The aphasia It is a neurological disorder that occurs as a result of an injury to the areas of the brain that support language. This type of alteration can cause deficits in expression, comprehension, reading and / or writing, in a complete or partial way (American Speech-Language-Hearing Association, 2015).
Generally, in most left- and right-handed people, lesions located at the brain level in the left hemisphere will cause aphasia or language-related disorders.
However, it is also possible that lesions present in the left hemisphere cause other types of deficits and alterations also related to language (American Speech-Language-Hearing Association, 2015).
Therefore, aphasia, in itself, is not a primary disease, but rather a secondary symptom to a brain injury caused by many different factors (National Institute of Neurological Disorders and Stroke, 2015).
Normally, aphasia is more frequent in adults who have suffered a cerebrovascular accident, brain tumor, serious infection, head trauma, or degenerative process (National Institute of Neurological Disorders and Stroke, 2015).
In addition, people who suffer from aphasia can also present other problems of the type: apraxia (deficit or inability to perform motor actions directed at a goal, associated with an order, familiar or learned), dysarthria (deficit in motor programming of speech) and / or swallowing problems, among others (American Speech-Language-Hearing Association, 2015).
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Aphasia is a neuropsychological disorder that produces different deficits in the linguistic area: production, comprehension, reading and writing (National Aphasia Association, 2015).
More specifically, aphasia is a deficit or alteration in the ability to use language that produces a deficit in verbal communication or an acquired loss of language.
It is characterized by the presentation of errors in the production of language (paraphasia), failures in understanding and difficulty in finding the ideal words in the use of language (anomie). In a more summarized way, a loss or disorder of language that occurs as a result of brain damage (Ardila and Rosselli, 2007).
Generally, aphasia has always been associated with the occurrence of ischemias or strokes in the left hemisphere, however, it is currently known that conditions such as brain tumors, infections or head injuries can also cause it (National Aphasia Association, 2015 ).
Typically, the signs and symptoms of aphasia tend to affect a specific aspect of language use: the ability to retrieve the names of objects, the ability to organize words in a sentence, the ability to read, etc. (National Aphasia Association, 2015).
Despite this, there are also cases in which there is a generalized deficit and multiple aspects of communication are altered (National Aphasia Association, 2015).
Anyone can suffer a brain injury that results in the development of an aphasic-type disorder, however, the majority of people with this type of disorder are older or middle-aged adults (National Insitute of Deafness and Other Communication Disorders , 2010).
About one million people in the United States have aphasia. The National Aphasia Association indicates that around 80,000 people acquire aphasia each year as a result of cerebrovascular accidents (National Insitute of Deafness and Other Communication Disorders, 2010).
The signs and symptoms of aphasia will depend fundamentally on the type, area and severity of the injury..
Some people will have difficulties producing words or phrases, while others will not be able to understand others (American Speech-Language-Hearing Association, 2015).
In addition, aphasia can also cause deficits in oral language (expression and comprehension) and in written language (reading and writing) (American Speech-Language-Hearing Association, 2015).
The Mayo Clinic (2015) points out that people with aphasia may present some of the following characteristics:
- Communicate with short or incomplete sentences.
- Speak in sentences with no literary or grammatical meaning.
- Speak in unrecognizable words.
- Not understanding other people's conversation.
- Write meaningless sentences.
Despite this, the deficits and difficulties that people with aphasia present are much broader, so they will depend on the type of aphasia they suffer..
Throughout the development of the medical and / or psychological literature, there are more than 20 classifications of different aphasias (Ardila and Rosselli, 2007).
In the case of the Boston group, three basic types of cortical aphasia stand out: 1) Broca's aphasia, 2) Wernicke's aphasia and 3) Conduction aphasia (Ardila and Rosselli, 2007).
Drill's aphasia, or non-fluent aphasia, occurs as a consequence of damage or injury to areas of the left frontal lobe (National Insitute of Deafness and Other Communication Disorders, 2010).
It is a type of aphasia that fundamentally affects the production of language. Those affected usually use very short sentences with meaning, but that are produced with great effort (National Insitute of Deafness and Other Communication Disorders, 2010).
Normally, they understand language without any difficulty, but communication difficulties can cause great discomfort (National Insitute of Deafness and Other Communication Disorders, 2010).
At the clinical level, drill aphasia is characterized by non-fluent expressive language, with poor articulation, made up of short, ungrammatical expressions and phases that occurs with great effort (Ardila and Rosselli, 2007).
In addition, people with CBA often have weakness or paralysis in the extremities on the right side of the body (National Insitute of Deafness and Other Communication Disorders, 2010).
Wernicke's aphasia or source aphasia results from damage or injury to temporoparietal areas (Wernicke's area) (National Institute of Deafness and Other Communication Disorders, 2010) and terms such as: sensory aphasia, receptive aphasia or central aphasia, have been used. for its denomination (Ardila and Roselli, 2007).
In most cases, the lesions occur in the left temporal lobe, however, it can also develop with damage associated with the right hemisphere (National Insitute of Deafness and Other Communication Disorders, 2010).
In the case of people with Wernicke's aphasia, they do not have difficulties in motor production of language, but without in expression. They tend to use long sentences, often meaningless. They tend to use unnecessary, invented or meaningless words (National Insitute of Deafness and Other Communication Disorders, 2010).
As a consequence of these alterations, it is difficult to follow the conversational thread of these people. In addition, they also present significant difficulties in understanding language and are often not aware of these errors (National Insitute of Deafness and Other Communication Disorders, 2010).
Conduction aphasia has also been known as: kinesthetic or afferent motor aphasia, central aphasia, efferent conduction aphasia, suprasylvian conduction aphasia, or specifically as conduction aphasia (Ardila and Rosselli, 2007).
In this type of aphasia, the main deficit affects repetition. It is characterized by a fluent spontaneous language, good comprehension, but with a poor repetition characterized by the presence of literal paraphasias (substitution of phonemes).
At the secondary level, they may also appear: difficulties and defects in the name, reading disorders or writing disorders (Ardila and Rosselli, 2007).
The most common cause of brain damage in aphasia is stroke (Mayo Clinic, 2015).
A cerebrovascular accident occurs when the blood supply to a brain area is interrupted, either by the obstruction of a blood vessel or by a stroke (National Institute of Neurological Disorders and Stroke, 2016).
When some brain area does not receive enough oxygen, brain cells begin to die, so brain areas begin to degenerate their function (National Institute of Neurological Disorders and Stroke, 2016).
On the other hand, damage to the brain caused by a head injury, tumor, infection or degenerative process can also cause aphasia (Mayo Clinic, 2015).
Head injuries occur when external trauma causes damage to the head, cranial area, or brain. A head injury can occur when the head violently hits an object or when it pierces the skull and accesses brain tissue (National Institute of Neurological Disorders and Stroke, 2016).
A tumor is an abnormal accumulation of cells that form a mass and that will cause damage at the neurological level, both due to the pressure they can exert on other brain and spinal structures and because of its spread through different areas (Johns Hopkins Medicine, 2016).
Infections at the brain or spinal level can cause significant tissue inflammation and therefore cause a wide range of symptoms. Specifically, meningitis is an infectious process that specifically affects brain tissues (National Institute of Neurological Disorders and Stroke, 2016).
Degenerative diseases (Alzheimer's, Parkinson's, Huntington's, ALS, Multiple Sclerosis, etc.), are characterized by the development of progressive damage to different brain areas or cells.
In addition to these factors, cases of transient aphasia have also been described, due to migraines, seizures or a transient ischemic attack (Mayo Clinic, 2015).
It is a type of headache that occurs in the form of a recurrent attack and causes throbbing or throbbing sensations that usually affect one side of the head. (World Health Organization, 2012; (National Institute of Neurological Disorders and Stroke, 2015).
Seizures or epileptic seizures occur as a result of unusual neuronal activity that is altered causing seizures or periods of unusual behavior and sensations and can sometimes cause loss of consciousness (Mayo Clinic, 2015).
It occurs when there is a momentary interruption of blood flow to a brain area. It generally occurs as a consequence of the presence of an arteriosclerotic plaque or thrombotic embolus and resolves in less than 24 hours..
Once the etiological cause has been diagnosed at the medical level, for the diagnosis of a possible language alteration it is essential that various areas are evaluated by a specialist in neuropsychology and speech therapy (American Speech-Language-Hearing Association, 2015):
- Expressive speech: ease of speaking, timbre volume, articulation, clarity, strength, coordination of movements, etc..
- Understanding: adequate use of vocabulary and grammar, understanding of simple grammatical forms, answering questions, ability to follow instructions, narrative ability, etc..
- Social comunication: pragmatic language, capacity for linguistic interaction, initiative, expression of ideas, capacity for clarification and reformulation, etc..
- Reading and writing.
- Other aspects: general cognitive functioning, swallowing, among others.
For the treatment of language disorders there are a wide variety of therapeutic approaches (American Speech-Language-Hearing Association, 2015).
The type of rehabilitation intervention will depend on the characteristics of the patient, objectives and needs (American Speech-Language-Hearing Association, 2015).
When damage to the brain is mild, language skills may be restored. However, many of the people who suffer from aphasia, undergo therapeutic interventions, rather than to recover the language at a complete level, they do it to generate compensatory strategies that allow them to maintain functional communication (Mayo Clinic, 2015).
The recovery of language skills is usually a slow and progressive process, some make significant progress and others are able to recover the functional levels of before the injury (Mayo Clinic, 2015)
Therefore, for a positive effect on language rehabilitation to be produced, it is essential, among other factors, to carry out a early boarding. Many studies have indicated that therapy is most affective when it is started shortly after the injury.
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