Aphasia

By Dr. Loretta Lanphier, ND, CN, HHP, CH

Imagine being suddenly unable to communicate your thoughts to others or understand what they are writing or speaking to you. These are the realities of a person afflicted with aphasia. I think it is safe to say that most of us take the ability to have a conversation or write a letter for granted, and if we were to suddenly lose those functions or have them drastically reduced, it would be frustrating to say the least-to both us and our family, friends, and coworkers. What could cause such a thing to happen, and is there anything we can do to prevent aphasia or reverse its effects if it should strike? As we will learn, the best way to reduce risk for aphasia is to make healthful choices that will lessen our chances of developing disease conditions that can potentially produce aphasia.

What is Aphasia?

Aphasia is a communication disorder that results in either partial or total inability to effectively use learned language skills, thus making oral or written communication difficult or impossible. Many individuals with aphasia are also unable to properly understand others when they attempt to interact with them through writing or speaking. Aphasia may be the result of several different factors that are damaging to the brain, but stroke is by far the leading cause of aphasia.

Due mainly to the large number of strokes that occur in this country (an estimated 500,000-600,000 per year), aphasia is a fairly common disorder. Approximately one million people in the United States suffer from aphasia, and about 80,000 new cases are reported annually. The incidence of aphasia has not been linked to factors such as race, gender, or age, except for the fact that certain groups (such as African Americans, men, and the elderly) are more likely to suffer a stroke than the general population. As devastating as aphasia can be, the good news is that treatments involving speech and language therapy have been developed that are often quite effective, and they happily do not necessitate the use of surgery or toxic medications.

Aphasia occurs when sections of the brain that are responsible for speech and language are damaged. In most people, this means the left hemisphere of the brain. However, left-handed people tend to have language and speech functions on both the left and right sides of the brain, which can make left-handed individuals more susceptible to aphasia, but at the same time increase their chances of recovery from aphasia. The type and degree of symptoms that accompany aphasia are dependent on the location within the brain that is affected, as well as the amount of damage.

What Are the Causes of Aphasia?

As we have already mentioned, stroke is responsible for most cases of aphasia. The majority of strokes, called ischemic strokes, are caused by a blood clot partially or totally blocking the supply of blood to the brain. The other major type of stroke is known as a hemorrhagic stroke, and is the result of a ruptured blood vessel (aneurism) in the brain. Both types of stroke can cause the death or damage of brain tissue within minutes, resulting in aphasia if the stroke affects the speech-language parts of the brain. Other than stroke, the most common causes of aphasia include:

  • Trauma to the brain, such as a severe head injury.
  • Infections such as encephalitis or meningitis that are bacterial or viral in nature, and cause damage to brain tissue.
  • Certain parasitic infections that impact the brain.
  • Tumors that can impact the function of the speech-language centers in the brain.

One particular type of aphasia is a rare form called primary progressive aphasia. It is unique in that it is the only one that is officially classified as a form of dementia. The cause is not known for sure, but primary progressive aphasia is linked to shrinkage of tissue in the language-speech parts of the brain. This type of aphasia progresses slowly but steadily, often leading to complete muteness within ten years. It is sometimes misdiagnosed as Alzheimer’s disease, especially in the early stages, as the symptoms of the two disorders are quite similar.

What Are the Signs and Symptoms of Aphasia?

Signs of aphasia differ depending on the particular parts of the brain affected and the degree of damage to the brain, but there are some general symptoms that can point towards aphasia. These include:

  1. Difficulty finding appropriate words when speaking or writing.
  2. Inability understanding others when they speak to you.
  3. Difficulty with reading comprehension.
  4. Writing using words and sentences that are nonsensical.
  5. Uncharacteristically poor spelling.
  6. Using made-up words.
  7. Interpreting figurative language (such as “I ran into Tom today at the store.”) literally.

Specific symptoms are associated with each variation of aphasia. Types of aphasia are classified according to the areas of the brain that are affected, and there are quite a few different forms that have been identified. They can all be put into three broad categories:

  1. Fluent aphasia: Also known as Wernicke’s aphasia, this form strikes the temporal lobes of language-related areas of the brain. It is characterized by the use of long, run-on sentences when speaking, often with little pause in between. Patients will also commonly use a lot of made-up words, typically making it difficult for others to understand them. Individuals with fluent aphasia are generally not aware of their abnormal behaviors.
  2. Nonfluent aphasia: This form is associated with damage to the language centers found near the front of the brain. Also referred to as motor aphasia or Broca’s aphasia, the most distinguishing sign of nonfluent aphasia is the tendency to speak in short, blunt sentences that often skip words. Patient’s speech has what is described as a “telegram” quality. Examples of such sentences would be: “Pass water” or “Give box.”
  3. Global aphasia: Aphasia falling under this category involves widespread damage to the brain that adversely affects large portions of the brain’s language-speech network. People with global aphasia are severely compromised when it comes to written or verbal communication, as well as their abilities to understand others.

Another common symptom that many aphasia victims experience is despair at their inability to effectively communicate with or understand others. Those with an awareness that their communicative skills are not working right can get frustrated, as well as those who do not understand what is happening to them, but may be quite upset that others cannot understand what they consider normal speaking and writing.

One of the most common difficulties that aphasia patients have to face is learning how to effectively communicate with friends and loved ones in different ways than everyone is used to. This can be stressful for both the patient and significant others. One of the complications of this disorder can be increased difficulty in relationships. Years of normal patterns of interacting are thrown out the window, and the whole family is back to square one. It takes quite a bit of patience and adjustment on the part of all parties concerned, and those that have a strong and supportive network of individuals that are willing to work alongside the patient are much more likely to recover a greater percentage of their former communicative skills.

What Treatments Are Available for Aphasia?

Aphasia is almost exclusively treated through the use of speech-language therapy that helps victims to regain former levels of communication. Statistically speaking, very few people with aphasia ever fully recover, but with proper therapy, and positive support at home, there is great hope that many folks can learn to communicate quite well, especially if they are motivated to work hard and adapt to new techniques.

One of the keys is early intervention. It is critical that a person with aphasia begins working with a speech-language therapist as soon as possible after the onset of the disease. Recovery will be much greater and occur much faster if this is the case. A good therapist will be able to identify strong points in the remaining communication skills, and focus on building them up as lost abilities are simultaneously being relearned. In this way, people can often make up for gaps in language and speech that may never fully return.

The protocol typically involves intense one-on-one therapy lasting from one to three months, followed by options such as group treatment that may go on for up to several years. Patients are taught to learn how to communicate using alternative means such as gestures, drawing pictures, or increasing their use of body language in order to get their needs known and be able to better understand what others are attempting to say or write to them. Advanced therapy may include field trips where a group of recovering aphasia patients will go out in public and practice overcoming their communication handicaps in the real world. Focus groups can also be formed to specifically help individuals prepare to return to the workplace.

Experts point out that the success of these therapies is dependent on two main factors: the commitment level of the patient and the amount of support that he or she receives during the healing process. Aphasia is truly a family illness that requires a team effort in order to experience the best results.

It is encouraging to see that conventional medicine has come up with such effective options for the aphasia patient. However, it is even more exciting to grasp the idea that aphasia can be prevented by a lifestyle that aggressively pursues wellness and avoids the pitfalls that contribute to stroke and its sidekick aphasia. Eating well by consuming healthful foods and avoiding fatty junk foods and empty calories that only lead to obesity is one of the major factors in preventing literally all forms of disease. Combine this with a regular program of physical exercise, and you will dodge most of the illnesses that are killing and crippling far too many people of all ages in our modern times.

If you or a loved one experience aphasia, remember to be patient and give yourself the time to heal and recover. In many parts of the country there are support groups available for both patients and their families. If there is not one near you, consider forming one. Reaching out to help others may turn out to be the best thing you can do to further your own healing as well.

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