This blog provides an overview of aphasia and stroke recovery, which is often misunderstood. Spread the word, raise awareness, and join us in providing support for persons with aphasia.
Aphasia is loss of language, NOT intellect. You may have seen this slogan around the internet, and it just could not be more accurate. Aphasia affects language, and it may affect expression or understanding, and can present with a variety of severities.
So what causes aphasia? Aphasia results from damage to the brain, from a stroke or hemorrhage, or from traumatic impact, such as being hit in the head. A stroke occurs when a clot blocks a vessel in the brain, which prevents blood supply to any areas of the brain supplied by that vessel. A hemorrhage, on the other hand, is when a vessel ruptures. Oddly enough, blood is poisonous to the brain, so if any parts of the brain are exposed to blood during a hemorrhage, those parts of the brain will be damaged.
Certain parts of the brain are responsible for language. There are two main areas: Broca’s Area and Wernicke’s Area. Generally speaking, Broca’s Area is in charge of speech, while Wernicke’s Area is in charge of understanding (though Broca’s area assists in some aspects of understanding as well). Broca’s Area is front of your ear, while Wernicke’s Area is behind your ear – they are both in your left hemisphere.
Now how these areas relate to aphasia… If one or both of these areas are injured during a stroke, hemorrhage, or traumatic event, aphasia can result. Aphasia ranges in terms of severity – it can be very mild, almost unnoticeable except to the person with aphasia or their close family members, marked by the occasional difficulty finding a word. It can be also extremely severe, leaving a person unable to speak or understand language; in this case, the person may rely on alternative and augmentative communication systems. Aphasia can occur simultaneously with cognitive issues, which might include difficulty with attention, executive function, memory, or visual processing. It can also occur along with decreased strength and coordination of any of the muscles in the body, such as your limbs or even your muscles responsible for swallowing. In short, one person’s aphasia may be completely different from another’s.
Aphasia therapy should be as individualized as possible, so Speech Pathologists like to get specific about the type of Aphasia a person may have, because it helps us to be specific and targeted in our therapy. We look at four major areas when we do this. First, in order to qualify for an Aphasia diagnosis, a person must have difficulty with “word-finding” or thinking of the word they want. Next we look at fluency – is this person speaking in a few words at a time, or maybe even only one word at a time, or are they speaking with a typical fluidity that you would expect (that does NOT necessarily mean that the right words are coming out). We also look at auditory comprehension – how well can the person understand language. Finally, we look at repetition – can the person repeat a word or sentence after hearing it.
Based on our findings, we can classify specific types of Aphasia, summarized in the table below.
|Transcortical Motor Aphasia||Impaired||Non-fluent||Good||Good|
|Transcortical Sensory Aphasia||Impaired||Fluent||Poor||Good|
So how do we look at these areas? There are several standardized tests that help us to do this, in addition to more informal assessments. Two of the most well-known and widely used standardized tests are the Boston Diagnostic Aphasia Evaluation, created by Dr. Harold Goodglass, and the Western Aphasia Battery, created by Dr. Andrew Kertesz.
Aphasia can affect written language as well. Alexia is a term that refers to difficulty reading, while agraphia refers to difficulty with writing. A person with aphasia may have one or both of these conditions.
Why do all of these classifications matter? By understanding a person’s specific, individual aphasia, SLP’s can determine the best treatment plan for each individual client.