Aphasia: a common disorder after brain damage

This language disorder is characterized by a loss, impairment or alteration of the ability to use language, which occurs as a sequel to brain damage suffered at any time after the acquisition and development of basic language skills in the subject (Omar, 2012; Ardila, 2006). Aphasia severely hinders the personal, family and social life of the affected person, and has consequences in the family environment.

The most prevalent symptom in this disorder is anomia, difficulty in recalling words (Helm-Estabrooks and Albert, 2005) and difficulties in literate language (Gonzalez and Hornauer-Hughes, 2014).

In the last 200 years, aphasia has occupied a preeminent place among speech disorders, being one of the most studied language pathologies. The results of the studies by Broca and Wernicke, in 1862 and 1874, on motor and sensory aphasia are now classics. The interest in aphasia has given rise to the development of numerous research studies; today there are more than 450,000 articles offered by Google Scholar with a search for aphasia and more than 17,000 in PubMed.

Between 21% and 38% of people with a stroke develop aphasia.

Regarding the age of onset of aphasia, it is more frequent in adults and the elderly, although children also suffer from it; its causes are cerebrovascular accident, encephalocranial trauma, brain tumors, brain infections and neurodegenerative diseases (La Pointe, 2011). Among the various neurological disorders, aphasia is the most common among stroke patients; between 21% and 38% of stroke patients develop this speech disorder (Lavados and Hoppe, 2005; Lavados, Sacks, Prina et al., 2005).

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Effective treatment for aphasia

Effective treatment requires a thorough and personalized assessment of the patient’s difficulties.

The areas of language studied in patients with aphasia are their oral expression and comprehension abilities, as well as their reading and writing skills (González-Lázaro, P. and González-Ortuño, B. (2012). Standardized tests are available to help perform this assessment, such as the Boston Test (García-Albea and Sánchez-Bernardos, 1986; Kaplan, Goodglass and Weintraub, 1978), the Western Aphasia Battery (WAB) by Kertestz (1982) and the Barcelona Test developed by J. Peña-Casanova (1991); these tests review the patient’s performance level in the different language areas, thus guiding the speech therapy intervention and facilitating the determination of the patient’s evolution.

In the evaluation of patients with aphasia, given the neurological origin of the disorder, it is common for them to suffer cognitive alterations, which must be taken into account, both in the evaluation and in the speech therapy treatment.

Gonzalez and Hornauer-Hughes (2014) point out as objectives of the speech therapy rehabilitation of aphasia the satisfaction of the communicative demands of daily life in the patient’s family, social and/or work environment, in addition to restoring functional communication, which may require the use of augmentative and alternative means.

Therapeutic programs to improve verbal expression (Helm-Estabrooks and Albert, 2005):

  • Voluntary control of involuntary productions.
  • Treatment of aphasia perseveration.
  • Melodic intonation therapy.
  • Visual action therapy.
  • Communicative drawing program.
  • Copy and recall anagram therapy.
  • Computer-assisted communicative and alternative approaches to non-fluent aphasia.
  • Treatment for Wernicke’s aphasia.

Bibliography

  • Ardila, A. (2006). Aphasia. Miami: Florida International University.
  • Garcia-Albea, J. E. and Sanchez-Bernardos, M. L. (1986). Boston Test for the Diagnosis of Aphasia. The assessment of aphasia and related disorders. Spanish adaptation. Panamericana, Madrid.
  • Gonzalez, R. and Hornauer-Hughes, A. (2014): Aphasia: a clinical perspective. Rev Hosp Clín Univ Chile, 25: 291-308.
  • González-Lázaro, P. and González-Ortuño, B. (2012) Aphasia. From theory to practice. Madrid, Médica panamericana.
  • Helm-Estabrooks, N. and Albert M. L. (2005): Handbook of aphasia and aphasia therapy. Second Edition. Madrid: Editorial Médica Panamericana.
  • Kaplan EF, Goodglass H, Weintraub S. The Boston Naming test. Philadelphia: Lea and Febiger, 1978.
  • La Pointe, L. (2011): Aphasia and related neurogénica language disorders. Fourth edition. New York: Thieme, 2011.
  • Kertesz, A. (1982): The Western Aphasia Battery. Grune and Stratton, Nueva York. Lavados, P.; Sacks, L.; Prina, L.; Escobar, A.; Tossi, C.; Araya, F. y col. (2005): Incidence, 30-day case-fatality rate, and prognosis of stroke in Iquique, Chile: a 2-year community-based prospective study (PISCIS project). Lancet, 365: 2206-15.
  • Lavados, P. y Hoppe, A. (2005): Unidades de tratamiento del ataque cerebrovascular (UTAC) en Chile. Rev Med Chile, 133: 1271–3.
  • Omar, E. (2012). Factores asociados a alteraciones secundarias del Sistema de Control Atencional en pacientes afásicos. Neurología Argentina, 4 (2): 59-66.
  • Peña-Casanova J. (1991): Test Barcelona, Programa Integrado de exploración neuropsicológica. Masson, Barcelona.