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This page will provide you with a comprehensive overview on the effects of aphasia, the symptoms of aphasia and the treatment for aphasia after stroke. We sincerely hope that our website helps to further your understanding on the topic of aphasia. If you have further questions, please contact a healthcare professional.
What are the Effects of Aphasia?
Aphasia, a communication disorder that affects the production or comprehension of speech, arises from brain injury after a stroke. Stroke, as defined by WHO (World Health Organization), is when there are “rapidly developing clinical signs of focal (or global) disturbance of cerebral function.” In other words, it is when the brain receives insufficient blood flow, and consequently, results with brain injury due to cell death. Typically, the prevalence of aphasia after a stroke is 25-40% as patients develop slurred speech after stroke. This is because the temporary hypoxic conditions caused by a stroke can easily result with significant damage in the brain. The severity of aphasia depends upon the extent of damage and can range from severe to very mild. In severe cases the effects of aphasia may make communication almost impossible whereas in mild cases the effects of aphasia may not even be noticeable. Moreover, the effects of aphasia may be singular (affecting only a single aspect of language) or it may be global (affecting multiple aspects of language). Nevertheless, aphasia will generally only result if there is substantial damage to the left hemisphere (the key region responsible for language). More specifically, the two areas in the brain typically affected are in the cortex (outer layer of the brain) and in the white matter (the area of the brain that contains primarily axon tracts and commissures); both of these areas are important for coordinating pathways in the brain.
Types of Aphasia
The types of aphasia patient’s acquire is dependent upon the location of the brain that has been damaged. It should come as no surprise that there are many different types of aphasia that can result from stroke including:
The effects of aphasia are most pronounced in global aphasia because it is the most extensive. Patients that have global aphasia typically have an impaired ability to produce words, understand words, and repeat words. These patients are also unable to read and write because of impaired comprehension. This form of aphasia is normally observed immediately after a person has a stroke and the extent of the damage will determine how rapidly the patient improves.
Broca’s aphasia, also called expressive aphasia, is characterized by severely reduced speech and a limited vocabulary. The area of the brain that is affected is called “Broca’s area” (located in the frontal lobe of the dominant hemisphere). Patients suffering from Broca’s aphasia often exhibit speech that sounds forced and halting.
Wernicke’s aphasia, also called ‘fluent aphasia,’ occurs when a patient is not able to grasp the meaning of words. More specifically, the production of speech itself is not affected but comprehension is. Notably, it is easy to recognize when a patient has this form of aphasia because they incorrectly incorporate unidiomatic words into their sentences.
Primary Progressive Aphasia:
Primary progressive aphasia is a rare neurological syndrome that is slow and progressive. This form of aphasia is not common after stroke as the effects of aphasia are too slow.
The effects of aphasia are not obvious in anomic aphasia because the individual understands speech and reads normally. The primary problem they face, however, is difficulties with finding the word for what they want to talk or write about. For example, the individual may incorrectly call a fork a spoon or a call a dog a cat.
Mixed Non-Fluent Aphasia:
A person that has mixed non-fluent aphasia may have sparse and effortful speech that is similar to Broca’s aphasia but the difference is they also have impaired comprehension.
Symptoms of Aphasia
The symptoms of aphasia vary greatly from person to person. This is because the damage may be in different locations of the brain and the severity depends on both the extent of the damage and the cause. For example, patients with damage to the front part of the brain normally have good comprehension but choppy speech. In contrast, patients with damage to the posterior regions of the brain typically have trouble with comprehension but are fluent in their speech. This causes their symptoms to be completely different as their strengths and weaknesses are dissimilar. However, there are some effects of aphasia that may be observed in any form including:
• Problems with expressing themselves through words or sentences
• Using words or producing sounds incorrectly (slurred speech after stroke is common)
• Paraphrasia: Switching sounds, syllables and letters within words or using made-up words
• Difficulties with understanding speech when there is background noise
• Misunderstanding what is said
• Difficulty with reading forms and books
Diagnosis of Aphasia
It is relatively difficult to diagnose aphasia because each individual will present with their own set of weaknesses and strengths in language. This is simply because different areas of the brain may be affected and to different extents. To diagnose aphasia a speech language pathologist typically evaluates an individual through various tests including: auditory comprehension, verbal expression, reading and writing, and functional communication. Like the name suggests, verbal expression simply requires the patient to describe a picture, respond to questions and hold a normal conversation. Similarly, auditory comprehension checks to see if the patient can understand words, directions and questions that are spoken, while reading and writing tests try to determine if the patient can understand what’s written. Lastly, functional communication methods (drawings, pictures and pointing) are used if a patient has difficulty conveying information.
Treatment for Aphasia after Stroke
In general, there are two types of therapies that clinicians may use as a treatment for aphasia after stroke: impairment based therapies and communication based therapies. Impairment based therapy revolves around helping reduce the effects of aphasia by helping a patient speak more comfortably. Typically, a speech language pathologist will encourage the patient to focus their attention on tasks that allow the patient comprehend and speak as successfully as possible. This is extremely important in stroke aphasia recovery. Today with technology there are even computer programs that assist with comprehension and word finding. Moreover, the medical field is starting to experiment with the use of virtual therapists to help retrain a patient. In contrast, communication based therapy tries to help the patient find other methods of communicating their feeling and messages. Alternative methods may typically use any language-based ability that the person has. Overall, medical professionals typically combine both therapies in a patient’s treatment of aphasia after stroke to optimize stroke aphasia recovery.
One example of an impairment-based therapy is constraint-induced therapy (CIT). In this type of therapy, the patient is forced to use speech because they are restrained from using gestures. Although this therapy sounds harsh, it is modelled after a physical therapy for paralysis (commonly in stroke patients). The idea is that by removing alternative means of communication the patient has to practice using spoken language again in order to convey their message. This helps prevent the patient from giving up, which an especially important consideration for communication after a stroke. Overall, it has a great success rate and is well known for its intensive schedules and short duration.
How to Communicate with a Person with Aphasia
The effects of aphasia may make a person unwilling to communicate and extremely vulnerable to negativity. For this reason, it is essential for communication after a stroke to stay positive and reinforcing. Here are some tips for communicating with a patient during stroke aphasia recovery:
1. Before speaking ensure the person knows you are speaking to them by gently tapping their shoulder or using eye contact.
2. Speak in a normal tone and at a normal level unless the person asks otherwise.
3. Try to speak a little bit more slowly than you normally would.
4. While talking watch the person’s body language and use of gesture.
5. Try to use simple sentences and words, but do not treat the person as if they are unintelligent.
6. Try to avoid conversation in locations where there is background noise or large groups.
7. Have patience if the individual is trying to speak or convey a message through drawings, gestures, writing or facial expressions.
8. Try to encourage independence.
For any additional information on the effects of aphasia or the treatment of aphasia after stroke, please contact your local healthcare professional.