Speaking, reading or writing: Aphasia affects numerous areas of language. The prominent case involving action star Bruce Willis has now brought the speech disorder into the public eye. But how does aphasia actually develop, what are the symptoms and what are the chances of recovery?
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What is aphasia?
According to the Secretary General, aphasia is defined as German Society for Neurology (DGN) Peter Berlit an “acquired language disorder” that can lead to varying degrees of word-finding disorders, language comprehension disorders and even a complete loss of language.
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How does aphasia come about?
According to Berlit, the most common cause of acquired aphasia, especially in older people, is a stroke, i.e. a sudden circulatory disorder in the brain. But there are also other causes: “Any brain disease that involves the speech center can lead to aphasia,” explains the professor of neurology. In younger people in particular, this includes craniocerebral trauma, head injuries with bleeding or other injuries to the speech center. Inflammations of the brain such as encephalitis or neuro-degenerative diseases can also cause aphasia. For example, aphasic speech disorders also occur in some variants of Alzheimer’s dementia.
What is the effect of aphasia?
Aphasia is therefore caused by damage to the brain and can affect various areas of language, such as vocabulary (lexicon), the meaning of words (semantics), sound structures (phonology) or language production. Those affected are limited by aphasia in their own speaking, but also in understanding and reading spoken and written language. According to the German Federal Association for Speech Therapy (DBL) Usually very suddenly and can vary depending on the form and severity.
What forms of aphasia are there?
In the case of aphasia, a distinction is made between various syndromes, some of which differ greatly in terms of symptoms, according to the DBL. A mild form of aphasia represents the “amnetic aphasia” dar. The language understanding is according to the Federal Association for Aphasia well preserved in this form of aphasia and reading and writing are hardly affected. Those affected usually suffer from slight word-finding disorders, but can communicate relatively unrestrictedly, regardless of isolated sentence breaks.
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The “Broca’s aphasia” or also “motor aphasia” According to the Federal Association of Aphasia, those affected are particularly troubled by so-called agrammatism – the language is grammatically distorted. With words, this leads to a lot of phonetic confusion and sentences can be incomplete. The flow of speech is restricted in this form of aphasia and communication is severely to moderately impaired, but those affected can usually understand speech well and can read and write.
Another form of aphasia is the “Wernicke Aphasia” According to the DBL, sentence entanglements or doubling of sentence parts are particularly common. Those affected often perceive this language deficit only to a limited extent. As a result, communication is severely to moderately impaired.
the “global aphasia” is considered the most severe impairment. So-called speech automatisms characterize the disorder, for example recurring syllable sequences or words that do not fit the context of the conversation, as well as a severely restricted speech flow. According to the Federal Association for Aphasia, patients can only speak or understand parts of words. Communication is very severely to severely impaired in “global aphasia”.
Can aphasia be treated?
Treatment for aphasia is also related to the cause of the speech disorder, Berlit said. “If you take the most common cause, stroke, it’s a sudden event, the aphasia comes on, and then it gradually gets better.” It’s treated with intensive speech therapy, typically done by a speech therapist, and which aims to ensure that what has been lost is at least partially regained – i.e. the understanding of language or the language coding, according to the expert. “But if the affected area of the brain is irreversibly damaged after a stroke, i.e. if necrosis has occurred there, complete recovery is usually not possible,” says Berlit.
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“In speech therapy, we always focus on the disorder-specific profile,” says Ruth Nobis-Bosch, speech therapist and professor of applied therapeutic sciences. In the case of aphasia, not only the verbal language is affected, but often also the written language, i.e. reading and writing. “Therefore, we would always treat each aphasia individually and see where services are still available – and always adjust our therapy accordingly,” says the professor. The aim of the therapy is not only the pure practice of language, but also directly to enable communicative participation.
Can aphasia be cured?
According to Berlit, in the case of brain inflammation, it is usually possible to completely heal aphasia with the help of drug therapy started in good time. In the case of injuries as the cause of aphasia, on the other hand, only incomplete improvement is usually possible – especially if tissue has been destroyed. “If the whole thing occurs as part of neurodegeneration, i.e. as a variant of dementia, you can actually only alleviate the symptoms, but ultimately the clinical picture progresses and a cure is not possible,” says the expert.
How is aphasia diagnosed?
According to Berlit, aphasia is diagnosed by defined language tests. A neurologist, neuropsychologist or a speech therapist carries out specific tests aimed at diagnosing aphasia and differentiating between the various sub-forms of aphasia, he explains. The most important and prominent is the Aachen Aphasia Test (AAT), explains Nobis-Bosch. “Specific linguistic knowledge is required to carry out the test and, above all, to evaluate it.”
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How many people with aphasia are there in Germany?
According to the Federal Aphasia Association in Germany, 0.1 to 0.2 percent of the population suffers from aphasia. More than 80 percent of aphasias in adults are caused by a stroke, 10 percent are caused by craniocerebral trauma, 7 percent by brain tumors and one percent each by inflammatory diseases of the central nervous system, brain atrophy or a lack of oxygen.
How should one deal with people with aphasia?
“It is very important that you approach those affected in a ‘normal’ way,” says Berlit. “A lot of people tend to treat someone who can’t communicate properly with the language like a small child – like someone underage,” he explains. In those affected, however, all other brain functions such as emotional sensitivity are intact. “That means those affected naturally feel hurt and not taken seriously if they are treated as underage.” He also emphasizes that non-verbal communication often persists with aphasic sufferers. “That means a lot can also be conveyed to those affected by gestures and facial expressions.”
According to Ruth Nobis-Bosch, aphasia-friendly conversational behavior is also important when dealing with those affected. This means that you give the person you are talking to time, listen patiently and clarify whether you should help them find the right word, for example. “Many have the impulse to complete a sentence. You can do that, but you should get your consent beforehand – that means clarifying how I should actually deal with the communication disorder: Should I intervene or should I ask again.” According to Nobis-Bosch, a quiet environment can also help those affected to have conversations.