aphasia n : inability to use or understand language (spoken or written) because of a brain lesion
EtymologyModern Latin, from ἀφασία, from ἄφατος, from ἀ- + φάσις.
- A partial or
total loss of language skills due to brain damage. Usually, damage to the
left perisylvian region, including Broca's area and Wernike's area,
- 1888, Rudyard Kipling, ‘The Conversion of Aurelian McGoggin’,
Plain Tales from the Hills, Folio 2005, p. 76:
- The Doctor came over in three minutes, and heard the story. ‘It's aphasia,’ he said.
- 1888, Rudyard Kipling, ‘The Conversion of Aurelian McGoggin’, Plain Tales from the Hills, Folio 2005, p. 76:
pathological speech disorder
mergefrom dysphasia Aphasia ( from Greek, aphatos : 'speechless' ), is also known as aphemia, and is a loss of the ability to produce and/or comprehend language, due to injury to brain areas specialized for these functions, Broca's area, which governs language production, or Wernicke's area, which governs the interpretation of language. It is not a result of deficits in sensory, intellect, or psychiatric functioning, nor due to muscle weakness or a cognitive disorder.
Depending on the area and extent of the 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.
CausesUsually, aphasias are a result of damage (lesions) to the language centres of the brain (like Broca's area). 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 head injury. Aphasia may also develop slowly, as in the case of a brain tumor or progressive neurological 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. Certain benzodiazepines such as temazepam and flunitrazepam have also been known causes of aphasias. Aphasia is also listed as a rare side effect of the fentanyl patch, an opioid used to control chronic pain.
DiagnosisAphasia 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.
SymptomsAny of the following may be considered symptoms of 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)
- uncompleted sentences
- inability to read
- inability to write
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.
TypesThe following table summarizes some major characteristics of different types of aphasia:
ClassificationClassifying 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.
Localizationist modelThe 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. The initial two categories here were devised by early neurologists working in the field, namely Paul Broca and Carl Wernicke. Other researchers have added to the model, resulting in it often being referred to as the "Boston-Neoclassical Model". The most prominent writers on this topic have been Harold Goodglass and Edith Kaplan.
- Individuals with Broca's aphasia (also termed expressive aphasia) were once thought to have ventral temporal damage 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. Broca missed these lesions because his studies did not dissect the brains of diseased patients so only the more temporal damage was visible. Individuals with Broca's aphasia often have right-sided weakness or paralysis of the arm and leg because the frontal lobe is also important for body movement.
- Working from Wernicke's model of aphasia, Ludwig Lichtheim proposed five other types of aphasia 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:
Fluent, non-fluent and "pure" aphasiasThe different types of aphasia can be divided into three categories: fluent, non-fluent and "pure" aphasias.
- Fluent aphasias, also called receptive aphasias, are impairments related mostly to the input or reception of language, with difficulties either in auditory verbal comprehension or in the repetition of words, phrases, or sentences spoken by others. Speech is easy and fluent, but there are difficulties related to the output of language as well, such as paraphasia. Examples of fluent aphasias are: Wernicke's aphasia, Transcortical sensory aphasia, Conduction aphasia, Anomic aphasia
Cognitive neuropsychological modelThe cognitive neuropsychological model builds on cognitive neuropsychology. It assumes that language processing can be broken down into a number of modules, 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. Use of this model clinically involves conducting a battery of assessments (usually from the PALPA), each of which tests one or a number of these modules. Once a diagnosis is reached as to where the impairment lies, therapy can proceed to treat the individual module.
A few less common subtypes include:
Primary and secondary aphasiaAphasia can be divided into primary and secondary aphasia.
- Primary aphasia is due to problems with language-processing mechanisms.
- Secondary aphasia is the result of other problems, like memory impairments, attention disorders, or perceptual problems.
HistoryThe first recorded case of aphasia is from an Egyptian papyrus, the Edwin Smith Papyrus, which details speech problems in a person with a traumatic brain injury to the temporal lobe.
- R. Chapey (Ed.) (2001). Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders (Fourth Edition). Philadelphia: Lippincott, Williams & Wilkins.
- Goodglass, H. & Kaplan, E. (1972). Assessment of Aphasia and Related Disorders. Philadelphia: Lea and Febinger.
- Kay, J., Lesser, R., & Coltheart, M. (1992). Psycholinguistic Assessments of Language Processing in Aphasia (PALPA). Hove: Erlbaum.
- Spreen, O. & Risser, A.H. (2003). Assessment of Aphasia. New York: Oxford University Press.
Personal experiences of aphasia
- Hale, S (2003), The Man Who Lost His Language, Penguin.
- Paul E. Berger and Stephanie Mensh, How to Conquer the World With One Hand...And an Attitude, 2nd Ed., ISBN 0-9668378-7-8
- Cindy Greatrex (2005) Aphasia in the Deaf Community.
- Dardick, Geeta (1991), Prisoner of Silence, Reader's Digest, June issue
- American Speech-Language-Hearing Association Description of aphasia and the role of the speech-language pathologist in assessment and treatment.
- Aphasia Center of California in Oakland, CA, U.S.
- Aphasia Center of West Texas in Midland, TX, U.S.
- The Aphasia Institute Pat Arato Aphasia Center
- NIDCD health information: Aphasia (public domain source)
- [http://media.cbc.ca:8080/ramgen/cbc.ca/thesundayedition/media/aphasia_se021215.rm "In So Many Words"] Radio documentary broadcast on the Canadian Broadcasting Corporation's "The Sunday Edition" program on Sunday, December 15, 2002
- "Picturing Aphasia" Documentary film about aphasia that uses drawings to help bridge the gap between hearing, seeing, and comprehending. Directed by Mores McWreath.
- Description of four types of aphasia: auditory, afferent, efferent, and semantic at University of Washington
- National Aphasia Association (U.S.)
- Aphasia Project: Research into assistive devices for people with aphasia (Princeton University)
- UK Based advice on aphasia and a forum for aphasics
- Linguish - a play about aphasia
aphasia in Bulgarian: Афазия
aphasia in German: Aphasie
aphasia in Spanish: Afasia
aphasia in Esperanto: Afazio
aphasia in Persian: زبانپریشی
aphasia in French: Aphasie
aphasia in Galician: Afasia
aphasia in Korean: 실어증
aphasia in Italian: Afasia
aphasia in Hebrew: אפאזיה
aphasia in Hungarian: Afázia
aphasia in Malay (macrolanguage): Afasia
aphasia in Dutch: Afasie
aphasia in Japanese: 失語症
aphasia in Norwegian: Afasi
aphasia in Polish: Afazja
aphasia in Portuguese: Afasia
aphasia in Romanian: Afazie
aphasia in Russian: Афазия
aphasia in Slovak: Afázia
aphasia in Serbian: Афазија
aphasia in Finnish: Afasia
aphasia in Swedish: Afasi
aphasia in Turkish: Afazi
aphasia in Ukrainian: Мовні регресії
aphasia in Urdu: عدمِ کلام
aphasia in Chinese: 失语症
anaudia, aphonia, aphrasia, deaf-muteness, dumbness, dysarthria, dysphasia, echolalia, hysterical aphonia, imperfect speech, inarticulateness, incoherence, jargon aphasia, loss of speech, motor aphasia, muteness, mutism, paranomia, paraphasia, psychophonasthenia, speech defect, speechlessness, tonguelessness, verbigeration, voicelessness, wordlessness