What is aphasia? Useful guide to fight lack of communication
What is Aphasia? A complete guide to Aphasia: What is it, what types are there and their classification, causes, clinical cases, evaluation, treatment and tips that will help communication with people with aphasia.
Anyone can at some point find communication barriers: “I have it on the tip of my tongue”, “No one understands you”, “It seems like I’m speaking Chinese!” … They are often frustrating moments filled with tension and discomfort. It seems like our thinking process and language have disconnected. This “contact failure” usually lasts for a few moments and then we are able to explain what we were trying to from the beginning. People with aphasia are not so lucky, they have to learn to cope with these difficulties that test their interaction with others every day.
What is Aphasia?- Definition
Aphasia is classified as a psychological alteration produced by a cerebral pathology or it’s a neuropsychological syndrome. A person with aphasia may find it difficult to understand and use verbal language or even lose the ability to speak.
What is aphasia? is a common question since there is confusion between the terms dysphasia and aphasia. Both are language disorders and have similar consequences that can affect comprehension, expression, naming, and repetition. However, aphasia is due to a brain anomaly and in dysphasia, there is no organic cause. Dysphasia refers more specifically to a language development problem.
When speaking about what is aphasia we give to this disorder specific causes and affected areas that will produce different consequences in different people.
Types of Aphasia
The different modalities of aphasia can be approached based on different criteria: affected brain injury, consequences in the language, associated clinical signs, altered abilities… To classify the different types of aphasia is very useful for a correct diagnosis and treatment. They are classified into seven categories and below we will describe the main effects of each one.
- Broca’s Aphasia: People with this type of aphasia suffer a great deterioration in the verbal production and the ability to repeat sentences. Sometimes they also have problems when it comes to naming objects. However, their understanding of language is normal, therefore, they have expressive disabilities but not comprehensive.
- Wernicke’s Aphasia: This aphasia causes deficiencies in the ability to repeat sentences, object naming and understanding language. However, it does not affect oral production. The deficiency found in the repetition and naming is produced by an alteration in comprehension, spontaneous production remains fluid.
- Conduction Aphasia: This type of aphasia has no consequences on oral production and comprehension. People who suffer from it understand and deliver oral messages correctly. However, they encounter problems when it comes to naming objects and repeating previously heard sentences.
- Global Aphasia: This type of aphasia severely affects the linguistic ability of the person including comprehension, production, repetition, and denomination.
- Anomic aphasia: the person with this aphasia presents a development of regular language, both at an expressive and comprehensive level, but has difficulty or inability to name objects he observes and already knows.
- Transcortical motor aphasia: the person has problems in the spontaneous verbal production, and object naming, but can repeat previously heard sentences without difficulty. The ability to decrypt received messages is not altered.
- Sensory Aphasia: There is deterioration in the naming of objects and understanding messages, but not in verbal production or in the ability to repeat sentences.
What is Aphasia?- Causes of Aphasia
Aphasia is necessarily caused by an organic alteration, a specific brain injury. But, what causes these brain injuries? There are two main causes of aphasia: traumatic brain injury and stroke.
The most frequent origin is the traumatic brain injury. By traumatic brain injury, it is implied to be an external impact on the skull that produces a deterioration of the same. The area affected by the blow will determine the type of aphasia, and thus the language abilities affected.
Aphasias can also be produced by cerebrovascular accidents (stroke). Strokes can be ischemic if the presence of a clot prevents the passage of blood into a particular brain region, or hemorrhagic, if a vessel ruptures, causing bleeding into brain tissue. In both cases, massive neuronal death happens.
Other pathologies such as tumors or infectious diseases can cause aphasic symptoms.
What is aphasia?- Clinical cases in aphasia
Here are two clinical assumptions for you to know the possible practical implications of two types of aphasia.
Wernicke’s aphasia by traumatic brain injury
Mike (26 years old) is a college student. A few months he had a car accident and received a blow to the head. After getting the TC scan results everything seemed normal and showed no alterations.
He starts having concentration and comprehension language difficulties that start affecting his grades. He is spontaneous and has a rich vocabulary. After several oral and written tests, we found that he couldn’t repeat things and involuntary substitutions of words. He says this didn’t happen before the accident.
Anomic Aphasia by stroke
Marta (78 years old) is currently in the hospital since last month after suffering from a stroke. After emergency surgery, she seemed to recover without difficulty. However, recently, she is having difficulty communicating. Her family members have perceived a lack of skill in the elaboration of her sentences. The patient claims to require great effort to express simple statements. After a specific examination of the case, we found, intermittently, a certain inability to name common objects and stimuli, from her usual environment. There are no alterations in comprehensive or recognition processes.
Evaluation and diagnosis
As we stated in the beginning, aphasia is always caused by an organic brain deterioration, therefore, for a proper diagnosis, a neurological study will be essential to provide detailed information about the affected area. Each type of aphasia is linked to a specific brain region.
Apart from a full neurological study, there are multiple neuropsychological assessments and evaluations to study this syndrome. An example of this is the Boston Diagnostic Aphasia Examination, which was created to examine six language areas in different patients. These areas were speech production, auditory compression, oral expression, reading ability, written language, and apraxias. It is also common to use verbal fluency and communicative skills during the assessment.
Today, more neuropsychological computer assessments are being used. They are easy to use and automatic. Among these assessments is CogniFit a worldwide tool for assessing and brain training.
Tips to improve communication with people with aphasia
People with aphasia find it very difficult to communicate because of their poor expression and/or lack of understanding of the language. These tips will not only help you to improve and control your communicative skills. They will also teach you strategies that help enrich the communication and linguistic interaction of people with aphasia.
People with aphasia and expressive impairment find it difficult to express what they want, even though they know for sure what they want to manifest. They have the ability to devise brilliant thoughts but are locked in themselves. This can be frustrating since they can’t even express opinions even though they feel a great interest in participating.
Imagine being invited to participate in a debate that you dominate. You begin to listen to the participants, who deliberate with enthusiasm and you come up with fantastic ideas to share. You are convinced that your contribution would enrich the debate, you know what you mean, but suddenly someone prohibits your participation. Are you frustrated?
This is what a person with aphasia experiences constantly. They have lost the ability to recognize terms they already used, and have failed to understand who they had always understood. Imagine that one day you turned on your computer and the system changed. All messages are now in German, a language you do not know, and the settings can not be modified. Would you feel comfortable working with it?
Finding communication barriers is irritating and deteriorates in our social, professional and personal relationships. In addition, it lessens autonomy in the person who suffers them and can have an important negative impact on their emotional development. How can we combat the effects of aphasia?
It is essential that both the aphasic person and those who interact with him have patience. The listener should not at any time press or try to rush the message that the aphasic person intends to say.
1. Encouraging patience does not mean giving up on sharing a message. If one communication route fails, try to find other alternatives. The use of non-verbal language can help both the patient and t interlocutors to communicate. The use of gestures, grimaces, and expressions can contribute much content to the conversation, and clarify meanings.
2. The degree of motivation that the subject with aphasia grants to social interaction is transcendental. After suffering constantly to understand and to be understood, it is easy to lose communication interest. It is very important that the person gets feedback during and after the communication, which makes them feel the success of the communication (for example, nodding without interrupting their messages). It is important that they feel that their listeners are interested in what they transmit.
3. We should not, under any circumstances, forget the value of practice. Although it is true that the exercises do not act on the existing cerebral damage, they are able to moderate its effects. Activities adapted to the type of aphasia suffered by the individual should be carried out, focusing on their specific needs.
4. Some examples of useful tasks are syllables and articulation terms, sentence repetition, active vocabulary review, auditory memory tasks, associations between images and words, object classification, essays on specific topics, storytelling, reading comprehension… These skills must be worked out vigorously, but without becoming a heavy burden on the aphasic person.
5. The language, one of the main cognitive processes affected by this disorder, is the tool that allows us to strengthen ties with those around us. We use it to manifest what we think and feel, and recognize what others think and feel. We are social beings and to relate is a vital necessity. Therefore, the presence of companions that promote communication of the aphasic person with their environment will be crucial for their general well-being.
What is Aphasia?- The President’s Speech
I can’t think of a better way to explain aphasia to you than by using an anecdote from the famous neurologist, Oliver Sacks. This is the curious case of The President’s Speech.
In a mental institution full of aphasics, there were a ton of patients laughing uncontrollably. The TV was showing the president speaking, and Sacks couldn’t understand what was happening. The president spoke perfectly, lacking nothing, saying exactly what people wanted him to but that was the problem.
Sacks compares aphasics to dogs, in the sense that they don’t understand what you’re saying at all and must rely on gestures. This is why no one can lie to them. It may have been that what the president was saying sounded sincere, but his tone of voice and gestures showed otherwise so only the aphasics could tell that he wasn’t being truthful.
Sacks also tell us about an opposite case of aphasia, agnosia. Those who suffer from agnosia are able to understand words but do not understand the tone of voice or gestures. These would have been the president’s ideal listeners. This, at least, is what we thought in the beginning, but an agnosia patient proved us wrong.
Emily D. was in the same room as the aphasics and also heard the president’s speech. The difference is that she listened to the words he used, rather than how he used them.
The surprising thing is that Emily didn’t trust what he was saying either. “It’s not convincing. He doesn’t speak good prose. He uses words incorrectly. He either has brain trauma or he’s hiding something”, she said.
Sack’s story shows us that both people with aphasia and agnosia did not trust what the president had to say, while spectators with no mental illness had less trouble believing him. In this case, those with the brain disorder ended up being more prudent.
If you liked this story and you want to know more about aphasia or agnosia, be sure to read The Man Who Mistook His Wife for a Hat, a highly recommended book written by Oliver Sacks.
Hope you liked this useful guide feel free to leave a comment below :).
This article is originally in Spanish written by Concha Gilbert, translated by Alejandra Salazar.
Alejandra is a clinical and health psychologist. She is a child specialist with a diploma in evaluation and intervention in autism. She has worked in different schools with young children and private practice for over 6 years. She is interested in early childhood intervention, emotional intelligence, and attachment styles. As a brain and human behavior enthusiast, she is more than happy to answer your questions and share her experience.