A stroke leaves a lasting imprint in both stroke survivor and his or her immediate family. The brain is primarily affected by the stroke but the whole body bears the brunt of the damage caused by the incident. Some of the lasting effects of a stroke are paralysis, weakness, pain, problems with activities of daily living, cognitive problems, emotional difficulties and speech problems.
One of the most noticeable problems affecting stroke survivors is aphasia which is a form of speech disability resulting from the stroke.
To better understand aphasia, let us look at how it is defined by the different organizations which seek to solve this post-stroke disorder.
According to the website of The National Institutes of Health (NIH) of the US, Aphasia is a disorder that is caused by damage to the parts of the brain that control language. The National Aphasia Association (NAA) also from the US, states that Aphasia is an acquired communication disorder that impairs a person’s ability to process language, but it does not affect intelligence. The NAA added that it impairs the ability to speak and understand others and that most people with aphasia experience difficulty reading and writing. The American Heart Association (AHA) defines aphasia as a total or partial loss of the ability to speak correctly or to understand or comprehend what is being said.
Both the AHA and the NIH state that it is most often caused by a stroke that causes injury to the brain’s language center. Because of the stroke, blood flow to the brain is impeded. This restriction of blood depletes the amount of oxygen and needed sustenance to the brain. As a result, the oxygen deprived brain cells eventually die. As a consequence, a stroke patient develops disabilities depending on the area of the brain which is affected.
Both AHA and NIH identified the language control area as the left hemisphere of the brain. The specific areas in the left side of the brain which control language are the Broca’s area and the Wernicke’s area. The Wernicke’s area is responsible for understanding speech and language. On the other hand, the Broca’s area is primarily responsible for the production of speech and language.
Aside from a stroke attack, aphasia may be brought about by other factors. The other causes of aphasia aside from stroke as identified by the National Institute on Deafness and Other Communicating Diseases (NIDCD) and the NIH are severe blows to the head, brain tumors, brain infections, dementia and other conditions that may affect the brain.
The type of problem a stroke patient acquires depends on which part of the brain is damaged and how much damage there is.
It can happen to anyone
The NAA said that anyone can acquire this disorder. And children are not exempt from developing aphasia. However, most people who do have this problem are middle-aged or even older. It does not discriminate between genders. It can affect both men and women. It also does not discriminate between races as well as nationalities.
The NAA added that 25% to 40% of stroke survivors acquire this language impairment. It estimates that about 80,000 stroke patients yearly develop this problem after their stroke incident. It added that in the US alone, the current number of people afflicted with aphasia is around 1 million. Roughly 1 in every 250 Americans suffers from this disability.
According to the NAA, aphasia is more common than Parkinson’s disease, cerebral palsy or muscular dystrophy. It estimated that more than 100,000 Americans develop this disorder yearly. The sad thing is a great number of people have not heard of the disorder, the NAA stated.
Types of Aphasia
The NAA said that their experience with studying aphasia has taught them that some components of language may be damaged in stroke patients who have the disorder. The NAA added that they have learned to recognize the different types or patterns of aphasia. The type of aphasia a stroke survivor has corresponds to the area of the brain where a stroke or an injury may have occurred.
According to the NAA, the common types of aphasia are:
This is the most severe form of the disorder. The NIH states that patients with global aphasia have severe communication difficulties. They can’t speak and can’t understand speech. A stroke patient who has this type of aphasia also can’t read or write. The NAA said that this variety of aphasia may be often seen immediately after a patient has suffered a stroke. They added that it may rapidly improve if the damage has not been too extensive. But if the damage to the brain was great, severe and disability may result.
Broca’s aphasia (non-fluent aphasia)
The NAA pointed out that patients with Broca’s aphasia have a severely reduced speech output. They added that speech is limited to short utterances of less than four words. They mentioned that vocabulary access is limited and the formation of sounds is often laborious and clumsy. A stroke victim with Broca’s aphasia can understand speech of others fairly well and may be able to understand the written language. However, they may have problems in writing down words. Also, a survivor with this type of aphasia has difficulty in voicing out what he or she has in mind. Survivors with this form of disorder frequently speak in very short phrases. These phrases are understandable but are produced with great effort by the patient.
Mixed non-fluent aphasia
Individuals with this form of aphasia have a sparse and effortful speech, according to the NAA. This type of aphasia may resemble a severe Broca’s aphasia. The difference with this type of aphasia with Broca’s aphasia is patients remain limited in their comprehension of speech and do not read or write beyond an elementary level.
Wernicke’s aphasia (fluent aphasia)
People with Wernicke’s aphasia have the ability to produce connected speech. However, they do have an impaired ability to grasp the meaning of the spoken word. Survivors with Wernicke’s aphasia have a type of speech that is far from normal. The sentences that they produce do not jive together and they may interject irrelevant words in between sentences. The stroke survivor who has Wernicke’s aphasia is often unaware that he is talking gibberish. Because of this, caregivers find it very difficult to follow what the stroke patient is trying to say. The NAA pointed out that reading and writing are also severely impaired with people who have Wernicke’s aphasia.
Another form of the disorder is anomic Aphasia. People who suffer from this disability easily get frustrated because they know the word they want to convey but just cannot pronounce it. As a result, they speak in circumlocutions (roundabout fashion) order which makes their speech quite vague.
The NAA stated that aside from these 5 types of aphasia which are repeatedly seen by healthcare professionals, there are other forms of aphasia which do not fall under these categories. They said that these other types of aphasia have many combinations of deficits that do not fit into these 5 groups.
The NAA said that the first to recognize aphasia is the neurologist. The neurologist is a member of the healthcare team who is tasked with treating a person’s brain injury. He carries out tests which require the stroke patient to follow commands, answers questions, name objects and carry on a conversation. If he suspects that a stroke survivor has aphasia, he refers the stroke patient to a speech-language pathologist. This other member of the healthcare team, on the other hand, then carries out a comprehensive examination of the stroke survivor’s communication abilities. The examination comprises the person’s capacity for speech, expression of ideas, conversing socially, understanding language, reading and writing, having the ability to swallow and use alternative and augmentative communication.
Treatment and therapy
People with aphasia need not be treated in some cases. Some individuals fully recover from this disorder even without treatment. This usually happens when blood flow to the brain is temporarily interrupted but is quickly restored. This type of spontaneous recovery is called a transient ischemic attack (TIA). Stroke patients with TIA may experience a return of their language abilities within a span of a few hours or within a few days.
On the other hand, most of the sufferers of aphasia may experience a longer time of language recovery. There are other instances where stroke patients do not fully recover from the disorder.
A number of people who suffer from aphasia do experience partial spontaneous recovery. If this occurs, some language abilities of the stroke patient return in a matter of days to a month after the brain injury. However, some form of aphasia still remains. To counter this, the stroke victim may undergo rehab under a speech-language therapist. It may take a long time to recover. Usually, a period of two years of rehab is needed for the stroke patient to recuperate. A good number of the members of the healthcare team believe that most effective treatment begins early in the recovery process. They identified some factors which can influence the amount of improvement a stroke patient may experience. These are the cause of the damage to the brain, the area of the brain that was injured, the extent of brain injury, and the age and health of the stroke patient. Additional factors were also identified by the healthcare team that may influence recovery. These additional factors are motivation, handedness and educational level.
The goal of therapy for a stroke patient suffering from aphasia is to have an improvement in the ability to communicate. This is done by the members of the healthcare team tasked with helping the stroke survivor to use his or her remaining language abilities as much as possible. These members of the healthcare team also help the stroke victim by teaching him how to compensate for language problems and to learn other methods of communicating with other people.
The stroke patient suffering from aphasia may undergo individual and group therapy. The focal point of individual therapy sessions is the specific need of the patient. On the other hand, group therapy session offers the opportunity to use new language skills in a small-group setting.
In the US, there are group therapies which cater to the needs of the person afflicted with the disorder. Stroke clubs, regional support groups formed by stroke survivors and other organizations are available in most major cities of the US. These organizations provide opportunity for people with aphasia to try new skills in language and speech. Aside from offering a venue for group support, these clubs can help a stroke patient and his or her family to adjust to the life changes that accompany a stroke or any other brain injury with aphasia.
Aside from personal involvement of the stroke survivor with aphasia and the encouragement given by the different support organizations, family involvement is also a crucial component of treatment. When family members are involved in the rehab, they can learn the best way to communicate with their loved one.
To help facilitate the rehab of their loved one, family members are encouraged to:
- Use a simplified form of language by saying short and uncomplicated sentences;
- Repeat the content words or to write down key words to clarify meaning as needed;
- Sustain a natural conversational manner which is suitable for an adult stroke survivor;
- Decrease distractions like loud radios or a loud TV whenever possible
- Always include a stroke survivor afflicted with aphasia during conversations
- Solicit advise and value the opinion of the stroke patient especially when it involves family matters;
- Encourage the person with aphasia to try any form of communication i.e. speech, gesture, pointing or drawing;
- Avoid correcting the stroke patient’s speech;
- Provide ample time to talk or speak his mind;
- Aid the stroke patient to become involved outside the home by looking for a support group that suits his need.
Aside from individual therapy and group therapy sessions available, there are other treatment and rehab options available for the stroke patient with aphasia. One of the new approaches available to improve language abilities is the use of computers. Studies detailing the use of computers in the rehab of patients with aphasia show that persons regain the use of certain parts of speech like the use of verbs. Aside from regaining speaking ability, computers also provide an alternative system of communication especially for people who have difficulty expressing language. Last but not the least, computers can make it easier for people who have difficulties in perceiving the difference between phonemes which are the sounds from which words are formed. They help by providing auditory discrimination exercises.