Hello, pauli1010-ga!
The nature of the therapy or treatment for Aphasia depends on the
cause and severity of the condition. There is currently no "cure" for
Aphasia, but speech therapy can be very helpful in helping an
individual regain remaining language skills and learn alternative
methods of communication. Surgery can also be helpful in the less
common cases where speech has been impaired due to pressure within the
brain (from a tumor or hematoma, for example). Medications have proven
to be of limited use in the treatment of aphasia thus far.
An early, multi-team approach to rehabilitation is often necessary
due to the other attendant problems often present with Aphasia. Early
intervention may includes a team comprised of speech-language
pathologists, physical and occupational therapists, clinical
neuropsychologists, nurses, social workers, physiatrists and
neurologists. Longer-term therapy typically involves continued work
with a speech-language pathologist in the clinical or home setting.
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OVERVIEW
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The National Aphasia Foundation has some excellent information
concerning Aphasia, some of which I have excerpted below. Please note
the link to the online forum in the event that you would like to touch
base with others who have a loved one with Aphasia.
From "Aphasia: The Facts."
http://www.aphasia.org/facts.php
"Aphasia is an impairment of language, affecting the production or
comprehension of speech and the ability to read or write. Aphasia is
always due to injury to the brain-most commonly from a stroke,
particularly in older individuals. But brain injuries resulting in
aphasia may also arise from head trauma, from brain tumors, or from
infections."
"Aphasia can be so severe as to make communication with the patient
almost impossible, or it can be very mild. It may affect mainly a
single aspect of language use, such as the ability to retrieve the
names of objects, or the ability to put words together into sentences,
or the ability to read. More commonly, however, multiple aspects of
communication are impaired, while some channels remain accessible for
a limited exchange of information. It is the job of the professional
to determine the amount of function available in each of the channels
for the comprehension of language, and to assess the possibility that
treatment might enhance the use of the channels that are available."
Varieties and special features of aphasia
-----------------------------------------
Global aphasia:
"This is the most severe form of aphasia, and is applied to patients
who can produce few recognizable words and understand little or no
spoken language. Global aphasics can neither read nor write. Global
aphasia may often be seen immediately after the patient has suffered a
stroke and it may rapidly improve if the damage has not been too
extensive. However, with greater brain damage, severe and lasting
disability may result."
Broca's aphasia:
"In this form of aphasia, speech output is severely reduced and is
limited mainly to short utterances of less than four words. Vocabulary
access is limited and the formation of sounds by persons with Broca's
aphasia is often laborious and clumsy. The person may understand
speech relatively well and be able to read, but be limited in writing.
Broca's aphasia is often referred to as a 'non fluent aphasia' because
of the halting and effortful quality of speech."
Mixed non-fluent aphasia:
"This term is applied to patients who have sparse and effortful
speech, resembling severe Broca's aphasia. However, unlike persons
with Broca's aphasia, they remain limited in their comprehension of
speech and do not read or write beyond an elementary level."
Wernicke's aphasia:
"In this form of aphasia the ability to grasp the meaning of spoken
words is chiefly impaired, while the ease of producing connected
speech is not much affected. Therefore Wernicke's aphasia is referred
to as a 'fluent aphasia.' However, speech is far from normal.
Sentences do not hang together and irrelevant words intrude-sometimes
to the point of jargon, in severe cases. Reading and writing are often
severely impaired."
Anomic aphasia:
"This term is applied to persons who are left with a persistent
inability to supply the words for the very things they want to talk
about-particularly the significant nouns and verbs. As a result their
speech, while fluent in grammatical form and output is full of vague
circumlocutions and expressions of frustration. They understand speech
well, and in most cases, read adequately. Difficulty finding words is
as evident in writing as in speech."
Other varieties of aphasia:
"In addition to the foregoing syndromes that are seen repeatedly by
speech clinicians, there are many other possible combinations of
deficits that do not exactly fit into these categories. Some of the
components of a complex aphasia syndrome may also occur in isolation.
This may be the case for disorders of reading (alexia) or disorders
affecting both reading and writing (alexia and agraphia), following a
stroke. Severe impairments of calculation often accompany aphasia, yet
in some instances patients retain excellent calculation in spite of
the loss of language."
Read further for an overview of other medical disorders that can
accompany or be confused with Aphasia:
http://www.aphasia.org/facts.php
* Find a support group in your state
http://www.aphasia.org/NAAcommunity.html
The Aphasia Handbook can be ordered online if you desire
http://www.aphasia.org/handbook.php
More helpful links
http://www.aphasia.org/infopacketonline.php
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TREATMENT
**********
The type of treatment for Aphasia depends on the nature and severity
of the disorder.
An initial evaluation by a speech language pathologist is necessary to
make an important determination of the abilities of the patient and
the degree of impairment. Some of the steps in evaluation and the
susequent treatment objectives are described on the American
Speech-Language-Hearing Association website:
From Speech-Language Assessment and Treatment
http://www.asha.org/public/speech/disorders/Aphasia_info.htm
The speech-language pathologist completes an assessment of speech and
language skills:
* Fluency, vocal quality and loudness, and the pronunciation and clarity of
speech
* Strength and coordination of the speech muscles
* Understanding and use of vocabulary ( semantics ) and understanding and use
of grammar ( syntax ) are evaluated.
* Understanding and answering both yes-no (e.g., Is your name Bob?) and Wh-
questions (e.g., What do you do with a hammer?).
* Understanding extendedspeech. The person listens to a short story or factual
passage and answers fact-based (the answers are in the passage) and
inferential (the patient must arrive at a conclusion based on information
gathered from the reading) questions about the material.
* Ability to follow directions that increase in both length and complexity.
* Ability to tell an extended story ( language sample ) both verbally and in
written form.
* Can the person tell the steps needed to complete a task or can he or she
tell a story, centering on a topic and chaining a sequence of events
together?
* Can he or she describe the "plot" in an action picture?
* Is his or her narrative coherent or is it difficult to follow?
* Can the person recall the words he or she needs to express ideas?
* Is the person expressing himself or herself in complete sentences,
telegraphic sentences or phrases, or single words?
* Is speech slurred and difficult to understand or is it intelligible?
* Social communication skills ( pragmatic language )
* Ability to interpret or explain jokes, sarcastic comments, absurdities in
stories or pictures (e.g., What is strange about a person using an umbrella
on a sunny day?).
* Proficiency with initiating conversation and conversational topics, taking
turns during a discussion, and expressing thoughts clearly using a variety
of words and grammatical constructions.
* Ability to clarify communication when his or her conversational partner does
not understand.
* Reading and writing of letters, words, phrases, sentences, and paragraphs.
The speech-language pathologist may look at the quality of the language
expression, accuracy of spelling, and letter formation and spacing of words
and letters on the page (to identify or rule out possible movement and/or
visual-perceptual difficulties).
* Swallowing (as needed)
* Ability to use an augmentative or alternative communication aid (as needed)
=
Depending on the results of the evaluation, therapy will be initated
to target the specific needs of the individual
Example of Speech/Language Therapy:
* "The speech-language pathologist works on drills and exercises to
improve specific language skills affected by damage to the brain. For
example, the person may practice naming objects, following directions,
answering questions about stories, etc. These exercises vary depending
on individual needs, and become more complex and challenging as skills
improve. For example, as the person's skills improve, he or she may be
asked to use a short phrase or sentence to explain how to use an
object after naming it."
* "The speech-language pathologist teaches the person ways to make use
of stronger language skills to compensate for weaker language skills.
For example, some people may find it easier to express their ideas
through gestures and writing than with speaking. The speech-language
pathologist may teach this person to use both writing and gestures to
help remember words for conversation."
* "The person may participate in group therapy sessions to practice
conversational skills with other persons with aphasia. The
speech-language pathologist may lead the group through structured
discussions, focusing on improving initiation of conversation,
turn-taking, clarification of ideas, and repairing of conversational
breakdowns. Group members may role-play common communication
situations that take place in the community and at home, such as
talking on the telephone, ordering a meal in a restaurant, and talking
to a salesperson at a store."
* "Eventually, persons may participate individual or group outings to
practice their use of communication strategies in real life
situations. They are asked to plan, organize, and carry out these
trips using the compensatory strategies they have learned. For
example, group members may practice functional reading and writing
skills by using a telephone book to find the phone number of a
restaurant and write it down. They may practice telephone skills by
calling the restaurant and making a reservation. They may practice
reading maps, taking public transportation to the restaurant, counting
the change needed to purchase a ticket, and ordering food. Later on in
recovery, the speech-language pathologist may work with a vocational
specialist to help the person return to work or school, if
appropriate. The speech-language pathologist works with employers
and/or educational specialists to implement the use of compensatory
strategies in these settings. This professional may work with them to
modify work/school environment to meet language needs."
* "If there is weakness of speech muscles, the speech-language
pathologist teaches exercises to strengthen these muscles. He or she
also learns strategies to make speech more intelligible to compensate
for the muscle weakness."
==
From Northwestern University - "Treatment of Communication Impairments
in Primary Progressive Aphasia."
http://www.brain.northwestern.edu/ppa/treatment.html
Approaches to Treatment:
"There are two basic approaches to treatment for PPA. One approach is
to focus treatment directly on the language skills that are impaired,
and the other is to provide augmentative/alternative communication
strategies or devices. We recommend that both treatment approaches be
used with PPA patients. Beginning in early stages of the disease,
treatment should be provided to enhance verbal language skills. For
example, treatments focused on word-retrieval skills may be helpful."
"Treatment focused on the use of augmentative/alternative
communication strategies also should be provided, even in the early
stages of PPA. These are strategies that either enhance verbal
communication or replace it. We suggest that the patient (and family
members) be trained in augmentative/alternative communication
strategies such as:
Use of a communication notebook
Use of gestures
Use of drawing
"Results of the speech and language evaluation will determine which
strategy (or strategies) is the best and some practice in using them
will be provided during the evaluation. However, follow-up treatment
with a Speech-Language Pathologist is important in order to further
develop the strategy and provide practice in using it."
(Read further for description of each communication strategy...)
==
Also read "Recovery and rehabilitation" from health.enotes
http://health.enotes.com/neurological-disorders-encyclopedia/aphasia
==
For an overview of what the future might hold for Aphasia treatment, see:
"Aphasia treatment and the crossroads: A biological perspective."
Wineburgh, L. F., & Small, S. L. (2004, April 27). The ASHA Leader,
pp. 6-7, 18.
http://www.asha.org/about/publications/leader-online/archives/2004/040427/f040427b.htm
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APHASIA CLINICS AND TREATMENT CENTERS
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University of Alabama - Speech Clinic
======================================
http://www.health.uab.edu/hospital/show.asp?durki=10629
"It is one of two clinics in Alabama that are accredited by the
Professional Standards Board of the American Speech-Language-Hearing
Association. Most of the patients seen here have been victims of
stroke or spinal cord injury. However, the staff clinicians are
equipped to provide professional treatment for a wide variety of
communication disorders."
Comprehensive Aphasia Center of Chicago
=========================================
http://www.aphasiacenter.com/
"The Comprehension Aphasia Center of Chicago cares for people with
acquired disorders of language, particularly those from strokes. We
take a comprehensive view of such problems, and clinic evaluations and
treatments are coordinated by a team of caregivers, including a
speech-language pathologist and a cognitive neurologist, both with
doctoral degrees and specialists in aphasia."
Aphasia Center of California
==============================
http://www.aphasiacenter.org/
"The mission of the Aphasia Center of California is to enhance
communication skills and maximize psychosocial well-being for all
those affected by aphasia following stroke."
Programs - http://www.aphasiacenter.org/
Moss Rehab Aphasia Center - Philadelphia
==========================================
http://www.einstein.edu/yourhealth/physicalrehab/aphasia/article8865.html
"To address the unmet needs of people with aphasia and their
families, MossRehab in Philadelphia, PA has developed a comprehensive
aphasia center. It is a place where people can find information and
peer support, as well as participate in on-going research and
treatment. MossRehab Aphasia Center is a joint effort between
MossRehab and Moss Rehabilitation Research Institute, one of the
nation's leading aphasia research centers."
University of Michigan - Ann Arbor
University Center for the Development of Language and Literacy
===========================================================
http://www.aphasiahelp.com/
We provide programs for adults with aphasia needing to improve
speech, language, reading, writing and memory skills. We enjoy a
national reputation for excellence in aphasia therapy, attracting
participants from across the United States and Canada."
UNC Hearing and Communication Center
University of North Carolina - Chapel Hill
=============================================
http://www.med.unc.edu/ahs/sphs/aphasiacenter/Home.html
(Page is currently being updated)
Contact Information
http://www.med.unc.edu/ahs/sphs/aphasiacenter/ContactUs.html
University of South Florida
Speech, Language and Hearing Center
====================================
http://www.cas.usf.edu/csd/clinic/clinic_page.htm
"With USF home to one of the nation?s foremost research and treatment
centers for aphasia...."
http://usfnews.usf.edu/page.cfm?link=article&aid=219
The Harold Goodglass Aphasia Research Center - Boston
=====================================================
http://www.bu.edu/aphasia/index.html
Become a Research Participant
http://www.bu.edu/aphasia/research/test_subject.htm
==
The Academy of Aphasia provides a list of clinics and therapists
throughout the world specializing in Aphasia treatment. These are by
no means the only treatment centers, but you may find the
international links useful. Click on the link for "Clinical Services"
on the left side of the page: http://www.academyofaphasia.org/
Directory of Speech Pathologists
=================================
To find a Speech Pathologist near you, see the "Online Directory of
Audiology and Speech-Language Pathology Programs."
http://www.asha.org/proserv/
==
Additional Aphasia Clinics and Centers in the U.S and Canada can be
found on the Aphasia Org. website - (scroll down to Clinics and
Centers)
http://www.aphasia.org/NAAweblinks.html
==
Also see resources from the Center for Aphasia Research -
Rehabilitation Institute of Chicago -
http://www.ric.org/research/aphasia.php
==
Please note that the above list is by no means comprehensive. Many of
the major hospitals have Stroke Centers which include speech and
language therapy programs for Aphasia sufferers. Depending on where
you are located, there may be a very good clinic nearby. If you would
like to disclose this information, I might be able to help guide you
to a clinic closer to your area.
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THERAPY AIDS
*************
You might be interested in reading about Lingraphia:
http://www.aphasia.com/
"Lingraphicare is dedicated to helping adults with aphasia
communicate. We make the Lingraphica, the speech generating device
designed specifically for aphasia. The Lingraphica combines images,
animation, text and spoken words to unlock communication. It enhances
existing therapy programs and provides communication for life. The
Lingraphica is based on years of government-funded research into
aphasia and has been refined during 13 years of use by Speech Language
Pathologists and patients. The Lingraphica is easy and risk-free to
try and is Medicare reimbursable."
===
I hope the material I have provided is helpful. However, please don't
hesitate to ask for clarification if necessary and I will try to
assist you further if I am able.
Sincerely,
umiat
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