Workgroup 2: Language & aphasia

What is aphasia?

Aphasia is an acquired disorder in language comprehension and language production in both speaking and writing. It is important to note that when a person acquired aphasia, intellectual capacities will remain.

There are different kinds of aphasia. Wernicke’s aphasia (sensory or receptive aphasia) is the ability to speak fluent, but the patient’s language comprehension is reduced. It is based around the superior temporal gyrus. Global aphasia is when the patient is not able to speak fluently, and the language comprehension is reduced as well. Anomic amnesia is the least severe. The patient has word retrieval failures and cannot express the words they want to say. Broca’s aphasia (motor or expressive aphasia) is when the patient has a good comprehension of language, but is not able to speak fluently. It is based around the inferior frontal gyrus.

There are 30.000 people with aphasia in the Netherlands. The most common cause of aphasia is CVA. Other caused are tumors, surgeries, trauma and neurogenerative diseases, like Alzheimer’s. About 75% of the people with aphasia is incapacitated due to aphasia. About 90% of the people with aphasia gets a feeling of being socially isolated from others.

Terminology

Speech automatism / recurring utterance

Constantly recurring fixed utterance, consisting of a combination of syllables, random words or sentences, and not appropriate for the context (e.g. do-do-do, “heerlijk, helder Heineken” (beer slogan / “Guinness is good for you”)).

Stereotype

Fixed formula that constantly recurs, but is usually appropriate for the situation (and so on, my God, you know what I mean)

Paraphasia

• Phonemic = Change in the sound of a word, target word is recognisable (man instead of map, aprizol instead of apricot)
• Semantic = Incorrect use of a word belonging to the same meaning category as the target word (mother instead of woman, axe instead of chisel).

Neologism new form, non-existent word.

• Semantic (snakethings instead of spaghetti; pay-machine instead of checkout)
• Phonological (rotal instead of telephone)

Jargon incomprehensible language

• Phonological = new words used in sequence, often with foreign accent!
• Semantic = existing words used in sequence without meaning.

Perseveration

Word-for-word repetition of an utterance previously said by the patient

Echolalia

Repetition of the other person’s utterances

Dysarthria

Difficulty with articulation (due to paralysis)

Dysprosody

Disturbance in intonation, emphasis, rhythm of speech

Paragrammatism

Combining different grammatical structures that don’t go together

Agrammatism

Inappropriate omission of function words (telegram style)

Diagnosis and treatment

When following the diagnostic process, the neuropsychologist will do an administration of language test to test the following abilities:

• Spontaneous speech
• Naming
• Verbal or written word fluency
• Repetition
• Comprehension
• Writing
• Reading aloud

Speech therapy is a very common type of therapy to use with aphasia. Therapy goals will be set, advice will be given and the neuropsychologist will use different kinds of tools, like a book with pictures of objects. During the first week it’s important to regain as much linguistic abilities as possible. In later stages, treatment of aphasia patients is more aimed at improving her/his daily communicative functioning

Characteristics of Broca’s aphasia

Language production: very slowed down

Articulation: often dysarthria, very laborious articulation

Prosody: often flattened

Sentence structure: agrammatism (telegram style), defective sentence structure

Word choice: very limited vocabulary, word-finding problems, not many semantic paraphasias

Sound structure: many phonemic paraphasias

Language comprehension: slight/moderate disturbance, difficulty with complex sentences

Others: self-improvement, communication mainly impaired by expressive disturbance

Characteristics of Wernicke’s aphasia

Language production: fluent

Articulation: not disturbed

Prosody: not disturbed

Sentence structure: paragrammatism (expansion and contraction of sentences and sentence constituents)

Word choice: many semantic paraphasias, often very difficult from the target word, semantic neologism (jargon)

Sound structure: many phonemic paraphasias, sometimes neologisms (jargon)

Language comprehension: severely disturbed

Others: excessive, but meaningless speech production, poor listening attitude, not much insight, no self-improvement, severely disturbed communication

Characteristics of anomic aphasia

Language production: very fluent

Articulation: not disturbed

Prosody: not disturbed

Sentence structure: only very slight disturbance

Word choice: replacement strategies with word-finding problems, a few semantic paraphasias

Sound structure: a few phonemic paraphasias

Language comprehension: slightly disturbed

Others: good communicative skills, descriptions are often laborious and not very informative

Characteristics of global aphasia

Language production: little or none, speech automatisms

Articulation: often dysarthria

Prosody: often flattened

Sentence structure: only separate words, speech automatisms

Word choice: very limited vocabulary, highly divergent semantic paraphasias

Sound structure: very many phonemic paraphasias, neologisms

Language comprehension: severely disturbed, only concrete and emotionally charged

Others: all aspects of language and speaking are severely disturbed, also virtually non-verbal communication, aware of communication problems