AL-ADAB JOURNAL, No. 104, Techniques & Treatments for Improving the Skills of Communication of Aphasics in English and Iraqi Arabic Institutions

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1 AL-ADAB JOURNAL, No. 104, 2013 Techniques & Treatments for Improving the Skills of Communication of Aphasics in English and Iraqi Arabic Institutions Baidaa Faisal Noori (PH.D.) & Shurooq A. Ali (M.A.) University of Baghdad College of Arts English Department Abstract Aphasia is described as a communication disorder characterized by either partial or total loss of the ability to communicate verbally. A person with aphasia may have difficulty in speaking, reading, writing, recognizing the names of objects, or understanding what other people have said. However, the language problems of aphasia can be understood by saying or writing something (expressive language) or in comprehending either spoken or written communication (receptive language).. There are different types of aphasia, these types are classified according to the area of the brain that is injured. The most common cause of aphasia is stroke - the blockage; i.e., rupture of a blood vessel in the brain. This disruption of the blood supply leads to the brain cells death or damage in the areas of the brain controlling language. Aphasia may also be caused by a severe head injury, a brain tumour or an infection. Thus, this study shows the important facts about this phenomenon and gives the techniques and treatments recommended by British institutions and organizations in comparison with those used in Iraq (specifically in Baghdad)... 1

2 1. Definitions of Aphasia Richards et al (1992:18) state that aphasia is a language disturbance caused by a lesion of the brain, making an individual partially or totally impaired in his ability to speak, write, or comprehend the meaning of spoken or written words. Similarly, Nicolosi et al (1978:9) define aphasia as a communication disorder caused by damage to one or more regions of the brain. It is a loss of the ability to produce and\or comprehend language, due to brain damage.. Hartmann & stork (1972:16) affirm that aphasia is definitively a language disorder that commonly results from either stroke or brain damage to a specific area of the brain. Moreover, Gale(1998:4) states that aphasia is an impairment in language-based communication in which the ability to understand language and to translate thoughts into words has been impaired by injury to the brain. Speaking, listening, reading or writing capabilities may be affected depending on the type of aphasia involved (see also Hornby et al, 1974:35 & AL-Hamash, 1982:14).. 2. Common Signs of Aphasia The symptoms of aphasia may be temporary or permanent, depending upon the amount of brain damage. Aphasia affects on one or more of a person's language functions. These could include speech, naming, repetition, hearing, comprehension, reading, and writing. The functions affected depend upon the type of aphasia an individual has (Krishner,1995:2). It is worth mentioning that aphasic person may: : : 1.speak in short abbreviated sentences.. 2. speak and write sentences that do not make sense.. 3.have difficulty in finding the right word.. 4.not comprehend other people s conversation.. 5.interpret figurative language literally.. 6.not understand written words.. 7.make significant spelling errors.. 2

3 The severity and scope of the problems depend on the extent of damage and the area of the brain affected. Some people may, for example, comprehend what others say relatively well but struggle to find words to speak. Other people may speak more clearly than they can write (Mayo Foundation for Medical Education and Research Centre (MFMERC), 2006:2-4).. 3. Causes of Aphasia It is important to know a little bit about the structure of the brain in order to understand what causes aphasia. The main portion of the brain is the cerebrum which is divided into two halves called the left and right hemispheres. The cerebrum is further divided into four lobes, the frontal, parietal, occipital, and temporal. In human beings, generally speaking, language control is located in the left hemisphere of the brain, called the language dominant area of the brain. It is here that information about word meaning is stored, spoken - written language is formulated and words are used properly. So, damage to the left hemisphere most often results in the symptoms of aphasia, see the figure below (Mysak,1976:21 & Hershey,2007:10).. The Left Hemisphere 3

4 However, Crystal (1987:270) points out that aphasia is caused by damage to one or more of the language areas of the brain. The cause of the brain injury is often a stroke. A stroke occurs when, for some reasons, blood is unable to reach a part of the brain. Brain cells die when they do not receive their normal supply of blood, which carries oxygen and important nutrients.. Besides, other causes of brain injury are severe blows to the head, brain tumours, brain infections, and other conditions of the brain. Aphasia strikes patients suddenly and it does not always happen from a stroke. In a large number of head injury patients, and in some rare causes, a brain infection or tumour can lead to aphasia (Goodglass,1993:33 & Barret,2007:9).. In children, head injuries, cerebral tumours, brain infection, or other neurological diseases are the most common causes. Aphasia is also common among older adults, caused primarily by stroke, brain tumour, or degenerate neurological diseases (Malberg, 1963:108 & Morey, 1972:159).. 4. Types of Aphasia Aphasia has different types which cause an impairment in the skills of communication, the most important types are classified by Gale(1998:4-5). They are as follows: : 1. Broca's aphasia: This aphasia is characterized by slow, laboured, telegraphic speech with prepositions and articles missing e.g. I went store, but with little or no effect on comprehension of written and spoken language. It affects the frontal lobe of the left hemisphere of the brain. Known as Broca's area, this part of the brain is named for Paul Broca ( ), a 19th-century French physician who studied the specialized functioning of the left and right sides of the brain. Symptoms include an inability for the afflicted person to express himself in complex sentences and a grammatism, a loss of the ability to use words like and or the. Despite these difficulties in expressing language, aphasics can understand it. they just can not use grammar.. 4

5 2. Wernicke's aphasia: In Wernicke's aphasia, the person's speech is overflowing with words logorrhoea that do not convey the speaker's meaning. The pitch and rhythm of the spoken words sound normal, but the words may either be used incorrectly or are made-up words with no meaning aphasic jargon. Besides their speech difficulties, persons with Wernicke's aphasia also have troubles in comprehending language, repeating speech, naming objects, reading, and writing. Wernicke's aphasia results from damage to the upper rear part of the left temporal lobe of the brain, an area that was first described in 1874 by German neurologist Carl Wernicke ( ). This is literally the opposite problem of Broca's Aphasia. Here, the patient can speak words but does not understand them. He\she also cannot repeat sentences which are said to him\her.. 3. Anomic aphasia: This form of aphasia results in a failure to remember the names of people, objects (like car or fruit), or places, but with comprehension of written and spoken language unaffected. 4. Global aphasia: This is caused by widespread damage to the dominant cerebral hemisphere which is characterized by an almost total loss of all types of verbal ability in speech, comprehension, reading, and writing. 5. Dysphasia: This term describes a general loss of language use. 6. Dysgraphia: It describes a form of aphasia characterized by problems in handwriting.. 7. Agraphia describes the complete inability to perform handwriting. 8. Disconnection Aphasias: They are caused by damage to the connections of Broca's or Wernicke's areas to each other or to other parts of the brain. 9. Conduction aphasia results from damage to the fibre bundles connecting the two language areas and is characterized by fluent but somewhat meaningless speech and an inability to repeat phrases correctly Transcortical sensory aphasia: In this type of aphasia, the connections between Wernicke's area and the rest of the brain are severed but the area itself is left intact. Persons with this condition have troubles in understanding language and expressing their thoughts but can repeat speech without any trouble.. 5

6 11. Word Deafness: This condition occurs when auditory information is prevented from reaching Wernicke's area of the brain. Persons affected by word deafness can hear sounds of all kinds and understand written language, but spoken language is incomprehensible to them, since the auditory signals cannot reach the part of the brain that decodes them (ibid) (For further information see Damasio, 1992: 531).. 5. Diagnosis of Aphasia Goodglass (1993:5) states that aphasia must be recognized by a specialist who treats the individual for her or his brain injury. As an aid to accurate diagnosis immediately following stroke, it is important to differentiate aphasia from cognitive disorders such as confusion and disorientation. To this end, brief, but general testing of the language functions (naming, comprehension, reading, writing, and repetition) can be incorporated into broader testing that might determine other cognitive functions. Evaluators must remember that language is the medium through which most of these other functions are observed. Therefore, language should be assessed first; if extensive aphasia is present, then only cautious interpretations of other cognitive functions may be given. At present, there are few available objectives and standardized measures for testing during the acute phases of disorders such as stroke.. Barret (2007:4) states that a number of standardized measures and extensive tests should be used to show the aphasic symptoms. These tests are useful in providing baseline and follow-up assessments to measure the progress in treatment, as well as to guide the treatment itself. A fairly general feature of aphasia tests is that individuals without aphasic symptoms should perform with almost no errors. Tests are available to measure the extent and severity of language impairments as well as to provide information about functional skills and outcomes. Finally, there are assessments designed specifically to look at the quality of life with aphasics. 6

7 6. Means of Communication with Aphasic Persons Both British and Iraqi institutions ( like Al-Amel, Al-Rajaa and other institutions ) agree upon the techniques used for improving the means of communication with aphasics. They give the following recommendations when dealing with an aphasic person: : : 1. Talk to the aphasic person as an adult not as a child.. 2. During conversation, minimize or eliminate background noise (i.e. television, radio, other people).. 3. Make sure that you have the person s attention before communicating with him/her.. 4. Praise all his/her attempts to speak; treat his/her speaking as a pleasant experience and provide stimulating conversation. Encourage or use all modes of communication( speech, writing, drawing, yes/no responses choices, gestures, eye contact, and facial expressions).. 5. Give aphasics time to talk and permit a reasonable amount of time to respond.. 6. Accept all communication attempts( gesture, writing, and drawing) rather than demanding speech. Downplay errors and avoid frequent criticism/corrections. Do not insist on aphasics to pronounce words perfectly.. 7. Keep your own communication simple. Simplify your sentences and speak slowly. Keep your voice at a normal volume level and emphasize key words.. 8. Encourage people with aphasia to be as independent as possible. Do not be overprotective or speak to the aphasic person except when absolutely necessary. Ask permission to do so.. 9. Continue normal home activities(i.e. dinner with family, company, going out). Do not shield people with aphasia from family or friends or ignore them in a group conversation. Involve them in family decision making as much as possible (see Bishop,1999:4)... 7

8 7. Techniques for Improving the Skills of Aphasics National institute on Deafness and Other Communication Disorders(NIDCD) (1997:3) and Al-Huda Institution assure that language recovery is not as quick or as complete as one thinks. Most people believe that the most effective treatment begins early in the recovery process. Some of the factors that influence the amount of improvement include the cause of the brain damage, the area of the brain that was damaged, the extent of the brain injury, and the age and health of the individual. Additional factors include motivation, handedness, and educational level.. Group therapy offers the opportunity to use new communication skills in a comfortable setting. Stroke clubs which are regional support groups for treating the individuals who have had a stroke are available in most major cities. These clubs also offer the opportunity for individuals with aphasia to try new communication skills. In addition, stroke clubs can help the individual and his/her family adjust to the life changes that accompany stroke and aphasia. Family involvement is often a crucial component of aphasia treatment so that family members can learn the best way to communicate with their aphasics(ibid).. Barret (2007:11) believes that the underlying cause of aphasia must be treated or stabilized. To regain language function, therapy must begin as soon as possible following the injury. Although there are no medical or surgical procedures currently available to treat this condition, aphasia resulting from stroke or head injury may improve through the use of speech therapy. One instructor in Al-Huda Institution mentions that for most individuals, the primary emphasis should be placed on making the most of retained language abilities and learning to use other means of communication to compensate for the loss of language abilities.. The most common techniques that are frequently used to improve the skills of the aphasics include the following: : 1. Exercise and Practice: Weakened muscles are exercised by repetitively speaking certain words or making facial expressions such as smiling Picture Cards: Pictures of everyday objects are used to improve word recall and increase vocabulary. The names of the objects may also be repetitively spoken aloud as part of an exercise and practice routine.. 8

9 3. Picture Boards: Pictures of everyday objects and activities are placed together, and the individual points to certain pictures to convey ideas and communicate with others.. 4. Workbooks: Reading and writing exercises are used to sharpen word recall and regain reading and writing abilities. Hearing comprehension is also redeveloped using these exercises.. 5. Computers: Computer software can sometimes be used to improve speech, reading, recall, and hearing comprehension by, for example, displaying pictures and having the individual find the right word.. Hershey(2007:12) believes that recovery from aphasia depends upon the severity of the brain injury. More than half of the patients who have symptoms of aphasia after a stroke, infection, head injury, or as a result of a brain tumour can recover. While people who are left handed are more likely to develop aphasia after a brain injury, they tend to recover more fully. This is because they have language centers on the right and left sides of the brain so language abilities can be recovered from either side. Surgery is only used to treat the cause of aphasia, such as to reduce pressure from a brain tumour or to reduce swelling from head trauma.. It is noted that in Baghdad institutions like AL-Amel, AL-Huda and AL-Rajaa, no attention is paid to written language, i.e. no letters, words, phrases or sentences are taught. Their concentration is on the concrete environment surrounding the aphasics like the type of clothes they wear, the food they have, the pieces of furniture around them, etc. Pictures are rarely used. According to some instructors in AL-Rajaa institution for aphasics, pictures can not activate and improve word recall. One of the instructors states that may be in the future the use of pictures will be an active tool to improve the aphasics ability to communicate with others. Generally speaking, the first stage in the treatment process is that the aphasics must be in direct contact with everyday objects to convey ideas and communicate with their family and other individuals.. 9

10 8. Conclusions The following points can be concluded from the previous discussion: 1. People with aphasia have been described as being locked inside their own head and everything has been washed from their brain.. 2. Speech pathologists and neurolpsychologists play a very important role for rehabilitating the language skills of the aphasic person The types of events that cause aphasia, such as stroke and head injury, are difficult to predict or prevent. For this reason there are no guidelines for preventing aphasia.. 4. The most important component of therapy is the family. Patients who have family to help them do much better. The family need to be taught how they can help. Many people think that aphasics do not understand, but many of them do have a degree of understanding. Most of them just can not communicate Individual and family commitment to a physician guided speech therapy programme can result in full to partial recovery.. 6. Encouragement is very important for enhancing the confidence of the aphasic person.. 7. Extensive tests are very important to show the severity of the aphasia and may also provide information regarding the exact location of the brain damage. This extensive testing is also designed to provide the information necessary to design an individualized speech therapy programme. 8. Computers in treatment are still very primitive. They cannot replace a good speech therapist because that person will assess the patient as an individual and work with his\her special needs.. 9. Techniques and guided therapeutic treatments should be applied from the initial stages of aphasia.. 11

11 Bibliography - Al-Hamash, K.I A Dictionary Of Linguistics And Phonetic- Terms. Baghdad: A Publication of The Institute for The Development of English Language.. - Bishop, Kathleen N "Therapy Helps Aphasia Patients Regain Speech". Health & Science. pp: Crystal, David The Cambridge Encyclopedia Of Language. Cambridge: Cambridge University Press.. - Damasio, Antonio R "Aphasia". The New England Journal Of --. Medicine.Vol:326,No:8,PP: Goodglass, Harold Understanding Aphasia. Sandiego: Academic Press.. - Hartmann, R.R.K. & Stork, F.C Dictionary of Language and Linguistics. London :Applied Science Publishers. - Hornby, A.S., Cowie, A.P. & Gimson, A.C Oxford Advanced Learner 's Dictionary of Current English. Oxford: Oxford University Press. - Krishner, Howard S Handbook Of Neurological Speech And Language Disorders. New York: Marcel Dekker Inc. - Malberg, Bertil Phonetics. New York: Dover Publication. - Morey, Muriel. 1972, The Development Disorders Of Speech In - -.Childhood. Longman: Longman Group Limited.. - Mysak, Edward Pathologies of Speech Systems. Baltimore: The Williams& Wilkins Company Nicolosi, Luciille, Harryman, Elizabeth & Kresheck, Janet. Terminology of Communication Disorder Baltimore: The Williams & Wilkins Company.. - Richards, Jack C., Platt, John & Platt, Heidi Longman Dictionary of Language Teaching & Applied Linguistics. Longman:. Longman Group UK Limited. 11

12 Internet References - Barret, Julia Aphasia. Personal Health Centre. - Gale, Thomson Encyclopedia of Childhood and Adolescence. - Hershey, Milton S Aphasia. Medical Center College of Education Mayo Foundation for Medical Education and Research (MFMERC). Symptoms of Aphasia National Institute on Deafness and Other Communication Disorders..(NIDCD) : ::