What is Aphasia?

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Aphasia often arises as a result of damage to Broca's area or Wernicke's area.

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.

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.
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.

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.

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.

Symptoms of Broca’s aphasia include:

  poor or absent grammar
 difficulty forming complete sentences
 omitting certain words, such as “the,” “an,” “and,” and “is” (a person with
Broca’s aphasia may say something like “Cup, me” instead of “I want
the cup”)
 more difficulty using verbs than nouns correctly
 difficulty articulating sounds and words
 difficulty repeating what has been said by others
 trouble with writing sentences
 difficulty reading
 problems with full comprehension
 difficulty following directions
 frustration

Other tips for communication include:

 Keep your sentences simple and short, but don’t speak to them as if
they’re a child.
 Remember that their interests have not changed, only their ability to talk
about them.
 Ask lots of yes and no questions, or questions that require very simple
answers.
 Use gestures or props to get your point across.
 Fold in simple interactions, such as sitting quietly in nature, where you
can enjoy each other’s presence without speaking too much.

Age: 47

Time Since Stroke: 14 years

Ginger was a friendly and hard-working young woman who had a stroke in her early 30's. She had a
severe non-fluent aphasia, a young daughter and a family business. She became significantly more shy
and embarrassed about her speech, losing her husband and her social hobbies. After years of therapy,
she was still embarrassed by her speech, but decided to keep working to make it better.

Problems:

Runs her own business and has to have employees call vendors for her

Cannot write checks

Cannot read or write emails

Needed help to use her Ipad and computer

Could not write or understand numbers

Assessment: While she spoke in 3-4 word sentences, the listener had to do most of the work to
understand. For example, "Babies, um, me, um, babies born me do" would mean "I help the babies
being born". She had little to no usable writing except for her name. She could read some single words
but always said that she couldn't read at all. Ginger came to the program wanting to learn to read
better, to write checks, to write and understand numbers, and to read and write emails. Her
comprehension was good except for complex commands. Moderate Broca's aphasia with apraxia.

Treatment: 8 weeks part-time. She began the program for 4 weeks, then decided that since she was
making so much progress she wanted to continue for another 4 weeks.

She learned to use strategies to help her read and write emails. She learned how to write checks and
practiced writing important words. She practiced making phone calls and roleplaying business
interactions. She also worked on a better sentence structure for speaking so people could more easily
communicate with her.

Results: Ginger and her family were thrilled that she could call vendors and employees as well as write
checks and read invoices. One vendor even commented on how well and how quickly she wrote his
check. She learned how to add drawing and writing to her communication. She could read sentences
and her email online. While she was nervous at first, she quickly learned that she could be successful
with all types of communication.

https://theaphasiacenter.com/aphasia-case-studies/