Aphasia

General information

The majority of the people aphasics did not lose the use of the word completely. The aphasia is, more precisely, a speech difficulty which can present considerable differences: certain patients show only light uncertainties, to find their words for example, whereas others almost completely lost faculty to be expressed by the language, to include/understand what one says to them, to read and/or write, whereas other faculties, like the memory or the orientation, are preserved. There exist several kinds of aphasia in which these various faculties can be differently decreased.

What aphasia

One speaks about aphasia when an individual lost completely or partially the capacity to communicate, i.e. of speaking and/or including/understanding what one says to him. The specialists in the language make a difference between the word and the language: if an individual has difficulties of articulation, pronunciation, one will say that it has a disorder of the word; if it tests difficulties of choosing its words, to combine them to make sentences or to even include/understand their direction, one will say rather than it has a problem of language. The aphasia is a speech difficulty to which difficulties of word are often added; it involves disturbances as well of the expression as of the comprehension of the language. Several forms of the language can be touched: the conversation, the reading, the writing, etc Souvent the aphasic does not manage any more to name objects, does not find any more the name of the people whom he knows; he may be even that he cannot answer clearly by yes or not. The aphasia is an acquired speech difficulty, i.e. it occurs at an individual who had a normal language before and is thus distinguished from the problems being able to appear during the development of the language in the child (for example, a dyslexia développementale or a stammering). It is suitable for assign the women as much that the men.

With what are due the aphasias?

The brain is composed of two parts, called hemispheres. Each hemisphere controls various activities. For some of them, the participation of the two hemispheres is important. The control of the movement by the brain is made in a crossed way, i.e. the left part of the brain controls the right-hand man and the right leg while the right part of the brain controls the left side of the body. The left hemisphere, in the majority of the population, is also responsible for the language (expression, comprehension, reading and writing). More specifically, in approximately 90 to 95% of the cases of post-organic speech difficulties (aphasias), the damage is localized in the left cerebral hemisphere. The attacks of the right hemisphere are responsible for the 5 to 10% remainders of the cases of aphasia.

Causes of an aphasia

a Cerebral vascular accident (“brain attack”): either a vessel bleeds and causes a Hémorragie, or it is stopped and it is then about a Ischémie.
a cranio-cerebral Traumatism (at the time of road accident, of a fall)
an expansive process (a cerebral Tumor, e.g.)
a degenerative process (Disease of Alzheimer, e.g.)
an infection (Encéphalite)

Various types of aphasia

Various types of aphasia result from attacks located in particular areas of the brain. The types of traditional aphasias most known touch roughly half of the patients aphasics.

Cortical surfaces of the word and the language at the Man.

Lesions located in the former frontal area, which one calls surface of Broca interfere with the production of the word; damage in a surface of the temporo-parietal cortex, known as surface of Wernicke, affects the comprehension of the language; lesions in convolution supramarginale disturb the repetition of the heard words. For the majority of the individuals, these functional areas are only in the cerebral hemisphere dominating, i.e. it left among droitiers.

Aphasia of Broca

This aphasia was highlighted by Paul Broca, a French surgeon, in 1861. This pathology makes following lesions in the surface of Broca , the cerebral surface in charge of the installation of the driving body diagrams of the language. This surface is located on the left hemisphere of the Cerveau at a droitier, in the left frontal lobe (with the foot of the 3rd convolution frontal-foot of F3).

An attack of this surface can involve an aphasia of Broca. The subject is then unable to formulate orally its ideas whereas those are intact in its spirit. Comprehension is touched rather little, but the expression is seriously decreased:

the subject borrows a telegraphic style , the rate/rhythm of word is very chopped;
the flow is slowed down;
its vocabulary is tiny room to some words;
the articulation is very difficult;
syntax and grammar can lose very clearly in quality.

Aphasia of Wernicke

The Aire of Wernicke (of the name of the Polish neurologist which described it, Carl Wernicke) is also located in the left hemisphere of the brain, in the temporal lobe (posterior half of the 1st temporal convolution, behind and below the left auditive cortex). It is the seat of the comprehension of the various signs of the language. It is an associative surface which receives information of other cerebral surfaces, like the primary surfaces auditive and visual.

The Symptôme S of this pathology are opposed almost point by point to the aphasia of Broca:

syntax and grammar only are touched very little;
the flow is fast and almost unverifiable;
the vocabulary does not lose in richness;
the articulation does not pose any problem;
the speech is, on the other hand, incomprehensible, because stripped of direction . The proposals are connected without logical construction .

The aphasia of Wernicke can be distinguished in two large types: - with phonemic prevalence, which is characterized by deformed paraphrasies and words; - with semantic prevalence, which is characterized by a substitution of words determined by a relationship of direction.

The spontaneous word is made lapses of memory of vocabulary, stereotypies, of jargon, or paraphrasies. The repeated word comprises it, of the paraphrasies or is impossible. Comprehension is difficult because written or oral comprehension is very strongly disturbed. The spontaneous writing is also disturbed whereas the writing copied is normal. It is the same for calculation.

Mixed aphasia

Also called total or total. 2 forms: Great aphasia of Broca with an attack of the surface and deep territory of the left artery sylvienne (3/4 of the initial aphasias), aphasia marked by an inhibition generalized in the communication, an apraxia and a disorder of oral and nonverbal comprehension. The 2nd form is the Great aphasia of Wernicke with cortical lesions and under cortical posterior left, more frequently at the old subject, not of hémiplégie G, too flowing expression, very jargonnée with tble important of comprehension, one finds also an apraxia and a hemianopsy and a visual agnosia.

Total aphasia

It is the most serious form of the aphasia. Among certain patients, cerebral deteriorations or the disease lead to a total loss of the capacity to include/understand the language or speaking, reading or writing. These patients preserve a certain form of automatic language, especially of emotional exclamations. They manage to pronounce only very few words, and do not show any pretense of syntax. The damaged cerebral surface is vast, and includes/understands broad zones of the frontal, temporal and parietal cortex, in particular the surface of Broca, that of Wernicke and convolution supramarginale. Among these patients, the forecast of a recovery of the language is extremely reserved.

Aphasia of conduction

The people who suffer from an aphasia of conduction characterize by a flowing language, quasi the absence of changes in the comprehension of the oral language, and by extreme difficulties of repeating words or sentences. When these patients try to repeat words, they emit phonemic Paraphasie S, i.e. words with the incorrect phonemes in the place of correct sounds. The description of the cerebral lesion which is at the origin of this form of aphasia is still discussed. Certain researchers claim that it is about the destruction of the Faisceau arched, beam which connects the surface of Wernicke to the surface of Broca. In certain cases, one notices also lesions in the auditive cortex, the insula and convolution supramarginale.

Symptoms aphasics

Symptoms

; Lack of the word: the aphasic tests difficulty of finding his words, a little as when one has the word “on the end of the language”. Sometimes it manages to give a synonym or to describe by a short sentence what it seeks to name. Often, it does not manage to find, it “resigns” and leaves its unfinished sentence. It is not a question of a disorder of the memory as such but of a difficulty of finding the word at the good moment. Moreover, the sought word can sometimes be produced without problem, some time after, in another situation.

; The reduction of the expression: the aphasic does not speak much. The quantity of produced words is reduced; he often answers the questions by one “yes” or “not”, he seeks his words and always does not manage to make sentences. Just as it tests difficulties of being expressed, it can also test difficulties of writing. Sometimes, it is just possible for him to write its name or to recopy some letters.

; Logorrhée: called more commonly " diarrhea verbale" , results in an irresistible need to speak, without for all this that have direction because of the disorders of comprehension ou/et of expression.

; The hoop net arthric: the pronunciation of the sounds is abnormal; it can be fuzzy or too tonic. Usually, the person who has a disorder Arthrique speaks more slowly. It can be sometimes difficult to include/understand it because the sounds are not articulated clearly or are deformed.

; Paraphasias: 2 principal kinds which are verbal paraphasia (word) and phonemic paraphasia (its). When the aphasic is mistaken in word (e.g.: Passes to me my cigarettes - when he wants to say glasses) or that he moves the letters in a word (e.g.: culvitator for farmer), one says that it makes paraphasias.

; Jargon: one speaks about " Jargon " or " jargonaphasy " when the aphasic deforms and confuses the words or even invents the new ones so much so that it becomes impossible to include/understand it.

; Stereotypy: sometimes an aphasic speaks very little and the only words which it manages to produce, whatever the situation, are always the same ones (e.g.: My God, My God or your, your, your). Even if one tries to make him say another thing, they are always the same words or syllables which return.

; Disorder of comprehension: the aphasic has difficulty in include/understand what people say to him, even if he hears well. Certain aphasics include/understand the short sentences best that the words, others interpret best the isolated words. These difficulties can apply not only to what is known as but with what is written: in this case, the aphasic does not manage to include/understand the direction of what it reads.

Good with knowing

Those which use the gestural language have an aphasia following a cerebral attack

Several descriptions of case provide interesting data on the aphasia observed in users of the gestural language. Meckler, Mack and Bennett (1979) described an young man who had been raised by deaf-mute parents, and who had become aphasic following an accident. Before the accident, it communicated as well by language by signs as by spoken language. Afterwards, it tested disorders quite as serious in its language spoken as in its gestural language or than in its writing. It was able to reproduce complex movements of the hands and fingers, when one showed him the gestures to be achieved, but it could not carry out them in a spontaneous way.

the individuals bilingual aphasics or polyglots generally present attacks in all the languages which they speak

The people who can speak and write in more than one language always fascinated the researchers, specialists in the aphasia. Do the lesions of the cerebral cortex produce similar damage in all the languages? Do very different languages use the same neuronal systems? Paradises and Goldblum (1989) reviewed of many cases which were published; they defined classes of symptoms and forms of recovery at individuals bilingual and polyglot aphasics. There exist various modes of recovery, but in the most current form, presented by almost half of the bilingual cases of subjects, the two languages are affected in a similar way, and recovery is the same one in both cases. However, there exist exceptions to this observation: after cerebral, unquestionable damage patient have an antagonism alternated between the two languages which they practiced; in these cases, the patients pass from one language to the other.

Evolution of the disorder

1. Can one prevent or cure the aphasia?

The aphasia can with difficulty be prevented or cured by drugs. So certain drugs decrease the tension and regularize general circulation, they do not cure the aphasia. One can with difficulty prevent a cerebral lesion which will cause disorders aphasics, the more so as there are two types of lesions possible: the Ischaemia, and the Brain hemorrhage.

2. Can the aphasia worsen?

Usually, the aphasia resulting from a vascular accident cérébro or a traumatism does not worsen; on the contrary, it tends to attenuate with time. However, if a big raise of the difficulties were noted, the attending physician would have then to be re-examined quickly. However, it can arrive certain days that the aphasia temporarily seems to be accentuated under the effect of tiredness, the irritation or a momentary concern. One should not be alarmed in addition to measurement at this phenomenon: the language of the aphasic, even more than that of the individual in good health, is very sensitive to the situations Stress handles.

Treatment of the aphasia

The touched neurons are never renewed. In other words, the cure of the aphasia is not possible that so of new connections are made, or if the nervous ways only are partially touched. In these cases, an orthoepic rehabilitation is necessary to hope to find a language close to the normal. This recovery is possible thanks to the capacity of the brain to create new neural networks still called cerebral plasticity. Thus, a patient reached of an aphasia of Broca caused by a lesion of the left hemisphere can cover with the capacities of oral expression through the song. Indeed, the melody and the music are treated by the right hemisphere. Through a method of rehabilitation called the melody and rythmée Therapy (or melodic intonation therapy), the patient will try to use his right hemisphere to say sentences with a musical intonation.

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