Gerald Hurowitz, M.D.·Published 2 February 2012·11 min read
Key points
Aphasia is a language disorder that results from damage to portions of the brain that are responsible for language.
Anyone can acquire aphasia, but most people who have aphasia are in their middle to late years.
Aphasia is caused by damage to one or more of the language areas of the brain.
Aphasia is usually first recognized by the physician who treats the individual for his or her brain injury, usually a neurologist.
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. Aphasia usually occurs suddenly, often as the result of a stroke or head injury, but it may also develop slowly, as in the case of a brain tumor. The disorder impairs both the expression and understanding of language as well as reading and writing. Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage.
Who has aphasia?
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. About one million persons in the United States currently have aphasia.
What causes aphasia?
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 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, brain tumors, 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 nonfluent aphasia. Affected people often omit small words such as “is,” “and,” and “the.” For example, a person with Broca’s aphasia may say, “Walk dog” meaning, “I will take the dog for a walk.” The same sentence could also mean “You take the dog for a walk,” or “The dog walked out of the yard,” depending on the circumstances. Individuals with Broca’s aphasia are able to understand the speech of others to varying degrees. Because of this, they are often aware of their difficulties and can become easily frustrated by their speaking problems. 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.
What is aphasia? Every human being uses language. Talking, finding the right words, understanding, reading, writing, and making gestures are part of our language use. If as a result of brain damage one or more parts of language use stop functioning properly, this is called aphasia.
Aphasia - A (=non) phasia (=speaking) means therefore that someone can no longer say what he or she wants. He or she cannot use language anymore. Apart from aphasia, paralyses could occur and/or problems with regard to:
- conscious acting,
Written and revised by
Gerald Hurowitz, M.D.
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- concentrating, taking initiatives, and the memory.
People cannot do two things at the same time anymore.
Many people experience the frustration during their holiday abroad of not being able to clearly state what they mean, or of not properly understanding what the other person says. Even in countries of which we master the language well, we can experience this for example when visiting a doctor. In countries of which we master the language less well, our communication capacities with the local population always become more limited, and we even don’t succeed all the time to order the dish we would really like to eat. People who suffer from aphasia experience these problems every day. Aphasia is therefore a language disorder. There are not two people who suffer from aphasia that are equal: aphasia is different for everyone. The severity and scope of the aphasia depend, among other things, on the location and the severity of the brain damage, the earlier linguistic competence, and someone’s personality. Some people with aphasia can understand language well, but have trouble finding the right words or constructing sentences. Others on the other hand do speak a lot, but what they say is not or difficult to understand for their conversation partner; these people often have great trouble understanding the language. The linguistic competence of most people with aphasia is somewhere between these two extremes. Do notice: someone who suffers from aphasia in general has his or her complete intellectual capacities at his or her disposal!
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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.” For example, someone with Wernicke’s aphasia may say, “You know that smoodle pinkered and that I want to get him round and take care of him like you want before,” meaning “The dog needs to go out so I will take him for a walk.” 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.
Which additional problems could occur? It seldom happens that someone only suffers from aphasia. Often other areas of the brain are affected as well. Examples of additional problems are:
- hemiplegic condition (hemi=half, plegic=paralysis). For people suffering from aphasia this is often the right part of the body. The conduct of the muscles on one side of the body is affected, as a result of which the muscles don’t collaborate well anymore. - loss of half of the eyesight (hemianopsia, hemi=half, opsia=to see). Mostly people do see everything that is located at the side of their healthy body half, but not the things that are located on their affected side. - not knowing anymore how certain actions have to be performed (apraxia, a=not, praxia=perform). Simple actions such as getting dressed, eating, and drinking can suddenly not be carried out consciously anymore. Someone who suffers from apraxia does, for example, not know how to blow out a candle if he or she is asked to do so (conscious action), whereas he does automatically blow out the match he or she is holding if he or she is in danger of burning his or her fingers. - problems with eating, drinking, and swallowing (dysphagia, dys=not well, phagia=swallowing). Because of the brain damage the digastric and swallow muscles can become paralysed, very sensitive, or even insensitive. This makes eating and drinking a difficult task. Because of the paralysis and loss of feeling in a part of the cheek, saliva can drip from the corner of the mouth unnoticed. - memory problems. When remembering information language plays a large role. Because of the language problems the memory seems to function less well. Therefore always note down a couple of key words; this makes it easier for someone suffering from aphasia to remember things. - react differently. Sometimes people react completely differently to events after suffering a stroke than they did before. The control of expressing emotions has become more difficult. It is possible that someone laughs and cries more often. It is also possible that it costs him or her more effort to stop doing so. - epilepsy. When the brains recover from an injury scar tissue is created in the brains. Sometimes this scar tissue causes a short circuit, so to speak, inside the brains. As a result of that the body convulses, someone often has problems breathing, and he or she can lose consciousness. Such an epileptic fit only lasts a few minutes, but often comes unexpectedly and the fright for the person who suffers from it as well as the family is therefore often huge.
The above list with additional problems is by no means complete. The aphasia symptoms and additional consequences are different for every human being. Each abovementioned problem can occur in combination with aphasia, but does not have to.
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.
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How is aphasia diagnosed?
Aphasia is usually first recognized by the physician who treats the individual for his or her brain injury, usually a neurologist. 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.
Development of aphasia
Aphasia develops as a result of brain damage. The origin of such brain damage is mostly a blood vessel disorder. Such a disorder is also called a stroke, cerebral haemorrhage, cerebral infarction or apoplexy. In medical terms it is called a CVA: Cerebral (=brains) Vascular (=blood vessel) Accident. Other causes for the development of aphasia are for example a trauma (an injury to the brains as a result of for example a (road) accident or a brain tumour.
Our brains need oxygen and glucose in order to function. If as a result of a CVA or one of the other causes the blood circulation in the brains is disrupted, brain cells die off on that location. In the brains there are all sorts of areas with different functions. For most people the areas for the use of language are located in the left half of the brains. In case of injury in these language areas we speak of aphasia.
What are the Complications associated with Aphasia? Aphasia can have a negative effect on a number of aspects of life, as communication is fundamental to day to day living. It can affect things such as personal relationships and work and can result in the patient suffering frustration and distress.
All of these can contribute to heavy psychological stress which can then lead to depression. Research has proven this to be a common complication of aphasia with approximately 25% of people diagnosed suffering depression at some point.
It is advised that someone with aphasia suffering from depression go to support groups or see their doctor about treatment.
How can Aphasia be prevented?
With the main cause of aphasia being a stroke, taking measures to avoid having one would lower the risk of aphasia. Precautions that can be taken to reduce stroke risk are:
regular exercise eating healthily monitoring and controlling blood pressure avoiding tobacco use keeping alcohol consumption low managing stress
If someone is suffering a stroke, getting them medical attention as soon as possible is crucial to recovery. There are certain signs to look out for that can determine if someone is suffering or about to suffer a stroke, these are:
Blurred, blackened, or double vision Dizziness, trouble walking, loss of balance and coordination Numbness, weakness, or paralysis on one side of the body Speech problems Sudden severe headache
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How is aphasia treated?
In some instances, an individual will completely recover from aphasia without treatment. This type of “spontaneous recovery” usually occurs following a transient ischemic attack (TIA), a kind of stroke in which the blood flow to the brain is temporarily interrupted but quickly restored. In these circumstances, language abilities may return in a few hours or 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 partial 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 2-year period. Most people believe that the most effective treatment begins early in the recovery process. 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 strives to improve an individual’s ability to communicate by helping the person to use 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. Individual therapy focuses on the specific needs of the person. Group therapy offers the opportunity to use new communication skills in a comfortable setting. Stroke clubs, which are regional support groups formed by individuals who have had a stroke, are available in most major cities. These clubs also offer the opportunity for individuals with aphasia to try new communication skills. In addition, stroke clubs can help the individual and his or her family adjust to the life changes that accompany stroke and aphasia. 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 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 is 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.
What are researchers investigating about aphasia?
Aphasia research is exploring new ways to evaluate and treat aphasia as well as to further understand the function of the brain. Brain imaging techniques are helping to define brain function, determine the severity of brain damage, and predict the severity of the aphasia. These procedures include PET (positron emission tomography), CT (computed tomography), and MRI (magnetic resonance imaging) as well as the new functional magnetic resonance (fMRI), which identifies areas of the brain that are used during activities such as speaking or listening. In-depth testing of the language ability of individuals with the various aphasic syndromes is helping to design effective treatment strategies. The use of computers in aphasia treatment is also being studied. Promising new drugs administered shortly after some types of stroke are being investigated as ways to reduce the severity of aphasia.
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- The Internet Stroke Center Association Internationale Aphasie (AIA)
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