Aphasia: Without Speech

A-phasia means “without speech” – the term derived from the Greek already describes the clinical picture. Aphasia is characterized by the impairment of speech that occurs as a result of acquired brain damage. In principle, all areas of language are affected: comprehension, speaking, reading and writing. The most common cause of aphasia in adults is a stroke resulting from a cerebral infarction or cerebral hemorrhage.

What is aphasia?

By definition, aphasia is the loss of already acquired language skills – therefore, young children with such disorders are not referred to as aphasia, but as a language development disorder. In older children, aphasia occurs predominantly as a result of an accident involving brain injury (traumatic brain injury).

Language center in the brain

Several regions in the brain (mostly the left hemisphere) must work together – in addition to anatomical structures such as the tongue and larynx – to understand heard and seen speech and to form language:

  • In the frontal lobe of the cerebral cortex sits the motor speech center (Broca’s speech center). This coordinates the speech muscles.
  • The parietal lobe is home to the sensory speech center (Wernicke speech center). This is indispensable to remember words and word sounds heard.
  • In the occipital lobe is the optical speech center. This is responsible, among other things, to detect and understand read language.

Types of aphasia and their symptoms

Depending on which areas of the brain are affected, four different types of aphasia are distinguished, which manifest themselves differently:

Amnestic aphasia: The affected person understands very well, his reading and writing are not or hardly affected. When he speaks for himself, he often has to search for appropriate words or paraphrase missing words. This delays his speech flow. Outsiders therefore not infrequently erroneously conclude from the slowed speech to slow thinking. A mild manifestation of this form of aphasia is called dysphasia. Broca’s aphasia: The affected person usually understands well, but can only speak with difficulty – often in short, choppy sentences with many pauses in speech (“telegram style”). Wernicke’s aphasia: In this case, speech comprehension is partially impaired. For example, the aphasic person only understands individual words, but not the context. The affected person speaks fluently and quickly, but mixes up letters or whole words and often makes mental leaps. Not infrequently, the utterances hardly make any sense (word deafness). Global aphasia: In this form of aphasia, several areas responsible for speech are affected, making it the disorder with the greatest impairment. Communication is difficult for the affected person, speech comprehension is severely impaired. If at all, only the simplest sentences are understood. Mostly only parts of words are spoken, which are often strung together in repetitions. Unfortunately, the impairment of speech often leads to the fact that people with aphasia are perceived by their environment as mentally impaired. However, this is not true. It is important to know that their logical thinking, as well as their comprehension and judgment skills, function just as they do in healthy individuals.

Aphasia: other disorders

Because aphasia is usually the result of a stroke, other impairments are often present. These, too, depend on the brain region affected and the size of the damaged area of the brain. Common symptoms include paralysis of one half of the body, which can range from mild impairment of fine motor skills (such as peeling potatoes) to pronounced gait disturbances. Swallowing disorders (dysphagia) are also common. Aphasia is often accompanied by dysarthria (also: dysarthrophonia), in which not speech comprehension but speech itself, i.e. the speech movement, is disturbed. In this case, the speech muscles – such as those of the mouth and tongue – are intact, but are no longer controlled correctly and synchronously by the responsible brain centers. As a result, the sounds can no longer be formed correctly – speech sounds washed out, incomprehensible or slow. Many sufferers complain of often being mistaken for drunk.

Agnosia and apraxia as additional problems

It is not uncommon to have agnosia, the inability to recognize a sensory perception even though the sensory organs, such as the eyes, ears, and sense of touch, are functioning.In acoustic agnosia (soul deafness), sounds and noises are not recognized; in optical agnosia (soul blindness), what is seen cannot be identified as a corresponding object. In apraxia, voluntary gestures and movements are no longer executed correctly, although there is no paralysis and sensory perception is also unimpaired. Thus, action sequences cannot be imitated, such as repeating a sentence or imitating a grimace. In addition, for example, balance problems, sensory disturbances, and concentration and memory disorders may also occur.

Aphasia: diagnosis and treatment

Diagnosis includes a detailed neurological examination to accurately assess all disorders and their cause. This is important for therapy and for the course of the disease. Depending on the location and extent of the damage, aphasia may regress completely or partially, but severe impairments may remain. It is therefore important to recognize aphasia in the first place, as well as its extent and form, and to distinguish it from other disorders such as dysarthria. In German-speaking countries, the Aachen Aphasia Test (AAT) is used for this purpose. Speech therapy (logopedics) is at the center of the treatment of aphasia. This supports the spontaneous recovery of language skills in the initial phase, and later serves to train and optimally use existing possibilities for communication. A good place to go for information and self-help groups is, for example, the German Aphasia Association (www.aphasiker.de), which even maintains its own website for aphasia in children.