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Aphasia - beyond just a Stroke


WHAT IS IT?


Aphasia is a disorder that results from damage from portions of the brain that are responsible for language. For most people, these areas are concentrated in various areas of the left hemisphere. The left side of the cerebral cortex has multiple areas that control language related functions and processing. Aphasia usually has a sudden onset as the result of a stroke or a brain injury. However, the disorder may progress slowly from a space occupying lesion (think tumor/neoplasm) or a progressive neurological disease. Aphasia is not a disease by itself, but more a symptom of an underlying problem(s), Aphasia can be an issue with expressive oneself or it could be a problem with comprehending what others have to say.


WHAT CAUSES IT?


Stroke gets the most attention in the aphasia/dysphasia arena as the brain's diffusion/blood flow gets interrupted as a result of an ischemic (thrombotic or embolic) or hemorrhagic (vessel weakness and subsequent rupture) event. The brain is a highly metabolic organ that readily needs and heavily utilizes both oxygen and glucose. But stroke is not the ONLY cause. As stated before -- Infections, traumatic injuries (blunt/penetrating) malignant or non-malignant lesions are also common causative agents. Chronic and progressive neurological diseases like Alzheimer's or Wernicke's Encephalopathy could render patients void of speech later on in those disease courses.


WHAT TYPES ARE THERE?


Fluent -

Temporal region issues around language comprehension (Wernicke's) - may speak in long, complicated sentences with even made-up words. However, there is no insight or comprehension from the patient. In its simplest terms the speech is effortless, but the meaning is greatly impaired. A helpful mnemonic courtesy of AJMonics: Well, why worry when we're Wasabi walruses!!


Non-Fluent -

Frontal region issues around speech production (Broca's aphasia) - may speak in short sentences with small words (usually requires great effort and concentration) However, they can understand speech and know what they want to say. They are easily frustrated because they are quite lucid. Additionally, you may also find right sided facial deficits and right extremity hemiparesis as part of your physical assessment. A helpful mnemonic courtesy of AJMonics: They are "BRO..ke" and frustrated!!


Conduction Aphasia -

Conduction aphasia is a rare form of aphasia in which both expression and comprehension remain intact, but the patient shows an isolated impairment in their ability to repeat simple phrases. A helpful mnemonic courtesy of AJMonics: Can You Repeat That??


Global Aphasia -

Comes from extensive damage to many areas of the brain. These folks often have a multifaceted problem when they are severely limited in their ability to both speak and understand the speech of others.



CLEARING UP SOME MISCONCEPTIONS -

  • Aphasia has nothing to do with intellect

  • Aphasia isn't as rare as it may seem

  • Aphasia doesn't affect hearing either -- speaking louder won't help

  • Aphasia has many causes other than stroke

February 5, 2024

Author: Joshua Ishmael, MBA, MLS(ASCP)CM, NRP

Pass with PASS, LLC.

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