Aphasia: Difference between revisions

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However, the latter are far less common and so not as often mentioned when discussing aphasia.<ref name="ASHA Aphasia">{{cite web |url=http://www.asha.org/public/speech/disorders/Aphasia/ |title=American Speech-Language-Hearing Association (ASHA):- Aphasia |format= |work=asha.org |access-date=}}</ref> To be diagnosed with aphasia, a person's speech or language must be significantly impaired in one (or more) of the four aspects of communication following acquired brain injury, or have significant decline over a short time period (progressive aphasia). The four aspects of communication are auditory comprehension, verbal expression, reading and writing, and functional communication.
 
The difficulties of people with aphasia can range from occasional trouble finding words, to losing the ability to speak, read, or write; intelligence, however, is unaffected.<ref name="ASHA Aphasia"/> Expressive language and receptive language can both be affected as well. Aphasia also affects [[visual language]] such as [[sign language]].<ref name="Damasio 1992" /> In contrast, the use of [[formulaic language|formulaic expressions]] in everyday communication is often preserved.<ref name = "Sidtis 2015">{{cite journal | vauthors = Stahl B, Van Lancker Sidtis D | title = Tapping into neural resources of communication: formulaic language in aphasia therapy | journal = Frontiers in Psychology | volume = 6 | issue = 1526 | pages = 1526 | year = 2015 | pmid = 26539131 | pmc = 4611089 | doi = 10.3389/fpsyg.2015.01526 }}</ref> For example, while a person with aphasia, particularly [[expressive aphasia|Broca's aphasia]], may not be able to ask a loved one when their birthday is, they may still be able to sing "Happy Birthday". One prevalent deficit in the aphasias is [[Anomic aphasia|anomia]], which is a difficulty in finding the correct word.<ref name=Manasco>{{cite book|last1=Manasco|first1=M. Hunter | name-list-style = vanc |title=Introduction to Neurogenic Communication Disorders|date=2014|publisher=Jones & Bartlett Learning |isbn=978-1-4496-5244-9 |page=72 |url=https://books.google.com/books?id=tSRjCwAAQBAJ|location=Burlington, MA}}</ref>{{rp|72}}
 
With aphasia, one or more modes of communication in the brain have been damaged and are therefore functioning incorrectly. Aphasia is not caused by damage to the brain that results in motor or sensory deficits, which produces [[dysarthria|abnormal speech]]; that is, aphasia is not related to the mechanics of [[speech]] but rather the individual's language cognition (although a person can have both problems, particularly if they suffered a hemorrhage that damaged a large area of the brain). An individual's "language" is the socially shared set of rules, as well as the thought processes that go behind verbalized speech. It is not a result of a more peripheral motor or sensory difficulty, such as [[paralysis]] affecting the speech muscles or a general hearing impairment.
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* Struggle in non-fluent aphasias: A severe increase in expelled effort to speak after a life where talking and communicating was an ability that came so easily can cause visible frustration.
* Preserved and automatic language: A behavior in which some language or language sequences that were used so frequently, prior to onset, they still possess the ability to produce them with more ease than other language post onset.
* Poor eyesight (Oral Dysmorphia) usually characterized by tingling in the arms and legs, and sometimes heart disorders.<ref name=Manasco/>{{cite bookrp|last1=Manasco|first1=M. Hunter|title=Introduction to Neurogenic Communication Disorders|date=2014|publisher=Jones & Bartlett Learning|location=Burlington, MA|pages=75–76}}</ref>
 
====Subcortical====
* Subcortical aphasias characteristics and symptoms depend upon the site and size of subcortical lesion. Possible sites of lesions include the [[thalamus]], internal capsule, and basal ganglia.
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However, no such broad-based grouping has proven fully adequate. There is wide variation among people even within the same broad grouping, and aphasias can be highly selective. For instance, people with naming deficits (anomic aphasia) might show an inability only for naming buildings, or people, or colors.<ref>{{cite book |author1=Kolb, Bryan |author2=Whishaw, Ian Q. |title=Fundamentals of human neuropsychology |publisher=Worth |location=[New York] |year=2003 |pages= 502, 505, 511|isbn=978-0-7167-5300-1 |oclc=464808209 }}</ref>
 
It is important to note that there are typical difficulties with speech and language that come with normal aging as well. As we age, language can become more difficult to process resulting in a slowing of verbal comprehension, reading abilities and more likely word finding difficulties. With each of these though, unlike some aphasias, functionality within daily life remains intact.<ref name=Manasco/>{{cite bookrp|last1=Manasco|first1=M. Hunter|title=Introduction to Neurogenic Communication Disorders|publisher=Jones and Bartlett Learning|pages=7}}</ref>
 
=== Boston classification ===
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*Individuals with Wernicke's' aphasia, also referred to as receptive or fluent aphasia, may speak in long sentences that have no meaning, add unnecessary words, and even create new "words" ([[neologism]]s). For example, someone with receptive aphasia may say, "delicious taco", meaning "The dog needs to go out so I will take him for a walk". They have poor auditory and reading comprehension, and fluent, but nonsensical, oral and written expression. Individuals with receptive aphasia usually have great difficulty understanding the speech of both themselves and others and are, therefore, often unaware of their mistakes. Receptive language deficits usually arise from lesions in the posterior portion of the left hemisphere at or near Wernicke's area.<ref> name=Manasco, M. H. (2014). Introduction to Neurogenic Communication Disorders. Burlington, MA: Jones & Bartlett Learning.</ref><ref>{{cite journal | vauthors = DeWitt I, Rauschecker JP | title = Wernicke's area revisited: parallel streams and word processing | journal = Brain and Language | volume = 127 | issue = 2 | pages = 181–91 | date = November 2013 | pmid = 24404576 | pmc = 4098851 | doi = 10.1016/j.bandl.2013.09.014 }}</ref><ref name=Manasco/>{{cite bookrp|title=Introduction to Neurogenic Communication Disorders|last1=Manasco|first1=Hunter|date=2014|publisher=Jones & Bartlett Learning|pages=71}}</ref> It is often the result of trauma to the temporal region of the brain, specifically damage to Wernicke's area.<ref>{{Cite news|url=https://www.nidcd.nih.gov/health/aphasia|title=Aphasia|date=2015-08-18|work=NIDCD|access-date=2017-05-02|language=en}}</ref> Trauma can be the result from an array of problems, however it is most commonly seen as a result of stroke<ref name=":0">{{Cite web|url=http://www.asha.org/Practice-Portal/Clinical-Topics/Aphasia/Common-Classifications-of-Aphasia/|title=Common Classifications of Aphasia|website=www.asha.org|language=en|access-date=2017-05-02}}</ref>
*Individuals with Broca's aphasia frequently speak short, meaningful phrases that are produced with great effort. It is thus characterized as a nonfluent aphasia. Affected people often omit small words such as "is", "and", and "the". For example, a person with expressive aphasia may say, "walk dog", which could mean "I will take the dog for a walk", "you take the dog for a walk" or even "the dog walked out of the yard". Individuals with expressive 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.<ref name="Brookshire 2007">{{cite journal |author=Brookshire R |title=Introduction to neurogenic communication disorders (7th edition). St. Louis, MO: Mosby}}</ref> While Broca's aphasia may appear to be solely an issue with language production, evidence suggests that Broca's aphasia may be rooted in an inability to process syntactical information.<ref>{{cite journal | author = Embick D, Marantz A, Miyashita Y, O'Neil W, Sakai KL | year = 2000 | title = A syntactic specialization for Broca's area | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 97 | issue = 11| pages = 6150–4 | doi = 10.1073/pnas.100098897 | pmid = 10811887 | pmc = 18573 }}</ref> Individuals with Broca's aphasia may have a speech automatism (also called recurring or recurrent utterance. These speech automatisms can be repeated lexical speech automatisms; e.g., modalisations ('I can't..., I can't...'), expletives/swearwords, numbers ('one two, one two') or non-lexical utterances made up of repeated, legal but meaningless, consonant-vowel syllables (e.g.., /tan tan/, /bi bi/). In severe cases the individual may be able to utter only the same speech automatism each time they attempt speech. (examples taken from [Reference for this addition] {{cite journal | author = Code C | year = 1982 | title = Neurolinguistic analysis of recurrent utterances in aphasia | url = | journal = Cortex | volume = 18 | issue = | pages = 141–152 | doi = 10.1016/s0010-9452(82)80025-7 | pmid = 6197231 | s2cid = 4487128 }}.)
*Individuals with anomic aphasia have difficulty with naming. People with this aphasia may have difficulties naming certain words, linked by their grammatical type (e.g., difficulty naming verbs and not nouns) or by their [[semantic]] category (e.g., difficulty naming words relating to photography but nothing else) or a more general naming difficulty. People tend to produce grammatic, yet empty, speech. Auditory comprehension tends to be preserved.{{citation needed|date=August 2012}} Anomic aphasia is the aphasial presentation of tumors in the language zone; it is the aphasial presentation of Alzheimer's disease.<ref>{{cite book|title=Aphasia| vauthors = Alexander MP, Hillis AE |journal=Handbook of Clinical Neurology|year=2008|<!--access-date = 2013-06-09 | -->isbn=9780444518972|editor=Georg Goldenberg |editor2=Bruce L Miller |editor3=Michael J Aminoff |editor4=Francois Boller |editor5=D F Swaab|edition=1|volume=88|pages=287–310|doi=10.1016/S0072-9752(07)88014-6|pmid=18631697|oclc=733092630}}</ref> Anomic aphasia is the mildest form of aphasia, indicating a likely possibility for better recovery.<ref name="Squire 2009">{{cite journal |author1=Squire LR |author2=Dronkers NF |author3=Baldo JV |title=Encyclopedia of neuroscience |year=2009 }}</ref>{{page needed|date=November 2017}}
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Most acute cases of aphasia recover some or most skills by working with a speech-language pathologist. Recovery and improvement can continue for years after the stroke. After the onset of Aphasia, there is approximately a six-month period of spontaneous recovery; during this time, the brain is attempting to recover and repair the damaged neurons. Improvement varies widely, depending on the aphasia's cause, type, and severity. Recovery also depends on the person's age, health, motivation, [[handedness]], and educational level.<ref name = "medicinenet.com" />
 
There is no one treatment proven to be effective for all types of aphasias. The reason that there is no universal treatment for aphasia is because of the nature of the disorder and the various ways it is presented, as explained in the above sections. Aphasia is rarely exhibited identically, implying that treatment needs to be catered specifically to the individual. Studies have shown that, although there is no consistency on treatment methodology in literature, there is a strong indication that treatment, in general, has positive outcomes.<ref name= "Schmitz O'Sullivan 2007">{{cite book |author1=Schmitz, Thomas J. |author2=O'Sullivan, Susan B. |title=Physical rehabilitation |publisher=F.A. Davis |location=Philadelphia |year=2007 |pages= |isbn=978-0-8036-1247-1 |oclc= 70119705 }}</ref> Therapy for aphasia ranges from increasing functional communication to improving speech accuracy, depending on the person's severity, needs and support of family and friends.<ref>{{cite web|url=http://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934663&section=Treatment|title=Aphasia|work=asha.org}}</ref> Group therapy allows individuals to work on their pragmatic and communication skills with other individuals with aphasia, which are skills that may not often be addressed in individual one-on-one therapy sessions. It can also help increase confidence and social skills in a comfortable setting.<ref name=Manasco/>{{cite bookrp|last1=Manasco|first1=M. Hunter|title=Introduction to Neurogenic Communication Disorders|publisher=Jones & Bartlett Learning|isbn=9781449652449|page=97|date=2013-02-06}}</ref>
 
Evidence does not support the use of transcranial direct current stimulation (tDCS) for improving aphasia after stroke. Moderate quality evidence does indicate naming performance improvements for nouns but not verbs using tDCS<ref>{{Cite journal|last1=Elsner|first1=Bernhard|last2=Kugler|first2=Joachim|last3=Pohl|first3=Marcus|last4=Mehrholz|first4=Jan|date=21 May 2019|title=Transcranial direct current stimulation (tDCS) for improving aphasia in adults with aphasia after stroke|journal=The Cochrane Database of Systematic Reviews|volume=5|pages=CD009760|doi=10.1002/14651858.CD009760.pub4|issn=1469-493X|pmc=6528187|pmid=31111960}}</ref>
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*Functional communication treatment (FCT) - focuses on improving activities specific to functional tasks, social interaction, and self-expression
*Promoting aphasic's communicative effectiveness (PACE) - a means of encouraging normal interaction between people with aphasia and clinicians. In this kind of therapy, the focus is on pragmatic communication rather than treatment itself. People are asked to communicate a given message to their therapists by means of drawing, making hand gestures or even pointing to an object<ref>{{cite book | vauthors = Alexander MT, Hillis AE | title = Neuropsychology and Behavioral Neurology: Handbook of Clinical Neurology | chapter = Aphasia | volume = 88 | veditors = Goldenberg G, Miller BL, Aminoff MJ, Boller F, Swaab DF | publisher = Elsevier Health Sciences | year = 2008 | pages = 287–310 | isbn = 978-0-444-51897-2 | oclc= 733092630}}</ref>
*Melodic intonation therapy (MIT) - aims to use the intact melodic/prosodic processing skills of the right hemisphere to help cue retrieval of words and expressive language<ref name=Manasco/>{{cite book rp| last1 = Manasco | first1 = Hunter | name-list-style = vanc | title = Introduction to Neurogenic Communication Disorders | chapter = The Aphasias | pages = 93 }}</ref>
*Other - i.e. drawing as a way of communicating, trained conversation partners<ref name="Schmitz O'Sullivan 2007"/>