The aphasia It is a neurological disorder that occurs as a consequence of injury to the brain-bearing areas of language (National Institute of Neurological Disorders and Stroke, 2015).
This type of alteration can lead to deficits in comprehension, reading, and / or writing, either completely or partially (American Speech-Language-Hearing Association, 2015).
Generally, in most right-handed and left-handed individuals, lesions localize at the brain level in the left hemisphere They will cause aphasia or language-related disorders.
However, it is also possible that lesions present in the left hemisphere cause other deficits and alterations also related to language (American Speech-Language-Hearing Association, 2015).
Therefore, aphasia, in itself, is not a primary disease, but a symptom secondary to a brain injury caused by very different factors (National Institute of Neurological Disorders and Stroke, 2015).
Typically, aphasia is more common in adults who have stroke , brain tumor , Severe infection, Traumatic brain injury , Or the degenerative process (National Institute of Neurological Disorders and Stroke, 2015).
In addition, people with aphasia may also have other problems of the type: Apraxia (Deficit or inability to execute Target-driven, associated with an order, family or learned), Dysarthria (Motor planning deficit of the Speaks) and / or Swallowing problems , Among others (American Speech-Language-Hearing Association, 2015).
What is aphasia?
The aphasia It is a neuropsychological alteration that produces different deficits Deficits In the linguistic area: Production, comprehension, reading and writing (National Aphasia Association, 2015).
More specifically, aphasia is a deficit or alteration of the ability to use language that produces a deficit in communication Verbal or an acquired loss of language and characterized by the presentation of errors in the production of language (paraphasias), errors in the Understanding and difficulty in finding the right words in the use of language (anomia) or in a more summarized way, A loss or language disorder that occurs as a result of brain damage (Ardila and Rosselli, 2007).
Usually , Aphasia has always been associated with the occurrence of ischemia or stroke in the left hemisphere , However, currently It is known what conditions such as brain tumors, infections or head trauma can also cause (National Aphasia Association, 2015).
Typically, the signs and symptoms of aphasia usually Specific aspect Of language use: ability to recover The names of objects, ability to organize words in a sentence, ability to read, etc. (National Aphasia Association, 2015).
In spite of this, there are also cases in which there is a Generalized deficit And meet Altered multiple aspects Of communication (National Aphasia Association, 2015).
Who can suffer aphasia?
Anyone can suffer a brain injury resulting in the development of an aphasic disorder, however, most People with this disorder are older or middle-aged (National Insitute of Deafness and Other Communication Disorders, 2010).
Approximately one million people in the United States suffer from aphasia. The National Aphasia Association reports that about 80,000 people Aphasia each year as a consequence of stroke (National Institute of Deafness and Other Communication Disorders, 2010).
Signs and symptoms
The signs and symptoms of aphasia will depend fundamentally on the type, area and severity of the injury.
In some people there will be difficulties in producing words or phrases, while others will not be able to understand others (American Speech-Language-Hearing Association, 2015).
In addition, aphasia can also provoke deficits in oral language (expression and comprehension) and written language (reading and writing) (American Speech-Language-Hearing Association, 2015).
The Mayo Clinic (2015) states that people with aphasia may exhibit some of the following characteristics:
- Communicate with short or incomplete sentences.
- Speak with sentences without literary or grammatical meaning.
- Speak with unrecognizable words.
- Do not understand the conversation of other people.
- Write nonsense sentences.
Despite this, the deficits and difficulties presented by people with aphasia are much broader, so these will depend on the type of Aphasia that suffers.
Types of Aphasia
Throughout the development of the medical and / or psychological literature there are more than 20 classifications of different aphasias (Ardila and Rosselli, 2007).
In the case of the Boston group, three basic types of cortical aphasia are highlighted: 1) Aphasia of Broca , 2) Wernicke's Aphasia And 3) Driving aphasia (Ardila and Rosselli, 2007).
1) Aphasia of Broca
The Aphasia of drill or aphasia not fluent , Occurs as a result of damage or injury in areas of the left frontal lobe (National Institute of Deafness and Other Communication Disorders, 2010).
It is a type of aphasia that fundamentally affects the production of language. Those affected often use very short sentences with meaning, but Which are produced with great effort (National Institute of Deafness and Other Communication Disorders, 2010).
Normally, they understand the language without any difficulties, but they can cause great discomfort to communication difficulties (National Institute of Deafness and Other Communication Disorders, 2010).
At the clinical level, drill aphasia is characterized by an expressive language that is not fluid, with poor articulation, formed by expressions and short phases, And that is produced with great effort (Ardila and Rosselli, 2007).
In addition, people who suffer from drill aphasia tend to have weakness or paralysis in the extremities of the right side of the body (National Insitute of Deafness and Other Communication Disorders, 2010).
2) Wernicke's Aphasia
The Wernicke's aphasia or aphasia source , Results from damage or injury in temporoparietal areas ( Wernicke area ) (National Institute of Deafness and Other Communication Disorders, 2010) and terms such as sensory aphasia, receptive aphasia or central aphasia have been used for their Denomination (Ardila and Rosselli, 2007).
In most cases, the lesions occur in the left temporal lobe, however, it can also develop with damage associated with Right hemisphere (National Institute of Deafness and Other Communication Disorders, 2010).
In the case of the people with Wernicke's aphasia, they do not have difficulties in the motor production of the language, but without in the expression. They usually employ Long phrases, often meaningless. Usually used unnecessary words, invented or meaningless (National Insitute of Deafness and Other Communication Disorders, 2010).
As a consequence of these alterations, it is difficult to follow the conversational thread of these people. In addition, they also present significant difficulties To understand language and are not usually aware of these errors (National Insitute of Deafness and Other Communication Disorders, 2010).
3) Driving Aphasia
The Driving aphasia Has also been known with the terms of: kinesthesic or afferent motor aphasia, central aphasia, efferent conduction aphasia, suprasilvian conduction aphasia, or specifically Such as driving aphasia (Ardila and Rosselli, 2007).
In this type of aphasia, the main deficit affects repetition. It is characterized by fluent spontaneous language, good comprehension, but with a Poor repetition characterized by the presence of literal paraphasias (substitution of phonemes). At the secondary level, difficulties may also arise: And defects in denomination, reading disorders or alterations in writing (Ardila and Rosselli, 2007).
Causes
The most common cause of brain damage in aphasia is Stroke (Mayo Clinic, 2015).
A stroke occurs when the blood supply to a brain area is interrupted, either by blockage of a vessel Or by a stroke (National Institute of Neurological Disorders and Stroke, 2016).
When some brain area does not receive enough oxygen, the brain cells begin to die, so that the brain areas begin to degenerate (National Institute of Neurological Disorders and Stroke, 2016).
On the other hand, damage to the brain due to traumatic brain injury, tumor, infection or degenerative process can also cause Aphasia (Mayo Clinic, 2015).
- Cranioencephalic trauma : Head trauma occurs when external trauma causes head injury, in The cranial or encephalic area. Craniocerebral trauma can occur when the head strikes an object violently or when it pierces the head. Skull and access to brain tissue (National Institute of Neurological Disorders and Stroke, 2016).
- Brain tumor : A tumor is an abnormal accumulation of cells that form a mass and is going to cause neurological damage, both by The pressure they can exert on other brain and spinal structures as well as the propagation of the brain through the different areas (Johns Hopkins Medicine, 2016).
- Infectious processes : Infections at the cerebral or spinal level can cause a significant inflammation of the tissues and therefore Both cause a wide range of symptoms. Specifically, meningitis is an infectious process that specifically affects brain tissues (National Institute of Neurological Disorders and Stroke, 2016).
- Degenerative processes : Degenerative diseases ( Alzheimer's , Parkinson's , Huntington , THE A , Multiple sclerosis , Etc.), if Characterized by the development of progressive damage to different areas of the brain or cells.
In addition to these factors, cases of transient aphasia have also been reported, due to migraines, seizures or transient ischemic attack (Mayo Clinic, 2015).
- Migraine : It is a type of headache that presents in the form of recurrent attack and that causes pulsating sensations or Palpitating that usually affects one side of the head. (World Health Organization, 2012, National Institute of Neurological Disorders and Stroke, 2015).
- Seizures : Seizures or epileptic seizures occur as a consequence of an unusual neuronal activity that is altered causing Seizures or periods of unusual behavior and sensations and may sometimes lead to loss of consciousness (Mayo Clinic, 2015).
- Transient ischemic attack : Occurs when there is an interruption of the blood flow of a momentary brain area. It usually occurs as a consequence of the presence of an atherosclerotic plaque or thrombotic embolus and resolves in less than 24 hours.
How is aphasia diagnosed?
Once the etiologic cause has been diagnosed at the medical level, it is fundamental for the diagnosis of a possible alteration of the language that several Areas are evaluated by a specialist in Neuropsychology And in speech therapy (American Speech-Language-Hearing Association, 2015):
- Expressive talk : Ease of speech, volume timbre, articulation, clarity, strength, coordination of movements, etc.
- Understanding : Adequate use of vocabulary and grammar, comprehension of simple grammatical forms, answer to questions, ability to Follow instructions, narrative ability, etc.
- Social comunication : Pragmatic language, capacity for linguistic interaction, initiative, expression of ideas, capacity for clarification And reformulation, etc.
- Reading and writing.
- Other aspects : General cognitive functioning, swallowing, among others.
Treatment
A wide variety of therapeutic approaches are available for the treatment of language disorders (American Speech-Language-Hearing Association, 2015).
The type of rehabilitation intervention will depend on the patient's characteristics, goals and needs (American Speech-Language-Hearing Association, 2015).
When damage to the brain is slight, it is possible that language-related skills may be recovered. However, many of the People who suffer from aphasia, undergo therapeutic interventions, rather than to recover the language at full level, they do so to generate Compensatory strategies that allow them to maintain functional communication (Mayo Clinic, 2015).
The recovery of language skills is often a slow and progressive process, some make significant progress and others are capable of To recover functional pre-injury levels (Mayo Clinic, 2015)
Therefore, in order to have a positive effect on language rehabilitation, a Early boarding . Many studies have pointed out that the therapy is more affective when it starts shortly after the injury.
References
- AA. (2016). Classification of aphasias . Obtained from Aphasia Association: http://www.afasia.org/
- Ardila, A., & Rosselli, M. (2007). Aphasia. In A. Ardila, & M. Rosselli, Clinical Neuropsychology.
- ASHA. (2015). Aphasia . Retrieved from the American Speech-language-hearing Association: http://www.asha.org/
- Mayo Clinic. (2015). Aphasia . Retrieved from the May Clinic: http://www.mayoclinic.org/
- NAA. (2015). National Aphasia Association . Obtained from Aphasia Definitions: http://www.aphasia.org/
- NIH. (2010). Aphasia . Retrieved from"National Institute on Deafness and Other Communication Disorders"(NIDCD):
- NIH. (2016). Aphasia Information Page . Retrieved from the National Institute of Neurological Disorders and Stroke: