Brain & Nervous System Aphasia

Subject: Brain & Nervous System Aphasia Sun Jan 02, 2011 7:40 pm

Aphasia is a condition that robs you of the ability to
communicate. Aphasia can affect your ability to express and understand
language, both verbal and written. The amount of disability depends on
the location and the severity of the brain damage that is the cause.

Aphasia typically occurs suddenly, after a stroke or a head injury. But
it can also come on gradually, from a slowly growing brain tumor or a
degenerative disease.

Once the underlying cause has been treated, the primary treatment for
aphasia is speech therapy that focuses on relearning and practicing
language skills and using alternative or supplementary communication
methods. Family members often participate in the therapy process and
function as communication partners of the person with aphasia.

Aphasia is a sign of some other condition, such as a stroke or a brain tumor.

A person with aphasia may:

* Speak in short or incomplete sentences
* Speak in sentences that don't make sense
* Speak unrecognizable words
* Not comprehend other people's conversation
* Interpret figurative language literally
* Begin to make spelling errors
* Write sentences that don't make sense

The severity and scope of the problems depend on the extent of damage
and the area of the brain affected. Some people may comprehend what
others say relatively well but struggle to find words to speak. Other
people may be able to understand what they read, but yet can't speak so
that others can understand them.

Types of aphasia
Your doctor may refer to aphasia as nonfluent, fluent or global:

* Nonfluent aphasia. Damage to the language network near the left
frontal area of the brain usually results in Broca aphasia, which is
also called nonfluent aphasia. People with this disorder struggle to get
words out, speak in very short sentences and leave out words. A person
might say, "Want food" or "Walk park today." Although the sentences
aren't complete, a listener can usually understand the meaning. A person
with Broca aphasia may comprehend what other people say to some degree.
People with this type of aphasia are often aware of their own
difficulty in communicating and may get frustrated with these
limitations. Additionally, people Broca aphasia may also have
right-sided paralysis or weakness.
* Fluent aphasia. Wernicke aphasia is the result of damage to the
language network in the middle left side of the brain. It's often called
fluent aphasia. People with this form of aphasia may speak fluently in
long, complex sentences that don't make sense or include unrecognizable,
incorrect or unnecessary words. They usually don't comprehend spoken
language well and often don't realize that others can't understand what
they're saying.
* Global aphasia. Global aphasia results from extensive damage to
the brain's language networks. People with global aphasia have severe
disabilities with expression and comprehension.

When to see a doctor
Because aphasia is often a sign of a serious problem, such as a stroke, seek emergency medical care if you suddenly develop:

* Difficulty speaking
* Trouble comprehending speech
* Difficulty with word recall
* Problems with reading or writing

The most common cause of aphasia is brain damage resulting from a stroke
— the blockage or rupture of a blood vessel in the brain. This
disruption of the blood supply leads to brain cell death or damage in
areas of the brain controlling language. Brain damage caused by a severe
head injury, a tumor, an infection or a degenerative process can also
cause aphasia.

Primary progressive aphasia is the term used for language difficulty
that develops gradually. This is due to the gradual degeneration of
brain cells located in the language networks. Sometimes this type of
aphasia will progress to a more generalized dementia.

Aphasia can create numerous quality-of-life problems because
communications is so much a part of your life. Communication difficulty
may affect your:

* Job
* Relationships
* Day-to-day function

Language barriers may lead to embarrassment, depression and relationship problems.

If your aphasia is due to a stroke or head injury, you'll probably first
be seen by an emergency room physician. You'll then be seen by a doctor
who specializes in disorders of the nervous system (neurologist), and
you may eventually be referred to a speech-language pathologist for
rehabilitation.

Because this condition generally arises as an emergency, you won't have
any time to prepare. If possible, bring any medications or supplements
that you take with you to the hospital so that your doctor is aware of
what you've taken.

When you have follow-up appointments, you'll likely need a friend or
loved one to drive you to your doctor's office. In addition, they may be
able to help you communicate with your doctor.

Some questions a loved one or friend may want to ask your doctor include:

* What's the most likely cause of these speech difficulties?
* Are any tests needed?
* Is aphasia temporary or long lasting?
* What treatments are available, and which do you recommend?
* Are there any types of services available, such as speech-language therapy or home health assistance?
* Is there any way to help my loved one understand others or communicate more effectively?

Your doctor will likely request an imaging test, such as a computerized
tomography (CT) scan or magnetic resonance imaging (MRI) to quickly
identify what's causing the aphasia.

You'll also likely undergo tests and informal observations to assess your language skills, such as the ability to:

* Name common objects
* Engage in a conversation
* Understand and use words correctly
* Answer questions about something read or heard
* Repeat words and sentences
* Follow instructions
* Answer yes-no questions and respond to open-ended questions about common subjects
* Tell a story or explain the plot of a story
* Explain a joke or a figurative phrase, such as "I need to unwind"
* Read and write letters, words and sentences

If the brain damage is mild, a person may recover language skills
without treatment. However, most people undergo speech and language
therapy to rehabilitate their language skills and supplement their
communication experiences.

Speech and language rehabilitation
Recovery of language skills is usually a relatively slow process.
Although most people make significant progress, few people regain full
pre-injury communication levels. In aphasia, speech and language
therapy:

* Starts early. Therapy is most effective when it begins soon after the brain injury.
* Builds on success. The speech-language pathologist uses exercises
to improve and practice communication skills. These may begin with
simpler tasks such as naming objects and evolve into more complex
exercises of explaining the purpose of an object.
* Shifts focus. The speech-language pathologist might teach the
person ways to compensate for the language impairment and to communicate
more effectively with gestures or drawings. Some people with aphasia
may use a book or board with pictures and words to help them recall
commonly used words or help them when they're stuck.
* Often works in groups. In a group setting, people with aphasia can
try out their communication skills in a safe environment. Participants
can practice initiating conversations, speaking in turn, clarifying
misunderstandings and fixing conversations that have completely broken
down.
* May include outings. Participating in real-life situations — such
as going to a restaurant or a grocery store — puts rehabilitation
efforts into practice.
* May include use of computers. Using computer-assisted therapy can
be especially helpful for relearning verbs and word sounds (phonemes).

People with aphasia
If you have aphasia, the following tips may help you communicate with others:

* Carry a card explaining that you have aphasia and what aphasia is.
* Carry identification and information on how to contact significant others.
* Carry a pencil and a small pad of paper with you at all times.
* Use drawings, diagrams or photos as shortcuts.
* Use gestures or point to objects.

Family and friends
Family members and friends can use the following tips when communicating with a person with aphasia:

* Simplify your sentences and slow down your pace.
* Keep conversations one-on-one to start with.
* Allow the person time to talk.
* Don't finish sentences or correct errors.
* Reduce distracting noise in the environment.
* Keep paper and pencils or pens readily available.
* Write a key word or a short sentence to help explain something.
* Help the person with aphasia create a book of words, pictures and photos to assist with conversations.
* Use drawings or gestures when you aren't understood.
* Involve the person with aphasia in conversations as much as possible.
* Check for comprehension or summarize what you've discussed.

Support groups
Local chapters of such organizations as the National Aphasia
Association, the American Stroke Association, the American Heart
Association and some medical centers may offer support groups for people
with aphasia and others affected by the disorder. These groups provide
people with a sense of community, a place to air frustrations and learn
coping strategies. Ask your doctor or speech-language pathologist if he
or she knows of any local support groups.

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