Aphasia: A Language Disorder

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Biology 202
1999 First Web Reports
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Aphasia: A Language Disorder

Joseph Xiong

"My most valuable tool is words, the words I can now use only with difficulty. My voice is debilitated - mute, a prisoner of a communication system damaged by a stroke that has robbed me of language," stated A. H. Raskins, one of approximately one million people in the United States who suffer from aphasia (1), a disorder which limits the comprehension and expression of language. It is an acquired impairment due to brain injury in the left cerebral hemisphere. The most common cause of aphasia is a stroke, but other causes are brain tumors, head injury, or other neuralgic illnesses. Of the estimated 400,000 strokes which occur a year, approximately 80,000 of those patients develop some form of aphasia (2). Another important observation is that within the United States, there are twice as many people with aphasia as there are individuals with Parkinson's disease (2). Yet, what is so astounding is the lack of public awareness about aphasia. Aphasia attacks an intricate part of a person's daily life - the simple act of communication and sharing. The disbursement of such a tool deprives an individual of education learned through their life, often leaving the ill fated feeling hopeless and alone. In considering the effects of aphasia, a deeper analysis of the two most common forms of aphasia will be examined: Broca's aphasia and Wernicke's aphasia. While both forms occur usually as a result of a stroke in the left hemisphere of the brain, their particular site of impairment produces different side effects in an individual's comprehension and speech. These regions have been further studied through experimental researches such as positron emission tomography (PET). Moreover, although there is currently no cure for the disorder, there are treatments and certain guidelines to follow when encountering an aphasic.

In physiological terms, Broca's aphasia and Wernicke's aphasia occur in the left hemisphere of the brain, which is responsible for controlling the right side of the body along with speech and language abilities. Broca's aphasia affects the frontal lobe adjacent to the primary motor cortex, and Wernicke's aphasia affects the posterior portion of the first frontal lobe (3). A general distinction made between the two disorders are that Broca's aphasia limits speech, while Wernicke's aphasia limits comprehension.

Broca's aphasia characterizes patients as people who has loss the production of complete sentence structures in speech and writing. Although the individual may retain the usage of nouns and verbs, the aphasic may have lost all forms of pronouns, articles, and conjunctions (3). Broca's aphasics struggle to speak more than one word at a time but shows signs of enormous effort; thus, patients with Broca's aphasia is characterized as "non-fluent aphasia" (4). Here is an example of a Broca's aphasic speech: Yes ... ah ... Monday ... er Dad and Peter H ... (his own name), and Dad ... er hospital ... and ah ... Wednesday ... Wednesday nine o'clock ... and oh ... Thursday ... ten o'clock, ah doctors ... two ... an' doctors ... and er ... teeth ... yah. (3) This passage shows the difficulty in interpreting a patient with Broca's aphasia. This particular aphasic may be trying to explain that he has a dental appointment at the hospital, or that his dad had an appointment. However, amazingly the Broca's aphasic comprehension level is less impaired. Case studies have shown that Broca's aphasics retained a good amount of their comprehension level. In an experiment to prove this, A. Caramaza and E.B. Zurif tested a Broca's aphasic comprehension level through sentence structures, whose nouns are irreversible as in the sentence: the girl is reading the yellow book. In this portion the aphasics tested rather well, because they managed to understand the sentence. However if the noun is reversible, such as the dog chased the cat, then their ability to recognize the sentence drops (3). This shows that Broca's aphasics retain a good majority of their comprehension level.

Wernicke's aphasics have different types of symptoms. Individuals with Wernicke's aphasia speak extremely fluently but with no informative purpose (3). In this respect, Wernicke's aphasia is known as "fluent aphasia" (4). An example of a Wernicke's aphasic speaking is as follows: Well this is .... mother is away here working her work out o'here to get her better, but when she's looking, the two boys looking in other part. One their small tile into her time here. She's working another time because she's getting, too. (3) Clearly, the aphasic has problems expressing his thoughts to their audience. The sentence structure does not follow correct grammatical patterns, and ultimately, there is no meaning. Moreover, their comprehension level is more reduced than a patient with Broca's aphasia (3). In the same case studies by Caramaza and Zurif with Broca's aphasics, in which irreversible and reversible nouns were placed in sentences, Wernicke's aphasics tested poorly on both occasions (3). Thus, Wernicke's aphasics have lost a majority of their comprehension ability.

N. Geschwind proposed a pattern for language function from examining the expressive behaviors of aphasics. He proposed that If a visual input is noticed, a message is sent to the visual center, the occipital lobe. This message then travels to Wernicke's area where the information is processed and linguistic words are formulated. The next step involves the message being sent to Broca's area, which translates the signal to motor commands that travels to muscles to induce a form of language expression. If another form of sensory is noted, the first signal travels to the sensory association center in the parietal lobe and follows the same pathway (3). Using this model as a guide to conceptualize the two forms of aphasia, the role of region specificity is enforced. If a patient has Broca's aphasia, although small levels of comprehension are impaired, forms of speech are near distinct. If a patient suffers from Wernicke's aphasia, their comprehension level is damaged but production of language is left remotely intact.

Experimental studies also have been done to verify the region specificity. One such approach is positron-emission tomography (PET). In PET, an individual is injected with radioactive glucose into their blood stream and monitored for levels of radioactive glucose consumption throughout the brain region. Glucose consumption occurs in regions where the brain is active. In order to determine region specific properties, high glucose consumption regions are depicted in color code shown in a PET scan. Physicians use PET scans to determine the extremity of the disorder and define brain functions (5).

Although, aphasics may never recover completely from their disorder, there are various techniques available for treating and increasing communication skills for an aphasic. Some specific techniques are (6): 1) imitating or repeating sounds; following commands 2) work on the functions they have retained 3) melotic - increase language skills through using music Another interesting approach is the use of alternative augmentative communication (AAC). The basis behind an augmentative approach is primarily based on symbols. The program known as Minspeak emphasizes the use of symbols that may have various meanings. These symbols are placed in context with one another tocreate an expression. An example is CUP, which could mean "drink", or the verb "to drink" with a action symbol. It could be linked in such an order: CUP + COW = "milk", or CUP + COW = "milk" + action symbol + CUP = "to drink." Another crucial point is that these images have to be transparent, if the patient does not know them, then he/she must be taught them (7).

In considering the two types of aphasics and the forms of treatment, an aphasic may never recover from the disorder. In the case of Broca's aphasia where the effect is mainly speech oriented, the individual does not loose their comprehension level entirely. As for Wernicke's aphasia, the loss may have more relevance because an individual may loose their entire comprehension level. It is crucial to say that aphasia completely changes a person as a normal functioning human being. Although his physical attributes are present, depending on the severity of the disorder his mind may be lost. And even though treatments are available to help the aphasia regain some communication skills, what is lost is lost. It is as if the individual must start from the beginning again only to learn that the extent of what he/she learns is already limited.

WWW Sources

1)Story of an Aphasic

2)Aphasia fact sheet

3) Carroll, David, Psychology of Language, third edition, Brooks/Cole Publishing Company, 1999, p.334-346

4)Aphasia fact sheet

5)Auderisk Terasa, Auderisk Gerald, Biology: Life on Earth, Prentice Hall Inc,NJ, 1999, p. 23 & 676-677

6)Quick Aphasia Fact Sheet

7)Augemtive Treatment

8)American-Speech-Langauge-Hearing- Association

9)National Institute of Health aphasia fact sheet

10)Stroke Fact sheet

 

Comments

Karen's picture

How people feel with all types of Aphasia

HEAR ‘ME’....

I have a type of aphasia so please:
• Speak slowly yet not as if you're talking to a child. Don't raise your voice or yell at me.
I need time to process the information to respond. Demanding a response confuses me.
• Exaggerate expression and gestures and stop frequently. Write instructions down for me.
I need patience and understanding. Stress causes me anxiety and confuses my thoughts.
• Use clear, simple words and short, active sentences. Know: I ‘know’ I forget things.
I am not incompetent or stupid. I simply process and do things differently now. Respect that.
• If you don't understand me, tell me. Do not pressure me for quick responses. Encourage me.
I do forget , especially rapid fire demands & multi task demands. Repetition is needed & important.
• Ask questions that allow two options only. Explain things slowly in an even tone. Don’t try to control me.
Don’t put me in a box and assume you know my thoughts, my wants and needs. Ask me. Give me time.
• Above all, be patient. I need to do my things my way. I am capable of making choices for now.
Respect my decisions even when you disagree. I need my autonomy, for now. HEAR ‘ME’

Patricia's picture

Hear Me

Thank you so much, your hear me describes my 50 year old son who had a stroke and heart transplant. Kevin has been saying this for a year and a half and dear God I just heard him from you. Thank you Thank you.

Andrew's picture

Aphasia and Parkinson's ?

I was diagnosed with Parkinson’s disease last December and have declined far more rapidly than the neurologist thought I should have done. Following an appearance before a doctors review panel there is now some doubt that I have ‘True Parkinson’s’ although I may have a ’variant’.

Two symptoms of a generalised relationship include my speech declining to what could only be described as incoherent – especially during a ‘phone call and; my writing (email and word processing) containing strange and totally out of context English phrases.

Examples include:
• I have compared Sarah with you and then re-worked some answers. This showed that some of the non calculated answers can be subjective. It also showed how tiring and monotonous the continual scanning with eyes is. We need to do a lot more automation to cover the eye counting. In addition I found the use of a BOQ dedicate to encourage a mistake orientated habit when doing another client with the same query. Notwithstanding that the warmth of the ferry men was appreciated

The last phrase about the ferry men being the one concerned

• Domain Server device use should be suitable server field in SIR table structure.But in the garden I slipped and got gjg

Again it is the last phrase about the garden being the one concerned and I located it in time to stop writing.

My question is what I am demonstrating possible aphasia or a symptom of PD? I understand that aphasia and Parkinson’s link closely together.

Larry 's picture

Brain lesions, morphine, strokes and aphasia

For a period of about 3 years, morphine and fentanyl were prescribed by the VA because of my chronic pain. After about a year and a half, I began to experience convulsions and loss of consciousness episodes. These would often occur after a severe bout of coughing or getting up from a chair too quickly. I would become dizzy and suddenly find myself on the floor, convulsing until my wife would bring me out of it by talking loudly or slapping me.

During this period I also had 2 episodes of renal failure. Manifesting hallucinations was a sure sign that I needed to go to the hospital. An EEG was performed and the technician asked me if I was an alcoholic. I have never used alcohol except in a few social situations. Apparently, I had lesions on my brain. At about the same time I began to experience the inability to use nouns in my talking and writing. Or to remember them. This has gotten worse over time.

I still take meds for my pain but not morphine or related drugs. I use Tramodol (Ultram) and infrequently, Vicodin. I have smoked marijuana since the age of 21 (I'm now 60) I am wondering if these drugs have caused my seizures and consequently, my aphasia. Also, as a military and civilian cop, on several occasions, I have experienced traumas that included loss of consciousness for brief periods. Possibly, these incidents of LOC contributed to my aphasia problems.

Is there anyone out there who can understand or relate to my experience?

Serendip Visitor's picture

Hello Larry. A friend of

Hello Larry. A friend of mine had a stroke which came from damage he suffered in 2 car accidents in the 60's. He suffered from aphasia since the stroke. A year later he started smoking marijuana and noticed his speech was much better and that he could get through speaking a sentence without getting stuck. A few months later he started having grand-mal seizures. People who have had strokes are more likely to suffer from seizures than those without brain damage. So his medical marijuana use lowered the seizure threshold.

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