Aphasia is a language disorder that can have deleterious effects on the quality of life of the patient. The condition often occurs secondary to stroke; however, it has also been linked to a number of other causes.
Aphasia is characterized by the progressive loss of aspects of linguistic competence, resulting in language impairment. Language impairment includes the loss of language production as well as comprehension. Impairment in the cognitive domain is also associated along with the loss in linguistic abilities.
What causes aphasia?
Aphasia is caused by damage to the left hemisphere, the region of the brain responsible for language comprehension in most persons. However, there have been instances of crossed aphasia, in which the right hemisphere of the brain is affected.
The most common causes of aphasia are stroke, ischemia, serious brain injury, brain cancer and infection. Surgery of the brain and progressive nerve diseases such as dementia are some other causes.
What are the common signs and symptoms of aphasia?
The development of symptoms of aphasia depends largely on the underlying cause and affects everyone differently. The symptoms may develop suddenly (e.g. in stroke) or may develop gradually over a period of time in conditions such as dementia.
- Difficulty in the expression of language - This may involve problems in finding appropriate words, increased usage of single words and short sentences, usage of telegraphic speech etc.
- Difficulty in comprehension of language – This may involve problems with understanding spoken words and messages. Patients also have problems understanding grammar and follow fast speech.
- Agraphia or inability to communicate via written words.
- Alexia or impairments in reading ability.
What are the treatment approaches for aphasia?
Aphasia can be treated using impairment-based approaches or functionally oriented interventions.
Impairment-based approaches focus on improving language functions. This involves strategies such as word retrieval, brain mechanism influence, constraint-induced methods and brain stimulation via non-invasive techniques.
Word retrieval is the main focus of all treatment interventions for aphasia. The approach involves the use of phonological and semantic cues to improve word retrieval. It includes activities such as “fill in the blanks”, rhyming cues, training on antonyms/synonyms etc.
Constraint-Induced Methods (CILT)
CILT encourages the use of verbal communication and discourages the use of gesturing and writing. It is said that this approach helps in reactivating the left hemisphere of the brain, which is involved in language processing.
Non-invasive Brain Stimulation (NBS)
Non-invasive brain stimulation (NBS) also works on the same principle as CILT. It helps to modulate the language relevant left hemisphere of the brain.
Functionally oriented interventions
This treatment involves the use of supported conversation and aphasia groups.
The approach focuses on re-engaging patient in life. The focus of this treatment depends on each person’s individual needs and basically encourages the use of daily communication activities.
In supported conversation, the patient leads the conversation, and the communication partner (family or physician; nurse) follows the patient’s lead. The method encourages the use of spoken words, body language, gesturing, and the use of pictographs by the patient. This approach can also be used in group settings.
The treatment strategy involves the participation of multiple people with aphasia. The use of groups promotes pragmatic skills. It also increases the use of a multitude of communication functions and speech acts.
When deciding upon a treatment strategy, the focus should be on providing a multi-faceted program that is based around the patient’s needs. The approach should involve the use of both the impairment and functional interventions. Involving patients the treatment decisions is also vital for ensuring the best outcomes.