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Aphasia: A Virtual Prison That Can Be Escaped

Brain disorder can leave patients unable to communicate

THURSDAY, June 13, 2006 (HealthDay News) -- You're like a prisoner in your own mind: People talk, but you can't understand a word they're saying, even though they seem to get what you're telling them.

Or you can comprehend what someone is telling you, but when you try to respond, nothing but gibberish escapes your mouth.

Or nothing that's written makes sense to you. Or, if it does, you can't write anything yourself that's intelligible.

This nightmarish scenario is the language disorder called aphasia, a devastating condition that can take several forms, robbing patients of their ability to either speak or comprehend or -- in worst cases -- both.

Nearly one million Americans -- about one in 300 people -- suffer from aphasia, according to the National Aphasia Foundation, a nonprofit group dedicated to educating the public about the disorder. Aphasia is more common than Parkinson's disease, cerebral palsy or muscular dystrophy. Despite that, most people have never heard of the disorder or understand its symptoms.

Aphasia results from damage to the brain's language centers, typically found in the left hemisphere, according to the National Institutes of Health. There is no known cure.

About three-quarters of aphasia cases occur due to stroke, said Dr. Martha Taylor Sarno, professor of rehabilitation medicine at New York University School of Medicine. The disorder can also be triggered by blows to the head, brain tumors, brain infections, and other conditions of the brain.

The effects vary from person to person, she said.

"Aphasia comes in so many different configurations," added Sarno, who's also director of the Speech-Language Pathology Department at the Rusk Institute of Rehabilitation Medicine in New York City. "One person might have all comprehension gone but can communicate. Others can communicate but don't understand a thing. It all changes depending on where the damage is in the brain," she said.

The National Aphasia Association divides the condition into two broad categories -- fluent and nonfluent aphasia.

People with fluent aphasia have trouble understanding spoken and written language, while people with nonfluent aphasia have problems communicating orally and in writing.

The association categorizes some specific types of aphasia, including:

  • Global aphasia, the most severe form of the disorder, in which the patient can produce few recognizable words and understands little or no spoken language. They can neither read nor write. This form is often seen immediately after a person suffers a stroke, but if the damage is not too extensive, they will regain all their language capability or suffer a less severe type of aphasia. But if the brain damage is severe, the disability may last a lifetime.
  • Broca's aphasia, in which speech output is severely reduced, limited mainly to short utterances of less than four words. Vocabulary is limited, and speaking can be torturous. However, the person may understand speech and be able to read.
  • Wernicke's aphasia, in which the ability to grasp the meaning of spoken words is impaired. However, the person can speak relatively well, although sentences sometimes do not make sense. Reading and writing are often severely impaired.
  • Anomic aphasia, in which the person has a persistent inability to supply words for the things they want to talk about, particularly nouns and verbs.

The only treatment for the disorder is therapy, in which aphasia victims are taught ways to get around their communication blocks.

For example, Harvey Alter, president of the National Aphasia Foundation, ended up settling on a musical solution to his aphasia.

"I think I am singing," Alter said, in a voice that is slightly mechanical but otherwise normal. "What I do is called melodic tone intervention. I just substitute words into songs, and practice a long time until the words and song become one."

Patients also might be taught to point at something that represents the word they're searching for, or describe the word -- for example, gesturing toward a desk.

However, a new form of aphasia therapy runs counter to those compensatory tactics.

In constraint-induced therapy, patients are asked to speak without resorting to any gestures or other means of communication. The theory, which is under investigation, is that the brain will find new pathways through which to supply oral communication if no other options are available.

"In essence, it's kind of a forced method," Sarno said. "You force a patient to keep talking, no matter what comes out. It's become a topic of interest in the literature."

If speaking to someone with aphasia, patience is key, Sarno and Alter said.

"Tell the person to speak slowly, take a breath, and that you'll be there to listen to what they have to say," Alter said. "Make them feel at ease."

It also helps if you hold the conversation in a quiet spot.

"If the ambient noise in the room is high, it makes it much harder for a person with aphasia to communicate," Sarno said. "Take away as many of the distractions as you can."

More information

To learn more, visit the National Aphasia Association.

SOURCES: Harvey Alter, president, National Aphasia Foundation, New York City; Martha Taylor Sarno, M.D., professor of rehabilitation medicine at New York University School of Medicine, and director of the Speech-Language Pathology Department at the Rusk Institute of Rehabilitation Medicine, New York City; National Aphasia Foundation; National Institutes of Health
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