Aphasia is the inability to understand and define language because of damage to certain brain regions. This damage is usually caused by cerebral vascular accidents (stroke), or head trauma; However, this is not the only possible cause. To be diagnosed with aphasia, a person's language or language should be significantly impaired in one (or several) of the four modalities of communication after a brain injury acquired or significantly decreased over a short period of time (progressive aphasia). The four modalities of communication are the understanding of hearing, verbal expression, reading and writing, and functional communication.
The difficulty of people with aphasia can range from the occasional difficulty of finding words to losing the ability to speak, read, or write; intelligence, however, is unaffected. Expressive language and receptive language can both be affected as well. Aphasia also affects visual language such as sign language. In contrast, the use of expression of formulas in everyday communication is often preserved. One of the common deficits in aphasias is anomia, which is a deficit in the ability of word discovery.
The term aphasia implies that one or more communication modalities in the brain have been damaged and therefore functioned incorrectly. Aphasia does not refer to damage to the brain that produces motor or sensory deficits, resulting in abnormal speech; ie, aphasia is not related to speech mechanisms but the cognition of individual languages ​​(although one can have both problems). A person's "language" is a socially shared set of rules and the process of thinking behind the spoken utterance. This is not the result of more peripheral motors or sensory difficulties, such as paralysis affecting the speech muscles or general hearing loss.
Affasia affects about 2 million people in the US and 250,000 people in the UK. Although nearly 180,000 people in the US experience this disorder a year, 84.5% of people have never heard of the condition.
Video Aphasia
Signs and symptoms
People with aphasia may experience one of the following behaviors due to brain injury acquired, although some of these symptoms may be due to related or simultaneous problems such as dysarthria or apraxia and not due to aphasia. Aphasia symptoms may vary based on the location of the damage in the brain. Signs and symptoms may or may not be present in individuals with aphasia and may vary in severity and degree of impaired communication. Often those who suffer from aphasia will try to hide their inability to mention objects by using words like things . So when asked to name a pencil they might say it is the thing used to write.
Related behavior
Given the aforementioned signs and symptoms, the following behaviors are often seen in people with aphasia as a result of compensatory attempts to deficit speech and language that occurs:
- Self-improvement: Further disruption in speech as a result of wrongful attempts to correct the production of false speech.
- Speech disorder: Include a previously mentioned non-existence including repetition and extension at the phonemic, syllable and word level displayed at a pathological/severe frequency level.
- The struggle in non-fluent aphasia: A severe increase in the effort spent to talk after a life where talking and communicating is an ability that comes easily can lead to visible frustration.
- Automatically preserved languages: Behavior where multiple language or language sequences are used very frequently, before onset, they still have the ability to produce them more easily than onset of other language post.
- Poor eye vision Dysmorphia is usually characterized by tingling in the arms and legs, and sometimes Heart Disorders
Subcortical
- The characteristics and symptoms of subcortical aphasia depend on the site and size of subcortical lesions. Possible site lesions include thalamus, internal capsules, and basal ganglia.
Maps Aphasia
Cause
Aphasia is most often caused by a stroke, but any illness or damage to the part of the brain that controls the language can cause aphasia. Some of these can include brain tumors, traumatic brain injury, and progressive neurological disorders. In rare cases, aphasia can also be caused by herpesviral encephalitis. Herpes simplex virus affects the frontal and temporal lobes, subcortical structures, and hippocampal tissue, which can trigger aphasia. In acute disorders, such as head injury or stroke, aphasia usually develops rapidly. When caused by brain tumors, infections, or dementia, it develops more slowly.
Substantial damage to tissues anywhere in the region indicated by the blue in the image below may potentially cause aphasia. Aphasia can also sometimes be caused by damage to subcortical structures deep within the left hemisphere, including the thalamus, internal and external capsules, and the basal ganglia causus nucleus. The area and level of brain damage or atrophy will determine the type of aphasia and its symptoms. A small number of people may experience aphasia after damage to the right hemisphere. It has been suggested that these individuals may have unusual brain organization before illness or injury, with perhaps greater overall dependence on the right hemisphere for language skills than in the general population.
Primary progressive prostasia (PPA), while its name can be misleading, is actually a form of dementia that has some symptoms that are closely related to some form of aphasia. It is characterized by gradual loss of language functions while other cognitive domains are largely retained, such as memory and personality. PPA usually begins with the difficulty of a sudden word search in an individual and develops a reduced ability to formulate grammatically correct sentences (syntax) and understanding disorders. Etiology of PPA is not due to a stroke, traumatic brain injury (TBI), or infectious disease; it remains unclear what started PPA in those affected.
Epilepsy may also include temporary aphasia as prodromal or episodic symptoms. Aphasia is also listed as a rare side effect of the fentanyl patch, the opioid used to control chronic pain.
Classification
Aphasia is best regarded as a collection of different disorders, not a problem. Every individual with aphasia will come with a combination of strengths and weaknesses of their own language. As a result, it is a big challenge just to document the difficulties that can happen to different people, let alone decide how they can be treated well. Most classifications of aphasia tend to divide the various symptoms into a broad class. A common approach is to distinguish between eloquent aphasia (where speech remains fluent, but content may be lacking, and the person may have difficulty understanding others), and an unrelated aphasia (where speech is very stalled and difficult, and may be only consisting of one or two words at a time).
However, no broad-based grouping has proven to be sufficient. There is wide variation among people even in the same group, and aphasia can be very selective. For example, people with naming deficits (anomic aphasia) may indicate an inability only for naming buildings, or people, or colors.
The Localizationist approach aims to classify aphasia according to their main characteristics and areas of the brain that are most likely to elicit it. Inspired by the early work of nineteenth-century neuroscientists Paul Broca and Carl Wernicke, this approach identifies two major subtypes of aphasia and several minor subtypes:
- Expressive aphasia (also known as "aphasia motor" or "Broca aphasia"), characterized by stuttered, fragmented, and easily understood utterances, but well-maintained comprehension relative to expression . Damage is usually in the anterior part of the left hemisphere, especially Broca's area. Individuals with Broca's aphasia often have right-sided weakness or paralysis of the arms and legs, since the left frontal lobe is also important for body movement, especially on the right side.
- Receptive aphasia (also known as "sensory aphasia" or "Wernicke aphasia"), characterized by greeting, but marked difficulty in understanding words and sentences. Although eloquent, speech may be lacking in major substantive words (nouns, verbs, adjectives), and may contain false words or even absurd words. This subtype has been associated with damage to the posterior left temporal cortex, particularly the Wernicke region. These people usually have no body weakness, because their brain injury is not near the parts of the brain that control movement.
- Conductive parasia, where speech stays smooth, and understanding is maintained, but the person may have disproportionate difficulties when repeating words or phrases. Damage usually involves the arcuate fasciculus and the left parietal region. Transcortical motoric phylias and transcortical sensory aphasia, similar to Broca and Wernicke's aphasia, but the ability to repeat words and sentences can not be recovered proportionately.
Recent classification schemes adopt this approach, such as the "Boston-Neoclassical Model", also classify these classical aphasia subtypes into two larger classes: insoluble aphasia (which includes Broca's aphasia and transcortical motor afasia) and eloquent aphasia which include Wernicke's aphasia, aphasia conduction and transcortical sensory aphasia). The scheme also identifies some further aphasia subtypes, including: anomic aphasia, characterized by the selective difficulty of finding names for things; and global aphasia, where speech expressions and speech are severely disrupted.
Many localization approaches also recognize the existence of additional forms of "pure" language disorder that may affect only one language skill. For example, in pure alexia, one may be able to write but not read, and in the word pure deafness, they may be able to produce speech and read, but do not understand speech when speaking to them.
Cognitive neuropsychological approach
Although the localization approach provides a useful way to classify different patterns of language difficulty into large groups, one problem is that large numbers of individuals do not fit into one category or another. Another problem is that the categories, especially the main ones such as Broca and Wernicke's aphasia, are still quite broad. Consequently, even among individuals who meet the criteria for classification to be subtypes, there is considerable variability in the type of difficulty they experience.
Instead of categorizing individuals into specific subtypes, the cognitive neuropsychological approach aims to identify key language skills or "modules" that do not work well in each individual. Someone is potentially having trouble with just one module, or with a number of modules. This type of approach requires a framework or theory for what skills/modules are required to perform different types of language tasks. For example, the Max Coltheart model identifies modules that recognize phonemes as they speak, which is important for any task that involves the introduction of words. Similarly, there are modules that store phonemes that people plan to make speeches, and this module is essential for any task involving the production of long words or long strings. Once a theoretical framework has been established, the function of each module can then be assessed using a specific test or series of tests. In a clinical setting, the use of this model usually involves performing a battery assessment, each of which tests one or a number of these modules. Once the diagnosis is reached for the skill/module in which the most significant disorder lies, therapy may be continued to treat this skill.
Progressive Aphasia
Primary progressive prostasia (PPA) is a neurodegenerative focal dementia that can be associated with progressive disease or dementia, such as frontotemporal dementia, progressive supranuclear palsy, and Alzheimer's disease, which is a gradual process of losing the ability to think. Decreased language function gradually occurs in the context of relatively well-maintained memory, visual processing, and personality to the advanced stage. Symptoms usually begin with the problem of word search (naming) and progress to grammatical (syntactic) and comprehension (sentence and semantic processing). & Lt; American Speech-Language-Hearing Association & gt; Loss of language before memory loss differentiates PPA from typical dementia. People suffering from PPA may have difficulty understanding what others are saying. They can also have difficulty finding the right words to make sentences. There are three classifications of Progressive Primary Aphasia: progressive nonfluent aphasia (PNFA), Semantic Dementia (SD), and Logopenic progressive aphasia (LPA)
Progression Jargon Prograsia is an eloquent or receptive aphorism in which a person's speech is incomprehensible, but it seems to make sense to them. Speech is smooth and easy with complete syntax and grammar, but the person has problems with the selection of nouns. Either they will replace the desired word with another that sounds or looks like the original or has some other connection or they will replace it with sound. Thus, people with aphasia jargon often use neologism, and may persist if they try to replace words they can not find with sound. Substitution usually involves selecting another word (actually) starting with the same sound (for example, clocktower - filter), selecting another semantic associated with the first (eg, scroll), or taking a phonetic similar to that intended (eg, path - late).
Deaf aphasia
There are many examples that show that there is a form of aphasia among the deaf individuals. Sign language is, however, a form of language that has been shown to use the same brain area as a form of verbal language. Mirror neurons become active when animals act in a certain way or observe the actions of other individuals in the same way. This mirror neuron is important in giving the individual the ability to mimic hand gestures. The production area of ​​Broca's speech has been shown to contain several mirror neurons that result in significant similarity of brain activity between sign language and vowel speech communication. Facial communication is an important part of how animals interact with each other. Humans use facial movements to create, what other human beings feel, into emotional faces. Combining these facial movements with speech, a more fully formed form of language that allows species to interact with much more complex and detailed communication forms. Sign language also uses these facial movements and emotions along with the main hand movements of how to communicate. These forms of facial motion communication come from the same brain area. When faced with damage to certain areas of the brain, vocal communication forms are in danger of severe forms of aphasia. Because these same brain areas are used for sign language, the same forms of aphasia, at least very similar, can be seen in deaf communities. Individuals can show Wernicke's aphasia form with sign language and they show deficits in their ability to produce any form of expression. Broca's aphasia appears on several people, too. These people find tremendous difficulty in being able to actually sign the linguistic concept they are trying to express.
Severity
The severity of the type of aphasia varies depending on the size of the stroke. However, there are many differences between how often one type of severity occurs in some types of aphasia. Ã, For example, all types of aphasia can range from mild to deep. Regardless of the severity of aphasia, people can make improvements because of spontaneous recovery and treatment during acute recovery. Klebic et al. (2011) found that people with severe aphasia improved after receiving therapy for one year, consequently reducing the severity of their aphasia. In addition, while most studies suggest that the greatest results occur in people with severe aphasia when treatment is given in acute stage of recovery, Robey (1998) also found that those with severe aphasia are able to make strong language profits at the chronic stage of recovery as well. This finding implies that people with aphasia have the potential to have a functional outcome regardless of how severe their aphasia is. Although there are no different patterns of aphasia based on their own severity, global aphasia usually makes functional language profits, but may be gradual because global aphasia affects many areas of the language.
Prevention
Here are some precautions to take to avoid aphasia, by reducing the risk of stroke, the main cause of aphasia:
- Exercise regularly
- Eat a healthy diet
- Keep alcohol consumption low and avoid tobacco use
- Control blood pressure
Management
When talking about Wernicke's aphasia, according to Bakheit et al. (2007), a lack of awareness of language disorders, a common characteristic of Wernicke's aphasia, may affect the extent and level of outcomes of therapy. Klebic et al. (2011) show that people benefit from continuous therapy after discharge from the hospital to ensure generalization. Robey (1998) determined that at least 2 hours of treatment per week is recommended for significant language gain. Spontaneous recovery may cause some language benefits, but without speech language therapy, the results can be half as strong as therapy.
When dealing with Broca's aphasia, better results occur when the person participates in the therapy, and treatment is more effective than no treatment for people in the acute period. Two or more hours of therapy per week in the acute and post-acute stages yield the greatest results. High intensity therapy is most effective, and low intensity therapy is almost equivalent to no therapy.
People with global aphasia are sometimes referred to as having irreversible aphasic syndrome, often making limited gain in hearing comprehension, and restoring no functional language modalities to therapy. With this being said, people with global aphasia can maintain gestural communication skills that can enable success when communicating with conversational partners in familiar conditions. Process-oriented treatment options are limited, and people may not be competent language users as readers, listeners, authors, or speakers no matter how extensive the therapy is. However, daily routines and quality of life can be improved with reasonable and simple goals. After the first month, there is no limit to healing most people's language skills. There is a grim prognosis that leaves 83% globally aphasic after their first month will remain global aphasia in the first year. Some people are so disturbed that their current process-oriented treatment approach offers signs of progress, and therefore can not justify the cost of therapy.
Perhaps due to the relative uncommon relative unconsciousness, several studies have specifically studied the effectiveness of therapy for people with this type of aphasia. From the research conducted, the results showed that therapy can help improve the results of certain languages. One of the interventions that had positive outcomes was the training of hearing repetition. Kohn et al. (1990) reported that hearing audit training related to improvement in spontaneous speech, Francis et al. (2003) reported improved sentence comprehension, and Kalinyak-Fliszar et al. (2011) reported an increase in short-term visual-audit memory.
Most acute cases of aphasia restore some or most of the skills by working with speech-language pathologists. Recovery and repair may continue for many years after a stroke. After the onset of Aphasia, there are about six months of spontaneous recovery period; During this time, the brain attempts to recover and repair damaged neurons. The increase varies greatly, depending on the cause, type, and severity of aphasia. Recovery also depends on the age, health, motivation, handicap, and level of education of a person.
No single treatment has been shown to be effective for all types of aphasia. The reason that there is no universal treatment for aphasia is due to the nature of the disorder and the various ways it is presented, as described in the above section. Aphasia is rarely exhibited identically, implying that care needs to be given specifically to individuals. Studies have shown that, although there is no consistency in treatment methodologies in the literature, there are strong indications that treatment, in general, has a positive result. Therapies for aphasia range from improving functional communication to improve sound accuracy, depending on the severity, needs and support of family and friends. Group therapy allows individuals to work on their pragmatic skills and communication with other individuals with aphasia, which is a skill that may not often be addressed in individual one-on-one therapy sessions. It can also help boost confidence and social skills in a comfortable setting.
The evidence dose does not support the use of transcranial direct current stimulation (tDCS) to increase aphasia after a stroke.
Special care techniques include the following:
- Copy and Recall Therapy (CART) - repetition and withdrawal of targeted words in therapy can strengthen orthographic representation and improve one word reading, writing, and naming
- Visual Communication Therapy (VIC) - the use of index cards with symbols to represent various speech components
- Visual Action Therapy (VAT) - usually treats individuals with global aphasia to train the use of hand gestures for certain items
- Functional Communications Care (FCT) - focuses on increasing activity specific to functional tasks, social interactions, and self-expression
- Promoting Aphasic Communicative Effectiveness (PACE) - a means to encourage normal interaction between people with aphasia and doctors. In this kind of therapy, the focus is on pragmatic communication rather than the treatment itself. People are asked to communicate the message given to their therapist by drawing, making hand gestures or even pointing to an object
- Melodic Intonation Therapy (MIT) - aims to use the processing skills of melodies/prosodies intact from the right hemisphere to help define expressive words and languages ​​
- More - that is drawing as a way of communicating, training conversational partners
Semantic feature analysis (SFA) - the type of aphasia treatment targeting the word search deficit. This is based on the theory that neural connections can be strengthened by using words and related phrases that are similar to the target word, to finally activate the target word in the brain. SFA can be implemented in various forms such as orally, in writing, using an image card, etc. The SLP questions individuals with aphasia to give the person the name of the given image. Studies show that SFA is an effective intervention to enhance confrontational naming.
Melodic intonation therapy is used to treat inflammation that is not fluid and has proven to be effective in some cases. However, there is still no evidence from a randomized controlled trial that confirms the efficacy of MIT in chronic aphasia. MIT is used to help people with aphasia voicing through a speech song, which is then transferred as a spoken word. Good candidates for this therapy include those who have left a hemispheric stroke, non-fluent aphasia such as Broca, good hearing comprehension, poor repetition and articulation, and good emotional and memory stability. An alternative explanation is that the efficacy of MIT depends on the neural circuitry involved in processing rhythmicity and formula expression (an example taken from the MIT manual: "I'm fine," "how are you?" Or "thank you"); while rhythmical features associated with melody intonation may involve the subcortical area of ​​the left hemisphere, the use of formula expressions is known to be supported by right subcortical nerve tissue and bilateral bilateral subcorticals.
According to the National Institute on Deafness and Other Communication Disorders (NIDCD), involving a family with the care of an Aphasic beloved is ideal for all involved, because while it will no doubt help in their recovery, it will also make it easier for members of the family to learn how best to communicate with them. "Aphasia". National Institute on Deafness and Other Communication Disorders . Retrieved December 16, 2017 .
When one's speech is insufficient, different types of augmentative and alternative communications can be thought of as alphabetical boards, picture communication books, special software for computers or applications for tablets or smartphones.
Intensity of care
The intensity of aphasia therapy is determined by the length of each session, the total hours of therapy per week, and the total week of therapy given. There is no consensus on what "intense" aphasia therapy requires, or how intense therapy should produce the best results. A 2016 review of Cochrane of speech and language therapy for aphasics finds that higher intensity care, higher doses or over long periods lead to better functional communication but people are more likely to get out of high-intensity treatments (until up to 15 hours per week).
The intensity of therapy also depends on stroke infertility. People with aphasia respond differently to intensive treatment in the acute phase (0-3 months post stroke), sub-acute phase (3-6 months post stroke), or chronic phase (6 months post stroke). Intensive therapy has proven to be effective for people with chronic, non-chronic, chronic aphasia, but is less effective for people with acute aphasia. & Gt; People with sub-acute aphasia also respond well to 100-hour intensive therapy for 62 weeks. This suggests that people in the sub-acute phase can greatly improve in language and functional communication measures with intensive therapy compared to regular therapy.
Delivery of individual services
Treatment intensity should be individualized based on stroke sterility, therapeutic goals, and other specific characteristics such as age, lesion size, overall health status, and motivation. Each individual reacts differently to the intensity of treatment and is able to tolerate treatment at different times following a stroke. The intensity of treatment after a stroke has to rely on motivation, stamina, and tolerance to therapy.
Results
If the symptoms of aphasia persist more than two or three months after a stroke, a total recovery is unlikely to occur. However, it is important to note that some people continue to increase for several years and even decades. Improvement is a slow process that usually involves both helping individuals and families understand the nature of aphasia and learning a compensatory strategy for communicating. "Aphasia FAQ". National Aphasia Association . Retrieved December 16, 2017 . < span>
After a traumatic brain injury (TBI) or cerebrovascular accident (CVA), the brain undergoes several healing and reorganization processes, which can result in improved language function. This is called spontaneous recovery. Spontaneous recovery is a natural recovery that the brain makes without treatment, and the brain begins to regulate and change to recover. There are several factors that contribute to a person's chance of healing caused by a stroke, including the size and location of the stroke. Age, sex, and education have not been found to be highly predictive.
Especially for aphasia, spontaneous recovery varies among people who are affected and may not look the same to everyone, making it difficult to predict a recovery.
Although some cases of Wernicke's aphasia have shown greater improvement than the milder forms of aphasia, people with Wernicke's aphasia may not achieve high levels of speech such as those with mild forms of aphasia.
History
The first recorded case of aphasia comes from Egyptian papyrus, Edwin Smith Papyrus, which details the problem of talking to someone with a traumatic brain injury to the temporal lobe.
During the second half of the 19th century, aphasia was a major focus for scientists and philosophers working in the early stages of psychology. In medical research, silence is described as a false prognosis, and there is no assumption that the underlying language complications are present. Broca and his colleagues were some of the first to write about aphasia, but Wernicke was the first to be credited for writing widely about aphasia as a disorder containing difficulty understanding. Despite claims that report on the first aphasia, it is F.J. Gall who gives the first complete description of aphasia after studying the wounds to the brain, as well as observations of speech impairment resulting from vascular lesions.
Etymology
aphasia is from the Greek a - ("without") phÃÆ'¡sis ( ????? , "speech").
The word aphasia comes from the word ?????? aphasia , in Ancient Greek, which means "silence", comes from ?????? aphatos , "can not speak" from? - a - , "no, un" and ???? phemi , "I'm talking".
Further Research
Research is currently being carried out using functional magnetic resonance imaging (fMRI) to witness the difference in how language is processed in the normal brain vs. the wicked brain. This will help researchers to understand exactly what the brain has to go through to recover from Traumatic Brain Injury (TBI) and how different areas of the brain respond after such injuries.
Another interesting approach that is being tested is drug therapy. An ongoing study is expected to reveal whether certain medicines can be used in addition to their speech therapy to facilitate the restoration of proper language functions. It is possible that the best treatment for Aphasia may involve a combination of drug treatment with therapy, rather than relying on one of the others.
One other method studied as a potential therapeutic combination with speech language therapy is brain stimulation. One particular method, Transcranial Magnetic Stimulation (TMS), alters brain activity in any field that occurs to stimulate, which has recently caused scientists to wonder whether the shift in brain function caused by this TMS can help people re-learn the language.
The research put into the Aphasia has just begun. Researchers seem to have many ideas about how aphasia can be more effectively treated in the future. "Aphasia". National Institute on Deafness and Other Communication Disorders . Retrieved December 16, 2017 .
See also
References
External links
- Afasia in Curlie (based on DMOZ)
- The Luria Area of ​​the Human Cortex Involved in Illustration Illustrative Luria Traumatic Aphasia bookstore
- Video clips featuring people with expressive type aphasia
- A video clip with someone who shows receptive aphasia
Source of the article : Wikipedia
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