Short Description or Definition
Aphasia, from the Greek term “aphatos” meaning “without language,” is a disorder caused by damage to the language areas of the brain. Depending on the type and severity of the damage, deficits may be noted in language comprehension and/or production and can include both the spoken and written modalities. Aphasia most commonly occurs secondary to stroke in which brain cells are deprived of oxygen, resulting in tissue death, but it can also be the result of degenerative disorders or traumatic brain injury. Aphasia can co-occur with other conditions including apraxia and dysarthria which are neurologically based motor disorders that can affect speech output.
Historically, aphasia has been classified according to the region of the brain that is affected and the symptoms that are displayed. For example, damage to what is considered “Broca’s area,” the region anterior to the Rolandic fissure, often results in a nonfluent form of aphasia in which comprehension is intact, but articulation and speech output, including syntax, is impaired. A disorder in which syntax and language output are preserved, while comprehension is impaired, is often referred to as Wernicke’s aphasia, due to the frequent damage that is observed in Wernicke’s area within the temporal lobe of the brain. However, as research continues to indicate that there is not necessarily a one-to-one correspondence between region in which brain damage is displayed and the type of symptoms that are experienced, other classification systems have developed.
More recently, types of aphasia have been divided into two categories: fluent and nonfluent aphasias. Fluent aphasias include Wernicke’s aphasia (above) and are characterized by individuals speaking in long sentences that often contain unnecessary words and are devoid of meaning. Comprehension in Wernicke’s aphasia is often impaired as well.
Nonfluent aphasias include Broca’s aphasia (above). In addition, global aphasia is another nonfluent aphasia that is characterized by extensive brain damage and severe communication deficits in both receptive and expressive language.
The incidence of aphasia is largely unknown, given that it occurs in many types of disorders including cerebrovascular, traumatic, and degenerative disorders. In general, it is estimated that about one million individuals in the USA demonstrate aphasia with approximately 80,000 individuals acquiring this disorder every year (ASHA 2008).
Natural History, Prognostic Factors, and Outcomes
Outcomes for patients with aphasia vary greatly depending on the type and location of brain damage and level of severity of the disorder. Recovery is often more favorable for younger individuals or individuals with less extensive brain damage. In addition, language comprehension skills are often recovered more completely than language production skills. Factors including age of onset, health, education level, and how soon treatment takes place after brain damage have been shown to be predictive of recovery in aphasia.
Clinical Expression and Pathophysiology
Aphasia typically manifests itself as a difficulty in language comprehension, production, or both depending on the type and severity of the condition. Aphasia most commonly occurs secondary to stroke, but it can also be the result of degenerative disorders or traumatic brain injury.
Evaluation and Differential Diagnosis
Aphasia is typically initially diagnosed by a neurologist or other physician who is responsible for the treatment of the patient’s physical and neurological symptoms utilizing case history and observation. Further evaluation by a licensed speech-language pathologist often follows. Evaluation includes the use of language in both comprehension and production contexts, including reading and writing. Evaluations typically include taking a comprehensive case history, observation of the patient in daily contexts, and formal evaluations of language skills, including naming of objects. Standardized evaluation tools that often are used include the Boston Diagnostic Aphasia Examination (Goodglass et al. 2000), the Boston Naming Test (Kaplan et al. 1983), and the Western Aphasia Battery (Kertesz 2006). Once the individual’s profile of language strengths and needs is determined, treatment is initiated.
Treatment for aphasia is often multifaceted and is typically individualized based on the patient’s profile of strengths and needs. Individuals with aphasia often enroll in formal speech-language therapy to address functional communication in a variety of settings in which they are expected to communicate. Therapy goals are focused on maximizing the individual’s ability to communicate effectively with peers and family members, given residual strengths. In addition, computer-assisted treatments are beginning to show promise as supports for individuals with aphasia.
Simplify language by using short, uncomplicated sentences.
Repeat the content words or write down keywords to clarify meaning as needed.
Maintain a natural conversational manner appropriate for an adult.
Minimize distractions, such as a loud radio or TV, 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 person’s speech.
Allow the person plenty of time to talk.
Help the person become involved outside the home. Seek out support groups such as stroke clubs.
References and Readings
- American Speech-Language-Hearing Association (ASHA). (2008). Incidence and prevalence of speech, voice, and language disorders in adults in the United States. Retrieved May 1, 2011 from www.asha.org/research/reports/speech_voice_language.htm.
- Barresi, B., Goodglass, H., & Kaplan, E. (2001). The assessment of aphasia and related disorders. Hagerstown: Lippincott, Williams & Wilkins.Google Scholar
- Chapey, R. (2008). Language intervention strategies in aphasia and related neurogenic communication disorders. Philadelphia: Wolters Kluwer/Lippincott, Williams & Wilkins.Google Scholar
- Goodglass, H., Kaplan, E., & Barresi, B. (2000). Boston diagnostic aphasia examination (BDAE-3) (3rd ed.). Austin: Pro-Ed.Google Scholar
- Kaplan, E., Goodglass, H., & Weintraub, S. (1983). The Boston naming test. Philadelphia: Lea and Febiger.Google Scholar
- Kent, R. D. (1994). Reference manual for communicative sciences and disorders: Speech and language. Austin: Pro-Ed.Google Scholar
- Kertesz, A. (2006). Western aphasia battery-revised (WAB-R). Austin: Pro-Ed.Google Scholar
- Lapointe, L. L. (2004). Aphasia and related neurogenic language disorders. New York: Thieme Medical Publishers.Google Scholar
- National Institute on Deafness and Other Communication Disorders (NIDCD). (2011). Aphasia. Retrieved May 1, 2011 from http://www.nidcd.nih.gov/health/voice/aphasia.htm.