Understanding Aphasia
Loss of Language Takes Many Forms

June is National Aphasia Awareness Month

Unless we are in the middle of the often-frustrating task of learning a new language or are listening in awe at our children as they begin to use words, we usually take language for granted. Language is all around us. It is unlikely that we could easily remove ourselves from words for more than just a moment or two. Language is vitally important to us - it forms the basis of our very thoughts and the sense we make of the world around us. Unfortunately, there are medical conditions that can result in the impairment of language as a function of the brain. This impairment is called aphasia.

Aphasia is a family of disorders in the ability to use language. A person with Broca’s aphasia, for example, may lose the ability to speak in full sentences and may have extraordinary frustration in producing individual words. A person with Wernicke’s aphasia, however, may speak with ease and fluency, but produce sentences that have no meaning. At its mildest, aphasia involves difficulty in finding the right words to say; at its most severe, a person with global aphasia loses almost all abilities to produce and understand language. The impact of any of these disorders on the events of everyday life is substantial. Every June, the National Aphasia Association promotes improved awareness in both the public and health care communities about aphasic disorders and the changes they can produce in the lives of those affected by the disorder and their loved ones.

Aphasia’s most common cause is stroke. The regions of the brain affected by the stroke will determine the type of language impairment. Aphasia may also be caused by physical injury to the brain, brain tumor, or other forms of neurological disease. Acquired language problems can also be produced a result of Alzheimer disease and other neurodegenerative conditions. In the hospital, transient language problems may be observed during acute confusional states.

Advances in aphasia diagnosis and treatment have been accumulating at an increasing pace during the past 20 years.

Earlier this year, my co-author Otfried Spreen and I published a book that examines advances in aphasia assessment. One important advance has been the awareness by diagnosticians that understanding this disorder requires both the careful diagnostic examination of language itself, but also an assessment of communication – the functional impact upon one’s ability to communicate in his or her larger family, social, and vocational/recreational life. Fortunately, a number of instruments have been created during the past decade to assess that aspect of aphasia.

Treatment advances in aphasia also are increasing, and are not simply directed at improving speech and language itself. Conventional speech-language therapy for aphasia has been a feature of rehabilitation medicine for many decades. Psychological and neuropsychological aphasia consultations are newer but established facets of ongoing patient care. Pharmacological interventions to help manage aphasia continue to be investigated, including the medications donepezil and bromocriptine. One of the more exciting aspects of treatment to emerge is the extension of intervention beyond the clinic setting into the real-life social environments that patients return to after release from acute hospitalization and rehabilitation. At the forefront of treatment efforts since the 1960s has been Martha Taylor Sarno, head of speech-language services at the New York University Howard Rusk Institute of Rehabilitation Medicine.

Sarno and her colleagues recently completed a study looking at improvements resulting from aphasia therapy directed at a patient’s psychosocial functioning at a time after onset when many professionals might believe that further improvement in language functioning would be only modest.

“I think what is interesting here,” she stated, “is the fact that significant long-term changes are noted with intervention which focused primarily on social interaction and functional communication.”

Findings like these can point toward strategies to maximize the individual’s remaining communicative strongpoints, despite acquired language impairment.

Here at the Texas Medical Center, Carol Stach, speech pathologist in the Houston VA Medical Center’s Audiology & Speech Pathology Department, believes advances in evidence-based clinical practice will be an important trend when applied to aphasia intervention.

“Clinicians are encouraged to find, evaluate and use best current evidence (in combination with individual clinical experience), in the provision of treatment. Attention to best evidence and collaboration between clinicians and researchers should, ideally, result in higher-quality service delivery for all patients, including those with aphasia,” Stach said.

She also looks forward to collaboration that includes novel investigational approaches to aphasia using functional MRI and other neuroimaging technologies to push improved patient care further into the new century.

Additional information about aphasia can be found at the NAA website at http://www.aphasia.org.

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URL: http://www.tmc.edu/tmcnews/06_01_03/page_24.html