wernicke's, transcortical sensory, conduction, and anomic:
1. Wernickes
Because Wernicke's aphasia is a fluent form, producing words is not the main problem. Patients can still form sentences. But they may not understand the meaning of the words. Although speech is fluent, it is abnormal and often meaningless. Without realizing it, the patient may include irrelevant or non-existent words in their sentences. Because they think they are logical, they can become confused when others do not understand them. When listening to a Wernicke's aphasia patient, you may notice the following:
- Words strung together into nonsense sentences.
- Made up words without meaning.
- Inflection as you would encounter in normal speech.
- Well articulated words.
- Quick speech.
- Difficulty with repetitions.
- Understand visual cues better than written or spoken words.
This type of aphasia involves damage to the left posterior temporal region of the brain, which is part of Wernick's area. This part of the brain gets its name from the German neurologist Carl Wernicke, who identified this speech defect.
2. Transcortical sensory
Transcortical sensory aphasia is another form of fluent aphasia. Those who have this can repeat long, complex sentences but have difficulty understanding speech. It is one of the less common forms of aphasia. Because patients may not be aware of their disability, they may be misdiagnosed with a mental disorder such as schizophrenia.
3. Control
Conduction aphasia is a rare form of aphasia in which expression and comprehension remain intactinability to repeat words or sentences. The patient can speak without major problems and maintains his understanding. Only the repeat is damaged. The patient may be able to formulate a similar response, but not repeat the same word or phrase he hears.
This unusual condition may be caused by reduced connectivity between Broca's and Wernicke's areas - the link between auditory processing and verbal output. In most cases, a patient with this condition can continue normal life activities. With practice a person can improve repetition.
4. Anomisk
Anomic aphasia is a mild form of the condition, although it can still cause frustration. Patients can understand language and speak fluently, but experience a persistent feeling of tip-of-the-tongue syndrome. They fightto find the right wordsto describe their thoughts, often using vague words such as 'things', or trying to describe words in a roundabout way.
For example, if the patient has trouble remembering the word "tongs," he or she might say, "the thing you use to pick things up." In some cases, speech may appear slow or halting as the individual has difficulty identifying the correct word.
The title "anomic" means "without names" - anomic patients can describe thoughts in complete sentences and with a high level of detail, while searching for specific words. They struggle most with remembering specific nouns and verbs. Problems finding the right words occur when writing and speaking. Like people with conduction aphasia, these individuals can continue with normal life activities.
What are aphasia treatments?
Sometimes aphasia goes away on its own without treatment, but in most cases speech and language therapy is necessary. A professional speech therapist helps the patient restore communication.
Speech and language therapy
A speech therapist caring for an aphasia patient will pursue certain goals, including:
- Reduction of impairment:The therapist helps the patient recover as much of his speech and language as possible. This process requires practice and patience. With non-fluent aphasia, the patient will need to practice forming sounds and words. With fluent aphasia, they work on defining and remembering words.
- Helping the patient communicate:The therapist will try to involve the patient as much as possible and encourage participation. They will help find means to convey thoughts.
- Find alternatives:Alternative forms of communication can be helpful. Strategies may include using cards or other visual aids or indicating the first letter of a target word.
- Provides information:During and after the treatment, the therapist will provide useful information to the patient and his loved ones.
Benefits of speech and language therapy
Speech and language therapy has many benefits for the patient and their family, including:
- Improving the individual's self-confidence.
- Reduce feelings of isolation and frustration.
- To provide communication strategies to the patient and their family.
- To provide alternatives to assist with communication.
- Helps reduce the symptoms of long-term effects.
Find a PAM Health site for stroke rehabilitation programs
Stroke-induced aphasia can cause obstacles and frustration for the patient and their loved ones. Strokes can cause many disabling problems in addition to speech and language problems, including difficulty walking, balancing or swallowing. After a stroke, most patients require extensive rehabilitation. If you are looking for a stroke rehabilitation program, considerPAM health.
At PAM Health, our caring and friendly staff help patients restore their previous quality of life. We provide inpatient care that includes individualized treatment plans, physician evaluations, physician-administered therapy, community access, and educational sessions. After inpatient treatment, patients have access to continued outpatient services, including therapy and support groups. If you would like to learn more about the comprehensive stroke care available at our hospitals across the country, find onePAM Health placementclose to you.
