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An Overall View of Aphasia: Cause, Type, Characteristics and Therapy.

By Ms. Minuja Merry Kurian : Speech Language Pathologist

Aphasia is a language disorder that results from damage to portions of the brain that are responsible for language. For most people, these are parts of the left side (hemisphere) of the brain. Anyone can acquire aphasia, but most people who have aphasia are in their middle to late years. Men and women are equally affected. It is estimated that approximately 80,000 individuals acquire aphasia each year.

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. Other causes of brain injury are severe blows to the head, brain tumours, brain infections, and other conditions of the brain. 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. Broca's aphasia is thus characterized as a non fluent aphasia. Individuals with Broca's aphasia often 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, 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.
In some instances, an individual will completely recover from aphasia without treatment. In most cases, however, language therapy should begin as soon as possible and be tailored to the individual needs of the patient. Rehabilitation with a speech pathologist involves extensive exercises in which patients read, write, follow directions, and repeat what they hear. Computer-aided therapy may supplement standard language therapy. The outcome of aphasia is difficult to predict given the wide range of variability of the condition. Generally, people who are younger or have less extensive brain damage fare better. The location of the injury is also important and is another clue to prognosis. In general, patients tend to recover skills in language comprehension more completely than those skills involving expression. The speech-language pathologist (SLP) works on drills and exercises to improve specific language skills affected by damage to the brain. For example, the person may practice naming objects, following directions, or answering questions about stories. These exercises vary depending on individual needs and become more complex and challenging as skills improve. The SLP also teaches the person ways to make use of stronger language skills. For example, some people may find it easier to express their ideas through gestures and writing than with speaking. The SLP may teach this person to use both writing and gestures to help remember words for conversation.

The person may participate in group therapy sessions to practice conversational skills with other persons with aphasia. The SLP may lead the group through structured discussions, focusing on improving initiation of conversation, turn-taking, and repairing conversational breakdowns. Group members may role-play common communication situations that take place in the community and at home, such as talking on the telephone, ordering a meal in a restaurant, and talking to a salesperson at a store. Eventually, individuals may participate in outings to practice communicating in real-life situations. They may be asked to plan, organize, and carry out these trips using the compensatory strategies they have learned. For example, group members may practice functional reading and writing skills by using a telephone book to find the phone number of a restaurant and write it down. They may practice telephone skills by calling the restaurant and making a reservation. They may practice reading maps, taking public transportation to the restaurant, counting the change needed to purchase a ticket, and ordering food.

Later on in recovery, the SLP may work with a vocational specialist to help the person return to work or school, if appropriate. The SLP works with employers and/or educational specialists to implement the use of compensatory strategies in these settings and may work with them to modify the environment to meet language needs.