Eng. 511 A paper presented to: Prof. Mohammad Kebbe.. By: Nasreen Al-Twairesh.. 425221301.. 1st term.. 1426..

Lipsing

"Aphasia": definition & causes..

Twairesh, N.

Aphasia (from Greek , privative, and , speech) is a term which means literally inability to speak, and is used to denote various defects in the comprehension and expression of both spoken and written language which result from lesions of the brain (Wikipedia). In other words, aphasia is a communication condition that results from damage to the language areas of the brain; a disorder which limits the comprehension and expression of language. It is an acquired impairment due to brain injury in the left cerebral hemisphere. Aphasia is defined by Webster's Dictionary as a "loss or impairment of the power to use or comprehend words usually resulting from brain damage." The most common cause of aphasia is a stroke or brain attack which occurs when the blood supply to the brain is interrupted. Other causes are brain tumors, head injury, or other neuralgic illnesses. Anyone can acquire aphasia, but most people who have aphasia are in their middle to late years. Men and women are equally affected. Primary signs of the disorder include difficulty in expressing oneself when speaking, difficulty with reading and writing and trouble understanding speech. Aphasia is not a disease, but a symptom of brain damage.

Types of aphasia:
There are many symptoms that indicate aphasia. These include: inability to comprehend speech, inability to write (agraphia), inability to read (alexia), inability to form words, inability to name objects (anomia), poor enunciation, excessive creation and use of personal neologisms (jargon aphasia), inability to repeat a phrase, persistent repetition of phrases, inability to speak -without muscle paralysis- and other language impairment. Twairesh, N. 2

There are many different systems for classifying aphasia and many different types of aphasia within each system. Some systems are mainly based on the location of the lesion. Others are based on the person's behavior. The common types of aphasia are: 1. Broca's aphasia (expressive aphasia): This type is also known as non-fluent aphasia. People with this type of aphasia have difficulty communicating with others orally and and in written. Broca's aphasia is called expressive aphasia because the aphasic knows what he wants to say but is not able to say or express it with words.People with this type of aphasia often have trouble performing the motor or output aspects of speech. Thus, it is also known as "motor" aphasia. People with Broca's aphasia have damage to the frontal lobe of the brain. These aphasics frequently speak in short, meaningful phrases that are produced with great effort and they often omit small words such as "is," "and," and "the". They often have right-sided weakness due to the fact that the frontal lobe is also important for the movement of the body. Patients with this type of aphasia frequently experience depression since they typically have great awareness of their deficits. Neighborhood signs include buccofacial (but not limb) apraxia and right hemiparesis involving the face and arm more than the leg. (eMedicine)

2. Wernicke's aphasia (receptive aphasia)

Twairesh, N.

This type involves difficulty understanding spoken or written language. The aphasic can hear the voice or see the print but is not able to make sense of the words. Patients with Wernicke's aphasia have impaired repetition but have more fluent speech than patients with Broca's aphasia. Despite the fluency, speech is full of emptiness and gibberish jargon speech. Comprehension is impaired. Grammar is better preserved than in Broca's aphasia. Wernicke's aphasia is caused by damage to the temporal lobe. Such aphasics usually have no body weakness because their brain injury is not near the parts of the brain that control movement. In Wernicke's aphasia, neighborhood signs include a superior quadrantanopsia due to involvement of optic radiations; limb apraxia due to involvement of the inferior parietal lobule; finger agnosia, acalculia, or alexia with agraphia; and components of the so-called Gerstmann syndrome due to involvement of the angular gyrus. (eMedicine) 3. Nominal aphasia (anomic aphasia) This form of aphasia may be the result of a recovered aphasia of another aphasia type. However, true anomic aphasia is its own aphasia type. The cause of this type could be lesions in multiple brain areas, including a lesion in the dorsolateral frontal cortex, posterior temporo-occipital cortex, or thalamus. A left anterior temporal lesion also can cause anomic.This type is considered the least severe form of aphasia. People suffering from this type have difficulty in finding and using the correct names for certain people, objects, places or events. 4. Global aphasia

Twairesh, N.

This type results from extensive and severe damage to the language areas of the brain. The aphasic suffers from almost total loss of verbal or written language ability. He cannot speak or understand speech, nor can he read or write. Many patients with global aphasia are quite proficient at making their needs understood without producing spoken or written speech. Some of the ways in which patients with global aphasia may communicate successfully include prosody, inflection, pointing, and expressions of approval or disapproval. Recovery in the first 6 months generally outpaces later recovery; however, some patients can recover function years after the initial injury. 5. Conduction aphasia Conduit d'approche refers to an attempt to correct errors. This type is also called associative aphasia. It is a relatively rare form of aphasia and results from damage to the nerve fibres in the arcuate fasciculus, which connects Wernicke's and Broca's areas. In this type, aphasics' language output is fluent but naming and repetition are impaired. Patients with conduction aphasia may have a remarkable written comprehension; cases of patients with conduction aphasia who read novels have been reported. Hesitations and word-finding pauses are frequent in such aphasics. The parts of the brain affected in conduction aphasia are the supramarginal gyrus and the angular gyrus. Neighborhood signs include superior quadrantanopsia; if the lesion undercuts the parietal lobe, limb apraxia, which is typically more disabling and less often diagnosed than the aphasia itself, may be present. These neighborhood deficits closely resemble those seen in Wernicke aphasia. Such neighborhood signs are not invariable. (eMedicine) Twairesh, N. 5

A few less common types include: 1. Transcortical aphasias: Transcortical motor aphasia This type results from an injury to the anterior superior frontal lobe. People suffering from this type of aphasia usually have good comprehension yet they experience effortful and halting "non-fluent" speech as a result of damage to the frontal lobe. The speech of such aphasics is usually one or two words long. This type is caused by anterior cerebral artery stroke and has associated leg weakness. Transcortical sensory aphasia Patients can produce fluent speech but do not understand fully, cannot name, or lose semantic associations of speech. This kind of aphasia is a result of damage to a region known as the Temporal-occipital-parietal junction, located behind Wernicke's area. This type is empty speech with short circumlocutory phrases predominating. It is typically seen in advancing Alzheimer disease and other progressive dementias. Mixed transcortical aphasia: Aphasics can repeat what is said but can neither produce speech nor understand it. This type is also called isolation of the speech area. 2. Subcortical aphasias: Subcortical motor aphasia Subcortical sensory aphasia 3. Acquired eleptiform aphasia (Landau Kleffner Syndrome)

Twairesh, N.

This is a rare type of aphasia. The symptoms begin in childhood and progress. The syndrome is treatable, although in some cases the seizures are controlled more than the aphasia.

Aphasia Aphasia, unable to repeat sentence

Type Expressive (Broca) Receptive (Wernicke) Conduction Global Speech Nonfluent Fluent Fluent Nonfluent Comprehension good poor good poor Localization Lower posterior frontal Posterior superior temporal Usually parietal operculum Large perisylvian lesion

Aphasia, able to repeat sentence well

Type Speech Comprehension Localization Anterior to Broca's area or supplementary speech area Surrounding Wernicke's area posteriorly both of the above Angular gyrus or second temporal gyrus

Tanscortical motor

Nonfluent

good

Transcortical sensory Transcortical mixed Anomic

Fluent

poor

Nonfluent

poor

Fluent

good

Source: http://neuroland.com/sands/aphasia.htm

How is aphasia treated?

Twairesh, N.

The kind of treatment the patient undergoes is determined by the physician based on a number of factors including: patient's age, overall health, and medical history, extent of the disorder, patient's tolerance for specific medications, procedures, or therapies, expectations for the course of the disorder and patient's opinion or preference. There are some studies that test how drugs can be used along with speech therapy to improve recovery of various language functions. Computers are used in other approaches to improve the language abilities of aphasics. Computer-assisted therapy can help people with aphasia retrieve and produce verbs. Among the factors that affect the degree of improvement are the cause of the brain damage, the area of the brain that was damaged, the extent of the .injury, and the person's general health

Where can I get additional information?

American Speech-Language-Hearing Association (ASHA) 10801 Rockville Pike Rockville, MD, 20852 Voice: (301) 897-5700 Toll-free Voice: (800) 638-8255, 8:30 a.m. - 5 p.m., Eastern time TTY: (301) 897-0157 Fax: (301) 571-0457 E-mail: actioncenter@asha.org Internet: www.asha.org Brain Injury Association of America 8201 Greensboro Drive, Suite 611 McLean, VA, 22102 Voice: (703) 761-0750 Toll-free Voice: (800) 444-6443, 9 a.m. - 5 p.m., Eastern time Fax: (703) 761-0755 E-mail: familyhelpline@biausa.org Internet: www.biausa.org

Twairesh, N.

Easter Seals, Inc. 230 West Monroe, Suite 1800 Chicago, IL, 60606 Voice: (312) 726-6200 Toll-free Voice: (800) 221-6827, 8:30 a.m. - 5 p.m., Central time TTY: (312) 726-4258 Fax: (312) 726-1494 E-mail: info@easterseals.com Internet: www.easterseals.com National Aphasia Association (NAA) 29 John Street, Suite 1103 New York, NY, 10038 Toll-free Voice: (800) 922-4622, 9 a.m. - 5 p.m., Eastern time Fax: (212) 267-2812 E-mail: naa@aphasia.org Internet: www.aphasia.org American Academy of Neurology 1080 Montreal Avenue St. Paul, MN 55116 Voice: (651) 695-1940 Internet: www.aan.com American Heart Association 7272 Greenville Avenue Dallas, TX 75231 Voice: (800) 242-8721 Internet: www.americanheart.org National Stroke Association 9707 East Easter Lane Englewood, CO 80112 Toll-free: (800) 787-6537 Internet: www.stroke.org http://66.218.69.11/search/cache?p=aphasia%3A+new+types&sm=Yahoo %21+Search&toggle=1&ei=UTF8&u=www.nidcd.nih.gov/health/voice/aphasia.asp&w=aphasia+new+types&d=TlI3V WFULjpn&icp=1&.intl=us

Sources:

Twairesh, N.

http://serendip.brynmawr.edu/bb/neuro/neuro99/web1/Xiong.html http://www.emedicine.com/NEURO/topic437.htm http://en.wikipedia.org/wiki/Aphasia http://www.ninds.nih.gov/disorders/aphasia/aphasia.htm http://www.sci.uidaho.edu/med532/Broca.htm http://www.umm.edu/ent/aphasia.htm http://seniorhealth.about.com/library/stroke/blaphasia2.htm http://www.wrongdiagnosis.com/a/aphasia/subtypes.htm http://www.aphasia.tv/

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