Aphasia

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Aphasia (or aphemia) is a loss or impairment of the ability to produce and/or comprehend language, due to brain damage.

Depending on the area and extent of the damage, someone suffering from aphasia may be able to speak but not write, or vice versa, or display any of a wide variety of other deficiencies in reading, writing, and comprehension.

Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage.

Usually, aphasias are a result of damage to the language centres of the brain (like Broca's area). These areas are almost always located in the left hemisphere, and in most people this is where the ability to produce and comprehend language is found. However, in a very small number of people language ability is found in the right hemisphere. In either case, damage to these language areas can be caused by a stroke, traumatic brain injury, or other head injury. Aphasia may also develop slowly, as in the case of a brain tumor or progressive neurological disease.

It is not a result of deafness or muscle paralysis, and it does not necessarily affect intelligence.

All these types of aphasia are classified as secondary; primary aphasia is a relatively rare condition with no known cause and often no other symptoms.

The brains of young children with brain damage sometimes restructure themselves to use different areas for speech processing, and regain lost function; adult brains are less adaptable and lack this ability.

Aphasia can be assessed in a variety of ways, from quick clinical screening at the bedside to several-hour-long batteries of tasks that examine the key components of language and communication.

[edit] Classification of aphasia

[edit] The locationist model

The locationist model attempts to classify the aphasia by major characteristics and then link these to areas of the brain in which the damage has been caused. The initial two categories here were devised by early neurologists working in the field, however, since then, more researchers have added to the model, resulting in it often being referred to as the "Boston-Neoclassical Model". The most prominent writers on this topic have been Howard Goodglass and Edith Kaplan.

Individuals with Broca's aphasia (also termed expressive aphasia) have damage to the frontal lobe of the brain. These individuals frequently speak short, meaningful phrases that are produced with great effort. Broca's aphasia is thus characterized as a nonfluent aphasia. Affected people often omit small words such as "is", "and", and "the". For example, a person with Broca's aphasia may say, "Walk dog" meaning, "I will take the dog for a walk". The same sentence could also mean "You take the dog for a walk", or "The dog walked out of the yard", depending on the circumstances. Individuals with Broca's aphasia are able to understand the speech of others to varying degrees. Because of this, they are often aware of their difficulties and can become easily frustrated by their speaking problems. Individuals with Broca's aphasia often have right-sided weakness or paralysis of the arm and leg because the frontal lobe is also important for body movement.

In contrast to Broca's aphasia, damage to the temporal lobe may result in a fluent aphasia that is called Wernicke's aphasia (also termed receptive aphasia). Individuals with Wernicke's aphasia may speak in long sentences that have no meaning, add unnecessary words, and even create new "words" (neologisms). For example, someone with Wernicke's aphasia may say, "You know that smoodle pinkered and that I want to get him round and take care of him like you want before", meaning "The dog needs to go out so I will take him for a walk". Individuals with Wernicke's aphasia usually have great difficulty understanding the speech of both themselves and others and are therefore often unaware of their mistakes. These individuals usually have no body weakness because their brain injury is not near the parts of the brain that control movement.

Working from Wernicke's model of aphasia, Ludwig Lichtheim proposed five other types of Aphasia but these were not tested against real patients until modern imaging made more indepth studies available. The other five types of aphasia in the locationist model are:

1. Pure Word Deafness (all understanding impaired, but expressive channels intact).
2. Conduction Aphasia (speech, writing and silent reading intact, but repetition, reading aloud and dictation impaired).
3. Apraxia of Speech Which is now considered a separate disorder in itself.
4. Transcortical Motor Aphasia (Understanding of speech, writing, repetition and reading intact, but impaired voluntary speech and writing).
5. Transcortical Sensory Aphasia,(Impaired comprehension of speech and writing, but writing, reading aloud and speech spared).

Anomia is another type of aphasia proposed under what is commonly known as the Boston-Neoclassical model, which is essentially a difficulty with naming. The sufferer may have difficulties naming certain words, linked by their grammatical type (e.g. difficulty naming verbs and not nouns) or by their semantic category (e.g. difficulty naming words relating to photography but nothing else) or a more general naming difficulty. Sufferers are usually aware and it is comparable to a 'tip of the tongue' sensation experienced by most people.

A final type of aphasia, global aphasia, results from damage to extensive portions of the language areas of the brain. Individuals with global aphasia have severe communication difficulties and will be extremely limited in their ability to speak or comprehend language.

In practice however, very few patients fit one of the types perfectly, and so an alternative model was proposed.

[edit] The cognitive neuropsychological model

The cognitive neuropsychological model builds on cognitive neuropsychology. It assumes that language processing can be broken down into a number of modules, each of which has a specific function. Hence there is a module which recognises phonemes as they are spoken and a module which stores formulated phonemes before they are spoken. Use of this model clinically involves conducting a battery of assessments (usually from the PALPA), each of which test one or a number of these modules. Once a diagnosis is reached as to where the impairment lies, therapy can proceed to treat the individual module.

[edit] Types of aphasia

Diagram of left hemisphere gyri. In the figure above the specific gyri related to different types of aphasia are highlighted. Damage to a specific gyrus will result in a specific type of aphasia.

Any of the following can be considered symptoms of aphasia:

• inability to comprehend speech
• inability to read (alexia)
• inability to write (agraphia)
• inability to speak, without muscle paralysis
• inability to form words
• inability to name objects (anomia)
• poor enunciation
• excessive creation and use of personal neologisms (jargon aphasia)
• inability to repeat a phrase
• persistent repetition of phrases
• other language impairment

The common types of aphasia are

• Broca's aphasia (expressive aphasia)
• Wernicke's aphasia (receptive aphasia)
• Nominal aphasia (anomic aphasia or Semantic amnestic aphasia)
• Global aphasia
• Conduction aphasia

It is worth noting that a combination of the above is possible.

A few less common varieties include

• Transcortical motor aphasia
• Subcortical motor aphasia
• Transcortical sensory aphasia
• Subcortical sensory aphasia
• Mixed transcortical aphasia
• Acquired eleptiform aphasia (Landau Kleffner Syndrome)

The following table summarizes some major characteristics of different types of aphasia:

[edit] Aphasia in popular culture

• Grandpa Jim in Lynn Johnston's For Better or For Worse comics began suffering from aphasia in late 2006 due to a stroke. (see Dec. 11th strip, "I'm speechless.")
  • Oct. 5-7, 16, 18-21, 23
  • Nov. 6-9, 2006
• Aphasia has sometimes been used as an avenue by which writers can explore the concept of human communication.
  • The Star Trek: Deep Space Nine episode “Babel” features an aphasia virus, which slowly but steadily infects the population of the titular space station, causing them to say random words in place of what they mean to say.
  • The play Fuddy Meers, by David Lindsay-Abaire, also explores this idea, albeit in an unusual way; the main character, Claire, is an amnesiac whose life is one discovery after another, and her kidnapper's mother, who has suffered a stroke and become aphasic, is the only one who knows the full truth about Claire's situation. The title of the play is based on the mother's pronunciation of the phrase "funny mirrors".
  • The condition is demonstrated in “Failure to Communicate,” episode 10 of season 2 of the series House, M.D., wherein Wernicke’s aphasia and agraphia are present in a patient following head trauma. The patient substitutes spoken words associated with the words he intends to say in sentences, but is able to correctly say “yes” or “no” in response to direct questions.
  • Lucky, one of the four characters in Samuel Beckett’s play Waiting For Godot, uses the word “aphasia” in his long speech and mimics the condition by persistent repetition of phrases.
  • Arthur Kopit’s play Wings is about a woman (a former aviatrix) suffering from aphasia. Originally a radio play, it was adapted into a fully staged production and then adapted again into a musical.
  • Edward Einhorn’s play Linguish also posits a virus that causes aphasia. In it, four people suffering from four variants of aphasia try to find new ways to communicate.
  • Sam Shepard’s play A Lie of the Mind features the character Beth, who appears to have non-fluent aphasia after being severely beaten by her husband.
  • The character Misato Katsuragi from Neon Genesis Evangelion suffered from aphasia during several years after a traumatic event in her teens.

[edit] Famous individuals who suffered from Aphasia

• Maurice Ravel
• Jan Berry of Jan and Dean
• Sven Nykvist
• Ralph Waldo Emerson
• Robert E. Lee

[edit] See Also

• Dysnomia

[edit] References

[edit] Academic references

• R. Chapey (Ed.) (2001). Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders (Fourth Edition). Philadelphia: Lippincott, Williams & Wilkins.
• Goodglass, H. & Kaplan, E. (1972). Assessment of Aphasia and Related Disorders. Philadelphia: Lea and Febinger.
• Kay, J., Lesser, R., & Coltheart, M. (1992). Psycholinguistic Assessments of Language Processing in Aphasia (PALPA). Hove: Erlbaum.

[edit] Personal experiences of aphasia

• Hale, S (2003), The Man Who Lost His Language, Penguin.
• Paul E. Berger and Stephanie Mensh, How to Conquer the World With One Hand...And an Attitude, 2nd Ed., ISBN 0-9668378-7-8
• Cindy Greatrex (2005) Aphasia in the Deaf Community
• Dardick, Geeta (1991), Prisoner of Silence, Reader's Digest, June issue

[edit] External links

• American Speech-Language-Hearing Association Description of aphasia and the role of the speech-language pathologist in assessment and treatment.
• Aphasia Center of California in Oakland, CA, U.S.
• The Aphasia Institute Pat Arato Aphasia Center
• NIDCD health information: Aphasia (public domain source)
• National Institute of Health: MEDLINEplus Medical Encyclopdia entry on Speech Impairment (adult) (note: not public domain, even though it is on a .gov website)
• "The Missing Pieces of Aphasia Treatment" an award-winning approach
• "In So Many Words" Radio documentary broadcast on the Canadian Broadcasting Corporation's "The Sunday Edition" program on Sunday, December 15, 2002
• "Picturing Aphasia" Documentary film about aphasia that uses drawings to help bridge the gap between hearing, seeing, and comprehending. Directed by Mores McWreath.
• Description of four types of aphasia: auditory, afferent, efferent, and semantic
• National Aphasia Association (U.S.)
• UK Based advice on aphasia and a forum for aphasics