When a Left-Hemisphere Stroke Affects Language
One day, you can speak clearly to others and understand what they say in return. You can write an e-mail and read a sign. The next day, some or all of these crucial abilities are gone.
That’s how it is for more than one million Americans who have aphasia—a disorder caused by damage to parts of the brain that control speech and language. The most common cause of aphasia is a stroke. Specifically, it’s usually a stroke on the left side of the brain, called the left hemisphere. In most people, this is the side of the brain where language is based.
Language is the key to expressing ourselves and understanding others. Basically, it's how we interact with the world. As a result, “aphasia can be emotionally devastating,” says Nina Simmons-Mackie, Ph.D., professor of communication sciences and disorders at Southeastern Louisiana University. “Because language is how we project our intelligence and our personality, aphasia can be socially isolating as well.”
Types of Aphasia
The symptoms and severity of aphasia vary widely, depending on the exact location and amount of the brain damage. However, the disorder can be categorized by four basic types:
Anomic aphasia is the mildest form. People with this condition may be able to carry on a normal conversation in many situations. But they have trouble thinking of the right names for particular people, places, things, or events.
Expressive aphasia refers to difficulty using language to convey one’s thoughts. It can cause problems with speaking, writing, or both. For example, people may speak haltingly, with many stops and starts. They may use the wrong words; omit little words, such as “the” and “of”; or put words in the wrong order. People usually struggle for the correct words although they have no problem understanding language.
Receptive aphasia refers to difficulty understanding language. It can cause problems with comprehending speech, reading, or both. People can hear what’s said or see what’s written, but they can’t make sense of the words.
Global aphasia is the most severe form—the result of severe, extensive brain damage. People with this condition may lose almost all language ability. They say little or nothing and don’t understand what others say. They also lose their reading and writing skills.
Approaches to Treatment
Fortunately, speech-language therapy can help. Treatment approaches for aphasia are as varied as the symptoms. However, they can be divided into two broad categories: linguistic and social.
Linguistic approaches focus on helping people come up with words or grammatical structures. For example, let’s say you’re a speech-language pathologist working with a stroke patient who has expressive aphasia. He can think of what a cat is, but he can’t think of the word for it. “You might start by showing him a picture of a cat and having him say the word along with you,” says Dr. Simmons-Mackie. “You slowly build up to where he can say the word on his own in response to the picture. Then you build up to where he can say the word in response to a question.” Eventually, the goal is to reach the point where he can come up with the word completely on his own.
Social approaches focus on helping people reengage in life and do the things that are important to them. Let’s say our stroke patient belonged to a club before his stroke and wants to return to meetings. “First you and he would analyze what participation in a meeting involves,” says Dr. Simmons-Mackie. “Then you would work on finding ways to improve participation.”
For instance, you might build the person’s skills by rehearsing situations that are likely to come up, such as greeting a friend or being introduced to someone new. You might also suggest steps such as reserving a seat near the speaker (which helps the person focus on the speaker rather than competing sounds) or setting up a whiteboard where the speaker can write key words (which helps the person follow what’s being said). In addition, it may help to prepare cards or handouts for the other members that explain what aphasia is and offer communication tips, such as speaking slowly.
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