The Aphasia of Broca Is a language impairment due to brain injury. This type of aphasia was discovered in 1861 by Paul Broca, who observed a patient who only uttered an expression: "so". However, he perfectly understood simple phrases as he responded to questions by gestures.
A few years later, he found 25 cases with similar alterations that presented lesions in the left hemisphere, occupying the third frontal gyrus. What associated with this type of aphasia that today bears his name.
Broca's aphasia is characterized by poor fluency, difficulty and slow speech. The problem is centered in the pronunciation of the words, being perfectly conserved the meaning of the message.
If you want to know more, now we will present this type of aphasia more carefully.
What does it consist of?
Broca's aphasia, also called non-fluent or expressive aphasia (National Aphasia Association, 2016), presents a series of characteristics: alterations in the orofacial movements that cause him to speak with little fluency, agramatismo, writing and reading deteriorated, and difficulties in the Repetition of sentences The understanding of language is somewhat more preserved than its expression.
We will describe the signs and symptoms of this type of aphasia in more detail below.
Signs and symptoms
Patients with Broca's aphasia emit mostly loose words and short phrases with a lot of effort and slowness.
- It is common to comment on errors in the selection of phonemes (sounds of the language), leading to substitutions or intercalations of phonemes. For example, instead of"guard"they could say" Guild ". This is called Phonological paraphasia.
- They are presented many times Omissions Y Simplifications Of consonants. For example, they can pronounce" dice "Instead of"dart".
- Agrammatic expression: deficits in the use of suitable morphosyntactic constructions. This means that they are not able to establish an order of words and link them into correct phrases. Agramatismo can also appear alone, without problems for the linguistic pronunciation. An example may be to say" Garden dog "Instead of"the dogs are in the garden".
- Telegraphic language.
- They use few functional terms, which are short words like"un","he","en","over", etc. That its meaning depends on the other words that accompany them and are useful for forming sentences.
- They do not usually use compound verb tenses correctly. For example, a patient with this type of aphasia is "The child is hitting the ball" Before a drawing of a child who is hitting a ball in the head.
- Repetition of statements altered. This is the main difference of this type of aphasia with the transcortical motor aphasia, in which the repetition is preserved.
- Anomia: or difficulty finding the right word. It is a common symptom of all Aphasia But it is very remarkable in Broca's aphasia, since it is speech is very little fluid and the patients show great effort in searching the words that is seen in their facial expression and the emission of sustained sounds like"eeeh..."
- The denomination of objects, animals and people is bad, although it can improve if it is aided giving him tracks like saying the first syllable of the word.
- Altered understanding: they do not capture passive passive reversals like"the girl was kissed by the child". However, they do not have problems with active phrases"the child kissed the girl"or active non-reversible"the child fell to the ground".
- Reading impaired, even affecting the understanding of what is read.
- Altered writing, with aphasic writing; Which means that there are problems with writing due to brain damage . His writing is clumsy, slow, abridged and agrammatic. You can see previews (such as Lelo Instead of"hair"), perseverations (such as Pepo Instead of"hair") and omissions of letters or syllables ("libo"instead of"book"). These alterations are virtually the same as those observed when the patient speaks.
- Aprosodia .
- These patients, unlike Wernicke's aphasia, are aware of their limitations as they notice that their pronunciation is not correct and try to correct it.
- Awareness of their problems leads to patients feeling irritated and annoyed, and often make gestures to indicate more clearly what they are trying to say. They may develop symptoms of depression Y anxiety .
- Hemiparesis or right motor paralysis mainly, that can vary in gravity that can go from a weakness in the face until a Total hemiplegia .
- Apraxias As the ideomotor, which implies the inability to use the intact limbs voluntarily to perform the required actions.
- Like other types of aphasia, intellectual abilities that are not related to language are intact (National Aphasia Association, 2016).
- Sensory deficits resulting from the injury, although this is very rare.
How does it originate?
The most common cause is ictus , Especially those that give rise to lesions in the left middle cerebral artery that is the one that irrigates the zones of the language. However, it can also appear by tumors, Cranioencephalic trauma , Infections or after a brain surgery.
Curiously, it seems that for the fact that the appearance of Broca's aphasia is not enough with only one injury in the Broca area , As Paul Broca announced. In fact, if only this area is damaged; There would be a"foreign accent"effect, that is, slight problems in the agility of the articulation of language and some deficits in finding the necessary words. In addition, there would be no hemiparesis or apraxia, which does accompany numerous times to Broca's aphasia described in this article.
Rather the truly known as Broca's aphasia at present arises from lesions in the Broca area, the adjacent lateral cortex ( Areas of Brodmann 6, 8, 9, 10 and 26), the Insula and the White matter Nearby. The basal ganglia also have an important influence on articulation and grammar.
This produces the symptoms that we have indicated here, since these cerebral structures are in charge of the correct use of the prepositions, conjunctions, verbs, etc. Giving rise to problems in both production and understanding as long as they are phrases whose meaning depends on prepositions and specific order of words.
On the other hand, anomia and agrammatism appear to be produced by subcortical or Frontal lobe lower. These symptoms, together with the articulatory deficit, can be combined in different ways depending on the location of the brain damage and the recovery phase in which the patient is.
It seems that in Broca's aphasia there is a deficit in the syntactic processing, which gives rise to problems with the grammatical components of the language. That is to say, there are many phrases in which its meaning depends on a single preposition, adverb or conjunction and if this is not processed well it is not going to be understood.
What types are there?
- Type I aphasia, minor or Broca area: Which is produced by a brain damage that only covers the area of Broca (whose symptoms we described in the previous section).
- Aphasia Type II or extended drill: Occurs when the brain lesion occupies the frontal operculum, the anterior insula, the precentral gyrus and the white matter.
Important do not confuse Broca's aphasia with Dysarthria (Injury to brain areas that control the muscles that are used for speech) or speech apraxia (inability to plan the sequence of movements of oropharyngeal muscles necessary for language due to acquired brain lesions)
What is its prevalence?
Broca's aphasia is the second most frequent type of aphasia after global aphasia (Vidović et al., 2011).
It is also known that it is more frequent in men than in women, the opposite occurring with Wernicke's aphasia .
What is the forecast?
The first few weeks after injury there are always severe and variable symptoms. However, it improves very fast in parallel with brain recovery (usually lasting between 1 and 6 months).
The aphasias that have a better prognosis are those caused by a trauma because they usually occur in young people and the injury is usually not very extensive; While the vascular ones have a worse evolution since among other things, it usually affects older people with a lower brain plasticity And tends to occupy more Parts of the brain .
It can be aggravated by the presence of dysarthria, which consists of difficulties in the execution of movements of the mouth and tongue to produce speech.
How is it evaluated?
- It is very useful when it is suspected that the patient has aphasia, to use the Boston Test for Diagnosis of Aphasia (TBDA). It also helps detect what type of aphasia it is. This test examines all areas of language. Some of them are: understanding, repetition, naming, reading, writing...
- Token Test: It is a group of 20 tokens that have different shapes, sizes and colors. The patient must perform the orders given by the examiner, for example" Touch the blue tab" . This test serves to understand at easier levels and in the most complicated can measure working memory or understanding grammatical structures (which are affected in patients with Broca's aphasia). That is, a patient with this problem would do well the simplest levels, but would have errors when the task rises of difficulty including sentences like: "Place the green circle between the red square and the yellow circle".
- Boston Vocabulary Test: Consists of a group of pictures with drawings that the patient must name.
- Tests of verbal fluency like FAS: In this test the subject must say all the words that occur to him that begins with"f", with"to"and with"s"(which corresponds with fluency of phonological type) whereas in a second phase it must say all the Names of animals you remember (semantic fluency).
- The level of agramatismo can only be seen with the Initial interview
Assess other cognitive functions that may have been altered with brain damage such as:
- Attention and concentration
- Spatial, temporal and personal orientation
- Memory
- Perceptive skills
- Executive functions
- Intellectual capacity
- Processing speed
- Motor aspects
The diagnosis can also be confirmed through Magnetic Resonance tests.
How is it treated?
There is no specific and definite treatment for Broca's aphasia, rather it depends on the patient and his symptoms. The main objective of rehabilitation is to improve the quality of life of the person.
To treat aphasia, we must intervene in:
- Language and communication
- Cognitive-behavioral adaptation of the patient to the environment
- Intervention with the family
- Social ambit
This can be achieved with a multidisciplinary team consisting of: neuropsychologists, speech therapists, physicians, nurses, occupational therapists and social workers.
It is important to keep in mind that in order to design a suitable rehabilitation program, it is necessary to focus on the person, that is, to be exclusively created for that patient to better adapt to their strengths and weaknesses.
It is also essential not to forget the affective aspects. It is very frequent that after the brain injury or by the own conscience of its limitations, the person has anxiety or depression. You can also see changes in emotional expression that need to be monitored and improved.
Awareness of the disease can be useful for the person to be motivated to collaborate with the treatment.
For Broca's aphasia it has been very useful:
- To maximize the linguistic abilities conserved; Such as comprehension of oral and written language by raising levels of difficulty, gesticulation, drawing and simple arithmetic operations.
- Rehabilitate the deficits due to the damaged areas, training:
- The orofacial apraxia, so that the articulation of the language is improved.
- Begin by training the pronunciation of isolated words, then agrammatic phrases and later sentences with simple grammatical structure.
- Writing, by copying and dictation of words.
- Complete texts in which missing words of union to improve the agramatismo.
- Tackle deficits with new technologies, such as encouraging the use of computers or mobiles (it may be necessary here to train in parallel the motor deficits that can accompany aphasia).
On the other hand, it is also used:
- Melodic Intonation Therapy : Since it has been observed that there are patients who, surprisingly, do not have problems of fluency of the language when singing. It seems to use the conserved capacities of the right hemisphere (Melodic and prosodic) and rhythmic features and familiarity with the lyrics of the songs.
Wilson, Parsons & Reutens (2006) defend the benefits of this type of therapy, indicating that they facilitate speech by promoting storage and access to full sentence representations.
However, caution should be exercised in a study by Stahl et al. (2011) indicated that singing was not decisive in the production of speech in this type of aphasia, but what was important was the rhythm itself. They also suggest that good lyrics of these patients may be due to the long-term memory and the automation of song lyrics, whether sung or spoken.
- Induced restriction aphasia therapy : In this type of treatment the patient is"forced"only to speak without using compensatory strategies, unless they are absolutely necessary. The treatment is usually very intense, several hours a day; And is based on the enhancement of brain plasticity mechanisms to recover lost functions (Meinzer et al., 2007).
- In a study Conducted by the University of South Carolina in 2013: it was stated that patients with this type of aphasia significantly improved their verbal output when they had to imitate people who appeared in videos uttering words and phrases.
In this video you can see an example of Broca's aphasia:
References
- Aphasic Appearance . (April 1, 2015). Obtained from Nisa Hospitals. Neurorehabilitation Service.
- Aphasia . (S.f.). Retrieved on June 21, 2016, from the American Speech Language Hearing Association.
- Broca's Aphasia . (S.f.). Retrieved on June 21, 2016, from the National Aphasia Association.
- Meinzer, M., Elbert, T., Djundja, D., Taub, E., & Rockstroh, B. (2007). Extending the Constraint-Induced Movement Therapy (CIMT) approach to cognitive functions: Constraint-Induced Aphasia Therapy (CIAT) of chronic aphasia. Neurorehabilitation, 22 (4), 311-318.
- Sánchez López, M.P., Román Lapuente, F. and Rabadán Pardo, M.J. (2012). Chapter 9: Broca's aphasia. In M. Arnedo Montoro, J. Bembibre Serrano and M. Triviño Mosquera (Ed.), Neuropsychology. Through clinical cases . (Pp. 111-125). Madrid: Medical Editorial Panamericana.
- Stahl, B., Kotz, S., Henseler, I., Turner, R., & Geyer, S. (2011). Rhythm in disguise: why singing may not hold the key to recovery from aphasia. Brain, 13 4 (10): 3083-3093.
- Vidović, M., Sinanović, O., Šabaškić, L., Hatičić, A., & Brkić, E. (2011). Incidence and types of speech disorders in stroke patients. Acta Clinica Croatica, 50 (4), 491-493.
- Wilson, S., Parsons, K., & Reutens, D. (n.d). Preserved singing in aphasia: A case study of the efficacy of melodic intonation therapy. Music Perception, 24 ( 1), 23-35.