What is Expressive Aphasia?
Expressive aphasia is a language disorder that results from damage to the brain’s language centers, specifically in the frontal lobe. It is also known as Broca’s aphasia. This disorder affects people’s ability to express themselves through speech or writing. It also makes finding the right words or the construction of sentences difficult.
What Can Cause Expressive Aphasia?
The most common cause of aphasia is a stroke that affects the left frontal area of the brain. (1) It damages the Broca’s area of the brain and impairs the person’s ability to produce speech. However, this condition may occur due to other causes as well.
- Traumatic Brain Injury: A traumatic brain injury affecting the left frontal lobe of the brain may lead to expressive aphasia.
- Brain Tumor: A brain tumor affecting the left frontal lobe may put pressure on Broca’s area of the brain and cause expressive aphasia.
- Degenerative Brain Disease: Certain degenerative brain diseases including Alzheimer’s disease or frontotemporal dementia may also lead to expressive aphasia. (2)
- Infections and Inflammation: Meningitis or encephalitis is inflammation of the brain that may lead to expressive aphasia.
- Seizures: Seizures occurring in the left frontal lobe of the brain may cause damage to Broca’s area and may result in expressive aphasia.
Proper treatment of expressive aphasia may include speech therapy and may include strategies that may help a person in enhancing the ability to form words and sentences.
This condition impacts a person’s ability to communicate and participate in daily activities. Proper diagnosis and treatment may help in improving communication, reducing the risk of depression, facilitating rehabilitation, and improving social work and skills.
Anatomy and Physiology of Language Processing
A complex network of the brain is involved in language processing to enable communication. (3)
- The Broca’s area located in the left frontal lobe of the brain is responsible for speech production and sentence formation. Damage to this area of the brain can lead to expressive aphasia.
- Wernicke’s area in the left temporal lobe is responsible for language comprehension. Damage to this area of the brain can result in receptive aphasia. The individual may have difficulty understanding spoken and written languages.
- Arcuate Fasciculus connects Broca’s area to Wernicke’s area allowing the integration of language comprehension and production.
- Motor cortex is the region of the brain that is responsible for the movement of the mouth and tongue needed for speech production.
- Auditory cortex is the region of the brain that processes sound information including speech sounds.
- Visual Cortex is the region of the brain that processes visual information including the written word.
- Thalamus is the relay station for sensory information including auditory and visual information related to language processing.
Several processes are involved in language processing including perception, comprehension, and production. The information is processed as it travels through various regions of the brain and is analyzed and integrated to facilitate communication.
Damage to any of the above areas of the brain may result in language impairment. Understanding anatomy and physiology can be helpful in forming an appropriate treatment plan and rehabilitation strategies for an individual with language impairments.
Symptoms of Expressive Aphasia
The symptoms of expressive aphasia include:
- A person experiencing difficulty in forming words and sentences. They may find it difficult to find the right words to express their thoughts.
- The person may have impaired grammar. They may have difficulty with word order, syntax, and other aspects of language structure.
- They may have difficulty recalling words from their memory, resulting in anomia, a condition in which there is difficulty in naming objects or people.
- The person may repeat the same words or phrases repeatedly which can be frustrating for both the listener and the speaker.
- They may have limited vocabulary and may find it difficult to get the correct words to express themselves.
- There may difficulty in reading and writing
- As communication is difficult, the person with expressive aphasia may get frustrated and emotionally distressed and that may affect the overall quality of life.
The symptoms may vary in severity and also depend on the location and extent of brain damage.
How is Expressive Aphasia Diagnosed?
Expressive aphasia is diagnosed by a comprehensive evaluation by a healthcare professional, mostly by a speech-language pathologist or a neurologist.
- The healthcare professional may take a complete medical history including information about stroke, head injuries, or neurological conditions that may contribute to expressive aphasia.
- Physical examination is performed to test muscle strength, coordination, and reflexes.
- Language assessment is conducted to evaluate the individual’s ability to speak and write an understandable language.
- Imaging tests including CT scan and MRI scan can help in identifying areas of the brain contributing to language impairment.
- Neurophysiological testing may be used to evaluate the cognitive functions such as memory and attention that may be impacted due to language impairment.
Once diagnosed with expressive aphasia, the healthcare professional may work with the individual and the family members and develop a treatment plan including speech therapy, medication, and other interventions to improve language function.
Treatment of Expressive Aphasia
Treatment of expressive aphasia involves speech therapy including various other approaches to help people improve their ability to communicate. (4)
The various treatment approaches for Expressive Aphasia include:
- Intensive Language Therapy: It involves frequent intensive therapy sessions that may help a person practice language skill and improve communication.
- Melodic Intonation Therapy: It involves singing and intonation to help people with aphasia improve their ability to produce speech.
- Constraint-Induced Language Therapy: This involves limiting the use of gestures and other compensatory communication strategies to encourage individuals to use verbal communication.
- Communication Partner Training: This involves training family members and caregivers to communicate with individuals with expressive aphasia and provide support and assistance during daily activities.
- Augmentative and Alternative Communications: It involves using tools and devices such as picture boards, electronic tablets, and speech-generating devices to help individuals with expressive aphasia communicate.
Speech therapy can help people with expressive aphasia manage their symptoms. People may also benefit from groups and clubs of people who have experienced a stroke.
When the non-surgical options do not help, surgery techniques are considered, which include:
- Cortical Brain Stimulation: It involves placing electrodes at the surface of the brain to stimulate the areas involved in language production. This helps improve language function and reduce symptoms.
- Removal of Brain Tumor: When a brain tumor is the cause of the condition, the removal of the tumor can bring about a significant improvement in language function.
- Deep Brain Stimulation: It involves placing electrodes in the brain to stimulate specific areas involved in language production. It improves language function.
Surgery is not always the best option for treating expressive aphasia. A healthcare professional can help curate the best treatment plan suited to the condition.
Recovery and rehabilitation post-treatment can be a long and ongoing process and may vary depending on the severity of the condition. Patience, perseverance, and a supportive environment are needed to achieve the best result.
Coping with Expressive Aphasia
Coping with expressive aphasia can be challenging for the people suffering from it and their loved ones. There are a few strategies that may be helpful.
- Using alternative methods for communication if the speech is difficult or impossible. This may include using a communication book, pointing to pictures, or using electronic devices.
- Encourage communication even if communicating is a problem. This may include asking simple questions, offering choices, and listening attentively.
- Use simple language while speaking and avoid complex sentences to help facilitate communicating with someone with aphasia.
- People with expressive aphasia may need extra time to communicate, process information and respond to questions. This can help in reducing frustration.
- Seek professional help. Talking to a speech-language pathologist can be helpful in managing expressive aphasia.
- Focusing on strength of the person with aphasia can encourage activities that the person enjoys and can be helpful in boosting confidence.
Prevention and Outlook of Expressive Aphasia
Prevention of expressive aphasia involves managing the underlying condition causing it. This includes lifestyle changes such as quitting smoking, exercising regularly, and managing high blood pressure and cholesterol levels.
The outlook may vary depending on the causes and severity of the condition. Some may experience only mild language difficulty while others may have more severe and persistent difficulties. Working closely with a healthcare professional can help manage underlying conditions contributing to aphasia.
Expressive aphasia is a language disorder that affects a person’s ability to express themselves in spoken and written languages. It can occur due to various factors including stroke, traumatic injury, or neurological conditions.
Its prevention involves managing underlying conditions including high blood pressure and cholesterol levels, quitting smoking, and wearing helmets.
Speech therapy is the most common form of treatment for expressive aphasia. With the right therapy and support, communication skills can be improved in people with expressive aphasia. Early intervention and treatment can help people with expressive aphasia achieve the possible outcome.