Normally I try to talk about lighthearted topics so I can throw in the occasional pun and keep this whole thing entertaining for myself. I won’t be doing that today, but I do feel that this topic is incredibly important, and more people should know about it. Today I will be talking about acquired aphasia.
Aphasia is a language disorder that is caused by damage to the language centres of the brain (usually in the left hemisphere for right-handed people). This damage is typically the result of a stroke but can also be caused by a severe blow to the head or some other type of traumatic brain injury. Aphasia is an incredibly complex disorder that can present many different symptoms.
The important thing to be aware of from the outset is that aphasia is a language disorder and not a cognitive impairment. This is a hurtful misconception and a stigma that aphasia sufferers and their advocates are working very hard to overcome daily. If there is only one thing that you take from this post, let it be this.
In terms of the types of aphasia, this is largely dependent on where in the brain the damage is. Let’s start by talking about two major brain areas related to language. These areas are Wernicke’s area and Broca’s area (named after the physicians that discovered them). Wernicke’s area is located in the temporal lobe of the language dominant hemisphere (in orange) and Broca’s area is located in the lower part of the frontal lobe (in blue).
Wernicke’s area in the brain is associated with language comprehension meaning that damage to this area often results in nonsense speech being produced and their general unawareness that they are producing things that do not make any sense. You can see this is in the following video clip where a person with fluent aphasia is producing a lot speech effortlessly, but it doesn’t make any sense at all.
You will also notice that this man does not seem to know he is not making sense. What is perhaps most interesting though comes at the end of the video. When the speech pathologist working with him tells him that their session is over, he produces a very coherent statement that is on topic. This is a good example of a frozen phrase, which is something that is basically an automatic response. Imagine you see someone sneeze (I know, terrifying nowadays) and you instinctively say, “bless you” or “gesundheit”. Those could be considered frozen phrases because they are automatic things that we will say without having to think about them.
When the man reciprocated the “thank you very much” at the end of the video, it gives you a glimpse into his true ability to communicate. All the words and the phrases are still there, the aphasia is just jumbling things up for him.
This type of aphasia is known as Wernicke’s aphasia or fluent aphasia. The name fluent aphasia comes from the fact that the flow of speech is not disrupted at all. People with this type of aphasia are not aware that they are making the speech errors either so it can be very tricky to interpret their speech a lot of the time.
Broca’s area is associated with language production so any damage here will result in word finding difficulties and disfluent speech. In line with the naming conventions from before, this type of aphasia is known as Broca’s aphasia or non-fluent aphasia. To get a sense of what this might look like, take a look at the video here of a person with non-fluent aphasia.
You will notice that a lot of the speech produced is lacking function words (the, to, is, etc.) and consists mostly of just nouns and verbs. This is known as telegraphic speech, and it is one of the most obvious symptoms of non-fluent aphasia.
The brain is a complex and sensitive organ, and unfortunately this isn’t always a good thing. It is seldom the case that any damage due to stroke or other injury will be isolated to only a single area. It is quite common for patients to experience damage in both Broca’s and Wernicke’s area, as well as in various other areas of the brain. This is why you often see people who have movement difficulties or even complete paralysis on one side of their body in addition to the possibility of these language disorders after having a stroke.
This can also mean that people can suffer from a combination of these two types of aphasia depending on the severity of the damage in each of the areas. The extreme form of this is called global aphasia which means that the person is non-fluent, is unable to comprehend any spoken messages, and is unable to repeat any words or phrases.
Just take a moment to imagine how hard it would be to go about your daily life like this. Especially remembering the fact that this is not a cognitive issue. It is not the case that you have forgotten these words, you just are unable to say the things that you want to. The amount of frustration you would experience is not something I can even begin to fathom.
But this is where linguists are here to help! Speech language pathologists (to be more specific) are trained professionals who work with a variety of people that need language help. Their clients could be kids with speech impediments or recent immigrants who want to improve their accent and sound more “native-speaker-like”. Speech pathologists will also work with recovering stroke patients. They work one-on-one with patients to develop specific care plans and assistance to improve their communication abilities. This can include many things from exercises to improve phonation time (producing an “ahhh” sound for an extended period) to practice on word recognition and repetition.
Having access to speech pathologists is an important part of stroke recovery. There has been research which shows that patients who receive speech therapy intervention after a stroke will recover significantly more language ability compared to those who receive no intervention. Stroke recovery is never an easy thing. Even with speech therapy, many patients will never fully recover their language use ability to pre-stroke levels.
I know this is a little bit of a depressing topic, but I feel that this is important. It feels weird to think about, but the whole reason I even discovered linguistics in the first place was my desire to become a speech pathologist after watching someone I knew recover from a stroke. My career path has changed since then, but I will always remember my roots and the whole reason I am here.
Knowing the signs of a stroke is important because the best chance you can give yourself when it comes to having a stroke is to seek medical attention as soon as possible. The acronym you can remember for this is F.A.S.T.
F = Face Drooping – Does one side of the face droop or is it numb? Ask the person to smile. Is the person’s smile uneven?
A = Arm Weakness – Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
S = Speech Difficulty – Is speech slurred?
T = Time to call 911
These are the keys to recognizing a stroke and it is a good idea to remind yourself them occasionally. Strokes come out of nowhere with little to no warning, so it is a good idea to know how to recognize the signs of a stroke. You could save a life with this one day.