The Broca's aphasia it is an alteration of the language due to a brain injury. This type of aphasia was discovered in 1861 by Paul Broca, who observed a patient who only emitted one expression: "so". However, he understood simple sentences perfectly as he responded to questions through gestures.
A few years later, he found 25 cases with similar alterations that presented lesions in the left hemisphere, occupying the third frontal gyrus. What he associated with this type of aphasia that today bears his name.
Broca's aphasia is characterized by poor fluency, difficulties and slow speech. The problem is centered on the pronunciation of the words, the meaning of the message being perfectly preserved. It presents a series of characteristics:
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The main symptoms of people with Broca's aphasia are:
Broca's aphasia patients mostly utter single words and short phrases with great effort and slowness.
It is common for errors in the selection of phonemes (sounds of the language) to be commented, giving rise to substitutions or collations of phonemes. For example, instead of "guard" they could say "guadria”. This is called phonological paraphasia..
Omissions and simplifications of consonants occur many times. For example, they can pronounce “dice"Instead of" dart ".
Deficits in the use of adequate morphosyntactic constructs. This means that they are not able to establish an order of the words and link them forming correct sentences. Agrammatism can also appear on its own, without problems for linguistic pronunciation. An example might be saying “garden dog"Instead of" the dogs are in the garden ".
They do not tend to use compound verb tenses correctly. For example, a patient with this type of aphasia is normal to say "The boy is hitting the ball" before a drawing of a child who is hitting a ball on the head.
This is the main difference of this type of aphasia with transcortical motor aphasia, in which the repetition is preserved..
Anomie is the difficulty in finding the right word. It is a common symptom of all aphasias but it is very noticeable in Broca's aphasia, since speech is very little fluent and patients show great effort in looking for the words that are seen in their facial expression and the emission of sustained sounds like "eeeh ..."
The naming of objects, animals and people is bad, although it can improve if you help him by giving him clues how to say the first syllable of the word.
Passive reversible phrases such as "the girl was kissed by the boy" are not captured well. However, they have no problems with active phrases "the boy kissed the girl" or non-reversible active phrases "the boy fell to the ground".
It means there are writing problems due to brain damage. His writing is clumsy, slow, abbreviated, and grammatical. Paragraphs can be viewed in advance (such as "Lelo" instead of "hair"), perseverance (like "Pepo" instead of "hair") and omissions of letters or syllables ("libo" instead of "book"). These alterations are practically the same as those observed when the patient speaks.
These patients, unlike Wernicke's aphasia, are aware of their limitations as they notice that their pronunciation is not correct and try to correct it.
Awareness of their problems results in patients feeling irritated and upset, and they often make gestures to indicate more clearly what they are trying to say. They may have symptoms of depression and anxiety.
- Hemiparesis or mainly right motor paralysis, which can vary in severity that can range from a weakness in the face to a total hemiplegia.
- Apraxia such as ideomotor, which implies the lack of ability to use intact limbs voluntarily to perform the required actions.
- Like other types of aphasia, intellectual abilities that are not related to language are intact.
- Telegraph language.
- Impaired reading, affecting even the understanding of what is read.
- Aprosodia.
- Sensory deficits resulting from the injury, although this is very rare.
The most common cause is stroke, especially those that lead to lesions in the left middle cerebral artery, which is the one that irrigates the language areas. However, it can also appear due to tumors, head injuries, infections or after brain surgery..
Interestingly, it seems that the fact that Broca's aphasia appears is not enough with just an injury in Broca's area, as Paul Broca announced. In fact, if only this area is damaged, a “foreign accent” effect would be observed, that is, slight problems in the agility of language articulation and some deficits in finding the necessary words.
In addition, hemiparesis or apraxia would not appear, which do accompany Broca's aphasia described in this article many times..
Rather, what is truly known as Broca's aphasia today arises from lesions in Broca's area, the adjacent lateral cortex (Brodmann areas 6, 8, 9, 10, and 26), the insula, and the nearby white matter. The basal ganglia also have an important influence on articulation and grammar..
This produces the characteristic symptoms of this type of aphasia, since these brain structures are responsible for the correct use of prepositions, conjunctions, verbs, etc. Giving rise to problems both in production and in understanding as long as they are sentences whose meaning depends on prepositions and specific order of the words.
On the other hand, anomia and agrammatism appear to be caused by subcortical lesions or in the lower frontal lobe. These symptoms, together with the articulatory deficit, can be combined in different ways depending on the location of the brain damage and the recovery phase the patient is in..
It seems that in Broca's aphasia there is a deficit in syntactic processing, leading to problems with the grammatical components of language. That is, there are many phrases in which its meaning depends on a single preposition, adverb or conjunction and if this is not processed well it will not be understood.
It is caused by brain damage that only covers Broca's area (whose symptoms we describe in the previous section).
Occurs when brain injury occupies the frontal operculum, anterior insula, precentral gyrus, and white matter.
Important do not confuse Broca's aphasia with dysarthria (injury to brain areas that control muscles used for speech) or with apraxia of speech (inability to plan the sequence of movements of the orophonatory muscles necessary for language, due to acquired brain injuries)
Broca's aphasia is the second most common type of aphasia after global aphasia (Vidović et al., 2011).
It is also known that it is more frequent in men than in women, the opposite occurring with Wernicke's aphasia.
The first weeks after the injury, severe and variable symptoms are always observed. However, it improves very quickly in parallel with brain recovery (which usually lasts between 1 and 6 months).
The aphasias that have the best prognosis are those caused by trauma because they usually occur in young people and the injury is not usually very extensive; while vascular ones have a worse evolution since, among other things, it normally affects older people with less brain plasticity and tends to occupy more parts of the brain.
It can be aggravated by the presence of dysarthria, which consists of difficulties in executing the movements of the mouth and tongue to produce speech.
It is very useful when it is suspected that the patient has aphasia, to use the Boston Test for the Diagnosis of Aphasia (TBDA).
This helps detect what type of aphasia it is. This test examines all areas of language. Some of them are: comprehension, repetition, denomination, reading, writing ...
It is a group of 20 tiles with different shapes, sizes and colors. The patient must carry out the orders given by the examiner, for example “touch the blue tab ".
This test is used for understanding at easier levels and in more complicated levels, it can measure working memory or understanding of grammatical structures (which are affected in patients with Broca's aphasia)..
That is, a patient with this problem would do well the simpler levels, but would have errors when the task increases in difficulty including sentences such as: "Place the green circle between the red square and the yellow circle".
It consists of a group of pictures with drawings that the patient must name.
In this test the subject must say all the words that occur to him that begin with "f", with "a" and with "s" (which corresponds to phonological fluency) while in a second phase he must say all the names of animals you remember (semantic fluency).
The level of agrammatism can be seen only with the initial interview.
Assess other cognitive functions that may have been altered with brain damage, such as:
- Attention and concentration
- Spatial, temporal and personal orientation
- Memory
- Perceptual skills
- Executive functions
- Intellectual capacity
- Processing speed
- Motor aspects
The diagnosis can also be confirmed through MRI tests..
There is no specific and defined treatment for Broca's aphasia, rather it depends on the patient and their symptoms. The main objective of rehabilitation is to improve the quality of life of the person. To treat aphasia, it is necessary to intervene in:
- Language and communication
- Cognitive-behavioral adaptation of the patient to the environment
- Intervention with the family
- Social ambit
This can be achieved with a multidisciplinary team made up of: neuropsychologists, speech therapists, doctors, nurses, occupational therapists and social workers.
It is important to bear in mind that in order to design an adequate rehabilitation program, it is necessary to focus on the person, that is, it must be created exclusively for that patient to better adapt to their strengths and weaknesses..
It is also essential not to forget the affective aspects. It is very common that after the brain injury or because of the awareness of their limitations, the person has anxiety or depression. Changes in emotional expression can also be observed that must be monitored and improved.
Awareness of the disease can help motivate the person to collaborate with treatment.
How to understand oral and written language, increasing levels of difficulty, gesturing, drawing and simple arithmetic operations.
Rehabilitate deficits due to damaged areas, training:
It has been observed that there are patients who, surprisingly, do not have language fluency problems when singing. It seems to use the preserved capacities of the right hemisphere (melodic and prosodic) and the rhythmic features and familiarity with the lyrics of the songs..
Wilson, Parsons & Reutens (2006) defend the benefits of this type of therapy, indicating that they facilitate speech, promoting storage and access to representations of complete sentences..
However, one must be cautious, since in a study by Stahl et al. (2011) indicated that singing was not decisive in the production of speech in this type of aphasia, but rather the rhythm itself was important..
They also suggest that the good pronunciations of the lyrics of these patients may be due to long-term memory and the automation of the lyrics of the songs, whether they are sung or spoken..
In this type of treatment, the patient is “forced” to speak without using compensatory strategies, unless they are absolutely necessary. Treatment is usually very intense, lasting several hours a day; and is based on the enhancement of brain plasticity mechanisms to recover lost functions.
In a study conducted by the University of South Carolina in 2013: it was stated that patients with this type of aphasia significantly improved their verbal production when they had to imitate people who appeared in videos pronouncing words and phrases.
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