Aphasia
Aphasia is an impairment of the ability
to sometimes use or comprehend words, usually acquired as a result
of a stroke or seizure. Depending on where and to what extent
the brain is injured each person with aphasia has a unique set
of language abilities.
“I am not drunk, retarded or mentally unstable”
“Aphasia is not a loss of intelligence.”
Normal Brain
The
Lobes of the Brain
Frontal Lobe
- Located in front of the central sulcus.
- Concerned with reasoning, planning, parts of speech and movement (motor cortex), emotions, and problem solving.
- Broca’s area is located in the frontal lobe. Damage to the frontal lobe can result in aphasia.
Parietal Lobe
- Located behind the central sulcus.
- Primary sensory area for reception of tactile and proprioceptive information.
Temporal Lobe
- Located below the lateral fissure.
- Concerned with perception and recognition of auditory stimuli (hearing) and memory (hippocampus).
- Wernicke’s area is located in the temporal lobe – damage may result in aphasia.
Occipital Lobe
- Located at the back of the brain, behind the parietal lobe and temporal lobe.
- Primary sensory reception area for visual impulse.
- Sensory
association area for vision, auditory and tactile information.
Language functions are lateralized in the left hemisphere. Four areas that are especially important for language are: Broca’s area, Wernike’s area, Parietal areas and the arculate fasiculations.
- Broca’s area is responsible for planning speech and some aspects of grammar.
- Wernicke’s area is responsible for language comprehension and for many semantic functions.
- The
arcuate fasciculus
is a band of fibers that connects the Broca’s
and Wernicke’s areas.
Web Links:
- Brain Mapping and Brain Atlas: Short movies and 3–dimensional images of the brain.
- MRI of a normal brain: Harvard medical school web page. It is an interactive page – you can click on the drop down menu and select the part of the brain you wish to see.
- Explore the Brain and the Spinal Cord: A great resource for learning about the many characteristics and functions of the brain.
- Brain Connection: The website presents interesting ‘brain facts’, images of different parts of the brain, and brain games and research articles.
Neurological Bases of Aphasia
Stroke or Cerebrovascular Accident (CVA)
- Cerebral thrombosis – occurs when an artery has gradually filled in with plaque – result in closing of an artery, leading to lack of oxygen to an area of the brain, with subsequent death of the tissue (infarct).
Web
Links:
o Heart
Center Online: This
page contains animation on a series of heart and brain related
disorders. Please scroll down the page and select ‘Plaque
Rupture’ to learn about how a thrombosis may occur.
- Cerebral hemorrhage – rupture of blood vessels into the brain or meninges. It may be caused by an aneurysm, which is a weakening in the artery that bulges and eventually breaks, interrupting blood flow to tissues fed by the artery.
Web
Links:
o The Brain Aneurysm
Foundation: This website lists factors and symptoms that
result in an aneurysm and also short video clips on aneurysm.
- Cerebral embolism – Cerebral embolus is a plugging of a blood vessel by a small blood clot, tumor, fat, air or clumps of bacteria.
Web
Links:
o Embolism: This page provides illustrated explanation
about how am embolism may occur.
Cerebral Trauma
- Closed Head Injury – No penetration, fracture or displacement of the skull though force of the blow causes the brain to turn, twist and push against the skull, resulting in contusion, concussion, and damage to the brain.
Web
Links:
o KO
Studios: This page has a pictorial explanation of a closed
head injury.
- Open Head Injury – Penetration of the skull whereby the integrity of the skull is damaged and underlying brain tissue is destroyed.
Web
Links:
o Virtual Hospital: A CT scan of intra cranial trauma, due to a direct blow.
Other Neuropathologies
- Cancer
o
Tumor/Growths: these are benign. They can occur
on the surface within the tissue coverings/meninges;
taking up space and pressure on the brain.
Web Links:
Beginning Stages
of tumor (
- Metastasis: These are invasive and malignant. They occur within the interior of the brain causing damage to the brain tissue.
o
Web Links:
Cancer
Network: A CT scan showing tumor in the left frontal lobe.
· Poison or toxins
§
Web Links:
- Infectious diseases commonly caused by bacteria. If treatable, may produce temporary effects, but may also cause permanent damage if they destroy areas of brain tissue. Examples meningitis, viral encephalitis and brain abscess.
§
Web Links:
Viral
Encephalitis: The
web page defines encephalitis and explains how it may be caused.
o
Brain
Abscess:
o
Meningitis: The web page defines meningitis and
explains how it may be caused.
· Seizures – caused by abnormal electrical discharges from brain cells, often in the cerebral cortex. It is not a distinct disease; it is secondary to a particular brain abnormality or neurological disorder. (http://www.neurologychannel.com/seizures/)
§
Web Links:
Types
of seizures: The
web page presents an explanation of the types of seizures with
a diagram of the brain to localize the seizure.
Description of Aphasic Spontaneous Verbal
Language
Global Aphasia: Nonfluent and reduced to a few words, emotional
exclamations and a few formulaic utterances.
Broca’s
Aphasia: Nonfluent with reduced
prosody, short phrase length, impaired articulation, and telegraphic
utterances characterized by reduced use of articles, prepositions,
auxiliaries, copulas, and inflectional and derviational
endings.
Transcortical
Motor Aphasia: Nonfluent with
remarkably well-preserved verbal repetition; output is similar
to Broca’s aphasia.
Wernicke’s
Aphasia: Fluent with relatively good articulation and
prosody, longer phrase length, and evidence of grammatical form
characterized by neologisms and semantic and literal paraphasias.
Transcortical
Sensory Aphasia: Fluent with remarkably well-preserved
verbal repetition; output is similar to Wernicke’s
aphasia.
Conduction Aphasia:
Fluent with remarkably impaired verbal repetition skills, relatively
good articulation and prosody, longer phrase length, and evidence
of grammatical form characterized by semantic and literal paraphasias.
Anomic Aphasia: Fluent with
adequate phrase length and syntax and characterized by anomia.
Quotes from ATP members
Related Movies, Books and Plays
Documentary
"After Words"
The West Coast premier of this film was at
Requests for the film should be made to:
Vincent Straggas at vstraggas@rcn.com
Books
My Stroke of Luck
By Kirk
Brain
Exercises or “Neurobics”
Here are some things you can do to exercise your brain and keep it healthy and fit. Some involve physical activity and some mental activity, but there is something for everyone! There are some that you can start doing right now.
Physical
- Walk 20 minutes a day to improve learning, concentration and blood circulation.
- Do morning exercises. Wiggle, scrunch and stretch your toes before getting out of bed to help stimulate your brain.
- Run to increase memory and learning ability. This produced extra brain cells in mice!
- Learn a new task such as square dancing, yoga, or tai chi to stimulate brain cells.
Mental
- Use a different hand to write with.
- Simply think about exercising a muscle.
- Combine two senses at once. Try listening to music while smelling flowers, or share a meal using only visual cues to communicate (no talking!).
- Change your routine once in a while. Try shopping at a new grocery store or taking a new route to school.
- Use one or more senses in everyday tasks. Try washing your hair with your eyes closed, for example.
- Do
a crossword puzzle, play scrabble, or participate in a Bingo
game.
Information comes from the following website:
http://www.fi.edu/brain/exercise.htm.
Please visit it for more exercise ideas.
Brain Food
You know that your body needs vitamins and minerals to stay strong and healthy. So do your brain and nerves. Check out this list and see if your diet includes "brain food."
Vitamin B1 (Thiamine)
This is essential for healthy brain and nerve cells. It is found in whole grain and enriched grain products like bread, rice, pasta, and fortified cereals, pasta, and pork.
Vitamin B5 (Pantothenic acid)
This forms a coenzyme that helps in transmission of nerve impulses. It can be found in meat, poultry, fish, whole-grain cereals, legumes, milk, vegetables, and fruit.
Vitamin B6 (Pyridoxine)
This helps convert tryptophan into serotonin, a brain chemical. It can be found in chicken, fish, pork, liver, and kidney, as well as whole grain cereals, nuts, and legumes.
Vitamin B12 (Cyanocobalamin)
This helps maintain healthy nervous tissue. It is found in eggs, meat, fish, poultry, and milk and dairy products.
Folic acid
This is essential for metabolism of fatty
acids in the brain. It is found in bananas, orange juice, fortified
cereals, lemons, strawberry, cantaloupe, leafy vegetables, dried
beans and peas
The following minerals play a role in nerve function:
Magnesium
It is found in whole grains, legumes, nuts, and green vegetables.
Potassium
It is found in apricots, avocados, bananas, cantaloupe, grapefruit, honeydew, kiwi, oranges, prunes, strawberries, potatoes, meat, and fish.
Calcium
It is found in milk and milk products such
as cheese, yogurt, calcium-fortified foods, and fish with edible
bones.
"Notice the variety of foods listed above," says Mindy Fretz, UI Hospitals and Clinics dietitian, "All the food groups are represented. It’s important to eat a variety of foods.”
Research @ CSD
Research Participant Needed
Individual will participate in treatment for Aphasia that requires naming pictures. The goal of the study is to see if naming unfamiliar objects will help those with aphasia to name familiar and unfamiliar objects in conversation.
Location:
Requirements:
- Aphasia
- Difficulty naming
- No motor speech problem
- Be
available for one quarter of therapy
Contact: Janet Patterson, Ph. D.
Tel: 510-885-7557
Email: janet.patterson@csueastbay.edu
Local Resources
California
Stroke Support Group of
Contact: Ann Dzuna; (925) 376-6218
Email: ADZUNA@COMCAST.NET
Stroke + Head Injury Support Group
Contact: Susan Klingman, M.S., CCC-SLP; (510) 818-6253
Email: speech1@whhs.com
CSU East Bay Aphasia Group,
Contact: Shelley Simrin,
M.A., CCC-SLP, Clinic Director; (510) 885-4762 Email: shelley.simrin@csueastbay.edu
Veterans Stroke Support Group
VA Outpatient Clinic
Contact: Jennifer Ogar; (925) 370-4129
Email: jenny.ogar@med.va.gov
Contact: Roberta Elman,
Ph.D.,
Email: RJElman@aol.com Website: www.aphasiacenter.org
Peninsula Stroke Association Support Group Network
Contact: Maria Daly, Programs Director; (650) 565-8485
Email: support@psastroke.org
Stroke Club, Stonestown Family YMCA
Contact: Kathy Orsi;
(415) 759-9632 ext. 217
Communication Group - Language Reintegration
Contact: Flo Leverenz, CCC-SLP; (925) 676-7733
Websites
Resourceful websites
American Speech-Language-Hearing
Association
http://www.asha.org/public/speech/disorders/Aphasia_info.htm
American Stroke
Association
http://www.strokeassociation.org/presenter.jhtml?identifier=1200037
http://www.employees.org/~accadmin/
Aphasia Hope
Foundation
http://www.aphasiahope.org/
National Aphasia
Association
http://www.aphasia.org/
National
http://www.nidcd.nih.gov/health/voice/aphasia.asp
National Stroke
Association
http://199.239.30.192/NationalStroke/default.htm
Recovering
After a Stroke
http://www.strokecenter.org/pat/ras_toc.htm#Table%20of%20Contents
Interesting Websites
Exploring
the Brain - an archived webcast showing
Audio archive
of a 1998 presentation by Arthur Shimamaura,
Memory, Aging and the Brain
Web
cast of sheep brain dissection
Brain structure
and function of a sheep is similar to humans – talks about
where memory processes take place in the brain.
Watching
the Brain at Work by
Jennifer Robins
Magazine
article from Exploratium Magazine online
that talks about functional MRI and what it can show of the brain
– “This amazing technology allows researchers to visualize
the brain’s functions and processes not just its structures.”
FAQ’s
What is aphasia?
Aphasia affects a person’s ability to communicate. Even though an individual with aphasia may think clearly, they may have difficulty talking, understanding others when they are speaking, reading, writing, and using numbers. Aphasia is a result of an injury to the brain. In older individuals, this damage is generally the result of a stroke, but brain injuries that cause aphasia may also come from head trauma, brain tumors, or infections.
There are many different types of aphasia. Aphasia can be mild or severe. It can affect a single aspect of language, like the ability to retrieve the names of objects, or it can impair several language modalities simultaneously. Depending on the type of aphasia an individual has, communication can be relatively easy or very difficult.
What Types of Aphasia Are There?
There are many types of aphasia. The four types listed below are the most common; however, not every individual fits neatly into one of the following categories. The impact will depend on where and how the brain was injured, what an individual’s communication skills were like prior to the stroke, and if there are any speech problems in addition to the aphasia.
Broca’s Aphasia- This type of aphasia is classified as “nonfluent.” An individual with Broca’s has an inability to express language and articulate sentences correctly. Their speech output is severely reduced and is limited to short sentences, often less than four words. Their grammar is impaired and their articulation of sounds may be impaired. However, comprehension is not greatly affected. These people have suffered damage to the frontal lobe of the brain and often have paralysis on the right side of their body.
Wernicke’s Aphasia- This type
of aphasia is classified as “fluent.” An individual
with Wernicke’s can speak fluently
and use correct grammar, but the content of their sentences is
nonsensical. They may use long sentences that have no meaning
or make up new words.
Anomic aphasia- This type of aphasia is also classified as “fluent.” It is the mildest type of aphasia. Individuals have difficulty naming items, specifically significant nouns and verbs. As a result, their speech is vague and sometimes difficult to understand. Their comprehension and reading are relatively in tact. Writing is more challenging because they have difficulty finding the words they want to say.
Global Aphasia- This type of aphasia is the most severe. Patients
with this type of aphasia have severe communication difficulties.
They may be able to produce few recognizable words and have very
limited auditory comprehension. Reading and writing skills no
longer exist. These individuals have suffered damage to extensive
portions of the brain.
What kind of speech difficulties can co-exist
with aphasia?
Dysarthria and
apraxia of speech are the two primary
types of speech problems that can co-exist with aphasia. Dysarthria is a speech disorder caused by
weakness or lack of coordination of the muscles that control speech
(i.e. breathing, voice, and articulation). A person
with dysarthria could have slurred speech
or a weak, breathy quality. Apraxia
is a motor planning deficit that affects a person’s ability
to say sounds that want. There is a problem between when the brain
sends a message to the mouth and what the mouth receives. A person
with apraxia of speech will make distorted
sounds or replace one sound for another. A person with apraxia
may appear to grope for the correct position for sounds and can
often verbalize automatic speech (counting, singing, prayers,
etc.) with ease.
How many people have aphasia?
There are approximately one million people in the
Who can have aphasia?
Aphasia may occur in persons of any age, sex, race, or nationality.
Vocation and education are not determining factors.
Can aphasia be temporary?
Yes. Temporary aphasia, called transient aphasia, refers to a
communication problem that lasts only a few hours or days. More
than half of those who initially show symptoms of aphasia recover
completely within the first few days.
Can aphasia be prevented?
There are no definitive steps that can be taken to prevent the
onset of aphasia in the event of a stroke or head trauma. The
condition is determined by the location and size of the area of
damage in the brain.
Can aphasia be cured?
At this time, there is no medicine or drug that can cure aphasia.
Surgery can be successful when pressure from a brain tumor impacts
a critical speech center. Surgery is not useful in cases of aphasia
following stroke, which represent the vast majority of instances.
Speech therapy is often provided to persons with aphasia, but
does not guarantee a "cure". The purpose of speech therapy
is to help the patient to fully utilize remaining skills and to
learn compensatory means of communication.
How is aphasia treated?
An individual with aphasia is usually referred
to a speech language pathologist (SLP) for treatment. There are
many different types of treatment that can be offered depending
on the type and severity of the aphasia. After doing a thorough
assessment of the individual’s communication skills and talking
with the individual and his or her family, the SLP will create
goals to address in therapy and at home. Speech therapy can be
given in a hospital, in a rehabilitation facility, at a private
clinic, or at home. The individual’s insurance coverage can
unfortunately dictate the length of time a person can be treated
by a SLP. Therapy will include “education and training for
the patient, family and caregivers, as well as methods to compensate
for communicative weaknesses.”
What happens when an individual stops
receiving therapy?
There is no one answer to this question. The severity of the aphasia, the availability of family/friend support, resources, activities, motivation and personality are all contributing factors. Unfortunately, many people have not ever heard of aphasia and therefore do not know how to communicate effectively with a person with aphasia. In order to prevent an individual with aphasia from becoming socially isolated or less active in their lives, more support needs to be in place for people with communicating difficulties.
Contact us
Phone: (510) 885–3241
Email: jan.avent@csueastbay.edu
Website: http://class.csueastbay.edu/commsci/aphaprog.htm
Friends of ATP-The following
people have made donations to the Aphasia Treatment Program during
2006-2007
1) Eric Bird
2) Mary Ann Bode
3) Arianna Comyns
4) Mary Eberhard
5) Audra Elliot
6) Stacey Hinnach
7) Mike Ikemoto
8) Latif Hotaki
9) Dorene Lopez and Georgia Lopez
10) Anne and Phil Meginness
11) Gary Milner
12) John Nelson
13) Janet Patterson
14) Bob and Mary Shearer
15) Kerry and Dale Walker
16) Jennifer Jacobs
17) Wilson and Helen Talley
18) Rasneet Kaur
19) Debi Short
20) Erin Leong
21) Allegra Apple
22) Vanna Nicks
23) Christine Gibson
24) Carolyn Bird
25) Marie Jensen
26) Lisa and Mike Roeder
Source:
Dr. Jan
Avent (02/04), Class Notes
Gillam,
R.B., Marquardt, T.P., Martin, F.N., (2000). Communicative sciences
and disorders: From science to clinical practice.
Chapey, R., (Ed.). (2001) Language intervention strategies
in aphasia and related neurogenic communication
disorder (4th ed.).
http://www.vh.org/adult/patient/dietary/prose/brainfoods.html
Web Master: Dr. William Rosenthal
Website Created by: Rasneet Kaur
Speech-language pathology graduate student,
Department of Communicative Sciences and Disorders,