In the United States, every 40 seconds, someone has a stroke. Approximately one third of people who have a stroke experience aphasia. Aphasia is an acquired language impairment following brain damage. It affects some or all language modalities such as expression and understanding of speech, reading, and writing. Rehabilitation, such as speech therapy for stroke patients, is essential to help aphasic patients gain their skills back. To know more about aphasia, read more!
In this article we will discuss:
Aphasia is an acquired neurogenic language disorder.
Aphasia is acquired. This means people with aphasia suffered from an injury to the brain. Most typically, it affects the left hemisphere where language is processed.
Aphasia involves varying degrees of impairment in four primary areas. Each type of aphasia may have different severity of impairment in the following areas:
Expression through spoken language
Comprehension in spoken language
Writing
Reading comprehension
There are two types of aphasia.
There are two main types of aphasia: fluent and non-fluent aphasia.
Non-Fluent
People with non-fluent or expressive aphasia find it more difficult to find and say the right words than what they really want to say. Expressive aphasia treatment focuses on rectifying this through increasing verbal (meaningful) output as well as compensating through different modes of communication.
1.Broca’s Aphasia
This type of expressive language aphasia is the most common non-fluent aphasia. It happens when there is a large lesion in the left lateral frontal, pre-Rolandic, suprasylvian region extending into the periventicular white matter deep to Broca’s area. Broca's aphasia treatment looks at a person's ability to express themselves. Symptoms include:
Having difficulty finding words or anomia (could result in a need for anomic aphasia treatment)
Speaking in short phrases with grammatical errors
Expressive language becomes telegraphic
Automatic speech
Substituting sounds in words or phonemic paraphrasia
Apraxia of speech and ideomotor apraxia
Right hemiplegia
Difficulty reading and writing
Adults need speech therapy too.
B. Transcortical Motor Aphasia
This type of aphasia involves a lesion in the frontal lobe of the left side of the brain deep in the left frontal substance or in the cortex. People with transcortical motor aphasia may have mild dysarthria, sensory and motor disorders, and lack of initiative and akinetic mutism. More symptoms include:
Having difficulty finding words or anomia
Intact naming
Difficulty reading aloud
Difficulty writing
Phonemic paraphrasia
Echolalia or repeating or echoing of words just heard
C. Global Aphasia
This type of aphasia is the most severe type of aphasia. This is a result of a large lesion of the left fronto-parieto-temporal zone of language, extending from Broca’s area to Wernicke’s area to the angular gyrus region and deep into subjacent white matter. Symptoms may include:
Profound Anomia (with virtually no speech output under any conditions)
Expressive language exhibits stereotypical utterances
Automatic speech
Right hemiplegia
Minimal language and severe comprehension deficits in oral and written modalities
Inability to write
Impaired reading
Difficulty naming
D. Mixed Transcortical Aphasia / Isolation syndrome
This type of aphasia involves a lesion in the widespread area of the anterior and posterior extrasylvian regions or watershed areas of the dominant hemisphere. Symptoms include:
Has combined signs and symptoms of the sensory and motor transcortical aphasias
Impaired reading
Difficulty writing
Impaired naming
Echolalia
Anomia
Fluent
People with fluent or comprehensive aphasia can produce long, complex sentences that don’t make sense or include incorrect or unnecessary words. They usually don’t understand spoken language well and often don’t realize that others can’t understand them.
A. Wernicke’s Aphasia
This type of fluent aphasia is the most common type of fluent aphasia. This typically happens usually associated with lesions of the posterior left peri- sylvian region or at the Wernicke’s area.Symptoms include:
Anomia and poor auditory comprehension
Repetition, naming, reading aloud, and writing are impaired.
Verbal output is fluent, characterized by phonemic and semantic paraphasia, neologisms, and empty speech, that results to many words that does not make sense.
Speech is often rapidly produced and copious, a phenomenon known as press of speech
Perseverations,
B. Transcortical Sensory Aphasia (TSA)
This type of aphasia involves a lesion at the posterior portion of the temporal or parietal lobes. Symptoms include:
Significant anomia and poor auditory comprehension
Relatively good repetition skills
Naming, reading, and writing are severely impaired
Speech is fluent. However, in many cases, they produce are meaningless words that are difficult to understand.
Semantic paraphasia such as saying “son” for “daughter”
Perseverations are present
C. Conduction Aphasia
Typically, this type of aphasia involves a lesion in the arcuate fasciculus or deep in the supramarginal gyrus. There might be a lesion in a subsylvian involvement of the Wernicke’s area, in the primary auditory cortex, or to a variable degree, the insula and its subcortical white matter. Symptoms include:
Anomia and fluent output with normal average phrase length
Auditory comprehension is good with some patients having problems understanding complex sentences
Repetition ability is significantly worse than words they typically produce.
Deficits in naming and writing are common
Reading aloud is impaired and contains semantic and phonemic paralexia
Presence of phonemic paraphasia, which the person often recognizes and attempts to correct.
D. Anomic Aphasia
Symptoms include:
Word-finding problems across tasks that require retrieval of specific substantive words
Average phrase length is within normal ranges
Auditory comprehension and repetition are relatively or entirely intact
Use of nonspecific phrases (“little things”) and circumlocutions (“The stuff that’s black”)
Paraphasic errors are rare or absent, but when they occur, they are likely to be of the semantic type
Because of unsuccessful attempts of self-correction, they often become frustrated
Common Causes of Aphasia
Aphasia is a type of language impairment following a damage in the brain. This can be caused by a lot of factors. This include:
1.Stroke
Stroke happens when parts of the brain lose its regular blood circulation. This is the most common cause of individuals who acquire language disorders. Risk factors include hypertension, smoking, diabetes, obesity, cardiac diseases, alcohol, and lack of physical activity.
There are three types of stroke.
Ischemic stroke: This type of stroke happens when a person’s blood level falls below the normal level. To maintain cellular function and to remove accumulating toxic waste, neurons die and an infarct develops with necrosis and loss of tissue bulk.
Hemorrhagic stroke: This type of stroke happens when there is a rupture in the blood vessels within the brain.
Transcient ischemic attack: This type of stroke is a brief focal cebreal event wherein symptoms develop rapidly. It lasts from 2-30 minutes until 24 hours, and at most 2-3-hours. The affected part of the brain temporarily becomes ischemic resulting to symptoms such as loss of communication and paralysis. When the ischemia resolves, symptoms start to disappear.
2. Traumatic Brain Injury (TBI)
This happens when a swiftly moving object hits the head or when moving head strikes a stationaly object.
3. Infections such as:
brain abscesses
encephalitis
acute disseminated encephalitis
meningitis
How is it Diagnosed?
Speech therapy after a stroke can help people get back some or all of their skills. A speech-language therapist can diagnose a patient with aphasia. They use several types of test that diagnose what type of aphasia a person has.
For example, The Western Aphasia Battery-Revised is an individually administered test designed to evaluate a patient’s language function following stroke, dementia, or other acquired neurological disorder. It measures linguistic skills such as expressive language, fluency, auditory comprehension, repetition, naming, reading, and writing; as well as non-linguistic skills including drawing, calculation, block design, and apraxia.
This test is used to:
Determine the presence, severity, and type of Aphasia
Measure the patient’s level of performance to provide a baseline for detecting any change over time
Provide comprehensive assessment of the patient’s language assets and deficits in order to guide treatment and management
Infer the location and etiology of the lesion causing aphasia
Speech therapists specialize in communication, but caregivers play a huge role in helping their loved ones who are trying to regain their language skills.
Speech therapy for adults with aphasia
There are different techniques in speech language therapy after a stroke. Depending on the severity of aphasia, a speech-language pathologist will treat based on the symptoms to maximize the person’s communicative skills. Aphasia treatment is ultimately dependent on many factors.
For example, the person has difficulty finding words to say. The Semantic Feature Analysis is a technique that is used for treatment for improving naming ability in a person with aphasia. SFA is an effective treatment for naming deficits, as it is designed to improve lexical retrieval by increasing the level of activation within a person’s semantic network.
For adults who have non-fluent aphasia, Melodic Intonation Therapy is used in aphasia therapy to stimulate verbal expression using melody and rhythm. To acquire a new way to deliver speech through humming, intoning, immediate repetition and delayed repetition of target phrases with increase difficulty.
Aphasia speech therapy is dynamic and there is no one way to approach it!
What can I do at home to help?
It is highly encouraged for adults with aphasia to focus on language based activities at home. Hours spent at physical, occupational, or speech therapy after a stroke cannot compare to the hours spent at home. That is why, it is important to introduce some activities at home to consistently offer language stimulation that can help improve an adult’s communicative skills.
Play a favorite card game, or board game – Playing a game with strategy stimulates important cognitive processes. Review the names or what is written on the cards. Also review the rules, steps, and problem-solving strategies involved in the game.
Play music and sing songs – Surprisingly, some clients who can’t speak after a stroke can still belt out their favorite song. These people can end up singing with more ease, since the singing abilities are located in a different part of the brain than language. Find out what their favorite music is, and sing along. You can even try “Happy Birthday.” Play games, such as guessing the title of a song that is on the radio, or even your own version of “Name That Tune,” if possible.
Discuss hobbies – Look at pictures or read magazines about the person’s hobbies. Gardening, favorite game shows, sports, or cooking. If someone is passionate about a certain topic, they are more likely to want to make an effort to talk about it.
Look at a family album – Seeing photos of loved ones from the past helps stimulate memory. You can name family members, or talk about events. Remember that some people will become emotional looking at these photos, so be mindful.
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About the Author
Mikee Larrazabal
I am a Speech-Language Pathologist with 14 years of experience working with children and adults who have communication difficulties. I completed my Bachelor of Science degree in Health Science at Cebu Doctors' University and have been helping people overcome their communication challenges ever since.
I have worked with individuals of different ages, including toddlers, preschoolers, school-aged children, adults and seniors. I'm passionate about speech therapy and take great satisfaction in helping people overcome their communication challenges and improve their lives through better communication skills. In my spare time I like reading books, going hiking in nature and taking care of my dog Locas.
