Aphasia
Aphasia: (uh-fay-zha) is the loss of language. It can be caused by a stroke or other brain injury. A person who has aphasia struggles to talk or may not be able to talk at all. S/he may not understand speech. Aphasia can affect a person’s’ ability to read, write, pay bills, or communicate via phone, text or email.
Aphasia does not affect a person’s intelligence. Aphasic language is not the same as the “language of confusion” observed in individuals with dementia. Aphasic individuals may evidence difficulty understanding speech, calling up words or making sentences. Typically aphasic people are oriented to space, time and person and their communication attempts are relevant. In dementia it is more common to see irrelevance and confabulation.
Another difference between aphasia and dementia is that the person with aphasia will show awareness off his/her difficulty. In dementia the person is more likely to deny that there is a problem and even argue about it.
Types of Aphasia:
Broca’s Aphasia: A type of non fluent aphasia in which it it hard to formulate sentences. People with Broca’s aphasia speak telegraphically, in short phrases with many pauses. It takes enormous effort and causes a great deal of frustration.
Wernicke’s Aphasia: A fluent aphasia in which the person speaks in long, rambling sentences and is not aware that s/he is not making sense. In this type of aphasia the person has difficulty understanding language.
Anomic aphasia: The person will have trouble calling up specific words. Although s/he can make sentences, the most important words are omitted or delayed.
Jargon aphasia: The person understands what is said and can formulate sentences. However s/he uses jargon, or non-words, instead of real words. Sometimes pieces of real words creep in. It is frustrating for both speaker and listener. Intent and speech intonation are preserved but speech in unintelligible.
Global aphasia: Los of both language comprehension and expression.
Aphasia may be accompanied by other neurological problems such as one-sided weakness, paralysis or impaired vision. A person with aphasia may have trouble knowing left from right, understanding numbers or deriving emotional content from language. Aphasia can co-occur with dysarthria, weakness of the speech muscles, or apraxia of speech, difficulty in forming or sequencing speech sounds.
How can an SLP help?
The first step is to complete an evaluation. An evaluation may involve testing the person’s ability to follow spoken directions, identify pictures, answer questions or verbally describe things. Reading, writing and drawing are also checked.
The evaluation helps the therapist determine how to help the person with aphasia practice in order to improve or regain lost skills. After the assessment, the SLP will meet with the patient to develop goals and then creates atreatment plan, which is like a step-by-step “recipe” for reaching those goals.
During speech therapy, the person with aphasia will do speech and language work outs. Speech exercises are tailored to each person’s needs. The exercises start easy and get harder as progress is made. Some of the work is listening and talking.
Here’s an example of a sentence completion exercise that might be fun:
When the baker took the cake out of the oven, he was astonished to see…
Suddenly, all of the people in the room…
The young woman excused herself from the table and...
During aphasia therapy, the SLP will try to “deblock” impaired signals by using other healthy neural pathways. We try to light up other circuits in the brain. This takes some trial and error and it can be frustrating.
In addition to language exercises, the SLP might teach the person with aphasia to use other modalities such as gesture, facial expression, sketching, writing, music, word prediction systems or apps. If successful, therapy can work around the blocks by gradually recruiting new pathways. Although the aphasic person may not communicate in the same way s/he did pre morbidly, the re organized behaviors should be functional.
YouTube video: Empowering Adults with Aphasia & Apraxia by TCUCOSD
Best practices use a “Life Participation Approach” to aphasia therapy. This means that the SLP will target functional communication from the first treatment session. The person with aphasia will work to communicate effectively with family members and friends. S/he will use the phone, internet and email. S/he will understand and pay bills, read menus, order in restaurants, make appointments etc.
All of this can take time.
Professionals used to believe that recovery from aphasia would be complete 6 to 9 months after onset. People used to think that there was a “window of opportunity” that closed shortly after the acute phase of a stroke. Recent research is more encouraging. Improvement can continue to occur years after a stroke due to neural plasticity, or ability of the brain to heal and develop new pathways.