Each year 180,00 new cases are recorded in the United States with a disorder that is not well known to the population in our world (8). 84.5% of the Earth’s population have never heard of this disorder or the term itself (9). This disorder is known as aphasia. Although there are a lot of new cases recorded each year, many people are not familiar with the disorder. The term “aphasia” can be defined as “a communication disorder that affects a person’s ability to process and use language (2).” Aphasia can greatly affect those who have the disorder by limiting the patients’ ability to communicate with others.
This paper discusses several different aspects of aphasia. The topics of aphasia that will be explored in this paper include the origin of aphasia, the symptoms, and the prevalence and incidence of the disorder. To follow up these topics, a variety of treatments will be discussed through past, present, and future treatment options.
History of Aphasia
Researchers recently discovered that aphasia has been around longer than they thought. In the 1800’s an Egyptian papyrus was located and translated by Edwin Smith. The papyrus had medical information from about 4000 years ago. This translated book discusses how there is a patient who is unable to speak. The papyrus states: “If thou examnist a man having a wound in his temple, penetrating to the bone and perforating his temporal bone….if thou ask him concerning his malady and he speak not to thee; while copious tears fall from both his eyes, so that he thrusts his hand often to his face that he may wipe both his eyes with the back of his hand as a child does (10).” Although no one can diagnose this patient with aphasia because of how long ago this case occurred, this patient did show some sign and symptoms of aphasia and could potentially be the first recorded case of this disorder.
The next recorded patient who was known for having aphasia was a man by the name of Monsieur Leborgne, also known as “Tan.” The only word that this patient was able to speak was the word tan. Leborgne was first admitted to a hospital outside of Paris because of his inability to speak. He battled epilepsy his entire life and was slowly deteriorating each day. In 1861, the patient came to the hospital ward where Paul Broca worked where he died soon after arriving there. Broca performed an autopsy on Leborgne where he discovered that there was a lesion on his brain that was “tucked back and behind the eyes.” Around this time, scientists were trying to determine if the certain parts of the brain were responsible for certain functions (4). Broca believed that the region that was damaged controlled the patient’s ability to speak. The area that was damaged soon became known as “Broca’s Area” and that term is still used today (4). This area that was damaged is responsible for speech production (6). We now use the term “Broca’s aphasia” or expressive aphasia for patients who have damage in the left hemisphere in the frontal region (12).
Carl Wernicke was a researcher and a neurologist who also played an important role in the development of aphasia (6!). Upon writing “The Aphasic Syndrome” in 1874, he became known for his research on sensory aphasia, which differs from the aphasia that Paul Broca discovered. Sensory aphasia can be described as defects in, or loss of speech and expression (5). Wernicke had found patients who had the ability to speak but could not understand language (6). When Wernicke was studying the brain, he discovered damage to the temporal lobe on the left side of the brain. This area of the brain is now known as “Wernicke’s area” and is responsible for the comprehension of speech (6). When there is damage to this region, Wernicke’s aphasia or sensory aphasia can occur (12).
Signs and Symptoms of Aphasia
Patients who have aphasia can be faced with a variety of signs and symptoms. Individuals who have this disorder can have difficulties with speaking, comprehension, writing, and reading (7). The symptoms that patients can be faced with can vary depending on the amount of damage and the location of the damage in the brain. Individuals with aphasia often have difficulties with both receptive and expressive language (8).
When patients have impairments with expressing spoken language, there are several common signs and symptoms that may arise. The symptoms and signs could include having to put a lot of effort into speaking, finding words when speaking may be difficult, or being short while speaking or speaking only one word during conversation. Shorter words such as the, of, or was may be omitted while speaking. Words or sounds may also be mixed up while the patient with aphasia is speaking (8). When there is damage in the brain that may cause impairments in the comprehension of spoken language, there are several common signs and symptoms that may occur. Some of these symptoms or signs may include difficulty comprehending what others are saying, needing extra time to understand what someone is saying, or they may provide answers to yes/no questions that are not reliable. Other problems that may occur could include not knowing when they make or hear errors in speech or even finding it hard to follow what people are saying when they are talking fast (8).
Patients with aphasia may also have difficulty with writing as well. These impairments may also be known as agraphia. Some of the common signs or symptoms that may occur in these cases may include difficulty or the inability to write, switching letters or words up or using incorrect grammar while writing. Another symptom or sign could also include writing sentences that do make sense (8). [Editor’s note: reasonably sure the student means to write ‘don’t make sense’ here] Patients with aphasia may also have impairments with comprehending while reading. The common signs and symptoms in the case could include being unable to sound out words, not being able to understand anything written, or even problems with recognizing words through sight. A couple more symptoms that may occur could be substituting words that may be associated or even not being able to read simple, noncontent words (8).
Another commonality for individuals who have aphaisa is that they usually have had a stroke or an injury to their brain. After either of these happens to the individual, aphasia can occur quickly after. There are a few warning signs that may occur if this happens such as one side of the body becoming weak or numb, difficulty with vision, dizziness, headaches, or confusion. All of these warning signs may occur suddenly. Although many of these signs and symptoms are common in patients with aphasia, everyone is affected differently and may show differences from patient to patient (9).
Incidence and Prevalence of Aphasia
Each year there are approximately 180,00 new cases of this disorder in the United States (8). With the number of cases continuing to increase every year, we have about 2 million people in the United States who currently have aphasia (9). Although 15% of individuals who are 65 or younger are diagnosed with aphasia after suffering from a stroke, it is more common for older adults to get it than younger adults. Older adults have a 43% chance of experiencing aphasia when they are over the age of 85. Researchers have also found that there is not a big difference in occurrence between men and women although there may be a difference in type of aphasia that is occurring in each gender. For example, women are more likely to experience Wernicke’s aphaisa or global aphasia and men are more likely to experience Broca’s aphasia (8). Aphasia is more likely to occur than some other common conditions such as cerebral palsy, multiple sclerosis, Parkinson’s disease, and even muscular dystrophy. After individuals suffer from a stroke, about 1/3 or 225,000 people are diagnosed with aphasia following the stroke (9).
Previous Treatment Options
Treatments for aphasia have been changing since the disorder emerged. The first known case of aphasia based on the symptoms, as mentioned before, was from the Edwin Smith Papyrus from the time of the ancient Egyptians. At this time, treatment consisted of rubbing ointment on the patient’s head and putting fatty liquid in the ears. There is a big gap between the time of the ancient Egyptians and when the second known case of aphasia came about in the late 1800’s. Around this time, a phoniatrician by the name of Hermann Gutzmann became known as the “father of aphasia treatment (13).” Gutzmann believed that patients with aphasia must begin practicing the simple parts of language and then moving on to more complex as each progressed. For example, he would start with single phonemes and then move towards practicing combinations of letters. He also believed using the left hand by writing would help stimulate the right hemisphere of the brain. He stated that by doing this, patients would be better prepared for articulation. His next therapy approach was to “combine the articulation exercises with writing exercises with the left hand. Reading and reading aloud is also used.” The “multimodal approach” was used for this treatment option (14).
Charles Mills was also very well known for his treatment of speech and language therapy around the same time as Gutzmann. Mills used several different treatments to help treat patients with aphasia. The first one he used was “the repetition of letters, phrase and sentences, recognized by him in reading or repeated by him after others.” Another technique used was to name objects on the spot or repetitively and the use of other senses. A couple more therapy options that Mills used was imitating the articulation of others and re-training grammar (14).
Present Treatment Options
For patients with aphasia in our world today, therapy is based on what the patient wants or needs. When patients are being treated for aphasia today, the whole goal is to help the individual get to the point where they can function on their own each day. There are several different treatment options that speech-language pathologists are using today. The first type of therapy is the use of computers and tablets to help patients practice specific tasks on software programs. These programs help therapists collect data on the individual when they are practicing. The next type of therapy is Constraint-Induced Language Therapy (CILT). This type of therapy is used to mass practice at a high intensity. CILT helps patients to work on spoken language and avoid gestures and writing. Melodic Intonation Therapy (MIT) is another treatment option that is used today. This type of treatment uses musical components to help individuals by singing simple phrases and improving to intonating more important phrases. Script training another option in which the client and the clinician come up with a script of an area of interest and then practice it until it is easy (15).
There are a few treatments that help patients to communicate using nonverbal strategies. Augmentative and Alternative Communication (AAC) is one of those treatments that can supplement or replace communication while using symbols, gestures, or manual signs to help individuals communicate. Another type of treatment is the Promoting Aphasics’ Communication Effectiveness (PACE) in which the individual and the clinician work on conversational skills. They can accomplish this by taking turns and using picture prompts. Visual Action Therapy (VAT) is the next type of treatment that helps with communication strategies. This treatment is a 12-step training method that begins with tracing objects and eventually moves to making gestures for objects that are not visible (15).
Reading is also being used to help individuals with aphasia. One strategy is known as Multiple Oral Reading (MOR). This technique helps patients with dyslexia or alexia and involves reading text aloud repetitively. Oral Reading for Language in Aphasia (ORLA) also involves repetitively reading sentences aloud with the SLP through phonology and semantics. The next type of reading strategy is known as supporting reading comprehension. This technique personalizes reading supports through drawings, photographs, and formatting that works best for the individual (15).
The next types of treatments are known as word-finding treatments that help to improve finding words in utterances. Response Elaboration Training (RET) is part of this type of treatments. RET has a training sequence in which the individual with aphasia is to respond to a prompt and the SLP helps assist with the response and provides reinforcement as needed. Semantic Feature Analysis Treatment is when the clinician is prompting the patient to say a certain word and helps by asking questions to help them recall the word. Verb Network Strengthening Treatment (VNeST) helps with the “production of basic syntactic structures (ex. Subject-verb-object/artist-paints-picture).” Word Retrieval Cuing Strategies such as phonological or semantic cuing to help clients recall words by giving clues. There are a lot of treatments to consider for patients with aphasia but the patient will get the best treatment when what their needs and wants are considered in the treatment plan (15).
Possible Future Treatment Options
Researchers are constantly trying to find new and better ways to help improve the lives of aphasia patients. As the hope for improvement continues, researchers are currently looking at the possibility of using Brain-Computer Interface (BCI) to help aphasia patients during their rehabilitation. Brain-Computer Interface is a system that functions by using “a head cap to pick up a faint brain signal in the unharmed side of the brain. It then sends commands to a computer, which is hooked up to a wearable exoskeleton.” This system has recently helped stroke patients to move to regain a small amount of mobility (16).
There was a study done recently, “Toward a P300 Based Brain-Computer Interface for Aphasia Rehabilitation after Stroke: Presentation of Theoretical Considerations and a Pilot Feasibility Study,” that evaluated Brain-Computer Interface with stroke patients. The goal was to evaluate BCI as a communication tool and how it might effect “neuronal plasticity by activating language circuits and thereby boost aphasia recovery.” The study discussed how aphasia patients have” attention deficits and this plays a very important role in language processing.” The patients in this study were able to successfully use the BCI system. The researchers found that “the use of the BCI system itself increases efficiency in terms of neuronal plasticity.” Although the researchers did not assess the language abilities of the patients, they did see an increase in a couple of the patients P300 amplitude. Since this was a smaller group that was studied, further research needs to be done to make conclusions about the use of BCI in aphasia patients and if attention does increase with the use of the P300 (17).
Technology is continuously evolving and will continue to help patients who have aphasia. The use of virtual reality is an up and coming concept in the world of speech therapy. Although there are few who use this concept now, virtual reality could likely become useful for many SLP’s in the future. There was recently a study done, “Evaluating the Benefits of Aphasia Intervention Delivered in Virtual Reality: Results of a Quasi-Randomised Study,” that looked at the benefits of virtual reality for patients with aphasia. “Virtual reality offers a number of potential benefits for aphasia therapy. It can deliver a playful, immersive experience that may raise motivation, and so encourage intensive language practice. Drop out might be similarly inhibited. Virtual reality may help to reduce feelings of embarrassment that can accompany real world communication failure, so encourage the practice of difficult communication exchanges. Related to this, generalisation of therapy skills, from the clinic to the real world, may be promoted. Virtual environments that enable people with aphasia to meet others may enhance social contact and reduce feelings of isolation.” “In terms of outcomes this study showed that five weeks of supported language stimulation delivered in EVA Park brought about significant gains on a test of functional communication. This is an important outcome, although it should be replicated in a larger study to increase our confidence that it is a true effect (18).”
Conclusion
Aphasia is a disorder that continues to effect individuals who have strokes or a traumatic injury to the brain. Although aphasia has been around for a long time, dating back to the early Egyptians, research continues to be done to find improvements to help the lives of aphasia patients. Communication difficulties with speaking, comprehension, writing, and reading are all indicators that an individual could potentially have aphasia even though each patient differs in severity and type of aphasia (7). Aphasia continues to increase with about 180,00 new cases each year in the United States (8). With this increasing number Speech-Language Pathologists have to try their hardest to help individual’s with aphasia to get to a point where they are reaching their maximum potential to help them become more independent. The evolution of the treatment for individuals with aphasia has continued to help improve life for these people. As time goes on, treatment options will likely to continue to get better and better, especially as technology develops.
Originally published 15.10.2019
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