A review of aphasia. Katrina Clarkson Principal Speech and Language Therapist, Regional Rehabilitation Unit, Northwick Park Hospital

Transcription

1 A review of aphasia Katrina Clarkson Principal Speech and Language Therapist, Regional Rehabilitation Unit, Northwick Park Hospital

2 Defining Aphasia Loss or impairment of language function caused by brain damage Aphasia is a multimodal disorder: Difficulties in speaking, understanding, reading, writing Reduction in capacity to interpret and formulate linguistic elements (e.g. sentences, words, morphemes the smallest grammatical unit in a language) Amount of loss across each area varies Murdoch (2010)

3 What aphasia is NOT Aphasia is NOT the result of: A sensory deficit A general intellectual deficit An impairment of cognition e.g. memory A psychiatric disorder A developmental disorder Brookshire (1992) Goodglass (1993)

4 And not to be confused with: Dysarthria: An impairment in the motor functions of respiration, phonation, resonance, articulation and prosody affecting production of speech Apraxia of Speech (AOS): An impairment in the motorprogramming of actions involved in speech production and in the absence of any muscle paralysis or weakness Dysphagia: A swallowing disorder Murdoch (2010)

5 Co-occurring factors Aphasia rarely occurs in isolation. Be aware of other factors post-stroke which may cooccur: Visual impairments Cognitive impairments Physical impairments Emotional impairments

6 What causes aphasia? ALWAYS a result of damage to the brain, i.e. neurological Most common: Cerebrovascular disorders particularly left MCA lesions affecting frontal temporal and parietal lobes May also arise from: Neoplasms (tumours) Head trauma Degenerative disorders e.g. dementia, PD Infections (meningitis, encephalitis) Chapey and Hallowell (2001) Murdoch (2010)

7 Incidence of Aphasia in Stroke Marquardsen (1969): One third of patients 7 days post stroke Scarpa et al (1987): 55% of patients with Left CVA evaluated days post stroke Pedersen et al (1995): 40% of patients evaluated in the first three days Engelter et al (2006): 30% of first ever ischaemic strokes More that 250,000 people are living with aphasia in the UK (Speakability, 2014) In the USA: >1,000,000 with aphasia, and 80,000 new cases every year (National Institute for Deafness and Communication disorders, 1999; American Academy of Neurology)

8 Aphasia or Dysphasia Aphasia: Total loss of language Dysphasia: Partial loss of language Terms are used inter-changeably Recent literature and RCSLT: advocates the use of Aphasia.

9 Expressive Symptoms of Aphasia Word finding difficulties Paraphasias: Semantic paraphasia: word related in meaning e.g. table/chair Phonological paraphasia: sound substitutions e.g. table/fable Unrelated paraphasia: random word substitution e.g. table/wind Neologism: non-word substitution e.g. table/shig Significant use of neologisms: JARGON aphasia Failure to repeat words Grammatical errors omission of connective words or morphemes, incorrect word order Dysgraphia Damasio (1981)

10 Receptive Symptoms of Aphasia Impaired to varying degrees: Difficulty following conversation Difficulty following instructions Inconsistent comprehension of single words Inconsistent yes/no responses Non-verbal semantic impairment Impaired reading comprehension Damasio (1981) Beware the patient who nods and smiles and appears to understand

11 Aphasia a summary so far Aphasia is a term that is used to describe a core impairment but for which there is a broad spectrum of symptoms of differing severity Be aware: what works for one patient, may not work for another If in doubt, speak to your friendly SLT team

12 Average pattern of recovery after stroke. Tilling K et al. Stroke. 2001;32: Copyright American Heart Association, Inc. All rights reserved.

13 Prognosis for recovery in Aphasia Dependent on: Biographical variables age, gender and premorbid education Medical variables type of stroke, time since onset, site and extent of lesion Language variables aphasia severity, particularly receptive abilities Various authors cited by Chapey (2001) chp 4.

14 Barriers for the person with aphasia In a hospital setting: Difficulty comprehending consent forms, prescriptions, health information Inability to read hospital signage and directions Exclusion from case conferences and care planning People with physical impairments: physical access via wheelchairs, ramps, automatic doors etc. Communicative access via communication ramps Kagan and Gailey (1993)

15 Communication Ramp What is a communication ramp? A way to communicate with aphasic individuals by modifying typical (your own) communication via the use of communication strategies and support materials

16 Communication Ramps Total Communication Modifications to our communication: Verbal language Gesture Drawing Writing Use of pictures and photos Aphasia Friendly Materials Modifications to patient information: Short message Clear sentences Easy words Good layout Diagrams and pictures Helpful guidance from the Stroke Association:

17 National Guidance to Support Practice National Stroke Strategy (2007) Provision of communication support to enable PWA to participate in managing their own care Cochrane Review (2014) Decision aids to help people who are facing health treatment or screening decisions (Stacey et al) NHS England (2014): Making Health and Social Care Information Accessible 2/ Stroke Association: Accessible Information Guidelines

18 How to help get the message IN Listen and watch Take your time Present one idea at a time. Don t bombard with questions. Use plain, clear English Check and double check before moving on Be prepared to do repeated visits to ensure information has been understood. Illustrate the idea by using: Drawing Writing Gesture Pictures/diagrams in leaflets Think about your environment quiet, distraction free, paper and pen UK Connect

19 How to help get the message OUT Encourage the person to use: Writing Drawing Gesture Facial Expression Summarise and check you have understood. Don t pretend to understand Think about conversation props: Paper and pen Pictures/photographs Alphabet charts Communication books Allow plenty of TIME Try asking questions in a different way UK Connect

20 Aphasia: A final summary Aphasia: An acquired language disorder of neurological origin Affecting all modalities of language May co-occur with other communication impairments For many will be a lifelong condition Remember to modify YOUR communication using communication ramps to reveal their competence

21 Questions? Thank you for listening

22 References Brookshire, R.H. (1992) An Introduction to Neurogenic Communication Disorders. St Louis: Mosby year book. Chapey, R and Hallowell, B. (2001) Introduction to Language Intervention Strategies in Adult Aphasia. Chp 1 in Chapey, R. (Ed) Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders. 4 th ed. Lippincott Williams and Wilkins. Goodglass, H (1993) Understanding Aphasia. San Diego: Academic Press Murdoch (2010) Acquired Speech and Language Disorders: A Neuroanatomical and Functional Neurological Approach. Wiley-Blackwell Marquardsen, J. (1969) The natural history of acute cerebrovascular disease: A retrospective study of 769 patients. Acta Neurologica Scandinavica, 45, supplement 38 Pedersen, P.M. Jorgensen, H.S. Nakayama, H. Raaschou, H.O. and Olsen T.S. (1995) Aphasia in acute stroke: Incidence, determinants and recovery. Annals of Neurology, 38(4)

23 Scarpa, M. Colombo, P. Sorgato, P. and DeRenzi, E. (1987) The incidence of aphasia and global aphasia in left brain-damaged patients. Cortex, 23, Engelter, S. Gostynski, M. Papa, S. Frei, M. Born, C. Ajdacic-Gross, V. Gutzwiller, F. and Lyrer, P. (2006) Epidemiology of Aphasia Attributable to First Ischemic Stroke: Incidence, Severity, Fluency, Etiology, and Thrombolysis. Stroke, 37, Speakability: American Speech Hearing Association (ASHA) Damasio, A. (1981) The nature of Aphasia: Signs and syndromes. In Sarno, M.T. (ed) Acquired Aphasia. Academic Press. Kagan, A. and Gailey, G. (1993) Functional is not enough: Training conversation partners for aphasic adults. In Holland and Forbes (eds) Aphasia Treatments: World Perspectives. P San Diego, Singular Publishing. UK Connect:

24 Stroke Association Accessible Information Guidelines: uidelines.pdf.pdf National Stroke Strategy: ov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh _ pdf Stacey D, Légaré F, Col NF, Bennett CL, Barry MJ, Eden KB, Holmes-Rovner M, Llewellyn-Thomas H, Lyddiatt A, Thomson R, Trevena L, Wu JHC (2014) Decision aids to help people who are facing health treatment or screening decisions. NHS England (2014) Making Health and Social Care Information Accessible