What is aphasia?
Aphasia is an acquired disorder in language comprehension and language production in both speaking and writing. It is important to note that when a person acquired aphasia, intellectual capacities will remain.
There are different kinds of aphasia. Wernicke’s aphasia (sensory or receptive aphasia) is the ability to speak fluent, but the patient’s language comprehension is reduced. It is based around the superior temporal gyrus. Global aphasia is when the patient is not able to speak fluently, and the language comprehension is reduced as well. Anomic amnesia is the least severe. The patient has word retrieval failures and cannot express the words they want to say. Broca’s aphasia (motor or expressive aphasia) is when the patient has a good comprehension of language, but is not able to speak fluently. It is based around the inferior frontal gyrus.
| Poor comprehension | Good comprehension |
Fluent | Wernicke | Anomic |
Non-fluent | Global | Broca |
There are 30.000 people with aphasia in the Netherlands. The most common cause of aphasia is CVA. Other caused are tumors, surgeries, trauma and neurogenerative diseases, like Alzheimer’s. About 75% of the people with aphasia is incapacitated due to aphasia. About 90% of the people with aphasia gets a feeling of being socially isolated from others.
Terminology
Speech automatism / recurring utterance
Constantly recurring fixed utterance, consisting of a combination of syllables, random words or sentences, and not appropriate for the context (e.g. do-do-do, “heerlijk, helder Heineken” (beer slogan / “Guinness is good for you”)).
Stereotype
Fixed formula that constantly recurs, but is usually appropriate for the situation (and so on, my God, you know what I mean)
Paraphasia
- Phonemic = Change in the sound of a word, target word is recognisable (man instead of map, aprizol instead of apricot)
- Semantic = Incorrect use of a word belonging to the same meaning category as the target word (mother instead of woman, axe instead of chisel).
Neologism new form, non-existent word.
- Semantic (snakethings instead of spaghetti; pay-machine instead of checkout)
- Phonological (rotal instead of telephone)
Jargon incomprehensible language
- Phonological = new words used in sequence, often with foreign accent!
- Semantic = existing words used in sequence without meaning.
Perseveration
Word-for-word repetition of an utterance previously said by the patient
Echolalia
Repetition of the other person’s utterances
Dysarthria
Difficulty with articulation (due to paralysis)
Dysprosody
Disturbance in intonation, emphasis, rhythm of speech
Paragrammatism
Combining different grammatical structures that don’t go together
Agrammatism
Inappropriate omission of function words (telegram style)
Diagnosis and treatment
When following the diagnostic process, the neuropsychologist will do an administration of language test to test the following abilities:
- Spontaneous speech
- Naming
- Verbal or written word fluency
- Repetition
- Comprehension
- Writing
- Reading aloud
Speech therapy is a very common type of therapy to use with aphasia. Therapy goals will be set, advice will be given and the neuropsychologist will use different kinds of tools, like a book with pictures of objects. During the first week it’s important to regain as much linguistic abilities as possible. In later stages, treatment of aphasia patients is more aimed at improving her/his daily communicative functioning
Characteristics of Broca’s aphasia
Language production: very slowed down
Articulation: often dysarthria, very laborious articulation
Prosody: often flattened
Sentence structure: agrammatism (telegram style), defective sentence structure
Word choice: very limited vocabulary, word-finding problems, not many semantic paraphasias
Sound structure: many phonemic paraphasias
Language comprehension: slight/moderate disturbance, difficulty with complex sentences
Others: self-improvement, communication mainly impaired by expressive disturbance
Characteristics of Wernicke’s aphasia
Language production: fluent
Articulation: not disturbed
Prosody: not disturbed
Sentence structure: paragrammatism (expansion and contraction of sentences and sentence constituents)
Word choice: many semantic paraphasias, often very difficult from the target word, semantic neologism (jargon)
Sound structure: many phonemic paraphasias, sometimes neologisms (jargon)
Language comprehension: severely disturbed
Others: excessive, but meaningless speech production, poor listening attitude, not much insight, no self-improvement, severely disturbed communication
Characteristics of anomic aphasia
Language production: very fluent
Articulation: not disturbed
Prosody: not disturbed
Sentence structure: only very slight disturbance
Word choice: replacement strategies with word-finding problems, a few semantic paraphasias
Sound structure: a few phonemic paraphasias
Language comprehension: slightly disturbed
Others: good communicative skills, descriptions are often laborious and not very informative
Characteristics of global aphasia
Language production: little or none, speech automatisms
Articulation: often dysarthria
Prosody: often flattened
Sentence structure: only separate words, speech automatisms
Word choice: very limited vocabulary, highly divergent semantic paraphasias
Sound structure: very many phonemic paraphasias, neologisms
Language comprehension: severely disturbed, only concrete and emotionally charged
Others: all aspects of language and speaking are severely disturbed, also virtually non-verbal communication, aware of communication problems
