Aphasia (pronounced /əˈfeɪʒə/ or pronounced /əˈfeɪziə/) is an acquired language disorder Language disorders or language impairments are disorders that involve the processing of linguistic information. Problems that may be experienced can involve grammar , semantics (meaning), or other aspects of language. These problems may be receptive (involving impaired language comprehension), expressive (involving language production), or a in which there is an impairment of any language modality. This may include difficulty in producing or comprehending spoken or written language.

Traditionally, aphasia suggests the total impairment of language ability, and dysphasia a degree of impairment less than total. However, the term dysphasia is easily confused with dysphagia Dysphagia is the medical term for the symptom of difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, the term is sometimes used as a condition in its own right. Sufferers are sometimes unaware of their dysphagia, a swallowing disorder, and thus aphasia has come to mean both partial and total language impairment in common use.

Depending on the area and extent of brain damage, someone suffering from aphasia may be able to speak but not write, or vice versa, or display any of a wide variety of other deficiencies in language comprehension and production, such as being able to sing but not speak. Aphasia may co-occur with speech disorders such as dysarthria Dysarthria is a motor speech disorder resulting from neurological injury, characterized by poor articulation . Any of the speech subsystems (respiration, phonation, resonance, prosody, articulation and movements of jaw and tongue) can be affected or apraxia Apraxia is a disorder caused by damage to specific areas of the cerebrum, characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements. It is a disorder of motor planning which may be acquired or developmental, but may not be caused by of speech, which also result from brain damage.

Aphasia can be assessed in a variety of ways, from quick clinical screening at the bedside to several-hour-long batteries of tasks that examine the key components of language and communication. The prognosis of those with aphasia varies widely, and is dependent upon age of the patient, site and size of lesion, and type of aphasia.

Classification

Classifying the different subtypes of aphasia is difficult and has led to disagreements among experts. The localizationist model is the original model, but modern anatomical techniques and analyses have shown that precise connections between brain regions and symptom classification don't exist. The neural organization of language is complicated; language is a comprehensive and complex behavior and it makes sense that it isn't the product of some small, circumscribed region of the brain. No classification of patients in subtypes and groups of subtypes is adequate. Only about 60% of patients will fit in a classification scheme such as fluent/nonfluent/pure aphasias. There is a huge variation among patients with the same diagnosis, and aphasias can be highly selective. For instance, patients with naming deficits (anomic aphasia) might show an inability only for naming buildings, or people, or colors.^[1]

Localizationist model

The localizationist model attempts to classify the aphasia by major characteristics and then link these to areas of the brain in which the damage has been caused. The initial two categories here were devised by early neurologists working in the field, namely Paul Broca Pierre Paul Broca was a French physician, anatomist, and anthropologist. He was born in Sainte-Foy-la-Grande, Gironde. He is best known for his research on Broca's area, a region of the frontal lobe that has been named after him and Carl Wernicke Carl Wernicke was a German physician, anatomist, psychiatrist and neuropathologist. He earned his medical degree at the University of Breslau (1870). He died in Germany due to injuries suffered during a bicycle accident. Other researchers have added to the model, resulting in it often being referred to as the "Boston-Neoclassical Model". The most prominent writers on this topic have been Harold Goodglass and Edith Kaplan Edith Kaplan was a respected pioneer of neuropsychological tests who did most of her work at the Boston VA Hospital. Throughout her 50-year career in psychology, Dr. Edith Kaplan made invaluable contributions to the promotion of clinical neuropsychology as a specialty area in psychology. Her impact on our field is widespread, and encompasses many.

• Individuals with Broca's aphasia (also termed expressive aphasia Expressive aphasia, known as Broca's aphasia in clinical neuropsychology and agrammatic aphasia in cognitive neuropsychology, is caused by damage to or developmental issues in anterior regions of the brain, including the left posterior inferior frontal gyrus known as Broca's area (Brodmann area 44 and Brodmann area 45). Expressive aphasia is one) were once thought to have ventral temporal damage, though more recent work by Nina Dronkers using imaging and 'lesion analysis' has revealed that patients with Broca's aphasia have lesions to the medial insular cortex. Broca missed these lesions because his studies did not dissect the brains of diseased patients, so only the more temporal damage was visible. Individuals with Broca's aphasia often have right-sided weakness Hemiplegia is a condition in which the limbs on one side of the body have severe weakness. Hemiplegia is more severe than hemiparesis, wherein one half of the body has less marked weakness. Hemiplegia may be congenital or acquired from an illness or stroke or paralysis of the arm and leg, because the frontal lobe is also important for body movement.

• In contrast to Broca's aphasia, damage to the temporal lobe The temporal lobe is a region of the cerebral cortex that is located beneath the Sylvian fissure on both the left and right hemi hellospheres of the brain may result in a fluent aphasia that is called Wernicke's aphasia (also termed sensory aphasia). These individuals usually have no body weakness, because their brain injury is not near the parts of the brain that control movement.

• Working from Wernicke's model of aphasia, Ludwig Lichtheim proposed five other types of aphasia, but these were not tested against real patients until modern imaging made more indepth studies available. The other five types of aphasia in the localizationist model are:

1. Pure word deafness Pure Word Deafness is caused by bilateral damage to the posterior superior temporal lobes or disruption of connections between these areas. It exhibits itself as inability to comprehend the meaning of speech, but still being able to hear, speak, read, and write
2. Conduction aphasia Conduction aphasia, also called associative aphasia, is a relatively rare form of aphasia. An acquired language disorder, it is characterized by intact auditory comprehension, fluent speech production, but poor speech repetition. Patients will display frequent errors during spontaneous speech, substituting or transposing sounds. They will also be
3. Apraxia Apraxia is a disorder caused by damage to specific areas of the cerebrum, characterized by loss of the ability to execute or carry out learned purposeful movements, despite having the desire and the physical ability to perform the movements. It is a disorder of motor planning which may be acquired or developmental, but may not be caused by of speech, which is now considered a separate disorder in itself.
4. Transcortical motor aphasia
5. Transcortical sensory aphasia

• Anomia Anomia is usually caused by brain trauma, such as an accident, stroke, or tumor. Dysnomia refers to a less severe form of this word-recall dysfunction. Learning disabilities caused by name-recall problems are usually diagnosed as dysnomia rather than anomia, but a review of the literature shows significant confusion between the two terms.[citation is another type of aphasia proposed under what is commonly known as the Boston-Neoclassical model, which is essentially a difficulty with naming. A final type of aphasia, global aphasia, results from damage to extensive portions of the perisylvian region of the brain.

Other ways to Classify Aphasia

Fluent, non-fluent and "pure" aphasias

The different types of aphasia can be divided into three categories: fluent, non-fluent and "pure" aphasias.^[2]

• Fluent aphasias, also called receptive aphasias, are impairments related mostly to the input or reception of language, with difficulties either in auditory verbal comprehension or in the repetition of words, phrases, or sentences spoken by others. Speech is easy and fluent, but there are difficulties related to the output of language as well, such as paraphasia Paraphasia is a feature of aphasia in which one loses the ability of speaking correctly, substitutes one word for another, and changes words and sentences in an inappropriate way. The patient's speech is fluent but is error-prone, e.g. 'treen' instead of 'train'. Examples of fluent aphasias are: Wernicke's aphasia, Transcortical sensory aphasia, Conduction aphasia Conduction aphasia, also called associative aphasia, is a relatively rare form of aphasia. An acquired language disorder, it is characterized by intact auditory comprehension, fluent speech production, but poor speech repetition. Patients will display frequent errors during spontaneous speech, substituting or transposing sounds. They will also be, Anomic aphasia^[2]

• Nonfluent aphasias, also called expressive aphasias are difficulties in articulating, but in most cases there is relatively good auditory verbal comprehension. Examples of nonfluent aphasias are: Broca's aphasia, Transcortical motor aphasia, Global aphasia^[2]

• "Pure" aphasias are selective impairments in reading, writing, or the recognition of words. These disorders may be quite selective. For example, a person is able to read but not write, or is able to write but not read. Examples of pure aphasias are: Alexia Alexia is an acquired type of sensory aphasia where damage to the brain causes a patient to lose the ability to read. It is also called word blindness, text blindness or visual aphasia, Agraphia Dysgraphia is a deficiency in the ability to write, regardless of the ability to read, not due to intellectual impairment, Pure word deafness Pure Word Deafness is caused by bilateral damage to the posterior superior temporal lobes or disruption of connections between these areas. It exhibits itself as inability to comprehend the meaning of speech, but still being able to hear, speak, read, and write^[2]

Primary and secondary aphasia

Aphasia can be divided into primary and secondary aphasia.

• Primary aphasia is due to problems with language-processing mechanisms.
• Secondary aphasia is the result of other problems, like memory impairments, attention disorders, or perceptual problems.

Cognitive neuropsychological model

The cognitive neuropsychological model builds on cognitive neuropsychology Cognitive neuropsychology is a branch of cognitive psychology that aims to understand how the structure and function of the brain relates to specific psychological processes. It places a particular emphasis on studying the cognitive effects of brain injury or neurological illness with a view to inferring models of normal cognitive functioning. It assumes that language processing can be broken down into a number of modules, each of which has a specific function. Hence there is a module which recognises phonemes In a language or dialect, a phoneme is the smallest segmental unit of sound employed to form meaningful contrasts between utterances as they are spoken and a module which stores formulated phonemes before they are spoken. Use of this model clinically involves conducting a battery of assessments (usually from the PALPA), each of which tests one or a number of these modules. Once a diagnosis is reached as to where the impairment lies, therapy can proceed to treat the individual module.

Acquired childhood aphasia

Acquired childhood aphasia (ACA) is a language impairment resulting from some kind of brain damage. This brain damage can have different causes, such as head trauma Head injury refers to trauma to the head. This may or may not include injury to the brain. However, the terms traumatic brain injury and head injury are often used interchangeably in the medical literature, tumors A tumor or tumour is the name for a neoplasm or a solid lesion formed by an abnormal growth of cells which looks like a swelling. Tumor is not synonymous with cancer. A tumor can be benign, pre-malignant or malignant, whereas cancer is by definition malignant, cerebrovascular Cerebrovascular disease is a group of brain dysfunctions related to disease of the blood vessels supplying the brain. Hypertension is the most important cause; it damages the blood vessel lining, endothelium, exposing the underlying collagen where platelets aggregate to initiate a repairing process which is not always complete and perfect accidents, or seizure disorders. Most, but not all authors state that ACA is preceded by a period of normal language development.^[3] Age of onset The age of onset is a medical term referring to the age at which an individual acquires, develops, or first experiences a condition or symptoms of a disease or disorder is usually defined as from infancy The term infant derives from the Latin word infans, meaning "unable to speak or speechless." It is typically applied to children between the ages of 1 month and 12 months; however, definitions vary between birth and 3 years of age until but not including adolescence Adolescence is a transitional stage of physical and mental human development generally occurring between puberty and legal adulthood (age of majority), but may also be defined as ending with the teenage stage. According to Erik Erikson's stages of human development, for example, a young adult is generally a person between the ages of 20 and 40,.

ACA should be distinguished from developmental aphasia or developmental dysphasia, which is a primary delay or failure in language acquisition Language acquisition is the process by which humans acquire the capacity to perceive, produce and use words to understand and communicate. This capacity involves the picking up of diverse capacities including syntax, phonetics, and an extensive vocabulary. This language might be vocal as with speech or manual as in sign. Language acquisition.^[4] An important difference between ACA and developmental childhood aphasia is that in the latter there is no apparent neurological Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue, such as muscle. The corresponding surgical specialty basis for the language deficit.^[5]

ACA is one of the more rare language problems in children and is notable because of its contribution to theories on language and the brain.^[4] Because there are so few children with ACA, not much is known about what types of linguistic problems these children have. However, many authors report a marked decrease in the use of all expressive language. Children can just stop talking for a period of weeks or even years, and when they start to talk again, they need a lot of encouragement. Problems with language comprehension Many studies of the human language comprehension process have focused on reading of single utterances without context. Extensive research has shown, however, that language comprehension is affected also by context preceding a given utterance, as well as many other factors are less common in ACA, and don't last as long.^[6]

Signs and symptoms

People with aphasia may experience any of the following behaviors due to an acquired brain injury, although some of these symptoms may be due to related or concomitant problems such as dysarthria or apraxia and not primarily due to aphasia.

• inability to comprehend language Many studies of the human language comprehension process have focused on reading of single utterances without context. Extensive research has shown, however, that language comprehension is affected also by context preceding a given utterance, as well as many other factors
• inability to pronounce Pronunciation refers to the way a word or a language is spoken, or the manner in which someone utters a word. If one is said to have "correct pronunciation", then it refers to both within a particular dialect, not due to muscle paralysis or weakness
• inability to speak spontaneously
• inability to form words
• inability to name objects
• poor enunciation In phonetics, enunciation is the act of speaking. Good enunciation is the act of speaking clearly and concisely. The opposite of good enunciation is mumbling or slurring. See also "pronunciation" which is a component of enunciation. Pronunciation is to pronounce sounds of words correctly
• excessive creation and use of personal neologisms A neologism ; from Greek νέος (neos 'new') + λόγος (logos 'speech') is a newly coined word that may be in the process of entering common use, but has not yet been accepted into mainstream language. Neologisms are often directly attributable to a specific person, publication, period, or event. According to Oxford English Dictionary the
• inability to repeat a phrase
• persistent repetition of phrases
• paraphasia Paraphasia is a feature of aphasia in which one loses the ability of speaking correctly, substitutes one word for another, and changes words and sentences in an inappropriate way. The patient's speech is fluent but is error-prone, e.g. 'treen' instead of 'train' (substituting letters, syllables or words)
• agrammatism Agrammatism is a form of expressive aphasia that refers to the inability to speak in a grammatically correct fashion. People with agrammatism may have telegraphic speech, a unique speech pattern with simplified formation of sentences , akin to that found in telegraph messages. Deficits in agrammaticism are often language-specific, however—in (inability to speak in a grammatically correct fashion)
• dysprosody Dysprosody, which is also known as pseudo-foreign dialect syndrome, refers to a disorder in which one or more of these prosodic functions are either compromised or eliminated completely (alterations in inflexion, stress, and rhythm)
• incompleted sentences
• inability to read Reading is a complex cognitive process of decoding symbols for the intention of deriving meaning and/or constructing meaning. Written information is received by the retina, processed by the primary visual cortex, and interpreted in Wernicke's area
• inability to write Writing is the representation of language in a textual medium through the use of a set of signs or symbols . It is distinguished from illustration, such as cave drawing and painting, and non-symbolic preservation of language via non-textual media, such as magnetic tape audio
• limited verbal output
• difficulty in naming

The following table summarizes some major characteristics of different types of aphasia:

Jargon aphasia is a fluent or receptive aphasia in which the patient's A patient is any person who receives medical attention, care, or treatment. The person is most often ill or injured and in need of treatment by a physician or other health care professional, although one who is visiting a physician for a routine check-up may also be viewed as a patient speech Speech is the vocalized form of human communication. It is based upon the syntactic combination of lexicals and names that are drawn from very large vocabularies. Each spoken word is created out of the phonetic combination of a limited set of vowel and consonant speech sound units. These vocabularies, the syntax which structures them, and their is incomprehensible, but appears to make sense to them. Speech is fluent and effortless with intact syntax In linguistics, syntax is the study of the principles and rules for constructing sentences in natural languages and grammar In linguistics, grammar is the set of structural rules that govern the composition of sentences, phrases, and words in any given natural language. The term refers also to the study of such rules, and this field includes morphology, syntax, and phonology, often complemented by phonetics, semantics, and pragmatics. Linguists do not normally use the, but the patient has problems with the selection of nouns A noun can co-occur with an article or an attributive adjective. Verbs and adjectives can't. In the following, an asterisk in front of an example means that this example is ungrammatical. They will either replace the desired word with another that sounds or looks like the original one, or has some other connection, or they will replace it with sounds. Accordingly, patients with jargon aphasia often use neologisms, and may perseverate if they try to replace the words they can't find with sounds.

Commonly, substitutions involve picking another (actual) word starting with the same sound (e.g. clocktower - colander), picking another se

Causes

Aphasia usually results from lesions to the language-relevant areas of the frontal, temporal and parietal lobes of the brain, such as Broca's area, Wernicke's area, and the neural pathways between them. These areas are almost always located in the left hemisphere, and in most people this is where the ability to produce and comprehend language is found. However, in a very small number of people, language ability is found in the right hemisphere. In either case, damage to these language areas can be caused by a stroke, traumatic brain injury, or other brain injury. Aphasia may also develop slowly, as in the case of a brain tumor or progressive neurological disease, e.g., Alzheimer's or Parkinson's disease. It may also be caused by a sudden hemorrhagic event within the brain. Certain chronic neurological disorders, such as epilepsy or migraine, can also include transient aphasia as a prodromal or episodic symptom.^{[citation needed]} Aphasia is also listed as a rare side effect of the fentanyl patch, an opioid used to control chronic pain.^[7]

Treatment

There is no one treatment proven to be effective for all types of aphasias. Melodic intonation therapy is often used to treat non-fluent aphasia and has proved to be very effective in some cases.

History

The first recorded case of aphasia is from an Egyptian papyrus, the Edwin Smith Papyrus, which details speech problems in a person with a traumatic brain injury to the temporal lobe.^[8]

Notable cases

• Knut Hamsun^[9]
• Ralph Waldo Emerson^[10]

See also

• Aphasiology
• Speech disorder
• Dysnomia disorder
• Aprosodia
• Dysprosody
• Glossolalia

Notes

1. ^ Kolb, Bryan; Whishaw, Ian Q. (2003). Fundamentals of human neuropsychology. [New York]: Worth. pp. 502, 505, 511. ISBN 0-7167-5300-6. OCLC 464808209.
2. ^ ^{a b c d} Kolb, Bryan; Whishaw, Ian Q. (2003). Fundamentals of human neuropsychology. [New York]: Worth. pp. 502-504. ISBN 0-7167-5300-6. OCLC 464808209.
3. ^ Murdoch, B. E. (1990). Acquired neurological speech/language disorders in childhood. Washington, DC: Taylor & Francis. ISBN 0-85066-490-X. OCLC 21976166.
4. ^ ^{a b} Woods, Bryan T. (1995). "Acquired childhood aphasia". in Kirshner, Howard S.. Handbook of neurological speech and language disorders. New York: M. Dekker. ISBN 0-8247-9282-3. OCLC 31075598.
5. ^ Paquier, P.F.; van Dongen (1998). "Is Acquired Childhood Aphasia Atypical?". in Basso, Anna; Coppens, Patrick; Lebrun, Yvan. Aphasia in atypical populations. Hillsdale, N.J: Lawrence Erlbaum Associates. ISBN 0-8058-1738-7. OCLC 37712996.
6. ^ Baker, Lorian; Cantwell, Dennis P. (1987). Developmental speech and language disorders. New York: Guilford Press. ISBN 0-89862-400-2. OCLC 14520470.
7. ^ "Fentanyl Transdermal Official FDA information, side effects and uses.". Drug Information Online. http://www.drugs.com/pro/fentanyl-transdermal.html#A02A9CB6-35CF-4F01-A980-C3733E0F861A.
8. ^ McCrory PR, Berkovic SF (December 2001). "Concussion: the history of clinical and pathophysiological concepts and misconceptions". Neurology 57 (12): 2283–9. PMID 11756611. http://www.neurology.org/cgi/content/abstract/57/12/2283.
9. ^ http://medical-dictionary.thefreedictionary.com/Afasi
10. ^ Richardson, Robert G. (1995). Emerson: the mind on fire: a biography. Berkeley: University of California Press. ISBN 0-520-08808-5. OCLC 31206668.

References

Handbooks

• Primary Progressive Aphasia (PPA) Handbook (Northwestern University)
• Lass, Norman J. (1988). Handbook of Speech-Language Pathology and Audiology. St. Louis: Mosby-Year Book. ISBN 1-55664-037-4. OCLC 18543553.
• Kent, Raymond D. (1994). Reference manual for communicative sciences and disorders: speech and language. Austin, Tex: Pro-Ed. ISBN 0-89079-419-7. OCLC 28889985.

Bibliographic Databases

• MLA International Bibliography
• Linguistics Abstracts Online
• Linguistics and Language Behavior Abstracts
• Encyclopedia of the Human Brain
• PsycINFO

Specialized Bibliographies

• MD Consult
• Psychology and Behavioral Sciences Collection
• Health Reference Complete (Academic)

Academic references

• Dr. Kalina Christoff, The Cognitive Neuroscience of Thought Laboratory publication
• Chapey, Roberta (2008). Language intervention strategies in aphasia and related neurogenic communication disorders. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. ISBN 0-7817-6981-7. OCLC 173201745.
• Barresi, Barbara; Goodglass, Harold; Kaplan, Edith (2001). The assessment of aphasia and related disorders. Hagerstwon, MD: Lippincott Williams & Wilkins. ISBN 0-683-03604-1. OCLC 43650748.
• Coltheart, Max; Kay, Janice; Lesser, Ruth (1992). PALPA psycholinguistic assessments of language processing in aphasia. Hillsdale, N.J: Lawrence Erlbaum Associates. ISBN 0-86377-166-1. OCLC 221303581.
• Risser, Anthony H.; Spreen, Otfried (2003). Assessment of aphasia. Oxford [Oxfordshire]: Oxford University Press. ISBN 0-19-514075-3. OCLC 474049850.
• Jürgen Tesak; Christopher Code (2008). Milestones in the History of Aphasia: Theories and Protagonists (Brain Damage, Behaviour, and Cognition). East Sussex: Psychology Press. ISBN 1-84169-513-0. OCLC 165957752.
• Leonard L., PhD. Lapointe (2004). Aphasia And Related Neurogenic Language Disorders. New York: Thieme Medical Publishers. ISBN 1-58890-226-9. OCLC 57071469.
• Byng, Sally; Duchan, Judith F.; Felson Duchan, Judith (2004). Challenging Aphasia Therapies: Broadening the Discourse and Extending the Boundaries. East Sussex: Psychology Press. ISBN 1-84169-505-X. OCLC 473789757.
• De Bleser, Ria; Papathanasiou, Ilias (2003). The sciences of aphasia from therapy to theory. Amsterdam: Pergamon. ISBN 0-585-47448-6. OCLC 53277297.

Personal experiences of aphasia

• Sheila Hale (2002). The man who lost his language. London: Allen Lane. ISBN 0-7139-9361-8. OCLC 50099900.
• Stephanie Mensh; Berger, Paul D.; Whitaker, Julian M. (2002). How to conquer the world with one hand-- and an attitude. Positive Power Pub. ISBN 0-9668378-7-8. OCLC 52445790.
• Cindy Greatrex (2005) Aphasia in the Deaf Community.
• Dardick, Geeta (1991), Prisoner of Silence, Reader's Digest, June issue

Categories: Aphasias | Communication disorders | Neurological disorders | Alexia acquired dyslexia | Language disorders | Symptoms and signs: Speech and voice

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