Aphasia – Communication Impairment

Aphasia is a general term used to describe one or more disorders that have caused the loss or impairment of the ability to speak or communicate. (Akmajian Demers, and Harnish 1979:306) This can be caused by disease (

such as a brain tumor), dementia, stroke or physical injury to the brain itself. The National Institute on Deafness and Other Communication Disorders (NIDCD) estimates that 80,000 people acquire aphasia every year and that approximately one million people in the U.S. have currently been diagnosed, most of these have been due to stroke. (www.nidcd.nih.gov) In this paper I will be addressing the varied causes of aphasia, its effect on language and its treatment.

It would be nearly impossible to talk of aphasia without addressing its root causes, which is usually damage to one of the two major language centers of the brain that are often associated with this illness, namely, Broca’s area and Wernicke’s area.

In 1861 a French surgeon named Paul Broca described a patient with severe speech impairment; after the patient died it was revealed that they had sustained an injury to the posterior inferior part of the left frontal lobe (see fig. 1). This area is now known as Broca’s area (Akmajian Demers, and Harnish 1979:307). A little over a decade after Broca’s findings, in 1874 a German physician, Karl Wernicke, described patients with brain lesions who also had severe speech deficits; the lesions however were not located in Broca’s area. The damage had occurred in another area, the left posterior temporal lobe (see fig. 1).

These findings together led to the inference that these two areas of the brain play crucial but different roles in speech and communication. Damage to these areas manifests itself differently, leading to separate but similar pathologies. Damage to Broca’s area results in what is termed Broca’s aphasia which is also called nonfluent or motor aphasia. (Clark, Eschholz and Rosa 1998:637) This kind of aphasia is characterized by short, halting, agrammatical speech that is often devoid of articles and prepositions. We are given this example from a patient with Broca’s aphasia; “The patient is trying to describe a picture showing a boy stealing cookies from a cookie jar while his chair is tipping over; a little girl is helping him. Their mother stands at the window staring into space while the sink in front of her overflows.” (Clark, Eschholz and Rosa 1998:637)
Cookie jar…fall over…chair…water…empty…ov…ov…[Examiner: “overflow?”] Yeah. (637)

Through Wernicke’s research he found that people without damage to Broca’s area but with damage to the temporal lobe where Wernicke’s area is located, developed speech pathologies that were quite different from Broca’s aphasia. Patients suffering from Wernicke’s aphasia often have little or no trouble producing long sentences with proper grammar. The speech itself though is often unintelligible with unnecessary and/or made up words. (Clark, Eschholz and Rosa 1998:637-38) In the text of Language: Readings in language and culture, a patient with Wernicke’s aphasia attempts to describe the same picture that the aforementioned Broca’s aphasiatic tried to describe:
Well, this is…mother is away here working out o’here to get her better, but when she’s working, the two boys looking in the other part. One their small tile into her time here. She’s working another time because she’s getting too. (638)

This led Wernicke to create the first model of language processing in the brain. Wernicke proposed that the words and meanings are stored in Wernicke’s area, after drawing a word from this area the thought is transmitted to Broca’s area by way of a bundle of nerves called the arcuate fasciculus. Once it reaches Broca’s area the sound structure of the intended speech is sent to the motor cortex where it then is transmitted as various commands to the physical areas related to speech (tongue, lips etc). Finally, language emerges. (Clark, Eschholz and Rosa 1998:638)
Aphasia is not always as clear cut as the preceding paragraphs seem to make it however. Factors such as the location of the injury, the patient’s age and health are all complicit in how severe the aphasia is and how it expresses itself.

(http://www.nidcd.nih.gov/) Often in the case of Broca’s aphasia partial paralysis may occur as it is quite close to the motor cortex. It can also manifest itself in areas other than oral communication such as reading and writing, and in fact is often more severe in these areas. To further complicate matters, the same types of aphasia do not have the same symptoms in different languages, causing researchers to search for language specific symptoms and universal symptoms. (http://www.nidcd.nih.gov/)

The diagnosis of aphasia can be performed by a speech pathologist who can examine the patient’s ability to comprehend speech, communicate orally, read and write. Other factors are also taken into account such as the ability to swallow, the ability to follow directions, both simple and complex. After this the mode of treatment that is best suited to the individual can be determined. (http://www.nidcd.nih.gov/)

The basic form of treatment involves work with the speech pathologist to focus on specific aspects of language that have been affected by the brain. Exercises such as naming objects and following directions can be increased in complexity as the patient improves.

Sometimes it may be better, or even necessary, for a patient to communicate primarily with the use of gestures and symbols. One such patient, Chil, had a massive stroke in the left hemisphere of his brain leaving him with little more than his right hand and arm to communicate with, though he could say three words, Yes, No and And.( McNeill 2000:84) Chil and his family were able to communicate through these three words combined with a series of hand gestures. Though the process can be time consuming it works for Chil and his family. McNeill describes a situation in which Chil would like to invite an additional two people for dinner:
With hindsight it is possible to see Chil wants to invite two additional guests, Mack and June to dinner. However, it takes intricate, temporally unfolding work for his interlocutors to discover this. (85-86)
Gestures may not be able to replace the intricacies that spoken language provides but it does serve as a useful and valid means of expression.

There are also group therapy sessions which may help the patient use new conversational skills. The NIDCD website lists some pointers for family members. Family members are encouraged to simplify their language, encourage the individual to communicate in whatever way they can, inclusion into decision making and in conversation. It is also recommended that they do not correct their speech and that they encourage them to become involved with activities out side of the home including stroke clubs which are regional support groups for people who have suffered a stroke.
New research into drug treatment has shown hope as the NIDCD website states:

Pharmacotherapy is a new, experimental approach to treating aphasia. Some studies are testing how drugs can be used in combination with speech therapy to improve recovery of various language functions by increasing the task-related flow of activation in the left hemisphere of the brain. These studies indicate that drugs may help improve aphasia in acute stroke and as an adjuvant to language therapy in post acute and chronic aphasia.

Science and medicine have improved and advanced significantly since the days of Paul Broca and Karl Wernicke. Scientists are now using machines like MRIs (magnetic resonance imaging) to create 3d virtual versions individual brains to study the inner workings of the brain and its pathologies. Something that Broca and Wernicke could never have imagined. Though there is less obfuscation concerning the inner workings of the brain and of the processes that lead to the comprehension and use of language in all its forms, aphasia is still a real concern that for some is nearly or completely crippling.

Akmajian, Demers and Robert M. Harnish
1975 Linguistics: An introduction to Language and Communication. Cambridge and London: The MIT Press

Clark, Eschholz and Alfred F. Rosa
1998 Language: Readings in Language and Culture. Boston: Bedford/St. Martin’s

D’Esposito, Mark
2003 Neurological Foundations of Cognitive Neuroscience. Cambridge: The MIT Press

McNeill, David
2000 Language and Gesture. Cambridge: Cambridge University Press

2006 National Institute on Deafness and Other Communication Disorders. Electronic document,
http://www.nidcd.nih.gov/health/voice/aphasia.asp, accessed September 8, 2006