June is National Aphasia Awareness Month
June is National Aphasia Awareness Month, a month-long campaign to increase public awareness about aphasia and the people living with it. This national awareness campaign asks you to learn more about this disorder that affects a person’s ability to comprehend language and communicate after a brain injury or stroke.
History of National Aphasia Awareness Month
Back in the early ages, language disorders were not usually classified into types, and their relation to the brain was also not recorded. Aside from one early exception in Ancient Egypt, most language disorder prognoses did not mention the underlying causes.
Over time, scholars attempted to explain language disorders in relation to mental processes, and this research picked up speed after two neuroscientists researched aspects of aphasia. However, at this time, the research only focused on recognizing and reproducing words, and the entire linguistic principles were ignored. Aphasia briefly took on a clinical role, used only to classify patients with language disorders. The fact that wounds on the brain could and do cause aphasia was only learned much later after extensive research and trials were conducted on this subject.
The National Aphasia Association came into existence to help individuals with aphasia communicate and have a better quality of life.
What is Aphasia?
Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is always due to injury to the brain-most commonly from a stroke, particularly in older individuals. But brain injuries resulting in aphasia may also arise from head trauma, brain tumors, or infections.
Aphasia involves varying degrees of impairment in four primary areas:
- Spoken language expression
- Spoken language comprehension
- Written expression
- Reading comprehension
Aphasia can be so severe as to make communication with the patient almost impossible, or it can be very mild. It may affect mainly a single aspect of language use, such as the ability to retrieve the names of objects, the ability to put words together into sentences, or the ability to read. More commonly, however, multiple aspects of communication are impaired, while some channels remain accessible for a limited exchange of information.
Incidence and Prevalence of Aphasia
It is estimated that there are 180,000 new cases of aphasia per year in the United States (National Institute on Deafness and Other Communication Disorders [NIDCD], 2015). On the other hand, it is estimated that approximately 1 million people, or 1 in 250 in the United States today, are living with aphasia.
Aphasia after stroke is more common for older adults than younger adults (Ellis & Urban, 2016). Fifteen percent of individuals under the age of 65 experience aphasia after their first ischemic stroke; this percentage increases to 43% for individuals 85 years of age and older (Engelter et al., 2006).
No significant differences have been found in the incidence of aphasia in men and women. However, some data suggest that differences may exist by type and severity of aphasia. For example, Wernicke's aphasia and global aphasia occur more commonly in women, and Broca's aphasia occurs more commonly in men (Hier, Yoon, Mohr, & Price, 1994).
What Causes Aphasia?
The most common cause of aphasia is stroke (about 25-40% of stroke survivors acquire aphasia). It can also result from a head injury, brain tumor, or other neurological causes.
How Common is Aphasia?
Aphasia affects about two million Americans and is more common than Parkinson’s Disease, cerebral palsy, or muscular dystrophy. Nearly 180,000 Americans acquire the disorder each year. However, most people have never heard of it.
While aphasia is most common among older people, it can occur in people of all ages, races, nationalities, and gender.
Can a Person have Aphasia without Having a Physical Disability?
Yes, but many people with aphasia also have weakness or paralysis of their right leg and right arm. When a person acquires aphasia it is usually due to damage on the left side of the brain, which controls movements on the right side of the body.
Can People Who Have Aphasia Return to their Jobs?
Sometimes. Since most jobs require speech and language skills, aphasia can make some types of work difficult. Individuals with mild or even moderate aphasia are sometimes able to work, but they may have to change jobs.
How Long Does it Take to Recover from Aphasia?
If the symptoms of aphasia last longer than two or three months after a stroke, a complete recovery is unlikely. However, it is important to note that some people continue to improve over a period of years and even decades. Improvement is a slow process that usually involves both helping the individual and family understand the nature of aphasia and learning compensatory strategies for communicating.
Does Aphasia Affect a Person’s Intelligence?
A person with aphasia may have difficulty retrieving words and names, but the person’s intelligence is basically intact. Aphasia is not like Alzheimer’s disease; for people with aphasia it is the ability to access ideas and thoughts through language – not the ideas and thoughts themselves- that is disrupted. But because people with aphasia have difficulty communicating, it is often confused with other conditions.
Are All Cases of Aphasia Alike?
No.There are many types of aphasia. Some people have difficulty speaking while others may struggle to follow a conversation. In some people, aphasia is fairly mild and you might not notice it right away. In other cases, it can be very severe, affecting speaking, writing, reading, and listening. While specific symptoms can vary greatly, what all people with aphasia have in common are difficulties in communicating.
Types of Aphasia
Over a century of experience with the study of aphasia has taught us that particular components of language may be particularly damaged in some individuals. We have also learned to recognize different types or patterns of aphasia that correspond to the location of the brain injury in the individual case. Some of the common types of aphasia are:
Global Aphasia
This is the most severe form of aphasia, and is applied to patients who can produce few recognizable words and understand little or no spoken language. Persons with Global Aphasia can neither read nor write. Global aphasia may often be seen immediately after the patient has suffered a stroke and it may rapidly improve if the damage has not been too extensive. However, with greater brain damage, severe and lasting disability may result.
Broca’s Aphasia
Also called “non-fluent aphasia”, speech output is severely reduced and is limited mainly to short utterances of less than four words. Vocabulary access is limited and the formation of sounds by persons with Broca's aphasia is often laborious and clumsy. The person may understand speech relatively well and be able to read, but be limited in writing. Broca's aphasia is often referred to as a 'non-fluent aphasia' because of the halting and effortful quality of speech.
Mixed Non-fluent Aphasia
This term is applied to patients who have sparse and effortful speech, resembling severe Broca's aphasia. However, unlike persons with Broca's aphasia, they remain limited in their comprehension of speech and do not read or write beyond an elementary level.
Wernicke’s Aphasia
In this form of aphasia, the ability to grasp the meaning of spoken words is chiefly impaired, while the ease of producing connected speech is not much affected. Therefore Wernicke's aphasia is referred to as a 'fluent aphasia.' However, speech is far from normal. Sentences do not hang together and irrelevant words intrude-sometimes to the point of jargon, in severe cases. Reading and writing are often severely impaired.
Anomic Aphasia
This term is applied to persons who are left with a persistent inability to supply the words for the very things they want to talk about-particularly the significant nouns and verbs. As a result their speech, while fluent in grammatical form and output is full of vague circumlocutions and expressions of frustration. They understand speech well, and in most cases, read adequately. Difficulty finding words is as evident in writing as in speech.
Primary Progressive Aphasia
Primary Progressive Aphasia (PPA) is a neurological syndrome in which language capabilities become slowly and progressively impaired. Unlike other forms of aphasia that result from stroke or brain injury, PPA is caused by neurodegenerative diseases, such as Alzheimer's Disease or Frontotemporal Lobar Degeneration. PPA results from the deterioration of brain tissue important for speech and language. Although the first symptoms are problems with speech and language, other problems associated with the underlying disease, such as memory loss, often occur later.
Other Types of Aphasia
In addition to the foregoing syndromes that are seen repeatedly by speech clinicians, there are many other possible combinations of deficits that do not exactly fit into these categories.Some of the components of a complex aphasia syndrome may also occur in isolation. This may be the case for disorders of reading (alexia) or disorders affecting both reading and writing (alexia and agraphia), following a stroke. Severe impairments of calculation often accompany aphasia, yet in some instances, patients retain excellent calculation in spite of the loss of language.
Treatment
Aphasia treatment is individualized to address the specific areas of need identified during assessment, including specific goals identified by the person with aphasia and his or her family. Treatment occurs in the language(s) used by the person with aphasia – either by a bilingual SLP or with the use of trained interpreters, when necessary.
Consistent with the World Health Organization’s ICF Framework, the goal of intervention is to help the individual achieve the highest level of independent function for participation in daily living.
Intervention is designed to:
- capitalize on strengths and address weaknesses related to underlying structures and functions that affect communication across partners, activities, and settings;
- facilitate the individual's activities and participation by (a) teaching new skills and compensatory strategies to both the individual with aphasia and his or her partner(s) and (b) incorporating AAC strategies if appropriate; and
- modify contextual factors that serve as barriers and enhance those that facilitate successful communication and participation, including accommodations such as large print, pictures, and aphasia-friendly formatting to support comprehension of written health materials (e.g., Rose, Worrall, & McKenna, 2003; Rose, Worrall, Hickson, & Hoffman, 2011).
How to Observe National Aphasia Awareness Month
Raise awareness
One of the key issues people with aphasia deal with is a lack of awareness among the general population. So, on this day, go ahead and research this day, and how best to deal with people afflicted with this condition. A little knowledge goes a long way, and you can even educate your loved ones about it.
Create your own support group
Another key area of help could be a special group full of people ready to help and support those with aphasia. Research shows such support groups are known to help people with aphasia by offering tips, guidance, and emotional support. Statistics indicate there are already more than 600 support groups for stroke and aphasia in the United States, and yours can be one of these impressive numbers too.
Visit the National Aphasia Association website
Not only do the National Aphasia Association hand out educational material during this month, but they also include a list of events and activities that can be checked out. Their website is categorized as per their specific needs and you can do your bit to contribute to their organization.
Sources:
https://www.aphasia.org/aphasia-definitions/
https://www.asha.org/practice-portal/professional-issues/collaborating-with-interpreters/
https://nationaltoday.com/national-aphasia-awareness-month/
https://publichealthmaps.org/calendar/2021/6/1/national-aphasia-awareness-month