Article summary with Language disorders in Guideline neuropsychological rehabilitation by Visch-Brink & Wencke Veenstra, Paragraph 3.9 - Chapter

What is aphasia?

Aphasia is a language disorder resulting from brain damage. Aphasia can occur simultaneously with dysarthria. Dysarthria is an articulatory disorder resulting from paralysis and / or verbal apraxia (a disorder in programming articulatory movements). This distinction cannot always be made clear in clinical practice. The following classical aphasia types that have clinical value can be distinguished: Broca's aphasia, Wernicke's aphasia, amnestic aphasia, global aphasia, conduction aphasia and sensory aphasia.

Which disorders related to the basic linguistic components can be distinguished?

Language has three basic linguistic components that can be individually or simultaneously impaired:

• Semantics (meaning). A semantic disorder is manifested in semantic paraphasia and misunderstanding of content words.

• Phonology (sound). A phonological disorder is mainly expressive and is characterized by phonemic paraphasia. The input route can also be disturbed, for example if 'leg' is understood as 'boat'.

• Syntax (sentence formation). In a syntactic disorder, someone speaks and writes in a telegram style and there are problems understanding complex sentence constructions, such as passive and compound sentences.

How is the presence of aphasia diagnosed?

A speech therapist uses certain measuring instruments to determine the presence, nature and severity of aphasia and to investigate the characteristics of the aphasia. The diagnosis focuses on the demonstration of disorders in the various language modalities and in the basic linguistic components and is important for cognitive-linguistic therapy.

Which test instruments are regularly used when investigating a language disorder as a result of brain damage?

• On the basis of 'Analysis Spontaneous Language', insight can be obtained into functional verbal communication and the spontaneous language can be assessed objectively. This can provide leads for follow-up research and setting up a therapy.

• The 'Boston Appointment Task' is used to diagnose word-finding disorders, to determine the course of aphasia and / or to evaluate the effect of therapy.

• The 'Semantic Association Test' serves to diagnose verbal and / or visual semantic disorders as a possible cause of a word-finding disorder. This can help set up follow-up treatment.

• The 'Token Test' distinguishes persons with brain injuries with aphasia from persons with brain injuries without aphasia.

What does the treatment of a person with aphasia look like?

The treatment of a patient with aphasia focuses on different levels, namely the function level, activity level and participation level. Treatment takes into account the patient's environmental and personal factors.

• At the function level, therapy focuses on restoring the language functions.

• At the activity level, the therapy focuses on the individual skills and competences of the patient in order to maintain oneself in social situations.

• At the participation level, it is about the actual implementation of communicative activities during the fulfilment of a social role.

How effective is aphasia therapy?

When looking at the effectiveness of aphasia therapy, the focus is on the content of the therapy, the intensity of the therapy and the timing. Research shows that early use of intensive cognitive-linguistic therapy in patients with aphasia as a result of brain injuries does not affect the quality of verbal communication. It also appears that semantic and phonological therapy can have a therapy-specific effect on verbal communication. Finally, there are no indications that cognitive-linguistic therapy can facilitate the generation of words according to a given concept (important for the word discovery). 

What is recommended when a person develops aphasia as a result of brain injury?

When a person develops aphasia as a result of a brain injury, it is not necessary to immediately apply an intensive cognitive-linguistic therapy aimed at the word discovery. It is better to wait for the spontaneous recovery and to investigate the more stabilised aphasia well. Then a therapy can be applied that is more tailored to the patient. In the acute phase, attention can first be paid to counselling and optimising communication between the patient and his or her loved ones.