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Aphasia

From Wikipedia, the free encyclopedia
Jump to: navigation, search For other uses, see Aphasia (disambiguation). Aphasia (pronounced /əˈfeɪʒə/ or pronounced /əˈfeɪziə/) is an acquired language disorder in which there is an impairment of any language modality. This may include difficulty in producing or comprehending spoken or written language. Traditionally, aphasia suggests the total impairment of language ability, and dysphasia a degree of impairment less than total. However, the term dysphasia is easily confused with dysphagia, a swallowing disorder, and thus aphasia has come to mean both partial and total language impairment in common use. Depending on the area and extent of brain damage, someone suffering from aphasia may be able to speak but not write, or vice versa, or display any of a wide variety of other deficiencies in language comprehension and production, such as being able to sing but not speak. Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage. Aphasia can be assessed in a variety of ways, from quick clinical screening at the bedside to several-hour-long batteries of tasks that examine the key components of language and communication. The prognosis of those with aphasia varies widely, and is dependent upon age of the patient, site and size of lesion, and type of aphasia.

[edit] Causes
Aphasia usually results from lesions to the language-relevant areas of the frontal, temporal and parietal lobes of the brain, such as Broca's area, Wernicke's area, and the neural pathways between them. These areas are almost always located in the left hemisphere, and in most people this is where the ability to produce and comprehend language is found. However, in a very small number of people, language ability is found in the right hemisphere. In either case, damage to these language areas can be caused by a stroke, traumatic brain injury, or other brain injury. Aphasia may also develop slowly, as in the case of a brain tumor or progressive neurological disease, e.g., Alzheimer's or Parkinson's disease. It may also be caused by a sudden hemorrhagic event within the brain. Certain chronic neurological disorders, such as epilepsy or migraine, can also include transient aphasia as a prodromal or episodic symptom.[citation needed] Aphasia is also listed as a rare side effect of the fentanyl patch, an opioid used to control chronic pain.[1]

[edit] Symptoms

People with aphasia may experience any of the following behaviors due to an acquired brain injury, although some of these symptoms may be due to related or concomitant problems such as dysarthria or apraxia and not primarily due to aphasia.
• • • • • • • • • • • • • • • • •

inability to comprehend language inability to pronounce, not due to muscle paralysis or weakness inability to speak spontaneously inability to form words inability to name objects poor enunciation excessive creation and use of personal neologisms inability to repeat a phrase persistent repetition of phrases paraphasia (substituting letters, syllables or words) agrammatism (inability to speak in a grammatically correct fashion) dysprosody (alterations in inflexion, stress, and rhythm) incompleted sentences inability to read inability to write limited verbal output difficulty in naming

[edit] Types
The following table summarizes some major characteristics of different types of aphasia: Types of aphasia Auditory comprehension Presentation

Repetition

Naming

Fluency

Wernicke's aphasia mild–mod mild–severe defective fluent paraphasic Individuals with Wernicke's aphasia may speak in long sentences that have no meaning, add unnecessary words, and even create new "words" (neologisms). 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". They have poor auditory and reading comprehension, and fluent, but nonsensical, oral and written expression. Individuals with Wernicke's aphasia usually have great difficulty understanding the speech of both themselves and others and are therefore often unaware of their mistakes. Transcortical sensory aphasia good mod–severe poor fluent Similar deficits as in Wernicke's aphasia, but repetition ability remains intact. Conduction aphasia

poor poor relatively good fluent Conduction aphasia is caused by deficits in the connections between the speechcomprehension and speech-production areas. This might be damage to the arcuate fasciculus, the structure that transmits information between Wernicke's area and Broca's area. Similar symptoms, however, can be present after damage to the insula or to the auditory cortex. Auditory comprehension is near normal, and oral expression is fluent with occasional paraphasic errors. Repetition ability is poor. Nominal or Anomic aphasia mild mod–severe mild fluent Anomic aphasia is essentially a difficulty with naming. The patient may have difficulties naming certain words, linked by their grammatical type (e.g. difficulty naming verbs and not nouns) or by their semantic category (e.g. difficulty naming words relating to photography but nothing else) or a more general naming difficulty. Patients tend to produce grammatic, yet empty, speech. Auditory comprehension tends to be preserved. Broca's aphasia non-fluent, effortful, mod–severe mod–severe mild difficulty slow Individuals with Broca's aphasia frequently speak short, meaningful phrases that are produced with great effort. Broca's aphasia is thus characterized as a nonfluent 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" which could mean "I will take the dog for a walk", "You take the dog for a walk" or even "The dog walked out of the yard". 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. It is associated with right hemiparesis, meaning that there can be paralysis of the patient's right face and arm. Transcortical motor aphasia good mild–severe mild non-fluent Similar deficits as Broca's aphasia, except repetition ability remains intact. Auditory comprehension is generally fine for simple conversations, but declines rapidly for more complex conversations. It is associated with right hemiparesis, meaning that there can be paralysis of the patient's right face and arm. Global aphasia poor poor poor non-fluent Individuals with global aphasia have severe communication difficulties and will be extremely limited in their ability to speak or comprehend language. They may be totally nonverbal, and/or only use facial expressions and gestures to communicate. It is associated with right hemiparesis, meaning that there can be paralysis of the patient's right face and arm. Transcortical mixed aphasia moderate poor poor non-fluent Similar deficits as in global aphasia, but repetition ability remains intact. Subcortical aphasias

Characteristics and symptoms depend upon the site and size of subcortical lesion. Possible sites of lesions include the thalamus, internal capsule, and basal ganglia. Jargon aphasia is a fluent or receptive aphasia in which the patient's speech is incomprehensible, but appears to make sense to them. Speech is fluent and effortless with intact syntax and grammar, but the patient has problems with the selection of nouns. They will either replace the desired word with another that sounds or looks like the original one, or has some other connection, or they will replace it with sounds. Accordingly, patients with jargon aphasia often use neologisms, and may perseverate if they try to replace the words they can't find with sounds. Commonly, substitutions involve picking another (actual) word starting with the same sound (e.g. clocktower - colander), picking another se

[edit] Acquired childhood aphasia
Acquired childhood aphasia (ACA) is a language impairment resulting from some kind of brain damage. This brain damage can have different causes, such as head trauma, tumors, cerebrovascular accidents, or seizure disorders. Most, but not all authors state that ACA is preceded by a period of normal language development.[2] Age of onset is usually defined as from infancy until but not including adolescence. ACA should be distinguished from developmental aphasia or developmental dysphasia, which is a primary delay or failure in language acquisition.[3] An important difference between ACA and developmental childhood aphasia is that in the latter there is no apparent neurological basis for the language deficit.[4] ACA is one of the more rare language problems in children and is notable because of its contribution to theories on language and the brain.[3] Because there are so few children with ACA, not much is known about what types of linguistic problems these children have. However, many authors report a marked decrease in the use of all expressive language. Children can just stop talking for a period of weeks or even years, and when they start to talk again, they need a lot of encouragement. Problems with language comprehension are less common in ACA, and don't last as long.[5]

[edit] Classification
Classifying the different subtypes of aphasia is difficult and has led to disagreements among experts. The localizationist model is the original model, but modern anatomical techniques and analyses have shown that precise connections between brain regions and symptom classification don't exist. The neural organization of language is complicated; language is a comprehensive and complex behavior and it makes sense that it isn't the product of some small, circumscribed region of the brain. No classification of patients in subtypes and groups of subtypes is adequate. Only about 60% of patients will fit in a classification scheme such as fluent/nonfluent/pure aphasias. There is a huge variation among patients with the same diagnosis, and aphasias can be highly selective. For instance, patients with naming deficits (anomic aphasia) might show an inability only for naming buildings, or people, or colors. [6]

4. 3. Ludwig Lichtheim proposed five other types of aphasia. Broca missed these lesions because his studies did not dissect the brains of diseased patients. Transcortical motor aphasia Transcortical sensory aphasia • • 1. which is now considered a separate disorder in itself. Individuals with Broca's aphasia often have right-sided weakness or paralysis of the arm and leg. namely Paul Broca and Carl Wernicke. . Other researchers have added to the model. 2. The initial two categories here were devised by early neurologists working in the field. because their brain injury is not near the parts of the brain that control movement.[edit] Localizationist model Cortex The localizationist model attempts to classify the aphasia by major characteristics and then link these to areas of the brain in which the damage has been caused. 5. because the frontal lobe is also important for body movement. so only the more temporal damage was visible. though more recent work by Nina Dronkers using imaging and 'lesion analysis' has revealed that patients with Broca's aphasia have lesions to the medial insular cortex. Working from Wernicke's model of aphasia. • Individuals with Broca's aphasia (also termed expressive aphasia) were once thought to have ventral temporal damage. resulting in it often being referred to as the "Boston-Neoclassical Model". but these were not tested against real patients until modern imaging made more indepth studies available. The other five types of aphasia in the localizationist model are: Pure word deafness Conduction aphasia Apraxia of speech. These individuals usually have no body weakness. The most prominent writers on this topic have been Harold Goodglass and Edith Kaplan. In contrast to Broca's aphasia. damage to the temporal lobe may result in a fluent aphasia that is called Wernicke's aphasia (also termed sensory aphasia).

non-fluent and "pure" aphasias The different types of aphasia can be divided into three categories: fluent. Transcortical motor aphasia. Examples of pure aphasias are: Alexia. or is able to write but not read. also called receptive aphasias. For example. each of which tests one or a number of these modules. global aphasia.[8] • • Primary aphasia is due to problems with language-processing mechanisms. phrases. Anomic aphasia Nonfluent aphasias. results from damage to extensive portions of the perisylvian region of the brain. such as paraphasia. non-fluent and "pure" aphasias. with difficulties either in auditory verbal comprehension or in the repetition of words.• Anomia is another type of aphasia proposed under what is commonly known as the Boston-Neoclassical model. Examples of nonfluent aphasias are: Broca's aphasia. or the recognition of words. but there are difficulties related to the output of language as well.[7] • Fluent aphasias. also called expressive aphasias are difficulties in articulating. a person is able to read but not write. It assumes that language processing can be broken down into a number of modules. writing. These disorders may be quite selective. Agraphia. attention disorders. or perceptual problems. Secondary aphasia is the result of other problems. [edit] Cognitive neuropsychological model The cognitive neuropsychological model builds on cognitive neuropsychology. [edit] Other ways to Classify Aphasia [edit] Fluent. or sentences spoken by others. Use of this model clinically involves conducting a battery of assessments (usually from the PALPA). Speech is easy and fluent. Transcortical sensory aphasia. each of which has a specific function. Hence there is a module which recognises phonemes as they are spoken and a module which stores formulated phonemes before they are spoken. are impairments related mostly to the input or reception of language. Conduction aphasia. Examples of fluent aphasias are: Wernicke's aphasia. but in most cases there is relatively good auditory verbal comprehension. Global aphasia "Pure" aphasias are selective impairments in reading. A final type of aphasia. like memory impairments. Pure word deafness • • [edit] Primary and secondary aphasia Aphasia can be divided into primary and secondary aphasia. Once a diagnosis is . which is essentially a difficulty with naming.

etc. Melodic intonation therapy is often used to treat non-fluent aphasia and has proved to be very effective in some cases. the free encyclopedia Jump to: navigation. the Edwin Smith Papyrus.wikipedia.reached as to where the impairment lies. search This article needs additional citations for verification.[9] [edit] Famous sufferers • • • • • • • • • • Maurice Ravel Vissarion Shebalin Jan Berry of Jan and Dean Sven Nykvist Ralph Waldo Emerson[10] Joseph Chaikin Antony Flew Bob Woodruff Kevin Ryder of The Kevin and Bean Show Toggle (Doonesbury character). Iraq war veteran injured by IED [edit] Treatment There is no one treatment proven to be effective for all types of aphasias. Someone who is totally unable to speak due to a speech disorder is considered mute. Please help improve this article by adding reliable references. which details speech problems in a person with a traumatic brain injury to the temporal lobe.org/wiki/Aphasia Speech disorder From Wikipedia. [edit] History The first recorded case of aphasia is from an Egyptian papyrus. This can mean stuttering. . therapy can proceed to treat the individual module. Unsourced material may be challenged and removed. http://en. (February 2008) Speech disorders or speech impediments are a type of communication disorders where 'normal' speech is disrupted. lisps.

Phonemic disorders are characterized by difficulty in learning the sound distinctions of a language. in the timing of utterance segments.[edit] Classification Classifying speech into normal and disordered is more problematic than it first seems. By a strict classification.[citation needed] Cluttering. The changes to the duration. It is now considered unlikely the childhood apraxia of speech and acquired apraxia of speech are the same thing. so that one sound may be used in place of many. it is not uncommon for a single person to have a mixed speech sound disorder with both phonemic and phonetic components. Dysarthria is a weakness or paralysis of speech muscles caused by damage to the nerves and/or brain. surgical accident. and brain tumors. Apraxia of speech may result from stroke or be developmental. • • • Stuttering is quite common. • • • • There are three different levels of classification when determining the magnitude and type of a speech disorder and the proper treatment or therapy:[2] . and in rhythm. though they share many characteristics. cadency. and involves inconsistent production speech sounds and rearranging of sounds in a word ("potato" may become "topato" and next "totapo"). head or neck injuries. a speech disorder that has similarities to stuttering. often physical. cranioencephalic traumatisms. but common phrases may sometimes be spoken spontaneously without effort. such as /s/ or /r/). deprive an individual's particular speech of its characteristics. Articulation disorders are characterized by difficulty learning to physically produce sounds. only 5% to 10% of the population has a completely normal manner of speaking (with respect to all parameters) and healthy voice.[1] Speech sound disorders involve difficulty in producing specific speech sounds (most often certain consonant. or cerebral palsy. all others suffer from one disorder or another. and intonation of words. Production of words becomes more difficult with effort. It is characterized by alterations in intensity. and are subdivided into articulation disorders (also called phonetic disorders) and phonemic disorders. Voice disorders are impairments. Dysarthria is often caused by strokes. that involve the function of the larynx or vocal resonance. and the intensity of tonic and atonic syllables of the sentences spoken. The cause of dysprosody is usually associated with neurological pathologies such as brain vascular accidents. ALS. parkinsons disease. Dysprosody is the rarest neurological speech disorder. the fundamental frequency. However.

1.e. A: Easily stimulable 2. teachers. with a tongue depressor) 3. and vocal abuse or misuse.[4] [edit] Treatment The examples and perspective in this article may not represent a worldwide view of the subject. there are various known causes of speech impediments. used meaningfully and contrastively 2. This estimate does not include children who have speech/language problems secondary to other conditions such as deafness"[3]. drug abuse. specialists. school-age children with a speech disorder are often placed in special education programs. brain injury. Sounds the patient can produce 1. not used in connected speech 2. Other treatments include correction of organic conditions and psychotherapy[5]. [edit] Social effects of speech disorders Suffering from a speech disorder can have negative social effects. In the United States."[3] Child abuse may also be a cause in some cases. physical impairments such as Cleft lip and palate. depending on the type of disorder they have. B: Phonetic. (December 2009) Many of these types of disorders can be treated by speech therapy.produced only upon request. Stimulable sounds 1. Those with a speech disorder can be targets of bullying because of their .and parents/family members. but others require medical attention by a doctor in phoniatrics. SLP's. Please improve this article and discuss the issue on the talk page. mental retardation. although extended day and summer services may be appropriate under certain circumstances. especially among young children. meaningfully. such as "hearing loss. More than 700.can be produced easily.000 of the students served in the public schools’ special education programs in the 2000-2001 school year were categorized as having a speech or language impediment. family doctors. neurological disorders. not used consistently. or contrastively. A team can include. B: No production ever observed [edit] Causes In many cases the cause is unknown. However. A: Phonemic. Cannot produce the sound 1. Patients will be treated in teams.Many school districts provide the students with speech therapy during school hours. A: Cannot be produced voluntarily 2. B: Stimulable after demonstration and probing (i.

Later in life. or both. cannot be cured.wikipedia. where language disorders are usually an impairment of either understanding words or being able to use words and does not have to do with speech production[6] http://en. Speech disorders refer to problems in producing the sounds of speech or with the quality of voice. Neuropsychological tests of dysnomic individuals show a significant difficulty recalling words or names.[1] Dysnomia can develop because of brain trauma or can be a learning disability. The bullying can result in decreased self-esteem. [2] As a long-term condition. Dysnomia is a difficulty or inability to retrieve the correct word from memory when it is needed. however.org/wiki/Speech_disorder Dysnomia (disorder) From Wikipedia. Dysnomia from strokes or head injuries will frequently reduce or disappear with time. The learning disability. bullying is experienced less by a general population. see Dysnomia. [edit] Language disorders Language disorders are usually considered distinct from speech disorders. writing abilities. This only becomes a medical condition when the recall problems interfere with daily life. search For other uses. dysnomia can be: . Normal individuals will occasionally suffer problems recalling words. Patients can improve their life skills by using coping strategies. the free encyclopedia Jump to: navigation.disorder. Dysnomia can affect speech skills. even though they are often used synonymously. [edit] Overview Word-recall problems become a medical condition when severe enough to interfere with a patient's daily life. Doctors use neuropsychological tests to diagnose the condition. as people become more understanding as they age.

[edit] Dysnomia and expressive aphasia . a search of online materials failed to reveal clear clinical criteria for when dysnomia shifts to anomia. hypothermia. Despite the separate diagnostic codes. not as a condition. Anomia. Dysnomia. [8] [9] Despite the difference. is a lesser level of dysfunction. hypoxemia.• • • • • An inherited learning disability [3] A symptom of dementia. hyperthermia. but separate references in diagnostic codes Anomia is cited more frequently/studied more frequently. low blood sugar. and other conditions and illnesses. almost as if he or she were suddenly required to converse in a foreign language". Dysnomia can be a symptom of alcohol intoxication. dys-nomia vs. a-nomia. anomia The difference between dysnomia and anomia is the level of function. a severe form of the "tip-of-the-tongue" feeling where the brain cannot recall the desired word or name. "renders a person completely unable to name familiar objects. This is indicated by the nature of the names. In this case it is used as a symptom. including Alzheimer's [4] A result of brain trauma. and other references list both and treat them as synonyms [12]. A review of available literature shows: • • • • The two diagnoses have similar. concussion. Dysnomics may pause or appear to struggle when trying to recall words or names [edit] Dysnomia vs. [edit] Symptoms Dysnomia impairs an individual's ability to succeed in speech and writing tasks. fluid/electrolyte imbalance. including accidents or stroke [5] A side-effect of certain drugs [6] A result of aging Dysnomia can also describe a short-term problem in recalling words or names. other references place anomia first [11]. nutritional deficiencies. dysnomia is sometimes mentioned as the primary [10]. some sources interchange the terms. on the other hand. possibly because anomic patients are more likely to be hospitalized or institutionalized Dysnomia appears more common in reference to a learning disability In cases where the two terms are used in the same materials. • • • People who have dysnomia may replace a word with a synonym in an attempt to express their thoughts without using the word they are having difficulty retrieving [7] Dysnomics will take longer to complete tests or leave timed tests incomplete.

the prescribing doctor can offer alternatives. [20] http://en. Rapid Automatized Naming times how quickly the patient can name common objects or colors. (Examples: [18]) For brain trauma cases. the condition may lessen or disappear as the child grows. Since the area of the brain dealing with word recall has not fully developed. In children with dysnomia. doctors recommend that.org/wiki/Dysnomia_%28disorder%29 Dysprosody . there is currently no way to cause the development or speed its process. This model "proposes that the deficit in verbal label retrieval creates a short-term memory deficit resulting in difficulty recalling word labels in reading. A published case study reported that antidepressants helped a dysnomic patient.Dysnomia is a type of expressive aphasia [13] [14] [edit] Relationship to dyslexia Some models of dyslexia identify it as being caused by dysnomia. [16] Rapid Automatized Naming is a good example of these tests. If a medication is causing dysnomia as a side effect. [17] [edit] Treatment Doctors recommend different treatments based on the cause of the dysnomia. "language therapy should begin as soon as possible and be tailored to the individual needs of the patient. A typical test would have the patient rapidly name five pictures of common objects or colors appearing repeatedly on a computer screen.wikipedia. Dysnomia caused by a brain trauma. The tests can measure the condition's severity and identify/eliminate other neuropsychological conditions with similar symptoms." [15] [edit] Testing methods Doctors use neuropsychological tests to diagnose dysnomia and anomia. is frequently treated by a speech pathologist using exercises to improve recall. The doctor compares the completion time against average times for the patient's age group." [19] Treatment is more difficult when dysnomia is caused by developmental issues. including injury or stroke.

[4] The next documented report of dysprosody occurred in 1919 by Arnold Pick. pauses. H. It is important to note. she was hemiplegic on her right side. intonation. and was aphasic. in 1907. and aphasia after the stroke. leaving her brain exposed. but over time they became much less pronounced and eventually she gained back full fluency of speech. Marie described the case of a Frenchman who started speaking in an Alsatian accent after suffering from a cerebrovascular accident which caused right hemiplegia.[5] The most well documented account of dysprosody was in 1943 by G. a French neurologist. but the timing of the speech was slower. she also spoke with uncharacteristic grammatical errors. intensity. was suffering from seizures.[5] Initially she could only speak in monosyllables. When first starting to speak again. stresses. however. a German neurologist. pragmatic.[2] Essentially. Monrad-Krohn. prosody has a wide array of functions including expression on linguistic.[2] Dysprosody. in Norway was hit with a shell fragment during an air raid in 1941 through her left frontal bone. a lesser version of hemiplagia.[1] As a result.[3] People diagnosed with dysprosody most commonly experience difficulties in pitch or timing control. Pick noticed that not only was the accent altered. . such as changes in pitch. [edit] History The first documented occurrence of dysprosody was described by Pierre Marie. refers to a disorder in which one or more of these prosodic functions are either compromised or eliminated completely. which is also known as pseudo-foreign dialect syndrome. The only form of effective treatment developed for dysprosody is speech therapy. yes and no. he is not able to control the way in which the words come out of his mouth. A woman. vocal quality and accents of speech. volume. not much is conclusively known or understood about the disorder. and rhythm of speech. Astrid L. The most obvious expression of dysprosody is when a person starts speaking in an accent which is not their own. and the patient spoke with uncharacteristic grammatical mistakes. Prosody refers to the variations in melody. that speaking in a foreign accent is only one type of dysprosody.. search Dysprosody is the rarest neurological speech disorder known. a person diagnosed with the disease can comprehend language and vocalize what he intends to say. but then started to form sentences. Pick later wanted to follow up on his research but was not able to since the patient had died with no autopsy performed. the free encyclopedia Jump to: navigation.[5] She was unconscious for four days and when she regained consciousness at the hospital. however. He noticed a 29 year old Czechoslovakian had started speaking in a Polish accent following a stroke. attitudinal. Pick's patient also suffered from right hemiparesis.From Wikipedia. It is still very unclear as to how damage to the brain causes the disruption of prosodic function. as the disease can also manifest itself in other ways. Since dysprosody is the rarest neurological speech disorder discovered. affective and personal levels of speech.

stroke and severe head injury.[4] In another reported case in 2004. she had trouble finding the Norwegian words for trivial objects.[5] This was not as helpful as Krohn would have liked. It was two years later that she was admitted to the Neurological University Clinic in Olso. or genetics has any impact on the development of dysprosody. In that same study. he found a large scar on the left frontotemporo-parietal region. Krohn examined the patient and noted that there was no noticeable difference in her fluency. Upon examination of her skull. however. The patient underwent surgery to correct a Reinke's edema. leaving her unable to speak. Over time. However. it could not be attributed to any known disorder or disease.[6] In 2006. motor functions. In 1999. Monrad-Krohn. There has been no evidence that ethnicity. there has been no conclusive evidence that gender affects the onset of dysprosody. another report was documented of Linda Walker. eventually recovering full fluency. Norway and seen by Dr. age. it is interesting to note that sometimes the accents they speak are from countries to which the person has never been. she began . such as light switch and match box. He found that in addition to her altered speech patterns. sensory functions. She also had to repeat the examiner's questions aloud before answering. Krohn then ran tests on Astrid to assess her language comprehension. 25 cases of dysprosody diagnosed between 1907-1978 were examined more closely. such as brain tumors. 16 of the patients were female while 9 were male. brain vascular damage. specifically strokes.[7] [edit] Causes Dysprosody is usually attributed to neurological damage.[5] Krohn could not understand how she had acquired a foreign accent.[4] There have been more recent occurrences of people who have developed accents after brain injuries. For those who suffer from this type of dysprosody. Thirteen of those cases were documented at the Mayo Clinic while the others were documented at clinics and hospitals elsewhere. a native of England. it was impossible for Krohn to pinpoint the exact region of the brain which was causing this altered speech. she sounded as though she was speaking her native Norwegian with a German accent. who developed a foreign accent after suffering from a stroke. but she developed a British accent despite living in the US for all of her life. brain trauma. After the surgery. Since the scar was so extensive. To better understand the causes of the disease. and had difficulty comprehending written instructions. which originates in the vocal folds of the larynx.[4] There have been another 21 cases documented up until 1978.However. Judi Roberts suffered a stroke which paralyzed the right side of her body. intonations and stress patterns. or coordination. had to say words out loud to herself before writing them down. her speech began to improve. This fact is very puzzling for neuroscientists since dialects and accents are considered to be an acquired behavior of learning pitches. It was found that the majority developed dysprosody after a cerebrovascular accident while another 6 cases developed after a head trauma. a patient presented with dysprosody under interesting circumstances.

It was possible that the patient suffered a lack of oxygen to the brain during the surgery.[9] A person suffering from dysprosody would not be able to accurately convey emotion vocally. or make any conclusion about another person's feeling through his speech. It is possible that one can present with both forms of dysprosody. and intonation of words.speaking in a foreign German accent. alters an individual’s vocal identity and impairs verbal communication. and in rhythm. there are nonverbal aspects of our speech that reveal information about our feelings and attitude.[10] . perceptual. linguistic and emotional."[8] These differences cause a person to lose the characteristics of their particular individual speech. and neurobehavioral functions all working together in a specific way. whether we realize it or not. however the severity may vary depending on what part of the brain has been damaged. There has been strong evidence that dysprosody does affect the ability to express emotion. in effect. sensory comprehension. [edit] Emotional Dysprosody Emotional dysprosody deals with a person's ability to express emotions through their speech as well as their ability to understand emotion in someone else's speech. Studies have shown that the ability to express emotional information is dependent on motor.[10] Regardless of the inability to vocally express feeling through prosodic controls. While the individual's personality. Prosodic control is essential to speech delivery because it establishes vocal identity since each individual’s voice has unique characteristics. [edit] Symptoms Dysprosody is "characterized by alterations in intensity. that each present with slightly different symptoms. causing dysprosody. prosody is responsible for verbal variations in interrogative versus declarative statements and serious versus sarcastic remarks. such as through pitch or melody. cadency. For example. in the timing of utterance segments. Linguistic dysprosody. Whenever we speak. [edit] Linguistic Dysprosody Dysprosody works on a linguistic level in that it specifies the intent of one’s speech. this case study shows that there can be other causes which are not necessarily neurologically based. Neurological examinations were carried out on the patient through magnetic resonance imaging. it makes it much more complicated to understand. and intelligence all remain intact. Since there are many different factors which contribute to emotional understanding of speech. which would have gone undetected by the resonance imaging.[8] Although most causes of dysprosody are due to neurological damage. emotions are still formed and felt by the individual. There are two types of dysprosody. but the results were completely normal. The only conclusion the doctors could make was that the surgery somehow changed the patient's vocal identification causing the new voice pattern. their grammar as well as vocal emotional capacity can be affected. motor skills.

as discussed in the preceding sections. not necessarily resulting in a foreign dialect. The most common types of dysprosody are associated with dysarthria and dyspraxia. rhythm. diagnosis involved an untrained ear determining impairments in the prosodic elements. which can sometimes lead to depression. he can also feel a sense of loss of personal identity. In the productive part. Once a person loses control of the timing. the patient is asked to listen to sentences being said and then answer questions about how they were stated. and impaired voice quality Hypokinetic dysarthria is characterized by harsh voice quality. One diagnosis technique is a rating scale. reduced volume and breathiness Ataxic dysarthria is characterized by harsh voice quality. In the comprehension section. of his speech. Each individual has a distinct voice characterized by all the prosodic elements.[5][11] In addition. There are also more involved diagnostic evaluations for which contain both productive and comprehensive parts. some people may begin speaking in an accent not native to their country of origin.[2] [edit] Diagnosis When studies of dysprosody first began. pitch. there have been some cases in which seizures began to develop in patients also suffering from dysprosody. four is given when sentence intonation is limited to abrupt pauses. and poor volume and pitch control Verbal dyspraxia is characterized by monotone and poor volume control[12] There can also be some emotional and mental side effects to dysprosody. although the reason seems to be unclear. over time and as dysprosody has been studied more closely. etc. but more common forms of dysprosody consist of alterations in vocal pitch. In order to determine linguistic dysprosody. One indicates no sentence intonation. However. monotone. and seven indicates normal intonation. Dysprosody can last for differing durations. reduced speech rate.[edit] Related Symptoms After experiencing brain injury. the patient is asked to say sentences with certain instructions. The exam is a subjective rating system of volume (from loud to normal to soft). How the . Among the most studied types are: • • • • Flaccid dysarthria is characterized by for little control over pitch and voice volume. and control. a patient is asked to read sentences that can either be a statement or a question using both declarative and interrogative intonations. timing. from a few months to years. a more concrete method of diagnosis has been developed. such as the Boston Diagnostic Aphasia Examination. reduced speech rate. melody. There are several different types of dysprosody which have been classified.[4] but no decisive conclusions connecting dysprosody and seizure activity have been made. which affect motor processing in speech. speech rate (from fast to normal to slow) and intonation which is rated on a scale from 1-7. voice (from normal to whisper to hoarse).

On the other hand. Scientists have attributed major control of the temporal aspects of prosody.[13] This model argued that the organization of language. Understanding these disorders and the areas of the brain affected in each case is key in conducting further studies of dysprosody. Patients with dysprosody will not be able to convey the emotions very well or differentiate their speech between the different emotions significantly. however. ultimately leading to a grossly oversimplified hemispheric model. however. In addition.[2] This hypothesis. has also been a cause for concern as studies have shown that people with left hemispheric damage exhibit prosodic deficiencies associated with the right hemisphere as defined by the Functional Lateralization hypothesis and vice versa. are believed to be organized in the right hemisphere. This belief led to the development of the “Functional Lateralization” hypothesis.[2] These conclusions have led scientists to believe that prosodic organization in the brain is extremely complex and cannot be attributed to hemispheric divisions alone.[2] It further states that the left is responsible for acoustic and temporal aspects of prosody while the right is responsible for pitch and emotion. sad. studies to identify prosodic organization in the brain continue. Scientists are continuing to study these patients in the hope of creating more concrete connections between areas of brain damage and prosodic abnormalities. primarily through the examination of damaged brain areas in patients suffering from dysprosody and their resulting vocal deficiencies. very few studies have given the model any substantial support. Although not well understood as of yet. scientists have been attempting to declare a particular area of the brain responsible for prosodic control.[3] Since its release. dysprosody has been associated with several other diseases including Parkinson's Disease.patient uses prosodic contours to distinguish between asking a question and saying a statement is recorded. During the comprehension section of the evaluation.[10] These techniques ultimately allow for the diagnosis of dysprosody and the degree of its severity in the patient. parallels the organization of prosody in the right hemisphere. Emotional dysprosody can be diagnosed by having a patient state a neutral sentence with different emotions.[2] In addition. it has also been found that damage to the medulla. such as happy. and behavioral disorders such as apathy. During the comprehension part. a clinician will say a sentence with specific emotional intonations and the patient must indicate the correct emotion. cerebellum. such as singing and linguistics related to emotion. [edit] Dysprosody in the Brain Since the discovery of dysprosody. Evaluation of these two parts can determine if the patient has linguistic dysprosody. centered in the left hemisphere. to the left hemisphere of the brain. gelastic epilepsy (gelastic seizure). a clinician reads simple sentences with either a declarative or interrogative intonation and the patient is asked to identify whether the sentence is a question or a statement. akinesia and aboulia. Huntington's Disease. which . stating that dysprosody can be caused by lesions in either the right or left hemispheres. It was long believed that the right hemisphere of the brain was responsible for prosodic organization. and basal ganglia may cause dysprosody. pitch perception. including rhythm and timing. and angry.

Parkinson's patients are less able to produce the loudness. dysprosody is also a common issue in individuals diagnosed with PD. rigidity. Upon completion of therapy.[15] It is important to note the degradation of prosody in PD over time is independent of motor control issues. they can start with more advanced forms of speech therapy. such as anger. words. and the patient repeats them with the same prosodic contours. the voice modulations needed to express strong emotions are particularly difficult for PD patients. however there is usually an improvement in pitch control only and not in the volume and emotional aspects of the disease. timing. such as normal conversation. A decrease in speech rate can also be observed in Parkinson's patients. Abnormalities in speech rate.[17] [edit] Treatments The most effective course of treatment for dysprosody has been speech therapy. [14] [edit] Parkinson's Disease and Dysprosody Parkinson's disease. Once a patient is able to effectively complete this drill. this inability to vocally express emotion has been linked to dysprosody and not the actual processing of emotions. phrases. These treatments include medications such as L-DOPA as well as electrophysiological treatments. or sometimes referred to as PD. pauses. and intonation. Because they generally have normal abilities to appreciate vocal or visual emotion presented to them. While common symptoms of PD are tremors.[15] A common characteristic feature of dysprosody in Parkinson's is monopitch. Typically a clinician will say either syllables. They have concluded that PD patients tend to struggle with specific areas of prosody.will hopefully someday lead to a full understanding of prosodic organization in the brain.[15] Studies have shown that normal treatment for PD can help with the dysprosody symptoms. or an inability to vary pitch when speaking.[16] In general. Speech therapy has proven most effective for linguistic dysprosody because therapy for emotional dysprosody requires much more . such as pitch. or nonsensical sentences with certain prosodic contours. most people can identify prosodic cues in natural situations. [15] Studies have also shown a progression of dysprosody in patients with PD over time. The first step in therapy is practice drills which consist of repeating phrases using different prosodic contours. and variation range in speech become worse as the disease progresses.[15] Several studies have been performed investigating the link between Parkinson's and dysprosody. is a chronic neurodegenerative disorder that involves the loss of dopaminergic neurons in the brain. and rhythm patterns required for expressing certain emotions. including both pauses in general speech and intra-word pauses.[16] Abnormal pauses in speech are also a characteristic of Parkinsonian dysprosody. and postural instability. bradykinesia. and is thus separate from those aspects of the disease. pitch.

[2] Since the part of the brain responsible for dysprosody has not definitely been discovered. melody. as testing for aprosodia secondary to other brain injury is only a recent occurrence. However. there have also been cases of people suffering from dysprosody gaining their native accent back with no course of treatment. stroke. this does . There are different types of dysprosody including linguistic and emotional. stress. pitch. The only course of treatment proven to be effective is speech therapy. search An Aprosodia is a neurological disease characterized by the inability of a person to properly convey and/or interpret emotional prosody.wikipedia. but since prosodic elements are so diverse. more common diseases such as Parkinson's disease. but also Huntington's disease. or severe head injury. there has been more research regarding dysprosody's link to other diseases. there has not been much treatment for the disease by means of medication. although normal speech may naturally resume. nor has the mechanism for the brain processes which cause dysprosody been found. Currently. etc.[10] Over time. These neurological deficits are the result of damage of some form to the non-dominant hemisphere areas of language production. The prevalence of aprosodias in individuals is currently unknown. Scientists believe that studying the connections between dysprosody and these better understood conditions may help them pinpoint specific areas of the brain responsible for prosody. It primarily results from neurological damage that can be caused by tumors. in particular Parkinson's disease. and gelastic epilepsy to name a few. [edit] Future Research In the past decade research on dysprosody has begun to focus on its relationship to other. Prosody in language refers to the ranges of rhythm.org/wiki/Dysprosody Aprosodia From Wikipedia. http://en. There have been several hypotheses proposed discussing the area of the brain responsible for prosodic control. timing. its organization in the brain is still unclear. rather than relying on prosodic cues. stress. intonation.effort and is not always successful. pitch and intonation.[2] [edit] Conclusion Dysprosody is an impairment in the prosodic elements such as rhythm. the free encyclopedia Jump to: navigation. which present different symptoms. One way that people learn to cope with emotional dysprosody is to explicitly state their emotions.

[2] As brain imaging techniques are refined to allow for greater temporal and spatial resolution. removal during surgery.[3] [edit] Aprosodia as a Symptom Aprosodia has also been shown to appear secondary to several diseases such as multiple sclerosis or post traumatic stress disorder[4]. [edit] Causes [edit] Localized Brain Damage One cause of aprosodia is suffering brain trauma to one of several specific areas of the brain. are: alcohol use by mother. as more becomes known about it. that this localization occurs over a range of areas that can vary from person to person and more research is required to further define these areas. When tested using the aprosodia battery. whether or not they are diagnosed with it.It is likely that as time passes more diseases will be shown to exhibit aprosodia as a symptom. when detoxified alcoholics and FAexp individuals were tested for impairment in cognitive function.not alter the impact that aprosodia is able to have on the lives of those who have the condition. progress can be made in both the recognition and treatment of aprosodic individuals. Through awareness. This brain damage can occur in the form of ischemic damage from stroke[1]. It is worth noting however. Aprosodia is a condition that was not often tested for in the presence of neurological deficits. the first study testing for aprosodia in MS did not occur until 2009. at least with respect to quantitative specificity. The major factors which influence affective prosody in those impacted by alcohol use. it was found that detoxified alcoholics and FAexp individuals demonstrated significant impairment in their ability to detect affective prosody when used by others. it is hoped that more will be able to be learned about aprosodias at a functional anatomical level. For example. however. how chronic the abuse is. resulting in the inability to properly process or convey emotional cues. age at initial abuse. . [edit] Alcohol Abuse An inability to process or exhibit emotions in a proper manner has been shown to exist in alcoholics and those who were exposed to alcohol while fetuses (FAexp). and the age when a person first becomes drunk. age at onset of chronic abuse of alcohol. from greatest to least impact. or trauma such as a localized bullet wound. brain lesions. This is especially so given that the patients tested in these studies scored poorer than the controls by a statistically significant amount. Initially. the aprosodia battery will likely be administered more frequently. as those were the more easily recognized by a physician not trained in analyzing affective prosody.[5] This is surprising given that changes in emotional affect would be expected to be noticed in patients exhibiting other changes in speech patterns. it was limited to testing the non-affective aspects of language. Diagnostic confirmation of aprosodia using brain scanning techniques is a relatively recent occurrence.

requiring the patient to mainly determine prosodic information contained in an interaction.[6].[7] [edit] Types [edit] Motor A motor aprosodia is characterized by the inability of a patient to produce or imitate emotional indicators. Those exhibiting only a motor aprosodia are still able to understand affective prosody when spoken by another. Aprosodia can be considered a lateralized function of the right hemisphere because of the differences in the ability of a patient to respond to affective prosodic information in those with left brain damage when compared to those with right brain damage. This is believed to occur due to problems at the execution level of affective prosody. Because the presence of an aphasia is often more pronounced in an individual than an aprosodia might be. Patients with affective-prosodic deficits in the left hemisphere (dysprosodic patients) showed improvement in understanding and repeating prosodic information when other conveyed linguistic information was simplified.[7] [edit] Sensory . No correlation was found between the distribution of cortical lesions in patients with left brain damage and the types of aphasic deficits pronounced in those patients. This improvement in processing affective prosodic information under reduced linguistic processing demands did not occur for patients with right brain damage. but damage to the motor areas of the brain causes an impairment in the uttering of affective prosody. The similarity of these regions has led scientists to view aprosodias in a similar manner to how some aphasias are viewed.g. A patient may have an understanding of what emotion they wish to produce. Because aphasias are rooted in deficiencies in language modalities rather than affective aspects of language. mainly through prosody or facial gestures. This is especially evident in those areas resembling Broca's area and Wernicke's area. Aprosodia can be considered a dominant function of the right hemisphere because strong correlation was found between deficits in affective prosody and distribution of lesions in the cortices of those with right brain damage.e. but are unable to respond in the same manner. apahsias have traditionally been more heavily studied. i.[edit] Brain Regions Research into the perisylvan region of the right hemisphere has shown that there are similarly mapped analogues to the speech center in the left hemisphere. it has been easier to characterize the underlying impairment caused by brain damage (e. Additionally. brain imaging tests were performed to determine if aprosodia is both a lateralized and dominant function of the right hemisphere areas of language production. inability to choose the right word or inability to speak due to motor control). in studying the brain regions associated with aprosodia. Combining aphasic research with right-left analogue mapping has allowed for researchers to produce hypotheses on the underlying process behind various aprosodias.

[edit] Diagnosis [edit] Emotional Batteries Emotional Batteries consist of asking patients to read various sentences with specific emotional indicators. much in the same way that patients with dominant hemisphere damage in the same area have a diminished ability to choose the right word. [edit] Expressive Expressive aprosodia occurs when a patient is unable to properly produce the intended emotional cues to those around them. The major differences in these result from functions which are characterized as belonging mainly to the left or right hemisphere. owing more from an inability to produce them at the cognitive than motor level. [9] [edit] Aprosodia vs.[9] [edit] Assessment Questionnaire Another method implemented to test for aprosodia involves having questionnaires filled out by those close to the patient. The doctors and nurses taking care of a patient are also requested to fill out a questionnaire if aprosodia is suspected. Their performance is subjectively analyzed by an expert to determine if they are aprosodic. The analysis is often performed by two experts independently. is characterized by the inability of a patient to comprehend or repeat emotional gestures. with one of the judges not being present during the interview in case the patient was still able to use facial cues. A patient with receptive aprosodia also has difficulty identifying emotions presented. This diagnosis method occurs more as an indicator that the aprosodia battery should be administered rather than being used as a singular diagnosis tool. In extreme cases of sensory aprosodia.[8] [edit] Mixed Mixed aprosodia is characterized by combinations of the other forms of aprosodia. It is often likely that an aprosodic individual will exhibit mixed aprosodia with varying degrees of intensity among the different aprosodias. Several of the functions have been described as dominant and lateralized functions of the . Dysprosody Brain imaging studies related to speech functions have yielded insights into the subtle difference between aprosodia and dysprosody.Sensory aprosodia. Implementation of the questionnaire is expected to become more widespread as aprosodia is revealed to be a side-effect of more diseases. a patient may have difficulty discerning the changes in stress and intonation. also referred to as receptive aprosodia.[2] It is believed that expressive aprosodia results from a lack of an emotional dictionary.

Although the biggest limitation on progress of aprosodia treatment is sample size. resulting in sample sizes too small to report statistical significance when comparing one treatment to another. affective prosody is as integral to communication as the ability to form and understand correct words. While it is often overlooked. [edit] Treatment Due to the rarity of reported aprosodia cases.[7] While the ability to express or be receptive to affective prosody is similar in dysprosody and aprosodia. The largest study of treatments for aprosodia consisted of only fourteen individuals. a significant difference in the characterization of them is dominant vs. only a few labs are currently researching treatment methods of aprosodia. [edit] Methods The two main forms of treatment are cognition based and imitation based. the data gained from this study still yielded some results and is being used in the next iteration of aprosodia research. However. Cognitive treatments attempt to rebuild the "emotional toolbox" of those with aprosodia. The basis for this treatment is the belief that there exists a defined set of emotional responses that can be chosen for a given scenario. Patients exhibiting extreme cases of aprosodia speak in a monotone fashion and are barely able or unable to distinguish changes in stress or intonation. The Rosenbek lab at the University of Florida is currently in a new phase of treatment study based on combinations of the cognitive-linguistic and imitative therapies delivered in a randomized .[10] [edit] Progress The methods of treatment are being evaluated and changed through several iterations to reach the most beneficial treatment for those with aprosodia.corresponding hemispheres. while some have been found to arise from communication between the two hemispheres. [edit] Impact The loss of ability to express and understand emotions is debilitating to those experiencing aprosodia. It is hypothesized that the motor damage occurs at the level of planning as well as the level of execution. and this deficiency can be likened to Broca's Aphasia but for emotions. some significant data has been found to influence each subsequent phase of study. It has a large impact on their lives and affects their day-to-day interactions with others. non-dominant hemispherical damage. Imitative treatments attempt to help "kickstart" the motor systems involved in the production of both vocal and facial emotive gestures. Choosing the proper emotional response can very much be likened to choosing the proper word when describing an object. The basis for this treatment is the belief that the pathways responsible for the motor elements of expressive prosody were damaged.

. nine o'clock. Intonation and stress patterns are deficient. Monday. yah. Even in such cases. Good . speech is difficult to initiate.. and er. is caused by damage to or developmental issues in anterior regions of the brain...wikipedia. which is characterized by a patient's inability to comprehend language or speak with appropriately meaningful words[1]. and Dad. a Broca's aphasic patient is trying to explain how he came to the hospital for dental surgery: Yes. including (but not limited to) the left posterior inferior frontal gyrus known as Broca's area (Brodmann area 44 and Brodmann area 45).... ah doctors..... Dad and Peter H.. two. over-learned and rote-learned speech patterns may be retained[3]—for . [edit] Presentation Sufferers of this form of aphasia exhibit the common problem of agrammatism. patients may be only able to produce a single word.. the free encyclopedia Jump to: navigation... which is characterized by a patient's inability to properly move the muscles of the tongue and mouth to produce speech. and halting.[1] Expressive aphasia is one subset of a larger family of disorders known collectively as aphasia.org/wiki/Aprosodia Expressive aphasia From Wikipedia... (his own name).. Boy . ah.. and oh. " For example..... in the following passage... search Expressive aphasia.. labored.[9] http://en. A person with expressive aphasia might say "Son . known as Broca's aphasia in clinical neuropsychology and agrammatic aphasia in cognitive neuropsychology. non-fluent... It is characterized by the loss of the ability to produce language (spoken or written). Good . ten o'clock.. teeth. and ah. omitting function words and inflections (bound morphemes).. after the only syllable he could say..... University . Similarly... Wednesday. For them.fashion in an effort to gain more insight into what most prominently affects aprosodia treatment. Language is reduced to disjointed words and sentence construction is poor. an' doctors.[2] Severity of expressive aphasia varies among patients.. er.... Thursday.....[1] Expressive aphasia differs from dysarthria. er.. The most famous case of this was Paul Broca's patient Leborgne. In the most extreme cases.. writing is difficult as well.... nicknamed "Tan". Wednesday. hospital. Smart . Expressive aphasia contrasts with receptive aphasia.

some patients can count from one to ten. Residual deficits will often be seen.[5] Expressive aphasia occurs in approximately 12% of new cases of aphasia caused by stroke. While word comprehension is generally preserved. A stroke is caused by hypoperfusion (lack of oxygen) to an area of the brain. cerebral hemorrhage[7]. damage to the homologous region of Broca's area in the right hemisphere should cause aphasia in a left-handed individual. it has been believed that the area for language production differs between left and right-handed individuals. Patients with classic symptoms of expressive aphasia generally have more acute brain lesions while patients with larger. widespread lesions exhibit a variety symptoms which may be classified as global aphasia or left unclassified. by extradural hematoma. This can be demonstrated by using phrases with unusual structures. expressive aphasia is caused by a stroke in Broca's area or the surrounding vicinity. In the past. A typical Broca's aphasic patient will misinterpret "the dog is bitten by the man" by switching the subject and object. meaning interpretation dependent on syntax and phrase structure is substantially impaired. but cannot produce the same numbers in ordinary conversation.[8] Understanding lateralization of brain function is important for understanding what areas of the brain cause expressive aphasia when damaged.[4] Note this element is a problem with receptive language. as opposed to fluent aphasia.[6] In most cases. [edit] Causes The most common cause of expressive aphasia is stroke. Some form of aphasia occurs in 34-38% of stroke patients. However.[5] Expressive aphasia can also be caused by trauma to the brain. Diagnosis is done on a case by case basis. However. not expressive language. Patients who recover go on to say that they knew what they wanted to say but could not express themselves. [edit] Classification and Diagnosis Expressive aphasia is also a classification of non-fluent aphasia. If this were true. More recent studies have shown that even left-handed individuals typically have language functions only in the left hemisphere. left-handed individuals are more likely to have a dominance of language in the right hemisphere. cases of expressive aphasia have been seen in patients with strokes in other areas of the brain.[1] [edit] Treatment . and is one reason why the problem is referred to as agrammatic aphasia. tumor.instance. which is commonly caused by thrombosis or embolism. as lesions often affect surrounding cortex and deficits are not well conserved between patients.

most patients receive traditional therapy for a few hours per day. Because patients are better at singing phrases than speaking them. Tapping further triggers the rhythmic component of speaking to utilize the right hemisphere. At the lowest level of therapy. Furthermore. [10] It is believed that this is due to the fact that singing capabilities are stored in the right hemisphere of the brain.5 hours per day for five days per week. Mechanisms are also taught in traditional therapy to compensate for lost language function such as drawing and using phrases which are easier to pronounce. individuals with small lesions in the left hemisphere seem to recover by activation of the left hemisphere perilesional cortex while in individuals with larger left-hemisphere lesions. Melodic intonation therapy has been shown to work particularly well in patients with large lesions in the left hemisphere.[10] FMRI studies have proven that melodic intonation therapy uses both sides of the brain to recover lost function as apposed to traditional therapies that only utilize the left hemisphere.Currently. there is no standard treatment for expressive aphasia.[11] The goal of melodic intonation therapy is to utilize singing to accesses the language-capable regions in the right hemisphere and use these regions to compensate for lost function in the left hemisphere. it has been seen that in MIT. longer phrases are taught and less support is provided by the therapist. there is a recruitment of the use of language-capable regions in the right hemisphere. the natural musical component of speech is used to engage the patients ability to voice phrases. Patients are taught to say phrases using the natural melodic component of speaking and continuous voicing is emphasized.[11] MIT therapy on average lasts for 1. Among other exercises. patients practice the repetition of words and phrases. [edit] Singing and Melodic Intonation Therapy Melodic intonation therapy was inspired by the observation that individuals with nonfluent aphasia sometimes can sing words or phrases that they normally cannot speak.[11] The efficacy of melodic intonation therapy has been proven by studies that show that MIT can result in greater recovery when compared to non intonation therapy. This phenomenon has been noticed for the past 250 years. which is likely to remain unaffected after a stroke in the left hemisphere. With increased treatment.[11] [edit] Constraint Induced Therapy . Most aphasia therapy is individualized based on a patients condition and needs as assessed by a speech therapist. In some studies patients were able to sing entire songs with provided text that they could not speak with normal intonation.[9] Emphasis is placed on establishing a basis for communication with family and caregivers in everyday life. In the months following injury or stroke.[11] The patient is also instructed to use their left hand to tap the syllables of the phrase while the phrases are spoken. The following treatments are currently being studied to determine the best possible method for treating aphasia. The majority of patients go through a period of spontaneous recovery following brain injury in which they regain a great deal of language function. simple words and phrases (such as "water" and "I love you") are broken down into a series of high and low pitch syllables.

it is believed that their brain can reestablish old neural pathways and recruit new neural pathways to compensate for lost function.[9] Constraint induced therapy is based on the idea that a person with an impairment (physical or communicative) develops a "learned nonuse" by compensating for their lost function with other means such as using an unaffected limb by a paralyzed individual or drawing by a patient with aphasia. even in everyday life. Edward Taub at the University of Alabama at Birmingham.Constraint induced aphasia therapy (CIAT) is based on the same principles as constraintinduced movement therapy developed by Dr. Chlordiazepoxide)[13] The most effect has been shown by piracetam and amphetamine which may increase cerebral plasticity and result in an increased capability to improve language function.[12] In constraint induced movement therapy. Methylphenidate.[12] The greatest advantage of CIAT has been seen in its treatment of chronic aphasia (lasting over 1 year). By constraining an individual to use only speech. It . Studies of CIAT have shown that further improvement is possible even after a patient has reached a "plateau" period of recovery. the patient is not allowed to use other forms of communication such as drawing or body language and they are constrained to using only spoken word.[9] It has also been proven that the benefits of CIAT are retained long term. However. Aniracetam.[9] [edit] Pharmacotherapy In addition to active speech therapy.[9] It is believed that CIAT works by the mechanism of increased neuroplasticity. pharmaceuticals have also been considered as a useful treatment for expressive aphasia. Bifemelane) – acts on acetylcholine systems[13] Amphetaminic drugs (Dexamphetamine.[9] Two important principles of constraint induced aphasia therapy are that treatment is very intense with sessions lasting for up to 6 hours over the course of 10 days and that it focuses on developing everyday language ability. The following drugs have been suggested for use in treating aphasia and their efficacy has been studied in control studies. the alternative limb is constrained with a glove or sling and the patient is forced to use their affected limb. • • • • Bromocriptine – acts on Catecholamine Systems[13] Piracetam – acts on the GABA-Minergic system[13] Cholinergic drugs (Donepezil.[9] Constraint induced therapy contrasts sharply with traditional therapy by the strong belief that mechanisms to compensate for lost language function should not be used unless absolutely necessary. This area of study is relatively new and much research continues to be conducted. In constraint induced aphasia therapy. improvements only seem to be made while a patient is undergoing intense therapy.

has been seen that priacetam is most effective when treatment is began immediately following stroke.[14] Bromocriptine has been shown by some studies to increase verbal fluency and word retrieval with therapy than with just therapy alone.[15] However.[17] It is thought that because the right hemisphere is not intended for full language function.[13] Furthermore.[16] [edit] Mechanisms of recovery Mechanisms for recovery differ from patient to patient. The procedure is a painless and noninvasive method of stimulating the cortex.[14] FMRI studies have shown that recovery can be partially attributed to the activation of tissue around the damaged area and the recruitment of new neurons in these areas to compensate for the lost function. its use seems to be restricted to non-fluent aphasia. By comparing .[14] Donepezil has shown a potential for helping chronic aphasia. the targeted area of the brain may be reactivated and thereby recruited to compensate for lost function. Research has shown that patients can show increased object naming ability with regular transcranial magnetic stimulation than patients in therapy without TMS. TMS works by suppressing the inhibition process in certain areas of the brain.[14] No study has established irrefutable evidence that any drug is an effective treatment for aphasia therapy.[16] Among all types of therapies it has been proven that one of the most important factors and best predictors for a successful outcome is the intensity of the therapy. magnetic fields are used to create electrical currents in specified cortical regions.[14] It has been stated by some researchers that the recruitment and recovery of neurons in the left hemisphere apposed to the recruitment of similar neurons in the right hemisphere is superior for long term recovery and continued rehabilitation. some patients fail to show any significant improvement from TMS which indicates the need for further research of this treatment. Some mechanisms for recovery occur spontaneously after damage to the brain while others are caused by the effects of language therapy.[14] Comparison between the recovery of language function and other motor function using any drug has shown that improvement is due to a global increase plasticity of neural networks.[15] By suppressing the inhibition of neurons by external factors.[13] Pharmaceutical therapy remains an important area of study in aphasia treatment. using the right hemisphere as a mechanism of recovery is effectively a "dead-end" and can only lead to partial recovery. no study has shown any drug to be specific for language recovery. When used in chronic cases it has been much less efficient. Recovery may also be caused in very acute lesions by a return of blood flow and function to damaged tissue that has not died around an injured area.[13] Furthermore. this improvement has been proven to be permanent and remains upon the completion of TMS therapy. [edit] Transcranial magnetic stimulation In transcranial magnetic stimulation (TMS).[15] Furthermore.

patients with expressive aphasia tend to show the most improvement within the first year.[20] It has also been seen that patients with aphasia caused by sub cortical lesions have a better chance of recovery than those with aphasia due to cortical stroke. It has been seen in receptive aphasia that larger lesions correlate to slower recovery. One of the most important aspects of Paul Broca's discovery was the observation that the loss of proper speech in expressive aphasia was due to the brain's loss of ability to produce language as opposed to the mouth's loss of ability to produce words. While both men made significant contributions to the field of aphasia.[21] [edit] History Expressive aphasia was first identified by the French neurologist Paul Broca.[6] Within the first year.[18] [edit] Prognosis In most individuals with expressive aphasia.[1] . it was Carl Wernicke who realized the difference between patients with aphasia who could not produce language and those who could not comprehend language (the essential difference between expressive and receptive aphasia). Similarly. patients diagnosed with global aphasia may be rediagnosed with expressive aphasia upon improvement. anxiety.[19] Location and size of the brain lesion may also play a role in the prognosis of aphasia.[1] The discoveries of Paul Broca were made during the same period of time as the German Neurologist Carl Wernicke who was also studying brains of aphasiacs post-mortem and identified the region now known as Wernicke's area.the length and intensity of various methods of therapies. he concluded that language ability was localized in the ventroposterior region of the frontal lobe. the majority of recovery is seen within the first year following a stroke or injury. little improvement is seen after the first year following a stroke.[9] Depression. This may be due to an expressive aphasiac's awareness and greater insight of their impairment (unlike in receptive aphasia) which motivates them to progress in treatment. it has been seen that continued recovery is possible years after a stroke with effective treatment using methods such as constraint induced aphasia therapy.[5] Studies have also found that prognosis of expressive aphasia correlates strongly with the initial severity of impairment. Those with the greatest initial disability tend to show the greatest improvement among test groups. and social withdrawal are all factors which have been proven to negatively affect a patient's chance of recovery.[5] When compared to patients with the most common types of aphasia. it was proven that intensity was a better predictor of recovery than the method of therapy used. By examining the brains of deceased individuals who acquired expressive aphasia in life. The majority of this improvement is seen in the first four weeks in therapy following a stroke and slows thereafter. However. Discoveries of both men contributed to the concept of localization which states that specific brain functions are all localized to a specific area of the brain.[6] Typically. the diagnosis of patients with expressive aphasia may change to anomic aphasia.

language abilities may return in a few hours or a few days. regional support groups formed by people who have had a stroke. express ideas. stroke clubs can help a person and his or her family adjust to the life changes that accompany stroke and aphasia. and learn other methods of communicating. and write. 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. understand language. For most cases. Additional factors include motivation. the patient is often referred to a speechlanguage pathologist. restore language abilities as much as possible. and educational level. handedness. How is aphasia treated? In some cases. name objects. in which some language abilities return a few days to a month after the brain injury. The examination includes the person's ability to speak. are available in most major cities. In addition. the extent of the brain injury. Recovery usually continues over a two-year period.org/wiki/Expressive_aphasia How is aphasia diagnosed? Aphasia is usually first recognized by the physician who treats the person for his or her brain injury. In these instances.http://en. Some of the factors that influence the amount of improvement include the cause of the brain damage. called a transient ischemic attack. If the physician suspects aphasia. Stroke clubs. Individual therapy focuses on the specific needs of the person. compensate for language problems. Frequently this is a neurologist. while group therapy offers the opportunity to use new communication skills in a small-group setting. While many people with aphasia experience partial spontaneous recovery. answer questions. the area of the brain that was damaged.wikipedia. Family members are encouraged to: . The physician typically performs tests that require the person to follow commands. and the age and health of the individual. This type of spontaneous recovery usually occurs following a type of stroke in which blood flow to the brain is temporarily interrupted but quickly restored. speech-language therapy is often helpful. read. In these circumstances. language recovery is not as quick or as complete. and carry on a conversation. a person will completely recover from aphasia without treatment. who performs a comprehensive examination of the person's communication abilities. Aphasia therapy aims to improve a person's ability to communicate by helping him or her to use remaining language abilities. some amount of aphasia typically remains. however. These clubs also offer the opportunity for people with aphasia to try new communication skills. as well as the ability to swallow and to use alternative and argumentative communication. converse socially. Many health professionals believe that the most effective treatment begins early in the recovery process.

Researchers are exploring drug therapy as an experimental approach to treating aphasia. Other research is attempting to understand the parts of the language process that contribute to sentence comprehension and production and how these parts may break down in aphasia. The goal is to understand how injury to a particular part of the brain impairs a person's ability to convey and understand language. Minimize distractions. since the treatment may change depending upon the cause of the language problem. such as a loud radio or TV. Other treatment approaches involve the use of computers to improve the language abilities of people with aphasia.• • • • • • • • • • Simplify language by using short. Avoid correcting the person's speech. Include the person with aphasia in conversations. Scientists are trying to understand the common (or universal) symptoms of aphasia and the language-specific symptoms of the disorder. Although different languages have many things in common when specific portions of the brain are injured. especially regarding family matters. there are also differences. such as the use of verbs. . it may be possible to pinpoint where the breakdown occurs and help in the development of more focused treatment programs. Seek out support groups such as stroke clubs. Repeat the content words or write down key words to clarify meaning as needed. In this way. pointing. Maintain a natural conversational manner appropriate for an adult. Other researchers are examining whether people with aphasia may still know their language but have difficulty accessing that knowledge. whether it is speech. The results could be useful in treating various types of aphasia. Help the person become involved outside the home. Encourage any type of communication. Studies have shown that computer-assisted therapy can help people with aphasia retrieve certain parts of speech. uncomplicated sentences. Ask for and value the opinion of the person with aphasia. whenever possible. These studies may help with the development of tests and rehabilitation strategies that focus on specific characteristics of one language or multiple languages. Allow the person plenty of time to talk. or drawing. gesture. Some studies are testing how drugs can be used in combination with speech therapy to improve recovery of various language functions. What research is being done for aphasia? Scientists are attempting to reveal the underlying problems that cause certain symptoms of aphasia. Lastly. computers can help people who have problems perceiving the difference between phonemes (the sounds from which words are formed) by providing auditory discrimination exercises. Computers can also provide an alternative system of communication for people with difficulty expressing language.

medicinenet.Researchers are also looking at how treatment of other cognitive deficits involving attention and memory can improve communication abilities. which also result from brain damage.com/aphasia/page3. or display any of a wide variety of other deficiencies in language comprehension and production. such as being able to sing but not speak. Aphasia (pronounced /əˈfeɪʒə/ or pronounced /əˈfeɪziə/) is an acquired language disorder in which there is an impairment of any language modality. site and size of lesion. from quick clinical screening at the bedside to several-hour-long batteries of tasks that examine the key components of language and communication. and dysphasia a degree of impairment less than total. Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech. and type of aphasia. . a swallowing disorder. Aphasia can be assessed in a variety of ways. However. For other uses. someone suffering from aphasia may be able to speak but not write. The results could have implications for both the basic understanding of brain function and the diagnosis and treatment of neurological diseases. This type of research may improve understanding of how these areas reorganize after brain injury. Depending on the area and extent of brain damage. Traditionally. some researchers are using functional magnetic resonance imaging (fMRI) to better understand the human brain regions involved in speaking and understanding language.htm Aphasia From Wikinfo Jump to: navigation. aphasia suggests the total impairment of language ability. The prognosis of those with aphasia varies widely. To understand recovery processes in the brain. and thus aphasia has come to mean both partial and total language impairment in common use. the term dysphasia is easily confused with dysphagia. or vice versa. search Search for "Aphasia" on Wikipedia • Wikimedia Commons • Wiktionary • Wikiquote • Wikibooks • Mediawiki Wikia • Wikitravel • Google Advanced Search • Yahoo Advanced Search • WorldCat Advanced Search • Amazon • Recent NY Times • Older NY Times. http://www. and is dependent upon age of the patient. This may include difficulty in producing or comprehending spoken or written language. see Aphasia (disambiguation).

an opioid used to control chronic pain.[1] Symptoms People with aphasia may experience any of the following behaviors due to an acquired brain injury. Aphasia may also develop slowly. and in most people this is where the ability to produce and comprehend language is found. syllables or words) agrammatism (inability to speak in a grammatically correct fashion) dysprosody (alterations in inflexion. can also include transient aphasia as a prodromal or episodic symptom.g. not due to muscle paralysis or weakness inability to speak spontaneously inability to form words inability to name objects poor enunciation excessive creation and use of personal neologisms inability to repeat a phrase persistent repetition of phrases paraphasia (substituting letters. In either case. It may also be caused by a sudden hemorrhagic event within the brain. although some of these symptoms may be due to related or concomitant problems such as dysarthria or apraxia and not primarily due to aphasia. stress. • • • • • • • • • • • • • • • inability to comprehend language inability to pronounce. language ability is found in the right hemisphere. Wernicke's area. These areas are almost always located in the left hemisphere. traumatic brain injury. Certain chronic neurological disorders. in a very small number of people. or other brain injury. temporal and parietal lobes of the brain. Aphasia is also listed as a rare side effect of the fentanyl patch.Causes Aphasia usually results from lesions to the language-relevant areas of the frontal. as in the case of a brain tumor or progressive neurological disease. and rhythm) incompleted sentences inability to read inability to write Types The following table summarizes some major characteristics of different types of aphasia: Type of aphasia Repetition Naming Auditory Fluency comprehension Presentation . damage to these language areas can be caused by a stroke.. such as epilepsy or migraine. such as Broca's area. and the neural pathways between them. However. Alzheimer's or Parkinson's disease. e.

Similar deficits as in Wernicke's aphasia. someone with Wernicke's aphasia may say. and fluent. Conduction aphasia is caused by deficits in the connections between the speech-comprehension and speech-production relatively good fluent areas. This might be damage to the arcuate fasciculus. but poor fluent repetition ability remains intact. and even create new "words" (neologisms). but nonsensical. meaning "The fluent defective dog needs to go out so I paraphasic will take him for a walk". They have poor auditory and reading comprehension. Similar . For example. "You know that smoodle pinkered and that I want to get him round and take care of him like you want before".Wernicke's aphasia mild–mod mild– severe Transcortical sensory good aphasia mod– severe Conduction aphasia poor poor Individuals with Wernicke's aphasia may speak in long sentences that have no meaning. add unnecessary words. oral and written expression. Individuals with Wernicke's aphasia usually have great difficulty understanding the speech of both themselves and others and are therefore often unaware of their mistakes. the structure that transmits information between Wernicke's area and Broca's area.

g. and oral expression is fluent with occasional paraphasic errors. Anomic aphasia. is essentially a difficulty with naming. difficulty naming verbs and not nouns) or by their fluent semantic category (e. linked by their grammatical type (e. can be present after damage to the insula or to the auditory cortex. effortful. difficulty naming words relating to photography but nothing else) or a more general naming difficulty. Repetition ability is poor. meaningful phrases that are produced with great effort. "Walk dog" which could mean "I will take the dog for a walk". however. Patients tend to produce grammatic. Broca's aphasia is thus characterized as a non-fluent.g. a person with Broca's aphasia may say. The patient may have difficulties naming certain words. and "the". nonfluent aphasia. "and". Affected people often slow omit small words such as "is". yet empty. For example. Auditory comprehension is near normal. Auditory comprehension tends to be preserved. speech.Nominal or Anomic aphasia mild mod– severe mild Broca's aphasia mod– severe mod– severe mild difficulty symptoms. "You take the dog for a walk" or . Individuals with Broca's aphasia frequently speak short.

and/or only use facial expressions and gestures to communicate. Because of this. but non-fluent declines rapidly for more complex conversations. Individuals with Broca's aphasia are able to understand the speech of others to varying degrees. Similar deficits as Broca's aphasia. meaning that there can be paralysis of the patient's right face and arm. meaning that there can be paralysis of the patient's right face and arm. they are often aware of their difficulties and can become easily frustrated by their speaking problems. Auditory comprehension is generally fine for simple conversations.Transcortical good motor aphasia mild– severe mild Global aphasia poor poor poor even "The dog walked out of the yard". Individuals with global aphasia have severe communication difficulties and will be extremely limited in their ability to speak or comprehend language. They may be totally non-fluent nonverbal. except repetition ability remains intact. It is associated with right hemiparesis. meaning that there can be paralysis of the patient's right face . It is associated with right hemiparesis. It is associated with right hemiparesis.

Accordingly.g.[3] Because there are so few children with ACA. or seizure disorders. and may perseverate if they try to replace the words they can't find with sounds. internal capsule. Problems with language comprehension are less common in ACA. but non-fluent repetition ability remains intact. and basal ganglia.[5] Classification . but the patient has problems with the selection of nouns. Possible sites of lesions include the thalamus. Commonly. and when they start to talk again. or has some other connection. but not all authors state that ACA is preceded by a period of normal language development. However. clocktower . they need a lot of encouragement.[2] Age of onset is usually defined as from infancy until but not including adolescence. Similar deficits as in global aphasia. but appears to make sense to them. ACA should be distinguished from developmental aphasia or developmental dysphasia. which is a primary delay or failure in language acquisition.colander).[3] An important difference between ACA and developmental childhood aphasia is that in the latter there is no apparent neurological basis for the language deficit.Transcortical mixed moderate aphasia poor poor Subcortical aphasias and arm. substitutions involve picking another (actual) word starting with the same sound (e. such as head trauma. patients with jargon aphasia often use neologisms.[4] ACA is one of the more rare language problems in children and is notable because of its contribution to theories on language and the brain. not much is known about what types of linguistic problems these children have. Jargon aphasia is a fluent or receptive aphasia in which the patient's speech is incomprehensible. and don't last as long. picking another se Acquired childhood aphasia Acquired childhood aphasia (ACA) is a language impairment resulting from some kind of brain damage. Children can just stop talking for a period of weeks or even years. They will either replace the desired word with another that sounds or looks like the original one. Most. Characteristics and symptoms depend upon the site and size of subcortical lesion. This brain damage can have different causes. or they will replace it with sounds. Speech is fluent and effortless with intact syntax and grammar. many authors report a marked decrease in the use of all expressive language. tumors. cerebrovascular accidents.

patients with naming deficits (anomic aphasia) might show an inability only for naming buildings. In contrast to Broca's aphasia. namely Paul Broca and Carl Wernicke. Individuals with Broca's aphasia often have right-sided weakness or paralysis of the arm and leg. which is now considered a separate disorder in itself. and aphasias can be highly selective. 4. Working from Wernicke's model of aphasia. No classification of patients in subtypes and groups of subtypes is adequate. 3. because the frontal lobe is also important for body movement. There is a huge variation among patients with the same diagnosis. resulting in it often being referred to as the "Boston-Neoclassical Model". because their brain injury is not near the parts of the brain that control movement. [6] The localizationist model attempts to classify the aphasia by major characteristics and then link these to areas of the brain in which the damage has been caused.Classifying the different subtypes of aphasia is difficult and has led to disagreements among experts. Only about 60% of patients will fit in a classification scheme such as fluent/nonfluent/pure aphasias. Broca missed these lesions because his studies did not dissect the brains of diseased patients. The initial two categories here were devised by early neurologists working in the field. These individuals usually have no body weakness. but these were not tested against real patients until modern imaging made more indepth studies available. • Individuals with Broca's aphasia (also termed expressive aphasia) were once thought to have ventral temporal damage. language is a comprehensive and complex behavior and it makes sense that it isn't the product of some small. The neural organization of language is complicated. which is essentially a difficulty with naming. or people. • . or colors. but modern anatomical techniques and analyses have shown that precise connections between brain regions and symptom classification don't exist. circumscribed region of the brain. The most prominent writers on this topic have been Harold Goodglass and Edith Kaplan. Transcortical motor aphasia Transcortical sensory aphasia Anomia is another type of aphasia proposed under what is commonly known as the Boston-Neoclassical model. For instance. The localizationist model is the original model. 2. so only the more temporal damage was visible. though more recent work by Nina Dronkers using imaging and 'lesion analysis' has revealed that patients with Broca's aphasia have lesions to the medial insular cortex. 5. The other five types of aphasia in the localizationist model are: Pure word deafness Conduction aphasia Apraxia of speech. A • • 1. Ludwig Lichtheim proposed five other types of aphasia. damage to the temporal lobe may result in a fluent aphasia that is called Wernicke's aphasia (also termed sensory aphasia). Other researchers have added to the model.

also called expressive aphasias are difficulties in articulating. writing. Once a diagnosis is reached as to where the impairment lies. global aphasia. Global aphasia "Pure" aphasias are selective impairments in reading. non-fluent and "pure" aphasias The different types of aphasia can be divided into three categories: fluent. attention disorders. like memory impairments. or the recognition of words. For example. Transcortical motor aphasia. Examples of nonfluent aphasias are: Broca's aphasia. each of which tests one or a number of these modules. . therapy can proceed to treat the individual module. but in most cases there is relatively good auditory verbal comprehension.final type of aphasia. Anomic aphasia Nonfluent aphasias. Cognitive neuropsychological model The cognitive neuropsychological model builds on cognitive neuropsychology. or sentences spoken by others. also called receptive aphasias. Other ways to Classify Aphasia Fluent. Secondary aphasia is the result of other problems. These disorders may be quite selective. each of which has a specific function. Examples of pure aphasias are: Alexia. or perceptual problems. a person is able to read but not write. phrases. with difficulties either in auditory verbal comprehension or in the repetition of words. are impairments related mostly to the input or reception of language. Examples of fluent aphasias are: Wernicke's aphasia. Hence there is a module which recognises phonemes as they are spoken and a module which stores formulated phonemes before they are spoken.[8] • • Primary aphasia is due to problems with language-processing mechanisms. Pure word deafness • • Primary and secondary aphasia Aphasia can be divided into primary and secondary aphasia. but there are difficulties related to the output of language as well. Agraphia. Speech is easy and fluent. non-fluent and "pure" aphasias.[7] • Fluent aphasias. or is able to write but not read. results from damage to extensive portions of the perisylvian region of the brain. such as paraphasia. Conduction aphasia. Use of this model clinically involves conducting a battery of assessments (usually from the PALPA). Transcortical sensory aphasia. It assumes that language processing can be broken down into a number of modules.

History The first recorded case of aphasia is from an Egyptian papyrus. 2008 About.wikinfo. Iraq war veteran injured by IED Treatment There is no one treatment proven to be effective for all types of aphasias..D. Ph.. Melodic intonation therapy is often used to treat non-fluent aphasia and has proved to be very effective in some cases. http://www.com Health's Disease and Condition content is reviewed by the Medical Review Board See More About: • common aphasias . former About. the Edwin Smith Papyrus.D. which details speech problems in a person with a traumatic brain injury to the temporal lobe.[9] Famous sufferers • • • • • • • • • • Maurice Ravel Vissarion Shebalin Jan Berry of Jan and Dean Sven Nykvist Ralph Waldo Emerson[10] Joseph Chaikin Antony Flew Bob Woodruff Kevin Ryder of The Kevin and Bean Show Toggle (Doonesbury character).com Guide Updated: July 22.org/index.php/Aphasia Aphasia Treatment in Stroke Importnat Information About Aphasia Treatment After Stroke From Jose Vega M.

" These exercises help patients practice comprehension skills while focusing on understanding the emotional components of language. As a result. and visual stimuli in the form of pictures. . are routinely used during aphasia therapy sessions. In other words. General Principles Several principles of therapy have been shown in small studies to improve the outcome of therapy. Gradual increases in the difficulty of language exercises practiced during a given therapy session improves the outcome. Aphasia treatment is an extremely important aspect of life after a stroke which has affected someone's ability to speak. some exercises require patients to interpret the characteristics of different emotional tones of voice. However. most forms of aphasia treatment are based on theoretical grounds which await further testing to prove their benefits. The effectiveness of aphasia therapy increases when therapists use multiple forms of sensory stimuli. aphasia is a disturbance in the production. drawings. For instance. Although multiple forms of treatment exist for the different types of aphasia. auditory stimuli in the form of music. only a few of them have been studied rigorously enough to have proven efficacy. most speech pathologists and physicians attest to the benefits of aphasia therapy.D. a given number of hours of therapy will yield a much better outcome if they are given in a few sessions over a few days rather than in many sessions over many days. Cognitive Linguistic Therapy This form of therapy emphasizes the emotional components of language. most commonly from stroke. processing.• • speech pathology aphasia therapy research Photo © A. For example. • • • Regardless of the type of therapy used. or understanding of language due to brain damage. Others require them to describe the meaning of highly descriptive words or terms such as the word "happy. based on their experience with patients. the outcome is better if the intensity of therapy is increased. In general terms. Listed below are some well-known forms of aphasia treatments.M.A.

Stimulation-Fascilitation Therapy: This form of aphasia therapy focuses mostly on the semantic and syntactic parts of language. The list of medications tried so far include piracetam. The latter appears to be especially helpful at enhancing the benefits of traditional non-medication based therapy. Family treatment strategies have a similar effect. . while getting important feedback from therapists and other aphasics. while also facilitating the communications of aphasics with their loved ones. The therapist and the patient take turns to convey their ideas. Pharmacotherapy: This is one of the most appealing forms of aphasia therapy although its efficacy has yet to be proven. PACE therapy sessions typically involve an enacted conversation between the therapist and the patient. which allows the therapist to discover communication skills that should be reinforced in the patient. piribedil and amphetamines might have some degree of efficacy in aphasia treatment. Group Therapy: This type of therapy provides a social context for patients to practice the communication skills they have learned during individual therapy sessions. The main stimulus used during therapy sessions is auditory stimulation. donezepil. idebenone and dextran 40. pictures. this type of therapy uses drawings. The difficulty of the materials used to generate conversation is increased in a gradual fashion. including pictures and music. it appears that at least donezepil. The therapist communicates with the patient by imitating the means of communication with which the patient feels most comfortable. and other visually-stimulating items which are used by the patient to generate ideas to be communicated during the conversation. One of the main assumptions of this type of therapy is that improvements in language skills are best accomplished with repetition. as some studies have shown a better outcome of therapy when patients are given amphetamines before therapy sessions. piribedil. a form of aphasia therapy that promotes improvements in communication by using conversation as a tool for learning.Programmed Simulation: This type of therapy uses multiple sensory modalities. Although the evidence is not very strong. bromocriptine. PACE (Promoting Aphasic's Communicative Effectiveness): This is one of the best-known forms of pragmatic therapy. introduced in a gradual progression from easy to difficult. amphetamines and several antidepressants. In order to stimulate spontaneous communication. bifenalade. Patients are encouraged to use any means of communication during the session.

Aphasia therapy aims to improve a person’s ability to communicate by helping him or her to use remaining language abilities. While many people with aphasia experience partial spontaneous recovery. Froma P Roth and Colleen K. Recovery usually continues over a two-year period. compensate for language problems. Cicerone et al. Some of the factors that influence the amount of improvement include the cause of the brain damage. In these instances. Stroke clubs. In addition. are available in most major cities. its efficacy is under intense investigation.com/od/caregiverresources/a/Aphasiarx. called a transient ischemic attack. 1681-1692. and learn other methods of communicating. but a large. Individual therapy focuses on the specific needs of the person. The type of magnetic therapy that has been tried in aphasia rehabilitation is the "slow and repeated" version of TMS. and educational level. Sources: Jordan Lori and Hillis Argye. apraxia and dysarthria. regional support groups formed by people who have had a stroke. . the area of the brain that was damaged.htm How is aphasia treated? In some cases. http://stroke. stroke clubs can help a person and his or her family adjust to the life changes that accompany stroke and aphasia. speech-language therapy is often helpful. Worthington treatment resource manual for speech and language pathology 2nd edition Delmar. Many health professionals believe that the most effective treatment begins early in the recovery process. A few small studies have had encouraging results. Current Opinion in Neurology 2006 19 (6): 580-585. TMS consists of aiming a magnet directly at a part of the brain which is thought to inhibit language recovery after stroke. recovery is enhanced. well-controlled study is still needed to ensure the efficacy of this form of treatment. some amount of aphasia typically remains. however. Additional factors include motivation. in which some language abilities return a few days to a month after the brain injury. Disorders of speech and language: aphasia. language recovery is not as quick or as complete. language abilities may return in a few hours or a few days. Albany NY.about.. and the age and health of the individual. These clubs also offer the opportunity for people with aphasia to try new communication skills. restore language abilities as much as possible. handedness. For most cases. This type of spontaneous recovery usually occurs following a type of stroke in which blood flow to the brain is temporarily interrupted but quickly restored. while group therapy offers the opportunity to use new communication skills in a small-group setting. By suppressing the function of that part of the brain. In these circumstances.Transcranial Magnetic Stimulation (TMS): Although this modality of treatment is seldom used. Evidence-based cognitive rehabilitation: Updated Review of the literature from 1998 to 2002 Archives of Physical Medicine and Rehabilitation 2005 Vol 86. the extent of the brain injury. a person will completely recover from aphasia without treatment.

such as the use of verbs. Avoid correcting the person’s speech. Lastly. Family members are encouraged to: • • • • • • • • • • Simplify language by using short. pointing. uncomplicated sentences. since the treatment may change depending upon the cause of the language problem. Allow the person plenty of time to talk. Although different languages have many things in common when specific portions of the brain are injured. Scientists are trying to understand the common (or universal) symptoms of aphasia and the language-specific symptoms of the disorder. Help the person become involved outside the home. The results could be useful in treating various types of aphasia. Studies have shown that computer-assisted therapy can help people with aphasia retrieve certain parts of speech. Include the person with aphasia in conversations. Top What research is being done for aphasia? Scientists are attempting to reveal the underlying problems that cause certain symptoms of aphasia. Seek out support groups such as stroke clubs. Encourage any type of communication. Other research is attempting to understand the parts of the language process that contribute to sentence comprehension and production and how these parts may break down in aphasia. or drawing. Ask for and value the opinion of the person with aphasia. In this way. Other treatment approaches involve the use of computers to improve the language abilities of people with aphasia. especially regarding family matters. Computers can also provide an alternative system of communication for people with difficulty expressing language. it may be possible to pinpoint where the breakdown occurs and help in the development of more focused treatment programs. Other researchers are examining whether people with aphasia may still know . whether it is speech. The goal is to understand how injury to a particular part of the brain impairs a person’s ability to convey and understand language. such as a loud radio or TV. Repeat the content words or write down key words to clarify meaning as needed. Maintain a natural conversational manner appropriate for an adult. gesture. computers can help people who have problems perceiving the difference between phonemes (the sounds from which words are formed) by providing auditory discrimination exercises. whenever possible.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. Minimize distractions. there are also differences.

This type of research may improve understanding of how these areas reorganize after brain injury. as well as families. to provide a comprehensive evaluation and treatment plan for the person with aphasia. These studies may help with the development of tests and rehabilitation strategies that focus on specific characteristics of one language or multiple languages. To understand recovery processes in the brain. treatment strives to improve a person's ability to communicate. physical therapists. and social workers.com/library/stroke/blaphasia3.about. Usually a speech-language pathologist works with other rehabilitation and medical professionals. neuropsychologists. some researchers are using functional magnetic resonance imaging (fMRI) to better understand the human brain regions involved in speaking and understanding language. and the person's general health. Some studies are testing how drugs can be used in combination with speech therapy to improve recovery of various language functions. such as physicians.gov/health/voice/aphasia. http://seniorhealth.their language but have difficulty accessing that knowledge.asp Aphasia Treatment In general.htm .nih.nidcd. http://www. nurses. The most effective treatment begins early in the recovery process and is maintained consistently over time. Researchers are also looking at how treatment of other cognitive deficits involving attention and memory can improve communication abilities. Researchers are exploring drug therapy as an experimental approach to treating aphasia. the area of the brain that was damaged. Major factors that influence the amount of improvement include the cause of the brain damage. the extent of the injury. occupational therapists. The results could have implications for both the basic understanding of brain function and the diagnosis and treatment of neurological diseases.