Aphasia Taskforce

1
Aphasia Taskforce

• California Association of Superior Court
  Investigators (CASCI)
• 2007 Statewide Training Conference
• John K. Johnson, M.Phil-DPS

2
Aphasia

• Aphasia is a disorder that results from damage
  to language centers of the brain. For almost all
  right-handers and for about 1/2 of left-handers,
  damage to the left side of the brain causes
  aphasia. As a result, individuals who were
  previously able to communicate through speaking,
  listening, reading and writing become more
  limited in their ability to do so. The most
  common cause of aphasia is stroke, but gunshot
  wounds, blows to the head, other traumatic brain
  injury, brain tumor, and other sources of brain
  damage can also cause aphasia.

3
Who has aphasia?

• Anyone can acquire aphasia, but most people who
  have aphasia are in their mid to later years. Men
  and women are equally affected.
• It is estimated that approximately 80,000
  individuals acquire aphasia each year. About one
  million persons in the United States currently
  have aphasia.

4
What causes aphasia?

• Aphasia is caused by damage to one or more of
  the language areas of the brain. Many times, the
  cause of the brain injury is a stroke. A stroke
  occurs when, for some reason, blood is unable to
  reach a part of the brain. Brain cells die when
  they do not receive their normal supply of blood,
  which carries oxygen and important nutrients.
  Other causes of brain injury are severe blows to
  the head, brain tumors, brain infections, and
  other conditions or trauma of the brain.

5
Causes aphasia continued

• Individuals with Broca's aphasia have damage to
  the frontal lobe of the brain. These individuals
  frequently speak in short, meaningful phrases
  that are produced with great effort. Broca's
  aphasia is thus characterized as a non-fluent
  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"
  meaning, "I will take the dog for a walk." The
  same sentence could also mean "You take the dog
  for a walk," or "The dog walked out of the yard,"
  depending on the circumstances.

6
Causes aphasia continued

• 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.
  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.

7
Causes aphasia continued

• In contrast to Broca's aphasia, damage to the
  temporal lobe may result in a fluent aphasia that
  is called Wernicke's aphasia. Individuals with
  Wernicke's aphasia may speak in long sentences
  that have no meaning, add unnecessary words, and
  even create new "words." 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."

8
Causes aphasia continued

• Individuals with Wernicke's aphasia usually have
  great difficulty understanding speech and are
  therefore often unaware of their mistakes. These
  individuals usually have no body weakness because
  their brain injury is not near the parts of the
  brain that control movement.

9
Causes aphasia continued

• A third type of aphasia, global aphasia, results
  from damage to extensive portions of the language
  areas of the brain. Individuals with global
  aphasia have severe communication difficulties
  and may be extremely limited in their ability to
  speak or comprehend language.

10
Brocas vs. Wernickes Aphasia
11
How is aphasia diagnosed?

• Aphasia is usually first recognized by the
  physician who treats the individual for his or
  her brain injury. Frequently, this is a
  neurologist. The physician typically performs
  tests that require the individual to follow
  commands, answer questions, name objects, and
  converse. If the physician suspects aphasia, the
  individual is often referred to a speech-language
  pathologist, who performs a comprehensive
  examination of the person's ability to
  understand, speak, read, and write.

12
How do you communicate with an aphasia patient?

• Some people with aphasia have problems primarily
  with expressive language (what is said) while
  others have their major problems with receptive
  language (what is understood). In still other
  cases, both expressive language and receptive
  language are obviously impaired. Language is
  affected not only in its oral form of talking and
  understanding but also in its written form of
  reading and writing.

13
Communicating with an aphasia patient, continued

• Typically, reading and writing are more impaired
  than oral communication. The nature of the
  problems varies from person to person depending
  on many factors but most importantly on the
  amount and location of the damage to the brain.

14
Communicating with an aphasia patient, continued

• Amount and location of the damage, along with
  other factors, e.g., age, educational level, and
  health status, also affect the severity of the
  problems. Persons with severe aphasia may
  understand almost nothing of what is said to them
  and say little or nothing. At best, their oral
  communication may be only approximations of "yes"
  and "no" and maybe common social phrases like
  "hi" and "thanks."

15
Communicating with an aphasia patient, continued

• Persons with mild aphasia may be able to carry
  on normal conversations in many communication
  settings. They may have trouble understanding
  language only when it is long or complex, or they
  may have some trouble finding the words they need
  to express an idea or to explain themselves,
  orally or in written form.

16
Communicating with an aphasia patient, continued

• Word finding problems ( anomia ) are common in
  people with aphasia and is most like the common
  experience of having a word "on the tip of our
  tongues" but not being able to remember it. The
  person may forget the word comb even though he or
  she can show you how to use it.

17
Communicating with an aphasia patient, continued

• There are also degrees of aphasia between mild
  and severe . A person may speak only in single
  words (e.g., names of objects) or in short,
  fragmented phrases. Smaller words of speech
  (e.g., the , of , and ), may be omitted, making
  the message sound like a telegram. Words may be
  put in the wrong order and incorrect grammar may
  be used.

18
Communicating with an aphasia patient, continued

• Sounds and/or words may be switched. A bed may
  be called a table or a dishwasher a wish dasher .
  Or, the person with aphasia may make up a word.
  In some cases, nonsense (or real) words are
  strung together quite fluently, but make no sense
  to the listener.

19
Communicating with an aphasia patient, continued

• It usually requires extra effort for the person
  with aphasia to understand spoken messages, as if
  he or she is trying to comprehend a foreign
  language. The person may need extra time to
  process and understand what is being said by the
  investigator. It may be especially hard to follow
  very fast speech like that heard on radio or
  television news. He or she may misinterpret
  subtleties of language, e.g., taking the literal
  meaning for a figure of speech like He kicked the
  bucket.

20
Communicating with aphasia patient, continued

• Difficulty with one or more of the
  aforementioned skills may lead to communication
  breakdowns and frustrating communication for both
  the person with aphasia and the investigator.

21
How is aphasia treated?

• In some instances an individual will completely
  recover from aphasia without treatment. This type
  of "spontaneous recovery" usually occurs
  following a transient ischemic attack (TIA), a
  kind of stroke in which the blood flow to the
  brain is temporarily interrupted but quickly
  restored. In these circumstances, language
  abilities may return in a few hours or a few
  days. For most cases of aphasia, however,
  language recovery is not as quick or as complete.

22
How aphasia is treated, continued

• While many individuals with aphasia also
  experience a period of partial spontaneous
  recovery (in which some language abilities return
  over a period of a few days to a month after the
  brain injury), some amount of aphasia typically
  remains. In these instances, speech-language
  therapy is often helpful. Recovery usually
  continues over a 2-year period.

23
How aphasia is treated, continued

• Most people believe that the most effective
  treatment begins early in the recovery process.
  Some of the factors that influence the amount of
  improvement include the cause of the brain
  damage, the area of the brain that was damaged,
  the extent of the brain injury, and the age and
  health of the individual. Additional factors
  include motivation, handedness, and educational
  level.

24
How aphasia is treated, continued

• Aphasia therapy strives to improve an
  individual's ability to communicate by helping
  the person to use remaining abilities, to restore
  language abilities as much as possible, to
  compensate for language problems, and to learn
  other methods of communicating.

25
How aphasia is treated, continued

• Treatment may be offered in individual or group
  settings. Individual therapy focuses on the
  specific needs of the person. Group therapy
  offers the opportunity to use new communication
  skills in a comfortable setting. Stroke clubs,
  which are regional support groups formed by
  individuals who have had a stroke, are available
  in most major cities.

26
How aphasia is treated, continued

• These clubs also offer the opportunity for
  individuals with aphasia to try new communication
  skills. In addition, stroke clubs can help the
  individual and his or her family adjust to the
  life changes that accompany stroke and aphasia.
  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.

27
How Can we as Investigators Communicate with
Aphasia Subjects?

• Follow these simple suggestions

28
Investigators should

• Simplify language by using short, uncomplicated
  sentences.
• Repeat the content words or write down key words
  to clarify meaning as needed.
• Maintain a natural conversational manner
  appropriate for an adult.
• Minimize distractions, such as a blaring radio,
  or TV whenever possible.
• Include the person with aphasia in conversations
  when interviewing others in the area.

29
Investigators should

• Ask for and value the opinion of the person with
  aphasia, especially regarding legal matters.
• Encourage any type of communication, whether it
  is speech, gesture, pointing, or drawing.
• Avoid correcting the individual's speech.
• Allow the individual plenty of time to talk.

30
Where can I get additional information?

• American Speech-Language-Hearing Association
  (ASHA) 10801 Rockville PikeRockville, MD
  20852Voice [phone]Toll-free Voice
  [phone]TTY [phone]Fax (301)
  571-0457E-mail actioncenter_at_asha.orgInternet
  www.asha.org

31
Where can I get additional information?

• Brain Injury Association of America 8201
  Greensboro Drive, Suite 611McLean, VA
  22102Voice [phone]Toll-free Voice
  [phone]Fax [phone]E-mail
  info_at_biausa.orgInternet www.biausa.org

32
Where can I get additional information?

• National Aphasia Association (NAA) 7 Dey Street,
  Suite 600New York, NY 10007Voice (212)
  267-2814Toll-free Voice [phone]Fax
  [phone]E-mail naa_at_aphasia.orgInternet
  www.aphasia.org