Aphasia – Types and therapy of speech disorders

Aphthae, also known as canker sores, are painful blisters that commonly occur inside the mouth. They can make eating and speaking uncomfortable. Learn about causes, symptoms, and effective treatments for aphthae to find relief and improve oral health.

Aphasia means “without language” – the term derived from Greek already indicates that the disease is a language disorder. All areas of the language can be affected: understanding, speaking, reading and writing. The disorder occurs as a result of acquired brain damage. The most common cause in adults is a  stroke  resulting from a cerebral infarction or  cerebral hemorrhage . What forms of aphasia are there? How do you recognize aphasia and is it curable? Information on types, symptoms and therapy is given below.

Definition: what is aphasia?

Aphasia is a speech disorder resulting from brain damage. Depending on which areas of communication skills are affected, sufferers may have difficulty speaking, understanding meaning, writing, or reading. These complaints can show up, for example, as word-finding difficulties, problems with sentence structure or a complete loss of speech.

According to the medical definition, aphasia is the loss of language skills that have already been acquired – in the case of small children with corresponding disorders, one does not therefore speak of aphasia, but of a language development disorder. 

Aphasia must be distinguished from  dysarthria.  This speech disorder is caused by damage to the nerves and muscles that are necessary for speech. Those affected therefore have motor difficulties with articulation or sound formation. However, aphasia and dysarthria can also occur in combination.

Causes of Aphasia

Aphasia often develops suddenly as a result of brain damage. Children are comparatively rarely affected. In older children and adolescents, the disease occurs mainly as a result of an accident with a brain injury (cranial trauma).

An accident can also trigger the speech disorder in adults. A stroke is also often the cause, as a result of which brain cells die. Other possible triggers are, for example, a  brain tumormeningitis  or brain atrophy, i.e. a slowly progressive loss of brain substance, for example in  dementia . Aphasia can also develop slowly. Even in the context of primary progressive aphasia (PPA), the speech disorder develops slowly and continuously.

How does the language center in the brain work?

In addition to the anatomical structures such as the tongue , the mouth muscles and the larynx, several regions in the brain (usually the left hemisphere) must work together to understand spoken and heard language and to form language  :

  • The  motor language center  (Broca’s language center) is located in the frontal lobe of the cerebral cortex. This coordinates the speech muscles.
  • The  sensory language center  (Wernicke language center) is located in the parietal lobe. This is essential in order to remember the words and word sounds heard.
  • The  optical language center is located in the occipital lobe.  Among other things, this is responsible for recognizing and understanding read language.

Aphasia: types and symptoms

Depending on which brain areas are affected, four different types of aphasia are distinguished, which are expressed through different symptoms:

  1. Amnestic Aphasia
  2. Broca-Aphasia
  3. Wernicke aphasia
  4. Global Aphasia

In the following we present the classification of the different types and their signs in more detail.

Amnestic aphasia – word-finding disorders

Those affected understand what is heard very well, reading and writing is not or hardly impaired. When they speak themselves, however, they often have to search for suitable words or paraphrase missing words. This word-finding disorder delays the flow of speech. It is not uncommon for outsiders to mistakenly conclude that slow speech means slow thinking. A mild expression of this form of aphasia is called  dysphasia.

Broca’s aphasia – choppy speech

Those affected by Broca’s aphasia (formerly also motor aphasia) usually understand well, but can only speak with difficulty and cannot form grammatically correct sentences. They often speak in short, choppy sentences with many pauses in speaking, often stringing together only the most important words (“telegram style”).

Wernicke’s aphasia – Impaired understanding of language

In Wernicke’s aphasia (obsolete: sensory aphasia), speech comprehension is partially impaired. For example, the aphasic only understands individual words, but not the context. Those affected speak fluently and quickly, but mix up letters or whole words and often make mental leaps or form long, convoluted sentences. It is not uncommon for the statements to make little sense (“word deafness”).

Global aphasia – extensive speech disorder

This form of aphasia affects several areas of the brain responsible for language, making it the most debilitating disorder. Patients find it difficult to understand, language comprehension is severely impaired. If at all, only the simplest sentences are understood. Usually only parts of words are spoken, which are often strung together in repetitions. Reading and writing are also severely impaired.

Aphasia: other disorders

Since aphasia is usually the result of a stroke, other impairments are often present. These also depend on the affected brain region and the size of the damaged brain area:

  • Common symptoms are  paralysis  of one half of the body (hemiparesis), which can range from slight impairment of fine motor skills (e.g. problems peeling potatoes) to pronounced gait disorders.
  • Difficulty  swallowing  ( dysphagia ) is also common.
  • Aphasia is often accompanied by  dysarthria  (also: dysarthrophonia), in which it is not the understanding of language but speaking itself, i.e. the speech movement, that is disturbed. As a result, the sounds can no longer be formed correctly – the speech sounds slurred, incomprehensible or slow. Many sufferers complain that they are often mistaken for drunk.
  • Agnosia  is the inability to recognize a  sense, even though the senses, such as eyes, ears, and touch, are functioning. With acoustic agnosia (“soul deafness”), tones and noises are not recognized, with optical agnosia (“soul blindness”) what is seen cannot be identified as a corresponding object.
  • In the case of  apraxia  , voluntary gestures and movements are no longer carried out correctly, although there is no paralysis and sensory perception is also unimpaired. Action sequences cannot be imitated, for example repeating a sentence or imitating a grimace.

Balance problems, sensory disturbances as well as concentration and memory disorders can also occur, for example.

diagnosis of aphasia

The diagnosis includes a detailed neurological examination in order to precisely record all disorders and their causes. The various language skills are examined in detail.

Depending on the location and extent of the damage, some or all of the aphasia may resolve (often within the first few weeks), but severe impairment may also remain. It is therefore important to recognize the severity and form and to differentiate the disease from other disorders such as dysarthria.

The  Aachen Aphasia Test (AAT) is  used for this in German-speaking countries. Reading, writing, repeating, understanding and naming skills are tested in a standardized interview. The test is also suitable for checking progress in therapy.

Part of this test is the so-called  token test,  in which those affected are verbally asked to select certain tiles from a set of 20 tiles of different shapes, colors and sizes or to carry out certain actions with them.

therapy of aphasia

Speech therapy (speech therapy) is at the heart of the treatment of aphasia. Appropriate exercises support the recovery of language skills in the initial phase. Later, this therapy serves to train and optimally use existing possibilities for communication. Occupational therapy is also one of the pillars of treatment to enable those affected to carry out everyday tasks. In addition, physiotherapy or neuropsychological treatments can also be used as part of rehabilitation.

Those affected often also suffer psychologically from the reduced ability to communicate with others. In addition, the impairment of language unfortunately often means that people with aphasia are perceived by those around them as mentally impaired, although their logical thinking, perception and judgment functions in the same way as in healthy people.

Psychotherapy or a self-help group can therefore be helpful in order to better deal with the psychological stress caused by aphasia. In addition, relatives should also be involved in the treatment in order to receive tips for working together.

 

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