"'Aphasia"' (sometimes spelled "Aphemia"; derived from the Greek words for "without speech" and "aphasia") is a condition in which a person experiences a loss or impairment of their ability to generate and/or comprehend language as a result of [[brain injury]]. Damage to the areas of the brain responsible for language (such as Broca's region) is typically the cause of this condition. These regions are usually always present in the [[left hemisphere]], and in most people, the ability to generate and comprehend language is situated in this part of the brain. However, linguistic capacity is only found in the right hemisphere of the brain in a very tiny percentage of persons. A [[stroke]], a [[traumatic brain injury]], or any other type of [[head injury]] can cause damage to these parts of the brain that control language. Aphasia can also develop gradually, as it does in some cases when a brain tumor is present. A person who has aphasia may be able to speak but not write, or vice versa; understand more complex sentences than he or she can produce; or display any one of a wide variety of other deficiencies in reading, writing, and comprehension. This is because the area and extent of the damage determines which of these symptoms a person with aphasia will exhibit.
'''Aphasia''', sometimes spelled '''Aphemia''', is a [[communication disorder]] characterized by the loss or impairment of the ability to produce and/or comprehend [[language]] due to damage in specific regions of the [[brain]]. The term originates from the [[Greek language|Greek]] word "aphatos," meaning "speechless."
[[File:Aphasia.png|thumb|Aphasia|right]]
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[[File:Aphasia.png|thumb|right|Aphasia affects language comprehension and expression.]]
Aphasia is a condition that can develop in conjunction with speech problems such as dysarthria and apraxia of speech, both of which are brought on by damage to the brain.
Aphasia typically results from [[brain injury]] affecting the [[left hemisphere]], where the [[language center]] is located in most people. This damage can be caused by a [[stroke]], [[traumatic brain injury]], [[brain tumor]], or progressive neurological diseases such as [[primary progressive aphasia]]. Although rare, in some individuals (particularly left-handed people), language functions may be dominant in the right hemisphere.
It is possible for the brains of young children who have suffered brain damage to rearrange themselves to use different areas for speech processing and restore lost function. The brains of adults are less "plastic" and lack the ability to do this function.
== Overview ==
A person with aphasia may:
* Speak fluently but without meaning
* Struggle to form coherent speech
* Understand speech but not write
* Display reading (''[[alexia (disorder)|alexia]]'') or writing (''[[agraphia]]'') difficulties
Aphasia can be evaluated in a number of different methods, ranging from a brief clinical screening that is performed at the bedside to a battery of tasks that lasts several hours and examines the fundamental aspects of language and communication.
These symptoms vary depending on the extent and location of the brain damage. Aphasia often co-occurs with other speech disorders like [[dysarthria]] and [[apraxia of speech]]. While the brain of a child can adapt to such damage with neuroplasticity, adults have more limited capacity for compensation.
==Types==
Aphasia can be broken down into the following categories, according to the Locationist Model:
The locationist approach makes an effort to categorize aphasia according to its key characteristics and then links these qualities to regions of the brain in which the damage has been created. However, since that time, many researchers have added to the model, which is why it is frequently referred to as the "Boston-Neoclassical Model." The first two categories shown below were developed by early neurologists working in the field. Howard Goodglass and [[Edith Kaplan]] are widely considered to be the two most influential writers on this subject.
==Neuroanatomy==
Damage to the frontal lobe of the brain is present in patients who suffer from [[Broca's aphasia]]. These individuals typically use succinct statements that are rich in meaning and are delivered with a great deal of concentration. Because of this, Broca's aphasia is referred to as a nonfluent kind of aphasia. People who are affected frequently leave off relatively insignificant terms like "is," "and," and "the." A person who suffers from Broca's aphasia, for instance, might say "Walk dog" when they actually mean "I will take the dog for a walk." It's possible that the exact same line might imply either "You take the dog for a walk" or "The dog walked out of the yard" depending on the context. People who have Broca's aphasia can understand the speech of others to varied degrees, depending on the severity of their condition. Because of this, they are frequently aware of their challenges and are prone to experiencing easy frustration as a result of their speaking issues. Due to the fact that the frontal lobe is also vital for body movement, people who have Broca's aphasia frequently suffer from right-sided weakness (also known as hemiplegia) or paralysis of the arm and leg.
==Wernicke's aphasia==
Wernicke's aphasia is a fluent form of aphasia that can be caused by damage to the temporal lobe, in contrast to Broca's aphasia, which is a receptive form of aphasia. People who have Wernicke's aphasia may speak in lengthy phrases that are meaningless, they may add words that aren't essential, and they may even manufacture new "words." A person who suffers from Wernicke's aphasia, for instance, can say something like "You know that smoodle pinkered and that I want to get him round and take care of him like you want previously," which translates to "The dog wants to go out so I will take him for a walk." Wernicke's aphasia patients typically have a significant deal of difficulty understanding speech and, as a result, are frequently ignorant of the errors they make in their own communication. These people typically do not experience any weakening in their bodies because the area of the brain that was injured is not close to the areas of the brain that govern movement.
Working off of Wernicke's concept of aphasia, [[Ludwig Lichtheim]] postulated five additional forms of aphasia; however, these classifications were never tested on actual patients until contemporary imaging made it possible to conduct more in-depth investigations.
== Assessment ==
Evaluation of aphasia ranges from quick bedside assessments to in-depth standardized language tests like the [[Western Aphasia Battery]] or the [[Boston Diagnostic Aphasia Examination]].
According to the locationist paradigm, the following are the other five forms of aphasia:
== Types of Aphasia ==
A condition known as "Pure Word Deafness" (all understanding impaired, but expressive channels intact).
The classification of aphasia is often based on lesion location and behavioral symptoms. The most widely recognized system is the '''Boston-Neoclassical Model'''.
Conduction aphasia is a type of aphasia (speech, writing and silent reading intact, but repetition, reading aloud and dictation impaired).
#'''[[Apraxia]]''' Which is now understood to be its own distinct illness in its own right.
The condition known as "'Transcortical Motor Aphasia"' (Understanding of speech, writing, repetition and reading intact, but impaired voluntary speech and writing).
The condition known as "'Transcortical Sensory Aphasia"' (Impaired comprehension of speech and writing, but writing, reading aloud and speech spared).
The [[Boston-Neoclassical model]] proposes another type of aphasia called [[anomia]], which is simply a problem with naming things. [[Anomia]] can be thought of as a difficulty with naming things. The individual may have trouble naming specific words, which may be linked by the grammatical category in which those words fall (for example, having trouble naming verbs but not nouns) or by the semantic category in which those words fall (for example, having trouble naming words relating to photography but not other topics) or by a more general difficulty in naming words. Individuals who have this condition are typically aware of it, and it can be compared to a sensation that some people get at the "tip of the tongue."
=== [[Broca's aphasia]] ===
Also known as ''expressive aphasia'', Broca's aphasia results from damage to the [[inferior frontal gyrus]] (Broca's area). Individuals:
* Speak in short, effortful phrases
* Omit small grammatical words
* Often understand speech relatively well
* Are aware of their difficulties
* May have associated [[right-sided hemiparesis]] or [[hemiplegia]]
The third and last kind of aphasia is called global aphasia, and it occurs when substantial regions of the language-processing areas of the brain are damaged. People who suffer from global aphasia have significant difficulties communicating and will have a severely impaired capacity for speaking and comprehending language.
Example: Saying "Walk dog" instead of "I will take the dog for a walk."
In clinical settings, however, only few patients were found to be an exact match for any of the kinds; hence, a different model was presented.
=== [[Wernicke's aphasia]] ===
Also known as ''receptive aphasia'', this fluent type of aphasia stems from damage to the [[posterior superior temporal gyrus]] (Wernicke's area). Individuals:
* Speak in fluent but nonsensical language
* May invent new words (''[[neologisms]]'')
* Are often unaware of their deficits
* Typically do not experience motor impairments
The cognitive neuropsychological model is referred to as The Model
Example: "The smoodle pinkered and I want to get him round."
[[Cognitive neuropsychology]] is the foundation upon which the Cognitive Neuropsychological model is built. It operates under the presumption that the process of language processing can be segmented into a number of modules, each of which serves a distinct purpose. As a result, there is a module that is able to recognize [[phonemes]] as they are being uttered, as well as a module that is able to store formed [[phonemes]] before they are spoken. When this model is applied in a clinical setting, it is necessary to carry out a battery of evaluations (often taken from the PALPA), each of which evaluates one or more of these modules. After a diagnosis has been made regarding the location of the impairment, treatment can then begin on an individual basis to address each module.
== Different Forms of Aphasia ==
=== [[Global aphasia]] ===
Aphasia can be caused by any of the following, including but not limited to:
This is the most severe form and occurs when large portions of the left hemisphere are damaged. Individuals with global aphasia:
* a failure to grasp spoken language
* Have profound impairments in speaking, understanding, reading, and writing
* a reading disability (also known as [[alexia (disorder)|alexia]]
* Often retain limited communication ability
* a lack of the ability to write ([[agraphia]])
* inability to create words
* inability to name items ([[anomia]])
* poor [[enunciation]]
* unable to speak without having paralysis of the muscles of the mouth or throat
* the excessive production of one's own [[neologism]]s and use of them ([[jargon aphasia]])
* the inability to repeat a sentence
* the repeated repetition of phrases
* any other language impairment
Broca's aphasia and other forms of aphasia are the most common types. ([[Wernicke's aphasia]]) Also known as [[expressive aphasia]]. (Aphasia of the [[receptive]] system) *Aphasia of the [[nominal]] system ([[anomic aphasia]])
=== [[Anomic aphasia]] ===
*[[Global aphasia]]
Characterized by difficulty retrieving words, especially [[nouns]] and [[verbs]]. Patients:
*[[Conduction aphasia]]
* Know what they want to say but cannot find the words
*[[Conduction aphasia]]
* Speak fluently with frequent pauses
* Are aware of the word-finding difficulty
It is important to keep in mind that it is not impossible to experience all of the above simultaneously.
=== [[Conduction aphasia]] ===
Results from damage to the [[arcuate fasciculus]], the pathway connecting Broca’s and Wernicke’s areas. Patients:
* Speak fluently and understand language
* Have difficulty with [[repetition]]
* Often produce phonemic errors (e.g., "papple" for "apple")
*[[Transcortical motor aphasia]] and
=== [[Transcortical motor aphasia]] ===
*[[Subcortical motor aphasia]] are two types of aphasia that occur much less frequently.
Similar to Broca’s aphasia but repetition is preserved. Caused by lesions near but not in Broca’s area.
*[[Transcortical sensory aphasia]] (often referred to as TSA)
Assessment of Aphasia and Related Disorders, edited by Harold Goodglass and Edith Kaplan, published in 1972 Februaryinger and Lea
Similar to Wernicke’s aphasia with preserved repetition. Caused by lesions in the temporoparietal junction.
Coltheart, M. Kay, and R. Lesser both contributed to the study (1992). Evaluations of Aphasia Patients' Psycholinguistic Capabilities Regarding Language Processing (PALPA). Hove: Erlbaum.
Personal Recollections of Living with Aphasia
=== [[Mixed transcortical aphasia]] ===
Also known as isolation aphasia. Comprehension and spontaneous speech are impaired, but repetition is preserved.
S. Hale's book "The Man Who Lost His Language," published by Penguin in 2003.
== Neuropsychological Perspective ==
The '''Cognitive Neuropsychological Model''' views language as modular. Impairment can occur in distinct modules:
* Phoneme recognition
* Lexical retrieval
* Semantic processing
== External connections ==
Evaluation tools such as the [[PALPA]] (Psycholinguistic Assessment of Language Processing in Aphasia) help localize the disrupted modules and guide [[speech-language therapy]].
*[http://www.untitledtheater.com/plays/strangers-linguish.html Linguish is a drama written by Edward Einhorn in which the author imagines a hypothetical form of aphasia that is contagious and spread by a virus. [http://www.nidcd.nih.gov/health/voice/aphasia.asp Information about Aphasia provided by the NIDCD] (public domain source)
*[http://www.nlm.nih.gov/medlineplus/ency/article/003204.htm [Entry on Speech Impairment (adult) from the MEDLINEplus Medical Encyclopaedia, maintained by the National Institutes of Health] (it should be noted that this content is not in the public domain, despite the fact that it may be found on a website associated with the government)
*[http://media.cbc.ca:8080/ramgen/cbc.ca/thesundayedition/media/aphasia se021215.rm "In Such a Vast Amount of Words"] Radio documentary that was shown on the program "The Sunday Edition" that was produced by the Canadian Broadcasting Corporation on December 15, 2002. The film was co-produced by Teresa Goff, and it tells the tale of her father Steve Goff, who has aphasia as a result of having a stroke. [http://23nlpeople.com/aphasia dysphasia.htm Ideas and Things to Think About Concerning Aphasia and Dysphasia]
*[http://www.aphasia.tv "Picturing Aphasia"] A documentary film about aphasia that employs the use of drawings as a means of bridging the gap between hearing, seeing, and comprehending what is being seen and heard. The purpose of the movie is twofold: first, to serve as a component of treatment for patients suffering from aphasia; second, to educate viewers of varying linguistic capacities about the illness. Mores McWreath is the director of this production. [http://braininfo.rprc.washington.edu/scripts/indexotheratlas.aspx?othersiteID=1045244870 Auditory, afferent, efferent, and semantic aphasia are the four subtypes of this communication disorder.
*Aphasia materials can be found at [http://www.aphasianow.org/] for aphasics. Aphasics resources are available here. Aphasia Therapy, Aphasia Software, and Aphasia Treatment Advice
*[http://aphasia.net/info/aphasia/default.asp [Aphasia, to put it in simple English] - An explanation of aphasia in layman's terms, as well as information for people who have recovered from the condition
*The [http://www.aphasia.org/ National Aphasia Association] (located in the United States) is a charitable organization that encourages public education as well as research, rehabilitation, and support services for persons who have aphasia and their family. Adler Aphasia Center is located in New Jersey, United States, and may be accessed via [http://www.adleraphasiacenter.org/]. Aphasia Center of California in Oakland, California, United States of America (http://www.aphasiacenter.org/).
==Aphasia in popular culture==
== Other Aphasia-Related Conditions ==
Aphasia has been a popular subject in literature and television as a means to explore the complexities of human communication. For example, in the "Star Trek: Deep Space Nine" episode "Babel," an aphasia virus infects the population of a space station, causing them to speak random words instead of what they intend to say. The play "Fuddy Meers" also delves into this idea, with the main character, Claire, who is an amnesiac and whose kidnapper's mother, who has suffered a stroke and become aphasic, is the only one who knows the truth about Claire's situation. The play's title is based on the mother's pronunciation of the phrase "funny mirrors" and serves as a metaphor for how the play is told and how we experience everyday life. Additionally, in Episode 10 of Season 2 of "House M.D.," a patient with aphasia resulting from head trauma is shown to substitute associated words in sentences but is able to answer yes or no to direct questions.
* [[Apraxia of speech]] – Motor planning disorder, not a language issue
* [[Alexia (disorder)]] – Impaired reading
* [[Agraphia]] – Impaired writing
* [[Jargon aphasia]] – Fluent but meaningless speech with invented words
* [[Landau-Kleffner Syndrome]] – Acquired epileptiform aphasia in children
* [[Primary progressive aphasia]] – Neurodegenerative form
== All Types of Aphasia ==
* [[Broca’s aphasia]]
* [[Wernicke’s aphasia]]
* [[Global aphasia]]
* [[Anomic aphasia]]
* [[Conduction aphasia]]
* [[Transcortical motor aphasia]]
* [[Transcortical sensory aphasia]]
* [[Mixed transcortical aphasia]]
* [[Subcortical aphasia]]
* [[Jargon aphasia]]
* [[Alexia]]
* [[Agraphia]]
== Aphasia in Popular Culture ==
* In ''Star Trek: Deep Space Nine'' episode "Babel," a viral form of aphasia spreads on the station.
* In ''House M.D.'' (Season 2, Episode 10), a patient displays word-substitution aphasia after trauma.
* In the play ''Fuddy Meers'', a character with aphasia highlights the disconnect in communication.
== External Links ==
* [https://www.nidcd.nih.gov/health/aphasia NIDCD – National Institute on Deafness and Other Communication Disorders]
* [https://www.aphasia.org/ National Aphasia Association]
* [http://www.aphasiacenter.org/ Aphasia Center of California]
* [http://aphasia.net/info/aphasia/default.asp Aphasia Simplified – Info for patients and caregivers]
== References ==
* Goodglass, H., & Kaplan, E. (1972). ''Assessment of Aphasia and Related Disorders.'' Philadelphia: Lea & Febiger.
* Coltheart, M., Kay, J., & Lesser, R. (1992). ''PALPA: Psycholinguistic Assessments of Language Processing in Aphasia.'' Hove: Erlbaum.
* Hale, S. (2003). ''The Man Who Lost His Language.'' Penguin Books.
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Revision as of 11:04, 26 March 2025
Aphasia, sometimes spelled Aphemia, is a communication disorder characterized by the loss or impairment of the ability to produce and/or comprehend language due to damage in specific regions of the brain. The term originates from the Greek word "aphatos," meaning "speechless."
Aphasia affects language comprehension and expression.
Display reading (alexia) or writing (agraphia) difficulties
These symptoms vary depending on the extent and location of the brain damage. Aphasia often co-occurs with other speech disorders like dysarthria and apraxia of speech. While the brain of a child can adapt to such damage with neuroplasticity, adults have more limited capacity for compensation.
The classification of aphasia is often based on lesion location and behavioral symptoms. The most widely recognized system is the Boston-Neoclassical Model.
Also known as receptive aphasia, this fluent type of aphasia stems from damage to the posterior superior temporal gyrus (Wernicke's area). Individuals:
Also known as isolation aphasia. Comprehension and spontaneous speech are impaired, but repetition is preserved.
Neuropsychological Perspective
The Cognitive Neuropsychological Model views language as modular. Impairment can occur in distinct modules:
Phoneme recognition
Lexical retrieval
Semantic processing
Evaluation tools such as the PALPA (Psycholinguistic Assessment of Language Processing in Aphasia) help localize the disrupted modules and guide speech-language therapy.
