Aphasia is caused by damage to one or more of the language areas of the brain. Many times, the cause of the brain injury is a stroke. A stroke occurs when, for some reason, blood is unable to reach a part of the brain. Brain cells die when they do not receive their normal supply of blood, which carries oxygen and important nutrients. Other causes of brain injury are severe blows to the head, tumors, and infections as well as other conditions of the brain.The characteristics of aphasia depend on the portion of the brain that is injured. There are many types of aphasia, each of which has unique characteristics. Broca's aphasia, global aphasia and Wernicke's aphasia are frequently recognized aphasic syndromes.
Individuals with Broca's aphasia have damage to the frontal lobe of the brain. These individuals frequently speak in short, meaningful phrases that are produced with great effort. The disorder is thus characterized as a nonfluent aphasia. People with aphasia often omit small words such as "is," "and," and "the". Individuals with Broca's aphasia are often aware of their difficulties and can become easily frustrated by their speaking problems. They may have right-sided weakness or paralysis of the arm and leg because the frontal lobe is also important for body movement.
In contrast to Broca's aphasia, damage to the temporal lobe may result in a fluent aphasia that is called Wernicke's aphasia. Individuals with Wernicke's aphasia may speak in long sentences that have no meaning, often add unnecessary words and even create new "words." Individuals with Wernicke's aphasia usually have great difficulty understanding speech and are therefore often unaware of their mistakes. These individuals usually have no body weakness because their brain injury is not near the parts of the brain that control movement.
A third type of aphasia, global aphasia, results from damage to extensive portions of the language areas of the brain. Individuals with global aphasia have severe communication difficulties and may be extremely limited in their ability to speak or comprehend language.
Aphasia is usually first recognized by the physician, often a neurologist, who treats the individual for his or her brain injury. The physician typically performs tests that require the individual to follow commands, answer questions, name objects and converse. If the physician suspects aphasia, the individual is often referred to a speech-language pathologist who performs a comprehensive examination of the person's ability to understand, speak, read, and write.The doctor may also run the Boston Diagnostic Aphasia Examination, the Porch Index of Communicative Ability, or the Minnesota Test for Differential Diagnosis of Aphasia. These tests use picture cards and other verbal activities to identify which areas of communication are most problematic for aphasia sufferers.
Treatment exists for sudden aphasia which may be due to strokes. Patients should go to an emergency room immediatley if this type of aphasia presents. In some instances an individual will completely recover from aphasia without treatment. This type of "spontaneous recovery" usually occurs following strokes, or transient ischemic attacks (TIA), in which the blood flow to the brain is temporarily interrupted but is quickly restored. In these circumstances, language abilities may return in a few hours to a few days. For most cases of aphasia, however, language recovery is not as quick or as complete. While many individuals with aphasia also experience a period of spontaneous recovery in which some language abilities return over a period of a few days to a month after the brain injury, some amount of aphasia typically remains. In these instances speech-language therapy is often helpful.
Recovery usually continues over a two-year period. Some of the factors that influence the amount of improvement include the cause of the brain damage, the area of the brain that was damaged, the extent of the brain injury, and the age and health of the individual. Additional factors include motivation, handedness, and educational level.
Aphasia therapy aims to improve an individual's ability to communicate by helping the individual to utilize remaining abilities, to restore language abilities as much as possible, to compensate for language problems and to learn other methods of communicating. Treatment may be offered in individual or group settings.
Family involvement is often a crucial component of aphasia treatment so that family members can learn the best way to communicate with their loved one. Family members are encouraged to:
- Simplify language by using short, uncomplicated sentences
- Repeat the content words or write down key words to clarify meaning as needed
- Maintain a natural conversational manner that is appropriate for an adult
- Minimize distractions, such as a blaring radio, whenever possible
- Include the person with aphasia in conversations
- Ask for and value the opinion of the person with aphasia, especially regarding family matters
- Encourage any type of communication whether it be speech, gesture, pointing or drawing
- Avoid correcting the individual's speech
- Allow the individual plenty of time to talk
- Help the individual become involved outside the home. Seek out support groups such as stroke clubs
