Main types of aphasia
The picture depends on which area is affected. With motor aphasia, a person understands speech, but speaks with effort, in short phrases, and sometimes repeats one syllable; he realizes his mistakes and worries about them. With sensory aphasia, speech flows freely, but consists of inappropriate or distorted words, and understanding is impaired, so the patient does not notice the problem. Often there is a mixed variant with a violation of both speech and understanding, and with extensive lesions - total aphasia.
- Motor: understands, but cannot articulate
- Sensory: speaks fluently, but does not understand or control speech
- Amnestic: forgets the names of objects
- Mixed and total forms
- Reading and writing are also often affected
Reasons
The leading cause in adults is stroke in the middle cerebral artery of the dominant hemisphere. In second place is traumatic brain injury, followed by tumors, abscesses and encephalitis. A separate issue is primary progressive aphasia, in which speech slowly deteriorates over months and years due to a neurodegenerative process. The distinction is fundamental: with a stroke, the first hours are important; with a progressive form, a routine examination and selection of a communication strategy are important.
- Ischemic and hemorrhagic stroke
- Traumatic brain injury
- Brain tumor
- Encephalitis, brain abscess
- Primary progressive aphasia
- Consequences of epileptic seizures
How to distinguish aphasia from dysarthria
These disorders are often confused, although the approach to them is different. With dysarthria, a person knows what he wants to say and constructs the phrase correctly, but speech is blurred and unclear due to weakness of the muscles of the tongue and lips; the letter was saved. With aphasia, the language itself suffers as a system: word selection, grammar, comprehension, as well as reading and writing. One patient after a stroke may have both disorders at the same time, and a speech therapist examines them separately.
- Dysarthria: unclear pronunciation with intact phrase structure
- Aphasia: errors in words, grammar and comprehension
- Writing is usually not affected by dysarthria
- In aphasia, reading and writing are impaired
- A combination of both disorders is possible
Diagnostics
In case of sudden speech impairment, the first priority is to exclude a stroke, so the patient is urgently hospitalized and a CT or MRI of the brain is performed. After stabilization, the speech therapist conducts a detailed examination of speech: naming objects, repetition, understanding instructions of varying complexity, reading and writing. This allows you to determine the form of aphasia and build a training program. Swallowing, vision, and cognitive function are additionally assessed because they affect rehabilitation.
- Emergency CT or MRI of the brain
- Examination by a neurologist, assessment of focal symptoms
- Examination of the vessels of the head and neck
- ECG and search for the source of embolism
- Speech therapy examination of speech, reading and writing
- Swallowing and cognitive assessment
Speech restoration
Rehabilitation begins in the hospital as soon as the condition allows, and continues on an outpatient basis and at home. Classes are based on preserved capabilities: with the motor form, they train the recall of words and phrases, with the sensory form, understanding and auditory control. Regularity and moderate exercise are important: short daily exercises are better than rare exhausting ones. At the same time, they treat the underlying disease and reduce the risk of a recurrent stroke - control blood pressure, sugar and heart rhythm, and stop smoking. Some patients develop depression, which inhibits recovery and requires the attention of a doctor.
- Early start of speech therapy sessions
- Daily short practice with loved ones
- Speak to a person in simple phrases without raising your voice
- Don’t finish speaking for him and give him time to answer.
- Use pictures, writing, gestures as support
- Monitoring blood pressure, blood sugar and heart rate
- Attention to mood, if necessary, help from a doctor