Aphasia: Causes, Symptoms, Types, Treatment, Recovery, Prognosis, Coping Tips
What is the Definition of Aphasia?
The condition or illness which disables your capacity to communicate is known as Aphasia. It can affect your capability to write, speak and understand language.
Usually aphasia occurs all of a sudden after a head injury or a stroke. There are possibilities of gradual occurrence of Aphasia from a brain tumor that grows slowly or a permanent, progressive damage caused by a disease. The degree of disability is determined based on where and how bad the damage of the brain is.
Once the cause of aphasia has been identified, the chief treatment for aphasia is the language and speech therapy. The aphasia person relearns and practices language skills and gains knowledge for using other ways for communicating. The family members usually take part in this process to aid the person suffering from aphasia to communicate.
How to Communicate with a Person with Aphasia?
Constant trials or efforts should be made by the close ones with the patient suffering from aphasia. This is a crucial part as miscommunication or lack of communication will lead the patient to other conditions like clinical depression. In the beginning months it will be very difficult for the relatives and friends to communicate with the patient who is challenged with aphasia. Without proper environment and care the patients of aphasia are vulnerable to mood swings and agitation.
You can do quite a few things in order to communicate effectively with the patients of aphasia:
- Firstly, get the attention of the patient and let them understand that you came to them to talk with them.
- Always try to maintain an eye contact with the aphasia patient and observe their body language.
- Make sure that there are no distractions or noises in the background while you are attempting to talk to them.
- Talk to them at a normal level of sound unless they ask you to speak louder.
- Do not try to dominate the patient with aphasia while talking.
- The sentence formation is crucial while you are talking to the victim of aphasia, do not complicate the sentences or use long sentences. Try to keep them short.
- It is better for the sufferer of aphasia if you do not talk fast. Talk to them little slowly.
- Do not finish the aphasia patients' sentences; let them express themselves fully.
- If you really want to help, the use a pen and book, hand gestures, drawings along with talking.
- Also encourage the aphasia patient to use pen and a book or drawings, gestures while taking.
- You can also use simple yes or no questions.
- Always try to encourage the aphasia patient while they are trying to communicate. Do not try to correct their words. Let them express themselves.
- Engage in normal activities along with the aphasia patient whenever possible.
- Promote independence in the aphasia patient and Stop being over protective.
How Common is Aphasia?
Aphasia affects around one million Americans or 1 in 250 people. It is more usual than muscular dystrophy, cerebral palsy or parkinson's disease. This disorder is acquired by nearly 180,000 Americans every year. Nevertheless, majority of the people have never heard about it.
Who Has Aphasia?
The disease of aphasia is most frequently found in adults who have endured a stroke. Aphasia can also result from an infection, brain tumor, dementia or head injury which damages the brain. It is anticipated that around 1 million people of the United States today suffer from aphasia. The type and the rigorousness of language dysfunction in aphasia depend on the exact location and the extent to which the brain tissue is damaged.
What Causes Aphasia?
Aphasia is caused by injury to one or more of the language areas of the brain. The cause for the brain injury is a stroke most of the times. When blood is not able to reach a part of the brain, stroke occurs. When brain cells don't receive their normal blood supply which carries essential nutrients and oxygen, they die.
What Happens to People with Global Aphasia?
A type of non-fluent aphasia with rigorous impairment of both receptive and expressive skills is known as global aphasia. It is normally associated with a big lesion in the perisylvian region of the temporal, frontal and parietal lobes of the brain which causes nearly complete reduction of all forms of written and spoken language.
What is the Difference between Apraxia of Speech and Aphasia?
Individuals with apraxia may not be able to act in response to the commands of the brain for making certain movements inclusive of those which produce speech. The language disorder in which individuals may have trouble producing or understanding language is known as aphasia and it is caused by injury to the left hemisphere of the human brain.
What is the Difference between Aphasia and Dysphasia?
Dysphasia and Aphasia- both are language associated conditions. The understanding, spoken and written language is controlled by specific regions of the human brain. There is just a single difference between dysphasia and aphasia. Aphasia signifies complete disruption and dysphasia signifies a medium disruption of spoken, understanding, and written language.
- When the conditions mentioned above become highly severe to the point of complete speech loss, doctors use the term aphasia.
- When the conditions are of moderate intensity without complete disruption in speech, doctors use the term dysphasia.
What is the Difference between Apraxia and Aphasia?
Apraxia and aphasia both has nervous system aetiology which has trouble in communicating, with familiar investigative procedures, usual management strategies and familiar complications. Both of these conditions originate from cerebrum of the human brain. Apraxia is unpredictable and inconsistent with islands of clear speech. Nevertheless Aphasia is inconsistent too but is predictable without islands of clear speech. The aspects which are affected by aphasia is dependent on the affected language centre or the cluster whereas only articulation is affected in apraxia. Increased rate of speech increases the intelligibility in apraxia whereas it has the contrasting effect in aphasia. Dyspraxia is related with aspiration pneumonia such as complication but aphasia has no relevance like that.
Both apraxia and aphasia have to be understood as distinct entities except resulting in slight similar results. But a cautious investigator will be able to identify the aspects that we have explained earlier that distinguish out the two. The management of these both is identical where the causative mechanisms are irreversible and compensatory efforts alone can be taken.
What is the Difference between Apraxia and Dysarthria?
Both dysarthria and apraxia have a nervous system aetiology and trouble in connection/ conversation. The management strategies, diagnosing methods and complications are identical in both. Apraxia originates from cerebrum while dysarthria is neural/ cerebral/ muscular or any amalgamation in between. Apraxia is unpredictable and inconsistent with islands of clear speech. Dysarthria is predictable and consistent without islands of clear speech. Dysarthria affects all aspects of speech whereas apraxia affects articulation alone.
Your muscle tone changes when you have dysarthria while there is no change in muscle tone with apraxia. Increase in the speech rate increases the intelligibility in apraxia while it has the contrasting effect in dysarthria. Dyspraxia is related with aspiration pneumonia such as complication but aphasia has no relevance like that.Both apraxia and dysarthria have to be understood as distinct entities except resulting in slight similar results. But a cautious investigator will be able to identify the aspects that we have explained prior that distinguish out the two. The organization of these both is identical where the causative mechanisms are irreversible and compensatory efforts alone can be taken.
Causes of Aphasia
Aphasia is the consequence of the damage to the portion of the brain involved in reading, writing, speaking and understanding.
Any kind of damage to the language sections of the brain can result in losing of function which in turn causes aphasia. The severity of aphasia in a person depends on the type of injury sustained by the human brain and its location.
The occurrence of aphasia can be by itself or alongside other disorders like mobility problems, visual difficulties, cognitive changes and weakness of limbs.
Aphasia can affect the language of a person and not affect the person's intelligence.
Brain Damage in Aphasia
Ways the brain can become damaged causing aphasia include:
- A stroke can cause Aphasia. During a stroke, the brain does not receive enough oxygen and blood that result in the death of brain tissue.
- Aphasia can also be caused by severe head injury. For instance, an injury due to traffic accident on road or a grave fall from height can reason to aphasia.
- Brain tumour can cause aphasia where unusual developments of cells grow inside the brain.
- Conditions of health which cause continuous loss of cells from the brain like dementia can lead to aphasia. Aphasia is not caused by parkinson's disease, however very analogous illnesses may do so which may be corticobasal degeneration (CBD) or progressive supranuclear palsy (PSP).
- Infections like encephalitis (an infection of the brain itself) and meningitis (an infection of the outer layer of the brain) which affects the brain can also cause aphasia but it is very rare.
Signs and Symptoms of Aphasia
There are multiple symptoms for aphasia. Depending on the location and the extent to which the brain is damaged, the particular signs and symptoms and severity of aphasia differs. The individuals with injury on the front portion of the brain may have non-fluent or "choppy" speech.
Nevertheless, they can usually understand what people say fairly well. Those patients with aphasia with injury to the posterior regions of the brain always have fluent speech- which means the rhythm and rate of speech may sound normal. Yet, their speech may include the wrong or made-up words. They also normally have trouble to understand what is spoken. Furthermore, all the individuals with aphasia may have one or many of the following problems:
- Difficulty in producing language is the major symptom of aphasia:
- Facing trouble with the upcoming words they want to say is a sign of aphasia.
- Replacement of the proposed word with some other word which may be related in meaning to the target word (for instance "chicken" for "fish") or unrelated is another symptom of aphasia.
- An Exchange sound within words (for example "wish dasher" for "dishwasher") is a classical symptom of aphasia.
- Usage of made-up words (for example "frigilin" for "hamburger") is another symptom of aphasia.
- Other symptom of aphasia is trouble in putting words together for forming sentences.
- Thread the real and made-up words together easily but without any making sense.
- Difficulty in understanding language is one of the symptoms of aphasia:
- Misinterpret others speech, particularly when they speak rapidly (for example television news) is a symptom of aphasia.
- Another symptom of aphasia is becoming difficult to make sense of speech in group situations or in the presence of background sounds.
- Misunderstand jokes and obtain the literal meaning of figure of speech (for example "it is raining cats and dogs")
- Signs and Symptoms of aphasia in reading and writing:
- Patients with aphasia have trouble in reading forms, books, pamphlets and other written material.
- Trouble in putting words together and spelling to write sentences is a symptom of aphasia.
- Complexity in understanding number concepts (for example telling time, counting money, adding/subtracting etc…) is a sign of aphasia.
When to Visit a Physician for Aphasia?
Since aphasia is always a sign of a grave problem like stroke, look for emergency medical care in case you develop the following signs and symptoms abruptly:
- Trouble in speaking
- Difficulty in understanding speech
- Trouble with word recall
- Trouble with writing or reading.
Types of Aphasia
There are majorly 5 types of aphasia which includes nonfluent, fluent, global, anomic and primary progressive type of aphasia:
- Nonfluent or broca aphasia is the first type of aphasia. Injury to the language network close to the left frontal area of the brain normally results in nonfluent aphasia also known as broca aphasia. People who have this type of disorder struggle to get words out, talk in very short sentences and omit or forget words. When a person say "walk park today" or "want food" a listener can normally understand the meaning. People with nonfluent or broca aphasia can understand what other people state better than they can speak. They are always conscious about their difficulty in communicating and can get frustrated. People with nonfluent or broca aphasia may have right-sided paralysis too or weakness.
- Fluent or Wernicke aphasia is the second type of aphasia. People with fluent type of aphasia might speak fluently and easily in long and complex lines which do not make sense or add incorrect, unrecognizable or unwanted words. They normally do not understand spoken language very well and always do not realize that others cannot understand them. Also termed as Wernicke aphasia, this kind of aphasia is the consequence of damage to the language network in the middle left side of the brain.
- Global aphasia is the third type of aphasia. Global aphasia results from extensive damage to the language networks of the brain. People with this condition have rigorous disabilities with comprehension and expression.
- Anomic aphasia is the fourth type of aphasia. The person is subjected to have difficulties in word-finding with anomic aphasia. Because of the complexities, the person struggles for finding the right words to write and speak.
- Primary progressive aphasia is the fifth type of aphasia. This is an uncommon disorder where people gradually lose their capacity to read, write, speak, talk and understand what they hear in discussion in some time. In case of a stroke, aphasia patient may improve with proper therapy. Primary progressive aphasia cannot be reversed as there is no treatment for it. People with primary progressive aphasia can communicate through other ways than speech. For example, they may use gestures. Combination of speech therapy and medications serves beneficial to many.
Aphasia might be severe or mild. In case of mild aphasia, the person might be able to converse, but have trouble in understanding complex conversations or finding the right word. Severe aphasia confines the communication ability of a person. The person might speak less and might not participate in or comprehend any conversation.
Complications involved in Aphasia
Various quality-of-life problems can be created by aphasia since communication is a major part of your life. The difficulty in communication may complicate your Work, personal relationships, Daily activities, Serious psychological stress which can then lead to despair or depression.
Language barriers create complications and may lead to depression, embarrassment and relationship problems.
Tests to Diagnose Aphasia
There are multiple specific tests to diagnose aphasia. In order to test the patients' strength, reflexes and feeling, and heart beats and the vessels in your neck, your doctor is likely to give you a neurological and a physical exam. For quickly identifying the cause of aphasia, he or she will likely request an imaging test.
You are also certain to undergo informal observations and tests for aphasia in order to assessing of your language skills, such as the ability to:
- The aphasia specialist might ask to name few general objects which are given to you.
- The specialist will try to assess the severity of aphasia by engaging in a conversation with the patient.
- The specialist will check comprehend and usage of correct words while in conversation with the patient.
- Answering questions about something heard or read
- Reiterating the words and sentences
- The doctor will ask the aphasia patient to follow the instructions (which will be given to them) to test the level of aphasia.
- Responding to open ended questions and answering yes or no questions about general subjects.
- Read and write.
Imaging Scans for Diagnosing Aphasia
Imaging scans for diagnosing aphasia is used for assessing the level of any injury to the brain. The two imaging techniques commonly used for diagnosing aphasia are:
- A CT (Computerized Tomography) scan is taken for diagnosing aphasia.
- A MRI (Magnetic resonance imaging) scan is also taken for diagnosing aphasia.
Rarely, a PET (positron emission tomography) scan may be used to evaluate the functionality and the state of the brain. PET scans are generally used only to carry out clinical research at the specialist centers.
Treatment for Aphasia
Speech and language rehab plays a major role in treating aphasia while medicines play a minor role. A person might recover his or her language skills without any treatment if the brain damage is mild. Nevertheless, majority of the people with aphasia undergo language and speech therapy for supplementing their communication experiences and rehabilitating their language skills. Researchers are presently researching the use of medications alone or in combination with speech therapy for helping people with aphasia.
Speech and Language Rehabilitation for Aphasia
Speech and language rehabilitation is the primary treatment for aphasia patients. Language skills recovery is typically a relatively slow process. Though majority of the people make important progress, only few people get back their whole pre-injury communication levels.
For aphasia, language and speech therapy attempts to enhance the ability of a person to communicate. It is by way of reinstituting as much language as feasible, teaching how to recompense for the lost language skills and finding other means of communicating.
SLT (speech and language therapy) can lead to an immense improvement still with global aphasia.
The results expected to be accomplished from SLT (speech and language therapy) are:
- Improved usage of the residual language abilities.
- Enhanced language skills, by relearning them
- Capability for communication in a special way, making up for lost words in speech
As there are diverse levels of aphasia and all the people do not learn in the same method, there are small variations of speech language therapy. These are:
- MIT or Melodic Intonation Therapy for Aphasia- Non-fluent aphasia is mostly treated with MIT or melodic intonation therapy. It includes the usage of singing or humming in rhythm (melodic intonation) when repeating words and phrases which the patient has been struggling with. This process stimulates the activity in the right hemisphere of the brain. This therapy is effectual at increasing the number of words the patient can remember.
- Group therapy for treating aphasia is where a little group of aphasia affected people get communally with a therapist and communicates. The patients get a chance to practice and improve their language skills by interacting with a collection of people in a helpful and comfortable environment.
- PACE or Promoting Aphasic's Communicative Effectiveness treatment for aphasia is a type of SLT (speech and language therapy) which improves the communication skills of the patient by way of engaging them in a conversation. Initially the patient will be shown a drawing or a picture and will be asked to react in any way which they can. The conversation level will begin simple but through time, it will become more involved.
- CST or Computerized Script Training for aphasia entails a computerized script which is based on daily conversations. It provides the patient a chance to practice their communication skills using practical situations.
Medications for Treating Aphasia
For treating aphasia, certain drugs are presently being studied. These comprise of drugs which may enhance the flow of blood to the brain, improve the recovery ability of the brain or aid in replacing exhausted chemicals in the brain (neurotransmitters). Numerous medications like piracetam and memantine (Namenda) have proved good in small studies. However more research is required prior to these treatments could be suggested.
Coping with Aphasia
Coping Tips for People with Aphasia
The following guidelines can help the patients of aphasia to cope with and communicate with others:
- Hold a card which explains that you have aphasia and what aphasia is, in order to cope with aphasia.
- Take information and identification on how to contact important people for better coping with aphasia.
- One of the coping tips for aphasia is to always carry a pencil and a small notebook with you.
- Usage of diagrams, drawings or photos as shortcuts will help in coping with aphasia effectively.
- Usage of gestures or spot to objects can help in coping with aphasia.
Role of Family and Friends in Coping with Aphasia
Friends and family members can use the following coping tips when communicating with a person with aphasia:
- Make simpler sentences and slow down your pace while talking with a person who is coping with aphasia.
- Maintain one on one conversations primarily when you are conversing with aphasia patient.
- Give time for the aphasia patient to talk.
- Do not correct errors or finish sentences of the aphasia patient.
- Lessen disturbing noise in the environment.
- Keep paper, pens or pencils accessible for aphasia patient.
- Write down a short sentence or key words to help out explain something.
- Aid the aphasia affected person make a book of words, photos and pictures to help with conversations.
- Use gestures or drawings when you did not understood.
- Engage the person with aphasia in conversations as greatly as possible.
- Make sure for understanding or sum up what you have discussed.
Role of Support Groups in Coping with Aphasia
Support groups play a major role in coping with aphasia. Certain divisions of organizations like the American Stroke Association, the American Heart Association, National Aphasia Association and certain medical centers may provide support groups for the aphasia affected persons and also for others affected by disorder. These support groups offer people with knowledge of community, a place to air frustrations and learn managing strategies. Enquire your speech-language pathologist or doctor if he or she knows about any local support groups.
Recovery Period/Healing Time for Aphasia
The recovery period/ healing time for aphasia is unpredictable. If the symptoms of aphasia last more than two months after a stroke, it is unlikely for a complete recovery. Nevertheless, it is significant to note that certain people keep on progressing over a period of years and even decades. Progress is a slow process which normally involve both helping the affected individual and family as well to comprehend the aphasia nature and learning compensatory or remedial strategies for communicating.
Yoga for Aphasia
Yoga can help and can be used as a complementary treatment for the patients of aphasia. Stress and depression can bring down the sufferers of aphasia. People affected by aphasia usually suffer from more than just a language loss. They can suffer from all the consequences and feelings which result from that language loss that includes depression, anxiety and stress. Apart from the damage of the emotional states of these people affected by aphasia, they can also have an impact on neuroplasticity, attention and memory performance. Essential capabilities have to be developed in these people when using language, compensating for lost language or attempting to regain language.
Research reveals that yoga can offer opportunity to individuals with aphasia for regaining the feelings of confidence, relaxation and an association between the body and mind and one which is habitually lost subsequent to a stroke or brain injury. Patients of aphasia were reevaluated after 12 weeks of (biweekly) yoga sessions by making use of formal language testing and they spoke about their yoga experience. The final formal language testing explained certain, though minimal had improvements in their expressive language ability. Patients who have practiced yoga for aphasia reported that they feel more relaxed and obtain an association with the mind and body after each yoga session which had not prevailed prior to the session.
Prognosis/Outlook for Aphasia
Because of the wide range of variability in aphasia, the outlook or prognosis for aphasia is hard to predict. Usually, younger people or people with mild brain damage recover better. The location of the injury plays a crucial part and it is an additional clue to the prognosis of aphasia. In common, patients are likely to recover skills in language comprehension more entirely than those with skills involving expression.
The NINDS (National Institute of Neurological Disorders and Stroke), National Institute on Deafness and Other Communication Disorders usually conduct and support a wide range of scientific investigations to augment the peoples' understanding of aphasia. Also for finding better treatments and discover better methods to reinstate lost function to people with aphasia.