When Sharing What’s On Your Mind is a Struggle

My former Academy roommate had a brain tumor – an Oligodendroglioma, to be exact.  The operation to remove it was a remarkable success.  He was in fantastic hands at the major cancer center caring for him….and his family.

Weakened by the cancer and the operation, while at home, he fell and injured the other side of his brain opposite the tumor.  When I first saw him post operation, he was trying to come out the resultant coma and could not speak.  In the weeks and months that followed, speech returned slowly, and the brilliant comedic repertoire of my good friend returned along with it.

A family member had a major stroke a few years back.  While almost all motor function returned to this vibrant man – He would dance up a storm and still carry on like no other – he could no longer speak.  There was no “hitch in his giddy-up”, just an inability to share what was in his mind.

He used props, an always funny and sometimes inappropriate sign language of his own making,  and a pad of paper to communicate with those around him.  He carried pictures to tell his story – one of a strong and valiant military veteran with a lengthy service career who loved his large family, especially his grandkids.

As a result of my friend’s fall and our family member’s stroke, these two amazing men suffered from aphasia.

June is Aphasia Awareness Month.  It is time to Talk About Aphasia (the Theme).

WHAT IS APHASIA ?

While Aphasia is currently impacting the lives of over 2,000,000 Americans, and the number of new cases each year is expected to triple by the year 2020,  nearly  85% of people surveyed say they have never heard the term.  Aphasia is a disturbance of the comprehension and expression of language caused by disfunction in the brain.  Aphasia is a language disorder; a = not and phasia = speaking.  It is not a speech disorder.

Some people with aphasia can understand language but have trouble finding the right words or lack the ability to construct sentences. Many people with aphasia confuse letters of a word. Others speak a lot, but what they say is difficult to understand; these people often have great difficulty understanding language themselves.

Aphasia may make it difficult to:

  • Speak
  • Read
  • Write
  • Understand spoken language
  • Use numbers and complete calculations
  • Use non-verbal gesturing

For people with aphasia, their difficult, daily reality is being unable to share with others what is clearly churning in their mind. They struggle with understanding and producing language.

Because people with aphasia have difficulty communicating, others often mistakenly assume they have problems with normal mental function, but the person’s intelligence is almost always intact.  While people suffering from aphasia cannot reach their language, cannot use the words in their language, and/or do not understand language normally, Aphasia does not affect intelligence!

WHAT IS DYSARTHRIA?

There is a difference between aphasia and dysarthria: Aphasia is language impairment while dysarthria is speech impairment. Literally dysarthria means: articulation difficulty. This may be due to coordination problems or muscle paralysis around the mouth.

Dysarthria may occur as a symptom in specific neurological disorders, for example, a cerebrovascular accident (CVA, more commonly known as stroke), a brain tumor, a brain injury, or a disease – such as Multiple Sclerosis (MS ), Parkinson’s disease and Amyotrophic Lateral Sclerosis (ALS).

A dysarthria may arise suddenly (for example, after a stroke), or gradually, in the case of a progressive disease.  The muscles of the lips, tongue, palate and vocal cords cannot be used properly. Talking is unclear, monotonous, nasal and voice production is weak.  One speaks with irregular intervals.  In short, there is little control when speaking.

Aphasia and dysarthria may co-occur in a single patient making rehabilitation much more difficult.  IN most cases where pure aphasia condition occurs, patients generally return to normal articulation compared to dysarthria patients, for whom speech will almost always be distorted.

Features of dysarthria:

  • Unclear to unintelligible speech
  • Change in the rate of speech, someone is going to talk more quickly or speaks very slowly and precisely.
  • Monotonous voice: no emphasis
  • Too high or too low voice
  • The voice may sound hoarse or very soft
  • Superficial and feeble respiration or very audible breathing in and out
  • Accidental repetition of syllables, syllables or phrases (not to be confused with stuttering)
  • The person may be heard as stuttering while they try to pronounce each syllable separately, or syllables can just blend too much.

WHAT IS APRAXIA (OF SPEECH)?

Apraxia is a disorder of the motor planning of the brain. This kind of disorder is caused by damage that occurs in the cerebrum. While Aphasia is caused by wounds on the left hemisphere of the brain making language function difficult, in Apraxia, the problem is how to control the muscles of mouth and tongue. It’s not always the same words or sounds that are challenging. The person with verbal apraxia simply struggles to pronounce words correctly.


In brief:

  • Aphasia is language impairment caused by stroke, degenerative diseases or head injury that damages that part of the brain where language area is located.
  • Dysarthria is speech impairment that might also be caused by stroke, traumatic head injury, or even impairment from drug or a Phil use. It affects the central or peripheral nervous system resulting in weak or improper muscle control.
  • Apraxia is a disorder of the motor planning of the brain making it a struggle to pronounce words correctly.

HOW DO YOU GET APHASIA ?

Aphasia usually occurs after a hemorrhage in the left hemisphere, because 90% of our language function is situated here…. Strokes that damage the frontal and parietal lobes in the right hemisphere of the brain can also cause a person to have difficulty expressing and processing language.

TYPES OF APHASIA

Aphasia types include expressive aphasiareceptive aphasiaconduction aphasiaanomic aphasiaglobal aphasiaprimary progressive aphasias and many others.  They may be acute or progressive.

Acute aphasia disorders usually develop quickly as a result of head injury or stroke.  Progressive forms of aphasia develop slowly from a brain tumorinfection, or dementia.

The terms Broca’s Aphasia (difficulty with speaking and language) and Wernicke’s Aphasia (impaired language comprehension in listening and reading) are common in diagnosis.  However, the brain is complicated, and understanding the real damage done by injury is even more complicated and extensive.  There is almost always a mixed picture, and many will have global aphasia.

Global Aphasia

Global Aphasia is the most severe form, applied to patients who can produce few recognizable words and understand little or no spoken language. Persons with Global Aphasia can neither read nor write. Like in other milder forms of aphasia, individuals can have fully preserved intellectual and cognitive capabilities unrelated to language and speech.

Global Aphasia is caused by injuries to multiple language-processing areas of the brain, including those classified as Wernicke’s and Broca’s areas. These brain areas are particularly important for understanding spoken language, accessing vocabulary, using grammar, and producing words and sentences.

Global aphasia may often be seen immediately after the patient has suffered a stroke or a brain trauma. Symptoms may rapidly improve in the first few months if the damage has not been too extensive. However, with greater brain damage, severe and lasting disability may result.

Damage to Broca’s region of the brain

In this form of aphasia, speech output is severely reduced and is limited mainly to short utterances of less than four words. Vocabulary access is limited, and the formation of sounds by persons with Broca’s aphasia is often laborious and clumsy.

The person may understand speech relatively well, and even be able to read, but be limited in writing. Broca’s Aphasia is often referred to as a ‘non-fluent aphasia’ because of the halting and labored quality of speech.

Patients with this disorder have problems with spontaneous speech as well as with the repetition of words or phrases. Their speech is often jerky. They also have difficulty understanding grammatical aspects of language, also called agrammatism – the inability to speak in a grammatically correct fashion.  People with agrammatism may have telegraphic speech.

This is evident not only in language expression, but also the understanding of sentences. For example, the phrase, “The boy ate the cookie,” is less problematic than the more complex sentence, “The boy was kicked by the girl”.  The second sentence is more difficult. If the patient is asked to repeat this sentence, he will probably say, “Boy kicks girl”.

Wernicke’s Aphasia

Damage in Wernicke’s area of the brain – the region of the brain that plays a role in understanding language – is  named after the discoverer Carl Wernicke.  It is also called the sensory speech center and is distinctly different than the motor speech center.

In this form of aphasia, the ability to grasp the meaning of spoken words is chiefly impaired, while the ease of producing connected speech is not much affected. Therefore, Wernicke’s aphasia is referred to as a ‘fluent aphasia.’

However, speech is far from normal. Sentences do not hang together and irrelevant words intrude-sometimes to the point of jargon, in severe cases. Reading and writing are often severely impaired. Disease or damage in Wernicke’s region can lead to dyslexia and sensory aphasia.

The spoken language of Wernicke patients usually sounds smooth but lacks meaning. The Wernicke’s area is found in the left temporal lobe of the brain.

THERAPY AND RECOVERY

Aphasia is different for everyone. The severity and extent of aphasia depend on the location and severity of the brain injury, their former language ability and even one’s personality.  While a full recovery from aphasia is possible, if symptoms persist long enough – usually more than six months – a complete recovery becomes increasingly unlikely.

Speech therapy is the most common treatment for aphasia. Other types of therapy have also proven effective for some stroke survivors, including:

  • Melodic intonation therapy sometimes allows stroke survivors to sing words they cannot speak. Also called Speech Music Therapy Aphasia/ SMTA
  • Art therapy
  • Visual speech perception therapy focuses on associating pictures with words.
  • Constraint-induced language therapy involves creating a scenario in which spoken verbal communication is the only available option, and other types of communication, such as visual cues from body language, are not possible.
  • Group therapy and support groups

If you have aphasia:

  • Stay calm. Take one idea at a time.
  • Draw or write things down on paper.
  • Show people what works best for you.
  • Use props to make conversation easier (photos, maps).
  • Use the Internet to connect to people via email or to create a personal webpage.
  • Take your time. Make phone calls or try talking only when you have plenty of time.
  • Create a communication book that includes words, pictures and symbols that are helpful.
  • Carry and show others a card or paper explaining what aphasia is and that you have it. Keep it in your purse or wallet.

It is important to speak with medical professionals about finding speech and language therapy as soon as possible after aphasia has been diagnosed.  You might use HealthLynked to find the right physician for you.

In HealthLynked, patients and physicians “Lynk” together in ways they never have been able to in the past, creating a network of practitioners and those seeking their services where enhanced collaboration on wellness is enabled through the most efficient exchange of health information.

Ready to get Lynked?  Go to HealthLynked.com today to get started for free!

Sources:

aphasia.org

strokeassociation.org

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