Aphasia

What is aphasia?

Aphasia is an acquired language disorder caused by a stroke or a head injury, whereby the established language function is disrupted due to the damage to the affected area in the brain.

What are the different communication problems that are caused by aphasia?

There are different types of aphasia:

Receptive aphasia is difficulty understanding spoken language and read material (alexia). In some cases people with receptive aphasia can have deficits in word or sentence comprehension. They may understand short and simple sentences but have more difficulty understanding longer and more complex sentences. This difficulty may also be present when reading, they may not recognize printed words, their reading may be slow and not fluent, they may read sentences one word at a time, they may also omit or substitute words.

Expressive aphasia is difficulty in spoken and written language (agraphia). Individuals with expressive aphasia may experience difficulty in finding words to express themselves; their speech may not be fluent as a result of their word finding deficits. In some cases, they may be able to make short sentences, but when trying to make longer sentences, they may leave out words, or they may not be able to complete sentences. In some cases there may be deficits in writing; these difficulties may be due to the paresis or paralysis of the preferred hand. There can be poor letter formation, confused or substituted letters, as well as nonsensical syllables. Among other symptoms, sentence structures can be inadequate and their syntax (e.g., word order) can be confused. Expressive aphasia can also be accompanied by apraxia and dysarthia, which are other speech problems caused by an injury to the brain.

Individuals suffering from a stroke or a brain injury can also have motor problems; they can have weakness or paralysis, or experience numbness on one side of the body depending, which area of the brain is affected. They can have personality changes, their vision may be impaired; they may experience memory and problem-solving difficulties, as well as problems with swallowing.

Global aphasia is when an individual has difficulty with both receptive and expressive language. It is common for persons with aphasia to have both their expressive and receptive language compromised.

Can a person with aphasia be treated?

A speech language pathologist is a professional trained to evaluate and treat persons with aphasia. To take full advantage of the spontaneous recovery that may occur in the first few days and up to six months after the onset of the stroke or injury, it is imperative to begin speech and language services as soon as the patient is medically stable. Additionally, the speech language pathologist works with the patient and his/her family, they support and counsel them, and in the event that the patient does not regain all his former skills, they teach the families strategies to help them cope and communicate with the patient.

What is Traumatic Brain Injury?

There are two types of Traumatic Brain Injury (TBI), a "closed head injury" (CHI)and an "open head injury" (OHI). Traumatic Brain Injury is caused by a severe trauma to the head; for example it can be from a motor vehicle accident, a blow to the head, or a fall.

A "closed head injury" is the trauma to the brain resulting from a rapid acceleration and deceleration "whip lash" of the head causing the brain to violently shift in the skull, thus damaging the nerve fibers that send out messages to the rest of the body.

An "open head injury" (OHI) is an externally visible head injury that is localized; the damage is limited to the area of the brain that sustained the injury.

Brain injury can also result from a cardiac arrest (heart attack), a stroke, drowning or any accident that deprives the brain of its oxygen supply for a period of time (anoxia). In the event that oxygen is cut, all the brain cells may be affected which can result in changes of behavior in the individual.

What are the symptoms of a Traumatic Brain Injury?

The extent of the damage caused by TBA depends on several factors; it can depend on the size of area of the brain that is affected as well as upon the location of the injury. Cognitive, Psycho-Social, and Physical impairments are common in a TBI.

The symptoms of Cognitive Impairments are: short term and/or long term memory, lack of concentration, markedly slowed thinking processes, speech and language problems, shortened attention, difficulties with perception, and problems with writing and reading, impaired judgment, and/or problems with planning and sequencing.

The symptoms of Psycho-Social impairments and Behavioral and Emotional Impairments, include fatigue, denial, self-centeredness, mood swings, depression, low self-esteem, inability to cope, lack of motivation, restlessness, difficulty relating to others etc.

Physical Impairments can affect speech and language, physical mobility, vision, hearing as well as other sensory impairments. The patient may also experience headaches, lack of coordination, spasticity of the muscles, paralysis of the limbs and seizures.

What can be done?

It is imperative that rehabilitation begins as soon as the patient is stabilized medically. Early intervention by professionals in rehabilitation such as physiotherapists, occupational therapists, speech language pathologists increases the chances of recovery; depending on the severity of the injury, these professionals will help each patient reach his/her maximum potential.

Head Injury in Children

A severe TBI as a result of a serious accident will result in the same impairments in children as in adults. However, children may have a mild brain injury caused by a fall or after accidentally knocking his/her head. If your child experiences symptoms that will not go away, then you must urgently seek medical advice.

Below is a list of symptoms that need immediate medical attention:

Ø Severe headaches that do not subside, even after taking an analgesic

Ø Seizures (eyes fluttering, body stiffening, staring into space)

Ø Child forgets everything, amnesia

Ø Weakened or shaking muscles

Ø Nausea or vomiting

If you need to see your pediatrician, ask him to refer you to a pediatric neurologist for a specialist consultation.

Apraxia

A motor speech disorder or apraxia, is when a person's speech is affected by the brain's inability to move the parts of the body involved in producing speech such as the lips, the jaw and the tongue. A person with apraxia has a problem initiating speech, producing sounds and producing syllables or words in a consistent manner.

Dysarthia

Dysarthia is another motor speech disorder caused by a weakness or paralysis in the muscles of the body parts which produce speech due to a stroke, Parkinson's disease, multiple sclerosis, or cerebral palsy. A person with dysarthia may have several problems; he/she may have difficulty producing speech sounds, speaking fluently, and /or may have a voice problem.

(For more information you can visit American Speech-Language-Hearing Association (ASHA)).

 Ø      Speech and Language Diagnostic and Treatment Services at JISH