APHASIA: TYPES, SYMPTOMS, CAUSES, TREATMENTS - NEUROPSYCHOLOGY - 2024

The Aphasia is a neurological disorder that occurs as a result of injury in brain areas that support the language. This type of alteration can cause deficits in expression, comprehension, reading and / or writing, in a complete or partial way (American Speech-Language-Hearing Association, 2015).

Generally, in most left- and right-handed people, lesions located at the brain level in the left hemisphere will cause aphasia or language-related disorders.

However, it is also possible that lesions present in the left hemisphere cause other types of deficits and alterations also related to language (American Speech-Language-Hearing Association, 2015).

Therefore, aphasia, in itself, is not a primary disease, but rather a secondary symptom to a brain injury caused by many different factors (National Institute of Neurological Disorders and Stroke, 2015).

Normally, aphasia is more frequent in adults who have suffered a cerebrovascular accident, brain tumor, serious infection, head injury, or degenerative process (National Institute of Neurological Disorders and Stroke, 2015).

In addition, people who suffer from aphasia may also present other problems of the type: apraxia (deficit or inability to perform motor actions directed to a goal, associated with an order, familiar or learned), dysarthria (deficit in motor programming of speech) and / or swallowing problems, among others (American Speech-Language-Hearing Association, 2015).

What is aphasia?

Aphasia is a neuropsychological disorder that produces different deficits in the linguistic area: production, comprehension, reading and writing (National Aphasia Association, 2015).

More specifically, aphasia is a deficit or alteration in the ability to use language that produces a deficit in verbal communication or an acquired loss of language.

It is characterized by the presentation of errors in the production of language (paraphasia), failures in understanding and difficulty in finding the ideal words in the use of language (anomie). In a more summarized way, a loss or disorder of language that occurs as a consequence of brain damage (Ardila and Rosselli, 2007).

Generally, aphasia has always been associated with the occurrence of ischemias or strokes in the left hemisphere, however, it is currently known that conditions such as brain tumors, infections or head injuries can also cause it (National Aphasia Association, 2015).

Typically, the signs and symptoms of aphasia tend to affect a specific aspect of language use: ability to retrieve names of objects, ability to organize words in a sentence, ability to read, etc. (National Aphasia Association, 2015).

Despite this, there are also cases in which there is a generalized deficit and multiple aspects of communication are altered (National Aphasia Association, 2015).

Who can get aphasia?

Anyone can suffer a brain injury that results in the development of an aphasic-type disorder, however, most of the people who suffer from this type of disorder are older or middle-aged adults (National Insitute of Deafness and Other Communication Disorders, 2010).

About one million people in the United States have aphasia. The National Aphasia Association indicates that around 80,000 people acquire aphasia each year as a result of strokes (National Institute of Deafness and Other Communication Disorders, 2010).

Signs and symptoms

The signs and symptoms of aphasia will depend fundamentally on the type, area and severity of the injury.

Some people will have difficulties in producing words or phrases, while others will not be able to understand others (American Speech-Language-Hearing Association, 2015).

Furthermore, aphasia can also cause deficits in oral language (expression and comprehension) and written language (reading and writing) (American Speech-Language-Hearing Association, 2015).

The Mayo Clinic (2015) points out that people with aphasia may present some of the following characteristics:

- Communicate with short or incomplete sentences.

- Speak in sentences without literary or grammatical meaning.

- Speak with unrecognizable words.

- Not understand the conversation of other people.

- Write meaningless sentences.

Despite this, the deficits and difficulties that people with aphasia present are much broader, so they will depend on the type of aphasia they suffer.

Types of aphasia

Throughout the development of the medical and / or psychological literature, there are more than 20 classifications of different aphasias (Ardila and Rosselli, 2007).

In the case of the Boston group, three basic types of cortical aphasia stand out: 1) Broca's aphasia, 2) Wernicke's aphasia, and 3) Conduction aphasia (Ardila and Rosselli, 2007).

Broca's aphasia

Drill's aphasia, or non-fluent aphasia, occurs as a consequence of damage or injury to areas of the left frontal lobe (National Insitute of Deafness and Other Communication Disorders, 2010).

It is a type of aphasia that fundamentally affects the production of language. Those affected usually use very short sentences with meaning, but which are produced with great effort (National Insitute of Deafness and Other Communication Disorders, 2010).

Normally, they understand language without any difficulty, but communication difficulties can cause great discomfort (National Institute of Deafness and Other Communication Disorders, 2010).

At the clinical level, drill aphasia is characterized by a non-fluent expressive language, with poor articulation, made up of short, ungrammatical expressions and phases that occur with great effort (Ardila and Rosselli, 2007).

In addition, people with CBA often have weakness or paralysis in the extremities on the right side of the body (National Insitute of Deafness and Other Communication Disorders, 2010).

Wernicke's aphasia

Wernicke's aphasia or source aphasia results from damage or injury in temporoparietal areas (Wernicke's area) (National Institute of Deafness and Other Communication Disorders, 2010) and terms such as: sensory aphasia, receptive aphasia or central aphasia, have been used. for its name (Ardila and Roselli, 2007).

In most cases, the lesions occur in the left temporal lobe, however, it can also develop with damage associated with the right hemisphere (National Insitute of Deafness and Other Communication Disorders, 2010).

In the case of people with Wernicke's aphasia, they do not have difficulties in motor production of language, but without in expression. They tend to use long sentences, often meaningless. They tend to use unnecessary, made up or meaningless words (National Institute of Deafness and Other Communication Disorders, 2010).

As a consequence of these alterations, it is difficult to follow the conversational thread of these people. In addition, they also present significant difficulties in understanding language and are often not aware of these errors (National Insitute of Deafness and Other Communication Disorders, 2010).

Conduction aphasia

Conduction aphasia has also been known by the terms of: kinesthetic or afferent motor aphasia, central aphasia, efferent conduction aphasia, suprasylvian conduction aphasia, or specifically as conduction aphasia (Ardila and Rosselli, 2007).

In this type of aphasia, the main deficit affects repetition. It is characterized by a fluent spontaneous language, good comprehension, but with a poor repetition characterized by the presence of literal paraphasias (substitution of phonemes).

At the secondary level, there may also appear: difficulties and defects in the name, reading disorders or writing disorders (Ardila and Rosselli, 2007).

Causes

The most common cause of brain damage in aphasia is stroke (Mayo Clinic, 2015).

A stroke occurs when the blood supply to a brain area is interrupted, either by a blocked blood vessel or by a stroke (National Institute of Neurological Disorders and Stroke, 2016).

When some brain area does not receive enough oxygen, brain cells begin to die, so the brain areas begin to degenerate their function (National Institute of Neurological Disorders and Stroke, 2016).

On the other hand, damage to the brain caused by a head injury, tumor, infection or degenerative process can also cause aphasia (Mayo Clinic, 2015).

Cranio-encephalic trauma

Head injuries occur when external trauma causes damage to the head, cranial area, or brain. A head injury can occur when the head violently hits an object or when it pierces the skull and accesses brain tissue (National Institute of Neurological Disorders and Stroke, 2016).

Brain tumor

A tumor is an abnormal accumulation of cells that form a mass and that will cause damage at the neurological level, both due to the pressure that they can exert on other brain and spinal structures and because of its spread through different areas (Johns Hopkins Medicine, 2016).

Infectious processes

Infections at the brain or spinal level can cause significant tissue inflammation and thus cause a wide range of symptoms. Specifically, meningitis is an infectious process that specifically affects brain tissues (National Institute of Neurological Disorders and Stroke, 2016).

Degenerative processes

Degenerative diseases (Alzheimer's, Parkinson's, Huntington's, ALS, Multiple Sclerosis, etc.), are characterized by the development of progressive damage to different brain areas or cells.

In addition to these factors, cases of transient aphasia have also been described, due to migraines, seizures or a transient ischemic attack (Mayo Clinic, 2015).

Migraine

It is a type of headache that occurs in the form of a recurrent attack and causes throbbing or throbbing sensations that usually affect one side of the head. (World Health Organization, 2012; (National Institute of Neurological Disorders and Stroke, 2015).

Convulsions

Seizures or epileptic seizures occur as a result of unusual neuronal activity that is altered, causing seizures or periods of unusual behavior and sensations and can sometimes cause loss of consciousness (Mayo Clinic, 2015).

Transient ischemic attack

It occurs when there is a momentary interruption of blood flow to a brain area. It generally occurs as a consequence of the presence of an arteriosclerotic plaque or thrombotic embolus and resolves in less than 24 hours.

How is aphasia diagnosed?

Once the etiological cause has been diagnosed at the medical level, for the diagnosis of a possible language alteration it is essential that various areas are evaluated by a specialist in neuropsychology and speech therapy (American Speech-Language-Hearing Association, 2015):

- Expressive speech: ease of oral expression, volume, timbre, articulation, clarity, strength, coordination of movements, etc.

- Comprehension: appropriate use of vocabulary and grammar, understanding of simple grammatical forms, answering questions, ability to follow instructions, narrative ability, etc.

- Social communication: pragmatic language, capacity for linguistic interaction, initiative, expression of ideas, capacity for clarification and reformulation, etc.

- Reading and writing.

- Other aspects: general cognitive functioning, swallowing, among others.

Treatment

For the treatment of language disorders, there are a wide variety of therapeutic approaches (American Speech-Language-Hearing Association, 2015).

The type of rehabilitative intervention will depend on the characteristics of the patient, objectives and needs (American Speech-Language-Hearing Association, 2015).

When damage to the brain is mild, language skills may be restored. However, many of the people who suffer from aphasia, undergo therapeutic interventions, rather than to recover the language at a complete level, they do it to generate compensatory strategies that allow them to maintain functional communication (Mayo Clinic, 2015).

The recovery of language skills is usually a slow and progressive process, some make significant progress and others are able to recover the functional levels of before the injury (Mayo Clinic, 2015)

Therefore, for a positive effect on language rehabilitation to take place, it is essential, among other factors, to carry out an early approach. A multitude of studies have indicated that therapy is most affective when it is started shortly after the injury.

References

1. AA. (2016). Classification of aphasias. Obtained from Afasia Association: afasia.org
2. Ardila, A., & Rosselli, M. (2007). Aphasia. In A. Ardila, & M. Rosselli, Clinical Neuropsychology.
3. ASHA. (2015). Aphasia. Retrieved from American Speech-language-hearing Association: asha.org
4. Mayo Clinic. (2015). Aphasia. Obtained from Mayo Clinic: mayoclinic.org
5. NAA. (2015). National Aphasia Association. Obtained from Aphasia Definitions: aphasia.org
6. NIH. (2010). Aphasia. Obtained from the National Institute on Deatness and Other communication Disorders (NIDCD): nidcd.nih.gov
7. NIH. (2016). Aphasia Information Page. Obtained from the National Institute of Neurological Disorders and Stroke: ninds.nih.gov