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It is a phenomenon rooted purely in the processing of the brain’s ability to translate thought into language expression.
Aphasia is a brain disability that creates an inability to understand or formulate language correctly. It is distinct from motor or sensory impairments that can affect speech, although a brain injury can cause both.
Because of this, it is one of the most frustrating conditions that speech and language pathologists will ever have to deal with.
Those who specialize in treating patients with Aphasia require a healthy dose of patience and incredible therapeutic and training skills.
Despite the frustration that can sometimes arise when working with patients with Aphasia, the prognosis for many is good. Almost all aphasics show some improvement, and most functions can be restored for some types.
This is an excellent specialty for speech and language pathologists who enjoy happy endings and want to go home knowing they made a difference in the lives of their patients.
Causes
Aphasia is always caused by brain damage, whether traumatic or related to the disease.
The most common cause of Aphasia today are strokes where blood flow is restricted (ischemic strokes) or hemorrhages (hemorrhagic strokes) in areas of the brain responsible for language processing.
This means that most patients with Aphasia are older and correspond to the population in which the stroke is more likely to occur, but Aphasia can also be the result of:
- Traumatic brain injury.
- Brain tumors.
- Other diseases affect the brain.
This means that Aphasia can affect anyone of any age and that speech and language pathologists must be prepared to treat Aphasia in any patient population.
Because the mechanism of the disorder stems from brain damage, it is often comorbid with other injuries or illnesses, including dysarthria and apraxia, as well as those that are not related to speech and language production.
These factors often complicate treatment plans for speech and language pathologists who work with patients with Aphasia, who have to overcome other difficulties in providing therapy.
Types of aphasias
The two main categories of Aphasia are fluid and non-fluid, each of which requires different treatments:
The fluid Aphasia: leaves the patient in a position to produce the sounds and words of his language without being able to combine them in a way that makes sense.
In the most extreme cases, this results in meaningless sentences pronounced ideally but having no meaning.
Patients may not realize they are using the wrong words and are frustrated when their listeners seem to ignore them.
On the contrary, they may be unable to understand the everyday speech of others.
Less severe cases may result in the loss of certain words, a condition known as anomic Aphasia.
Aphasia is not fluid: it results in the total inability to speak or say certain words.
Broca’s Aphasia (named for the area of the brain that seems to cause this type of Aphasia when it is damaged) leaves patients with the ability to understand speech but to lose all or part of their ability to speak.
In softer forms, small words such as “is,” “and” and “he” can be omitted in typical sentences. In other cases, the patient can talk, but only with great effort.
Treatment of Aphasia
There is a lot of good news for patients with Aphasia, starting with the fact that recovery often occurs naturally and begins almost immediately after the trauma.
Brain plasticity allows an enormous level of flexibility when reassigning functions from damaged parts of the brain to areas that were not affected. This is commonly the case in Aphasia, which has been used as a mechanism to study the plasticity of the brain itself.
The recovery of patients with Aphasia can continue over the years, so SLPs must do a great job whether the injury is recent or from the past.
Because the disorder affects the brain’s language centers, it can prevent speech and language pathologists from using many of the more common speech augmentation systems that they usually use in the course of speech therapy.
For example, aphasics who are already deaf and use LSA (American Sign Language) find that they lose the ability to sign as they do with speech.
On the other hand, multilingual patients sometimes discover that their ability to converse in one of their languages remains, even if others are affected.
This offers a means of communication that can be used as a lever to work on other language skills.
However, some approaches actively discourage using alternative communication mechanisms, essentially trying to force the patient’s brain to relearn lost language skills.
Like physiotherapy, which prevents patients from using a healthy limb to compensate for the deficiencies of another as a way to ensure that the unhealthy appendage recovers faster and more completely, speech and language pathologists use a method known as Restriction-Induced Language Therapy.
Repetition and encouragement for the patient to participate in everyday conversations are also used as part of routine Aphasia therapy.
This is an element of the approach known as the “Focus on participation in life for Aphasia” or LPAA. It seeks to administer Aphasia in the long term, helping patients return to life through daily activities.
Sometimes, therapies as basic as simply reading aloud from books can be helpful.
There are also more unusual techniques that have been found effective for some patients with Aphasia. Melodic intonation therapy, which uses the musical elements of speech, is a surprising approach that often works.
The left hemisphere of the brain is the part that has been damaged in patients with Aphasia since it controls language and other logic skills. But singing, a creative function, is driven by the right hemisphere.
In cases where that hemisphere remains intact, it may offer a way to take advantage of the healthy part of the brain for communication.
Research in New Therapies Can Reveal Secrets of the Brain
Aphasia has often proven to be a fertile ground for brain function research. That research, in turn, has helped speech and language pathologists develop new evidence-based therapies for aphasics.
The discovery of brain plasticity, for example, was due in part to research on the natural recovery of language skills in aphasic patients but understanding how it was happening helped speech and language pathologists to make better—use of phenomena.
The therapies such as the Naming Gestural Facilitation and Response Elaboration Training use repetitive cognitive training models to encourage the development of new neural pathways to provide language skills.
Researchers are also studying drug therapies to see if drugs that affect chemical neurotransmitters in the brain can help repair language functions.
Another, even stranger, approach that is being studied involves transcranial magnetic stimulation to initiate brain activity in damaged areas.
The use of magnetic fields to directly stimulate nerve cells in the affected regions is combined with more traditional therapies to accelerate recovery.
Specialized in Aphasia Treatment as Speech and Language Pathologists
Developments in the field will likely continue as our understanding and appreciation of how the brain works improve.
Speech and language pathologists who specialize in working with Aphasia will not be short of new approaches to try in the coming years, and it remains an exciting part of the field in which they should be involved.
Because Aphasia is a common condition and extends across age groups, most speech and language pathologists will probably end up working with aphasic patients at some point in their careers.
