Aphasia is a catch-all word that describes difficulty in speaking. Aphasia can range from mild difficulty in finding and expressing words or completing sentences to a complete inability to speak.. It is a significant finding in a physical assessment. The patient who presents with a new onset of aphasia has a concerning medical issue. Here are ten things to keep in mind the next time you encounter a patient who is having difficulty speaking.
1) Aphasia can be both receptive or expressive. If someone is having difficulty speaking they are said to be experiencing expressive aphasia. Receptive aphasia is a difficulty in understanding spoken words. A patient who has both receptive and expressive aphasia is said to have conductive aphasia (or global aphasia).
2) The primary area of the brain that assists us with our speech is known as Broca’s area. Word associations are also made using Wernikie’s area. Most all aphasia is caused by a disruption of the brain’s ability to process information in one of these two area.
3) The primary concern with acute, new-onset aphasia is stroke but it can also be caused by brain masses or lesions, head injury, vascular abnormalities and dementia.
4) Aphasic patients are not necessarily confused. Most aphasia occurs in the absence of confusion and it can be extraordinarily frustrating (and frightening) for the patient. Consider that every time the patient is unable to speak (or even write) there is something that they desperately want to say.
5) The signs of aphasia may be subtle. If the patient is speaking in an unusual way, slurring, stuttering or having difficulty finding the correct word to say, don’t be shy about asking them if this impediment in their speech is normal for them or if it is new. If it is new, try to figure out when it started. People who live alone may have aphasia for a significant amount of time before they recognize their own aphasia.
6) Broca’s area is located just in front and to the left of the brainstem, bordering on the frontal cortex. This makes aphasia is a left sided neurological deficit. Right sided brain injury or insult rarely results in true aphasia.
7) While we’ve been discussing acute onset aphasia, it can also have a slow onset if the underlying cause also has a slow progression (such as sepsis, dementia and brain mass).
8) This disorder can be highly selective. A patient with aphasia may only have difficulty in speaking but not writing (or vice-versa). They also may only have difficulty naming things like colors, objects or people.
9) A patient with complete aphasia is technically “unable to complete” the Cincinnati Prehospital Stroke Scale (CPSS). If a patient attempts the phrase but is unable to complete it correctly, they have failed the evaluation. If they are unable to attempt the phrase at all, they are recorder as “unable to complete” the exam.
10) Recovering from aphasia after a stoke can take years of speech therapy. Some patients may never fully recover their language abilities.
Hopefully this list will give you a few things to think about the next time you encounter an aphasic patient. Aphasia may be the only presenting symptom during a stroke or brain injury. When you recognize aphasia, treat it as a medical emergency.