10 Things You Should Know About Aphasia

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.

Comments

  1. Rebekah Donnithorne says:

    Last part of number 6 is NOT true! I have “true” aphasia and my stroke was in my speech center on the right side of my brain. This is because I was left-handed. Please not discount right-side aphasiac just because it does not happen regularly!

  2. Dysphasia is difficulty speaking. Aphasia is a complete inability to speak. A- is the prefix in medicine meaning absent. Asystole: absent systolic period (squeeze of the heart). Aphagia: absent ability to eat. Atraumatic: trauma is absent.

    Dys- is difficulty. Ie: dyspnea: difficulty breathing. Dysuria: difficulty urinating. Dysfunctional: diffulty functioning.

  3. Love your posts. Is there any way you can reference them?

    Tj

    @meditude

  4. My mom has had severe aphasia for over twelve years. Articles like this are a great way to spread the word about what is typically a very misunderstood condition. This is a great link to share with my friends to help them understand what my mom has been going through. Messaging is also very difficult for her, so I helped create a free platform for people with aphasia at http://www.tapgram.com. It allows her to independently send me and her close friends messages for the first time since her stroke – and we can send her replies. Aphasia – because it cuts at the core of what makes so many of us happy – communication and verbal expression – can be not only frustrating, but also very isolating and lonely.

    Thanks again for your informative post!

  5. Steve Whitehead says:

    @Rebekah Thanks for your comment. It reminds us that, no matter how rare, real people are exceptions to every one of our medical “rules”. While I appreciate the rarity of your condition, it doesn’t make the statement untrue. Aphasia from right sided brain insult remains a rarity.
    @Kevin Thanks for that. I’ve also found that, when we use the word Dysphasia in medical conversations we need to take care that we don’t confuse it with dysphagia, (difficulty swallowing), a common error.
    @Tj Most of these are fairly easy to reference through Google. if your having particular trouble with one or two let me know and I’ll help you find a source.
    @Chad Thanks for your contribution and your resource.

  6. @Steve. I do ALS and SCT (specialty care transport) and I frequently see aphasia and aphagia mixed up during reports from sending facilities as well as dysphasia and dysphagia. You could very easily do an article on mixed up words (ie vasopressors and lopressor, or dobutamine and dopamine) which could be beneficial to some of your readers!

  7. Great post, Steve! A friend of mine has periodic episodes of expressive aphasia. She had one at work and 911 was called. Unfortunately the paramedics who arrived thought she was faking her inability to speak, and said so to her during transport. She was aware of what was said the entire time, and was very upset by how she was treated by the EMS crew sent to help her. Now she has it printed on a medical alert bracelet, but I’m afraid many EMS people still wouldn’t know what it is. Thanks for getting the word out.

  8. Hi Steve,

    If you referenced your work, you’d have less criticism. For example your correspondent that picked you up on left/right sided insult.

    All the best,

    Tj

    @meditude

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