Aphasia

Aphasia

Definition  :

Aphasia is a condition that robs you of the ability to communicate. Aphasia can affect your ability to express and understand language, both verbal and written.
Aphasia typically occurs suddenly after a stroke or a head injury. But it can also come on gradually from a slowly growing brain tumor or a degenerative disease. The amount of disability depends on the location and the severity of the brain damage.

Once the underlying cause has been treated, the primary treatment for aphasia is speech therapy that focuses on relearning and practicing language skills and using alternative or supplementary communication methods. Family members often participate in the therapy process and function as communication partners of the person with aphasia.

Symptoms:

Aphasia is a sign of some other condition, such as a stroke or a brain tumor.
A person with aphasia may:

• Speak in short or incomplete sentences
• Speak in sentences that don't make sense
• Speak unrecognizable words
• Not comprehend other people's conversation
• Interpret figurative language literally
• Write sentences that don't make sense

The severity and scope of the problems depend on the extent of damage and the area of the brain affected. Some people may comprehend what others say relatively well but struggle to find words to speak. Other people may be able to understand what they read but yet can't speak so that others can understand them.

Types of aphasia
Your doctor may refer to aphasia as nonfluent, fluent or global:

• Nonfluent aphasia. Damage to the language network near the left frontal area of the brain usually results in Broca aphasia, which is also called nonfluent aphasia. People with this disorder struggle to get words out, speak in very short sentences and leave out words. A person might say "Want food" or "Walk park today." Although the sentences aren't complete, a listener can usually understand the meaning. A person with Broca aphasia may comprehend what other people say to some degree. People with this type of aphasia are often aware of their own difficulty in communicating and may get frustrated with these limitations. Additionally, people with Broca aphasia may also have right-sided paralysis or weakness.
  
• Fluent aphasia. Wernicke aphasia is the result of damage to the language network in the middle left side of the brain. It's often called fluent aphasia. People with this form of aphasia may speak fluently in long, complex sentences that don't make sense or include unrecognizable, incorrect or unnecessary words. They usually don't comprehend spoken language well and often don't realize that others can't understand what they're saying.
  
• Global aphasia. Global aphasia results from extensive damage to the brain's language networks. People with global aphasia have severe disabilities with expression and comprehension.

When to see a doctor
Because aphasia is often a sign of a serious problem, such as a stroke, seek emergency medical care if you suddenly develop:

• Difficulty speaking
• Trouble comprehending speech
• Difficulty with word recall
• Problems with reading or writing

Causes:

The most common cause of aphasia is brain damage resulting from a stroke — the blockage or rupture of a blood vessel in the brain. This disruption of the blood supply leads to brain cell death or damage in areas of the brain controlling language. Brain damage caused by a severe head injury, a tumor, an infection or a degenerative process also can cause aphasia. In these cases, the aphasia usually occurs with other types of cognitive problems, such as memory problems or confusion.

Primary progressive aphasia is the term used for language difficulty that develops gradually. This is due to the gradual degeneration of brain cells located in the language networks. Sometimes this type of aphasia will progress to a more generalized dementia.

Sometimes temporary episodes of aphasia can occur. These can be due to migraines, seizures or a transient ischemic attack (TIA). A TIA occurs when blood flow is temporarily blocked to an area of the brain. People who've had a TIA are at an increased risk of having a stroke in the near future.

Complications:

Aphasia can create numerous quality-of-life problems because communication is so much a part of your life. Communication difficulty may affect your:

• Job
• Relationships
• Day-to-day function

Language barriers may lead to embarrassment, depression and relationship problems.


Treatments and drugs:

If the brain damage is mild, a person may recover language skills without treatment. However, most people undergo speech and language therapy to rehabilitate their language skills and supplement their communication experiences. Researchers are currently investigating the use of medications, alone or in combination with speech therapy, to help people with aphasia.

Speech and language rehabilitation
Recovery of language skills is usually a relatively slow process. Although most people make significant progress, few people regain full pre-injury communication levels. In aphasia, speech and language therapy:

• Starts early. Therapy is most effective when it begins soon after the brain injury.
  
• Builds on success. The speech-language pathologist uses exercises to improve and practice communication skills. These may begin with simpler tasks such as naming objects and evolve into more complex exercises of explaining the purpose of an object.
  
• Shifts focus. The speech-language pathologist might teach the person ways to compensate for the language impairment and to communicate more effectively with gestures or drawings. Some people with aphasia may use a book or board with pictures and words to help them recall commonly used words or help them when they're stuck.
  
• Often works in groups. In a group setting, people with aphasia can try out their communication skills in a safe environment. Participants can practice initiating conversations, speaking in turn, clarifying misunderstandings and fixing conversations that have completely broken down.
  
• May include outings. Participating in real-life situations — such as going to a restaurant or a grocery store — puts rehabilitation efforts into practice.
  
• May include use of computers. Using computer-assisted therapy can be especially helpful for relearning verbs and word sounds (phonemes).

Medications
Certain drugs are currently being studied for the treatment of aphasia. These include drugs that may improve blood flow to the brain, enhance the brain's recovery ability or help replace depleted chemicals in the brain (neurotransmitters). Several medications, such as memantine (Namenda) and piracetam, have shown promise in small studies. But more research is needed before these treatments can be recommended.