Transcript Aphasia Taskforce

Aphasia Taskforce
California Association of Superior Court
Investigators (CASCI)
2007 Statewide Training Conference
John K. Johnson, M.Phil-DPS
Aphasia
Aphasia is a disorder that results from damage
to language centers of the brain. For almost all
right-handers and for about 1/2 of left-handers,
damage to the left side of the brain causes
aphasia. As a result, individuals who were
previously able to communicate through
speaking, listening, reading and writing become
more limited in their ability to do so. The most
common cause of aphasia is stroke, but gunshot
wounds, blows to the head, other traumatic
brain injury, brain tumor, and other sources of
brain damage can also cause aphasia.
Who has aphasia?
Anyone can acquire aphasia, but most
people who have aphasia are in their mid
to later years. Men and women are equally
affected.
It is estimated that approximately 80,000
individuals acquire aphasia each year.
About one million persons in the United
States currently have aphasia.
What causes aphasia?
Aphasia is caused by damage to one or more of
the language areas of the brain. Many times, the
cause of the brain injury is a stroke. A stroke
occurs when, for some reason, blood is unable
to reach a part of the brain. Brain cells die when
they do not receive their normal supply of blood,
which carries oxygen and important nutrients.
Other causes of brain injury are severe blows to
the head, brain tumors, brain infections, and
other conditions or trauma of the brain.
Causes aphasia continued:
Individuals with Broca's aphasia have damage to
the frontal lobe of the brain. These individuals
frequently speak in short, meaningful phrases
that are produced with great effort. Broca's
aphasia is thus characterized as a “non-fluent”
aphasia. Affected people often omit small words
such as "is," "and," and "the." For example, a
person with Broca's aphasia may say, "Walk
dog" meaning, "I will take the dog for a walk."
The same sentence could also mean "You take
the dog for a walk," or "The dog walked out of
the yard," depending on the circumstances.
Causes aphasia continued:
Individuals with Broca's aphasia are able
to understand the speech of others to
varying degrees. Because of this, they are
often aware of their difficulties and can
become easily frustrated by their speaking
problems. Individuals with Broca's aphasia
often have right-sided weakness or
paralysis of the arm and leg because the
frontal lobe is also important for body
movement.
Causes aphasia continued:
In contrast to Broca's aphasia, damage to the
temporal lobe may result in a fluent aphasia that
is called Wernicke's aphasia. Individuals with
Wernicke's aphasia may speak in long sentences
that have no meaning, add unnecessary words,
and even create new "words." For example,
someone with Wernicke's aphasia may say, "You
know that smoodle pinkered and that I want to
get him round and take care of him like you
want before," meaning "The dog needs to go
out so I will take him for a walk."
Causes aphasia continued:
Individuals with Wernicke's aphasia
usually have great difficulty understanding
speech and are therefore often unaware
of their mistakes. These individuals usually
have no body weakness because their
brain injury is not near the parts of the
brain that control movement.
Causes aphasia continued:
A third type of aphasia, global aphasia,
results from damage to extensive portions
of the language areas of the brain.
Individuals with global aphasia have
severe communication difficulties and may
be extremely limited in their ability to
speak or comprehend language.
Broca’s vs. Wernicke’s Aphasia
How is aphasia diagnosed?
Aphasia is usually first recognized by the
physician who treats the individual for his or her
brain injury. Frequently, this is a neurologist. The
physician typically performs tests that require
the individual to follow commands, answer
questions, name objects, and converse. If the
physician suspects aphasia, the individual is
often referred to a speech-language pathologist,
who performs a comprehensive examination of
the person's ability to understand, speak, read,
and write.
How do you communicate with
an aphasia patient?
Some people with aphasia have problems
primarily with expressive language (what
is said) while others have their major
problems with receptive language (what is
understood). In still other cases, both
expressive language and receptive
language are obviously impaired.
Language is affected not only in its oral
form of talking and understanding but also
in its written form of reading and writing.
Communicating with an
aphasia patient, continued:
Typically, reading and writing are more
impaired than oral communication. The
nature of the problems varies from person
to person depending on many factors but
most importantly on the amount and
location of the damage to the brain.
Communicating with an
aphasia patient, continued:
Amount and location of the damage, along with
other factors, e.g., age, educational level, and
health status, also affect the severity of the
problems. Persons with severe aphasia may
understand almost nothing of what is said to
them and say little or nothing. At best, their oral
communication may be only approximations of
"yes" and "no" and maybe common social
phrases like "hi" and "thanks."
Communicating with an
aphasia patient, continued:
Persons with mild aphasia may be able to
carry on normal conversations in many
communication settings. They may have
trouble understanding language only when
it is long or complex, or they may have
some trouble finding the words they need
to express an idea or to explain
themselves, orally or in written form.
Communicating with an
aphasia patient, continued:
Word finding problems ( anomia ) are
common in people with aphasia and is
most like the common experience of
having a word "on the tip of our tongues"
but not being able to remember it. The
person may forget the word comb even
though he or she can show you how to
use it.
Communicating with an
aphasia patient, continued:
There are also degrees of aphasia
between mild and severe . A person
may speak only in single words (e.g.,
names of objects) or in short, fragmented
phrases. Smaller words of speech (e.g.,
the , of , and ), may be omitted, making
the message sound like a telegram. Words
may be put in the wrong order and
incorrect grammar may be used.
Communicating with an
aphasia patient, continued:
Sounds and/or words may be switched. A
bed may be called a table or a dishwasher
a wish dasher . Or, the person with
aphasia may make up a word. In some
cases, nonsense (or real) words are strung
together quite fluently, but make no sense
to the listener.
Communicating with an
aphasia patient, continued:
It usually requires extra effort for the person
with aphasia to understand spoken messages,
as if he or she is trying to comprehend a foreign
language. The person may need extra time to
process and understand what is being said by
the investigator. It may be especially hard to
follow very fast speech like that heard on radio
or television news. He or she may misinterpret
subtleties of language, e.g., taking the literal
meaning for a figure of speech like He kicked
the bucket.
Communicating with aphasia
patient, continued:
Difficulty with one or more of the
aforementioned skills may lead to
communication breakdowns and
frustrating communication for both the
person with aphasia and the investigator.
How is aphasia treated?
In some instances an individual will completely
recover from aphasia without treatment. This
type of "spontaneous recovery" usually occurs
following a transient ischemic attack (TIA), a
kind of stroke in which the blood flow to the
brain is temporarily interrupted but quickly
restored. In these circumstances, language
abilities may return in a few hours or a few
days. For most cases of aphasia, however,
language recovery is not as quick or as
complete.
How aphasia is treated,
continued:
While many individuals with aphasia also
experience a period of partial spontaneous
recovery (in which some language abilities
return over a period of a few days to a
month after the brain injury), some
amount of aphasia typically remains. In
these instances, speech-language therapy
is often helpful. Recovery usually
continues over a 2-year period.
How aphasia is treated,
continued:
Most people believe that the most
effective treatment begins early in the
recovery process. Some of the factors that
influence the amount of improvement
include the cause of the brain damage,
the area of the brain that was damaged,
the extent of the brain injury, and the age
and health of the individual. Additional
factors include motivation, handedness,
and educational level.
How aphasia is treated,
continued:
Aphasia therapy strives to improve an
individual's ability to communicate by
helping the person to use remaining
abilities, to restore language abilities as
much as possible, to compensate for
language problems, and to learn other
methods of communicating.
How aphasia is treated,
continued:
Treatment may be offered in individual or
group settings. Individual therapy focuses
on the specific needs of the person. Group
therapy offers the opportunity to use new
communication skills in a comfortable
setting. Stroke clubs, which are regional
support groups formed by individuals who
have had a stroke, are available in most
major cities.
How aphasia is treated,
continued:
These clubs also offer the opportunity for
individuals with aphasia to try new
communication skills. In addition, stroke
clubs can help the individual and his or
her family adjust to the life changes that
accompany stroke and aphasia. Family
involvement is often a crucial component
of aphasia treatment so that family
members can learn the best way to
communicate with their loved one.
How Can we as Investigators
Communicate with Aphasia
Subjects?
Follow these simple suggestions:
Investigator’s should:
• Simplify language by using short, uncomplicated
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sentences.
Repeat the content words or write down key
words to clarify meaning as needed.
Maintain a natural conversational manner
appropriate for an adult.
Minimize distractions, such as a blaring radio, or
TV whenever possible.
Include the person with aphasia in conversations
when interviewing others in the area.
Investigator’s should:
• Ask for and value the opinion of the
person with aphasia, especially regarding
legal matters.
• Encourage any type of communication,
whether it is speech, gesture, pointing, or
drawing.
• Avoid correcting the individual's speech.
• Allow the individual plenty of time to talk.
Where can I get additional
information?
American Speech-Language-Hearing
Association (ASHA)
10801 Rockville Pike
Rockville, MD 20852
Voice: (301) 897-5700
Toll-free Voice: (800) 638-8255
TTY: (301) 897-0157
Fax: (301) 571-0457
E-mail: [email protected]
Internet: www.asha.org
Where can I get additional
information?
Brain Injury Association of America
8201 Greensboro Drive, Suite 611
McLean, VA 22102
Voice: (703) 761-0750
Toll-free Voice: (800) 444-6443
Fax: (703) 761-0755
E-mail: [email protected]
Internet: www.biausa.org
Where can I get additional
information?
National Aphasia Association (NAA)
7 Dey Street, Suite 600
New York, NY 10007
Voice: (212) 267-2814
Toll-free Voice: (800) 922-4622
Fax: (212) 267-2812
E-mail: [email protected]
Internet: www.aphasia.org