Aphasia is a neurogenic language disorder that is acquired through an injury to the brain. Ischemic stroke, hemorrhagic stroke, primary progressive aphasia, and injury, surgery, infection, or tumor to the brain can all cause aphasia (Owens, Farinella, & Metz, 2015 p.153). It can range from mild to severe where a patient with mild aphasia have similar language to that of a typical elderly person. A patient with severe aphasia has not being able to talk and/or not able to understand language anymore (Owens et al., 2015 p.144-145). Aphasia causes deficits to the person’s spoken language comprehension and expression, written expression, and reading comprehension (Owens et al., 2015 p.144-145). Almost all patients, seventy percent, of aphasia are over six-five and suffered some type of trauma (Owens et al., 2015 p.153). Because there is a variety of conditions that can be labeled as aphasia, the exact prevalence is unknown (Damico, Ball, , Müller, & Mller, 2012, p.318). To decide what the prevalence is, we have decide what we say aphasia is (Damico et al., 2012, p.318). While there is not an exact estimated number for prevalence, “we can infer that the prevalence of aphasia… is probably increasing… in the western world” (Damico et al., 2012, p.320).
Aphasia has two main categories, fluent and non-fluent (Owens et al., 2015 p.148). Fluent is when the patient is able to speech clearly and continuous but have linguistic processing deficits, being unable to comprehend what they hear (Owens et al., 2015 p.148). While they their flow is fine, it is filled with nonsense. It even can sound like a completely different language then what they are trying to say. Non-fluent patients have auditory information deficits, which mean that the patient cannot speak clearly and continuously but are able to comprehend what they hear and somewhat reply to it (Owens et al., 2015 p.151). They tend to speak slowly and only use the main words they need to get their idea across. They are able to follow the conversation and if not able to reply verbally, they can find other ways to communicate, like pictures or gesturing (Owens et al., 2015 p.151). Within the two categories, there are eight different types of disorders. The different disorders describe who severe the conversational speech, auditory comprehension, repetition, and naming are, and also where lesion location is (Owens et al., 2015 p.147-148).
Some of the deficits found with aphasia can be physical, visual, or paresis. Physical impairments include hemiparesis, which is a weakness on one side of the body, hemiplegia, which is paralysis of one side of the body, and hemisensory impairment, which is loss of sensory information. A visual impairment is hemianopsia, blindness of right visual field. Dysphagia, a swallowing difficulty, is a paresis impairment (Owens et al., 2015 p.146). Other deficits found with aphasia are agnosia, which is a deficit in perceiving sensory information and agrammatism, which is an omission of grammatical elements of speech. More deficits include difficulty writing known as agraphia and difficulty reading known as alexia. Anomia is a naming deficit and, jargon is a defect that causes meaningless and irrelevant speech (Owens et al., 2015 p.146-147). Neologism, substituting a novel word consistently, paraphasia, word substitutions that have associations with real words, and verbal stereotype, expression repeated over and over, are another three defects found with aphasia (Owens et al., 2015 p.148).
In the assessment of aphasia, the first step would be to learn about the patient's medical history (Owens et al., 2015 p.157). This can help to find if there are any genetic traces of aphasia in the family (Owens et al., 2015 p.157). An interview with family is also important because we can get a feel how the patient responding to family members and how well they can speak in a comfortable atmosphere with people close to them. Next would be screening the patient to see if there is a need for further assessment. Most speech pathologist prefer informal assessment over formal, standardized testing, often using their own local screening tools (Hersh, Wood, & Armstrong, 2018). If the patient needs more assessment, then next would be the assessments on oral peripheral, hearing testing, bedside evaluation, formal tests, functional assessment of communicative abilities (Hersh, et al., 2018). After all this, the type of aphasia can be determined, and treatment can then be looked into.
Intervention is to aid in recovery and to provide strategies to help with the deficits from the aphasia (Owens et al., 2015 p.148). Goals are made to help encourage the patient with their treatment. The speech-language pathologist is to come up with techniques that best suit the client. This will be a trial and error time until a treatment that works best for the client is found.
Treatment depends on the patient. Different treatment options include, but not limited to Community Support and Integration, Computer-Based Treatment, Constraint-Induced Language Therapy (CILT), and Melodic Intonation Therapy (MIT) (Aphasia: Treatment.) Community Support and Integration is about methods that focus on helping the patient engage in more life activities and give community support for the patient. Computer-Based Treatment is about the use of software programs or computer technology to focus and work on various language skills and modalities. Programs currently available produce data, that can be used in clinical documentation, about the individual’s progress on specific tasks. Constraint-Induced Language Therapy is about an rigorous treatment technique focused on discouraging the use of compensatory communication strategies while increasing the output of spoken language. Melodic Intonation Therapy is about boosting expressive language by using the musical elements of speech (Aphasia: Treatment).
All in all, aphasia is a complex impairment that differs from patient to patient. Aphasia causes deficits to the person’s spoken language comprehension and expression, written expression, and reading comprehension. It can have different severities and different varieties of this impairment. Severities can range from mild to sever. It has two main categories, fluent and non-fluent. Fluent aphasia is when the patient is able to speech clearly and continuous unable to comprehend what they hear. Non-fluent aphasia is when the patient cannot speak clearly and continuously but are able to comprehend what they hear and somewhat reply to it. Within the two categories, there are eight different types of disorders. The different disorders describe how severe the conversational speech, auditory comprehension, repetition, and naming are, and also where lesion location is. Aphasia can affect anyone, and it is our job as speech-language pathologists to help these patients to speak and understand to the best of their abilities.
References
Aphasia: Treatment. (n.d.).
https://www.asha.org/PRPSpecificTopic.aspx?folderid=8589934663§ion=Treatment
Damico, J. S., Ball, M. J., Müller, N., & Mller, N. (Eds.). (2012). The handbook of language and speech disorders. ProQuest Ebook Central, 318-320. https://ebookcentral.proquest.com/lib/oks-ebooks/reader.action?docID=792626&query=
Hersh, D., Wood, P., & Armstrong, E. (2018). Informal aphasia assessment, interaction and the development of the therapeutic relationship in the early period after stroke. Aphasiology, 32(8), 876–901. https://doi.org/10.1080/02687038.2017.1381878
Owens, R. E. Kimberly A. Farinella, Dale Evan Metz. (2015). Introduction to Communication Disorders: A lifespan evidence-based perspective (5th edition). Pearson. (143-163.)