Expressive aphasia: Difference between revisions
Jump to navigation
Jump to search
imported>Yashzx. ! |
imported>.motioblur |
||
| Line 1: | Line 1: | ||
{{ | {{Short description|Language disorder involving inability to produce language}} | ||
{{Distinguish|Receptive aphasia}} | |||
{{Infobox medical condition | {{Infobox medical condition | ||
| name | | name = Expressive aphasia | ||
| synonyms | | synonyms = Broca's aphasia, non-fluent aphasia, agrammatic aphasia | ||
| caption | | caption = Broca and Wernicke are two areas involved in language formation. | ||
| field | | field = [[Neurology]], [[Psychiatry]] | ||
| pronounce | | pronounce = | ||
| symptoms | | symptoms = | ||
| complications = | | complications = | ||
| onset | | onset = | ||
| duration | | duration = | ||
| types | | types = | ||
| causes | | causes = | ||
| risks | | risks = | ||
| diagnosis | | diagnosis = | ||
| differential | | differential = | ||
| prevention | | prevention = | ||
| treatment | | treatment = | ||
| medication | | medication = | ||
| prognosis | | prognosis = | ||
| frequency | | frequency = | ||
| deaths | | deaths = | ||
| image | | image = Brain - Broca's and Wernicke's area Diagram.svg | ||
}} | }} | ||
'''Expressive aphasia''' (also known as '''Broca's aphasia''') is a type of [[aphasia]] characterized by partial loss of the ability to produce [[language]] ([[Spoken language|spoken]], [[Sign language|manual]],<ref name="sciencedirect.com">{{cite journal|last1=Hicoka|first1=Gregory|title=The neural organization of language: evidence from sign language aphasia|journal=Trends in Cognitive Sciences|date=1 April 1998|volume=2|issue=4|pages=129–136|doi=10.1016/S1364-6613(98)01154-1|pmid=21227109|s2cid=7018568}}</ref> or [[Written language|written]]), although comprehension generally remains intact.<ref>{{Cite news|url=https://www.aphasia.org/aphasia-resources/brocas-aphasia/|title=Broca's Aphasia - National Aphasia Association|work=National Aphasia Association|access-date=2017-04-11|language=en-US}}</ref> A person with expressive aphasia will exhibit effortful [[speech]]. Speech generally includes important content words but leaves out function words that have more grammatical significance than physical meaning, such as [[preposition]]s and [[Article (grammar)|articles]].<ref name=":0">{{Cite book|title=An Introduction to Language|last1=Fromkin|first1=Victoria|last2=Rodman|first2=Robert|last3=Hyams|first3=Nina|publisher=Wadsworth, Cengage Learning|year=2014|isbn=978- | '''Expressive aphasia''' (also known as '''Broca's aphasia''') is a type of [[aphasia]] characterized by partial loss of the ability to produce [[language]] ([[Spoken language|spoken]], [[Sign language|manual]],<ref name="sciencedirect.com">{{cite journal|last1=Hicoka|first1=Gregory|title=The neural organization of language: evidence from sign language aphasia|journal=Trends in Cognitive Sciences|date=1 April 1998|volume=2|issue=4|pages=129–136|doi=10.1016/S1364-6613(98)01154-1|pmid=21227109|s2cid=7018568}}</ref> or [[Written language|written]]), although comprehension ''generally'' remains intact.<ref>{{Cite news|url=https://www.aphasia.org/aphasia-resources/brocas-aphasia/|title=Broca's Aphasia - National Aphasia Association|work=National Aphasia Association|access-date=2017-04-11|language=en-US}}</ref> A person with expressive aphasia will exhibit effortful [[speech]]. Speech generally includes important content words but leaves out function words that have more grammatical significance than physical meaning, such as [[preposition]]s and [[Article (grammar)|articles]].<ref name=":0">{{Cite book|title=An Introduction to Language|last1=Fromkin|first1=Victoria|last2=Rodman|first2=Robert|last3=Hyams|first3=Nina|publisher=Wadsworth, Cengage Learning|year=2014|isbn=978-1-133-31068-6|location=Boston, MA|pages=464–465}}</ref> This is known as "telegraphic speech". The person's intended message may still be understood, but their sentence will not be grammatically correct. In very severe forms of expressive aphasia, a person may only speak using single word utterances.<ref name='ASHA'>ASHA.org</ref><ref name="ASHA_aphasia_classifications">{{Cite web|url=https://www.asha.org/Practice-Portal/Clinical-Topics/Aphasia/Common-Classifications-of-Aphasia/|title=Common Classifications of Aphasia|website=American Speech-Language-Hearing Association|language=en|archive-url=https://web.archive.org/web/20170507120732/http://www.asha.org:80/Practice-Portal/Clinical-Topics/Aphasia/Common-Classifications-of-Aphasia/|archive-date=2017-05-07|access-date=2024-02-21}}</ref> Typically, [[Speech comprehension|comprehension]] is mildly to moderately impaired in expressive aphasia due to difficulty understanding complex grammar.<ref name="ASHA" /><ref name="ASHA_aphasia_classifications" /> A better way to describe aphasia is fluent or non-fluent rather than "expressive" or "receptive" given the typical presence of both expressive and receptive language deficits in all subtypes of aphasia.<ref>{{Cite journal |last=Tremblay |first=Pascale |last2=Dick |first2=Anthony Steven |date=November 2016 |title=Broca and Wernicke are dead, or moving past the classic model of language neurobiology |url=https://pubmed.ncbi.nlm.nih.gov/27584714 |journal=Brain and Language |volume=162 |pages=60–71 |doi=10.1016/j.bandl.2016.08.004 |issn=1090-2155 |pmid=27584714}}</ref> | ||
It is caused by acquired damage to the [[frontal lobe|frontal]] regions of the [[human brain|brain]], such as [[Broca's area]].<ref name="Purves">{{cite book|title=Neuroscience|publisher=Sinauer Associates, Inc.|year=2008|isbn=978-0-87893-742-4|edition=fourth|author=Purves, D.}}</ref> Expressive aphasia contrasts with [[receptive aphasia]], in which patients are able to speak in grammatical sentences that lack semantic significance and generally also have trouble with comprehension.<ref name=":0" /><ref name="Nakai_2017">{{cite journal|last2=Jeong|first2=JW|last3=Brown|first3=EC|last4=Rothermel|first4=R|last5=Kojima|first5=K|last6=Kambara|first6=T|last7=Shah|first7=A|last8=Mittal|first8=S|last9=Sood|first9=S|last10=Asano|first10=E|year=2017|title=Three- and four-dimensional mapping of speech and language in patients with epilepsy|journal=Brain|volume=140|issue=5|pages=1351–1370|doi=10.1093/brain/awx051|pmid=28334963|last1=Nakai|first1=Y|pmc=5405238}}</ref> Expressive aphasia differs from [[dysarthria]], which is typified by a patient's inability to properly move the muscles of the tongue and mouth to produce speech. Expressive aphasia also differs from [[apraxia of speech]], which is a [[motor disorder]] characterized by an inability to create and sequence motor plans for conscious speech.<ref name=":1">{{Cite book|title=Introduction to Neurogenic Communication Disorders|last=Brookshire|first=Robert|publisher=Mosby|year=2007|isbn=978- | It is caused by acquired damage to the [[frontal lobe|frontal]] regions of the [[human brain|brain]], such as [[Broca's area]].<ref name="Purves">{{cite book|title=Neuroscience|publisher=Sinauer Associates, Inc.|year=2008|isbn=978-0-87893-742-4|edition=fourth|author=Purves, D.}}</ref> Expressive aphasia contrasts with [[receptive aphasia]], in which patients are able to speak in grammatical sentences that lack semantic significance and generally also have trouble with comprehension.<ref name=":0" /><ref name="Nakai_2017">{{cite journal|last2=Jeong|first2=JW|last3=Brown|first3=EC|last4=Rothermel|first4=R|last5=Kojima|first5=K|last6=Kambara|first6=T|last7=Shah|first7=A|last8=Mittal|first8=S|last9=Sood|first9=S|last10=Asano|first10=E|year=2017|title=Three- and four-dimensional mapping of speech and language in patients with epilepsy|journal=Brain|volume=140|issue=5|pages=1351–1370|doi=10.1093/brain/awx051|pmid=28334963|last1=Nakai|first1=Y|pmc=5405238}}</ref> Expressive aphasia differs from [[dysarthria]], which is typified by a patient's inability to properly move the muscles of the tongue and mouth to produce speech. Expressive aphasia also differs from [[apraxia of speech]], which is a [[motor disorder]] characterized by an inability to create and sequence motor plans for conscious speech.<ref name=":1">{{Cite book|title=Introduction to Neurogenic Communication Disorders|last=Brookshire|first=Robert|publisher=Mosby|year=2007|isbn=978-0-323-04531-5|location=St. Louis, MO|url=https://books.google.com/books?id=tSRjCwAAQBAJ}}</ref> | ||
== Signs and symptoms == | == Signs and symptoms == | ||
| Line 33: | Line 34: | ||
For example, in the following passage, a patient with Broca's aphasia is trying to explain how he came to the hospital for dental surgery:{{blockquote|Yes... ah... Monday... er... Dad and Peter H... (his own name), and Dad.... er... hospital... and ah... Wednesday... Wednesday, nine o'clock... and oh... Thursday... ten o'clock, ah doctors... two... an' doctors... and er... teeth... yah.<ref name=":4" />}}The speech of a person with expressive aphasia contains mostly [[content word]]s such as nouns, verbs, and some adjectives. However, [[function word]]s like [[Conjunction (grammar)|conjunctions]], articles, and prepositions are rarely used except for "and" which is prevalent in the speech of most patients with aphasia. The omission of function words makes the person's speech agrammatic.<ref name=":1" /> A communication partner of a person with aphasia may say that the person's speech sounds [[Telegram style|telegraphic]] due to poor sentence construction and disjointed words.<ref name=":1" /><ref name=":4" /> For example, a person with expressive aphasia might say "Smart... university... smart... good... good..."<ref name=":3" /> | For example, in the following passage, a patient with Broca's aphasia is trying to explain how he came to the hospital for dental surgery:{{blockquote|Yes... ah... Monday... er... Dad and Peter H... (his own name), and Dad.... er... hospital... and ah... Wednesday... Wednesday, nine o'clock... and oh... Thursday... ten o'clock, ah doctors... two... an' doctors... and er... teeth... yah.<ref name=":4" />}}The speech of a person with expressive aphasia contains mostly [[content word]]s such as nouns, verbs, and some adjectives. However, [[function word]]s like [[Conjunction (grammar)|conjunctions]], articles, and prepositions are rarely used except for "and" which is prevalent in the speech of most patients with aphasia. The omission of function words makes the person's speech agrammatic.<ref name=":1" /> A communication partner of a person with aphasia may say that the person's speech sounds [[Telegram style|telegraphic]] due to poor sentence construction and disjointed words.<ref name=":1" /><ref name=":4" /> For example, a person with expressive aphasia might say "Smart... university... smart... good... good..."<ref name=":3" /> | ||
Self-monitoring is typically well preserved in patients with Broca's aphasia.<ref name=":1" /> They are usually aware of their communication deficits, and are more prone to [[Depression (mood)|depression]] and outbursts from frustration than are patients with other forms of aphasia.<ref>{{Cite book|title = Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders|last = Chapey|first = Roberta|publisher = Lippincott Williams & Wilkins|year = 2008|isbn = 978-0-7817-6981-5|location = Philadelphia, PA| | Self-monitoring is typically well preserved in patients with Broca's aphasia.<ref name=":1" /> They are usually aware of their communication deficits, and are more prone to [[Depression (mood)|depression]] and outbursts from frustration than are patients with other forms of aphasia.<ref>{{Cite book|title = Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders|last = Chapey|first = Roberta|publisher = Lippincott Williams & Wilkins|year = 2008|isbn = 978-0-7817-6981-5|location = Philadelphia, PA|page = 8}} {{verify source |date=September 2023 |reason=This ref was deleted Special:Diff/809386054 by a bug in VisualEditor and later restored by a bot from the original cite located at Special:Permalink/809384687 cite #7 - verify the cite is accurate and delete this template. [[User:GreenC_bot/Job_18]]}}</ref> | ||
In general, word comprehension is preserved, allowing patients to have functional receptive language skills.<ref name="Manasco">{{cite book|title=INtroduction to Neurogenic Communication Disorders|last1=Manasco|publisher=William Brottmiller|year=2014|isbn= | In general, word comprehension is preserved, allowing patients to have functional receptive language skills.<ref name="Manasco">{{cite book|title=INtroduction to Neurogenic Communication Disorders|last1=Manasco|publisher=William Brottmiller|year=2014|isbn=978-1-4496-5244-9|editor=Katey Birtcher|location=Pennsylvania, USA|pages=80–81|display-editors=etal}}</ref> Individuals with Broca's aphasia understand most of the everyday conversation around them, but higher-level deficits in receptive language can occur.<ref name=":6">{{cite book|title=Introduction to Neurogenic Communication Disorders|last1=Manasco|first1=M. Hunter|publisher=Jones & Bartlett Learning|isbn=978-1-4496-5244-9|page=80|date=2013-02-06}}</ref> Because comprehension is substantially impaired for more complex sentences, it is better to use simple language when speaking with an individual with expressive aphasia. This is exemplified by the difficulty to understand phrases or sentences with unusual structure. A typical patient with Broca's aphasia will misinterpret "the man is bitten by the dog" by switching the subject and object to "the dog is bitten by the man."<ref name=":7">{{cite web|url=http://bbsonline.cup.cam.ac.uk/Preprints/OldArchive/bbs.grodzinsky.html|title=Neurology of Syntax|work=Behavioral and Brain Sciences 23 (1)|archive-url=https://web.archive.org/web/20040518000003/http://bbsonline.cup.cam.ac.uk/Preprints/OldArchive/bbs.grodzinsky.html|archive-date=2004-05-18|access-date=2006-05-10}}</ref> | ||
Typically, people with expressive aphasia can understand speech and read better than they can produce speech and write.<ref name=":1" /> The person's writing will resemble their speech and will be effortful, lacking cohesion, and containing mostly content words.<ref name="Chapey 2008 8">{{Cite book|title=Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders|last=Chapey|first=Roberta|publisher=Lippincott Williams & Wilkins|year=2008|isbn=978-0-7817-6981-5|location=Philadelphia, PA| | Typically, people with expressive aphasia can understand speech and read better than they can produce speech and write.<ref name=":1" /> The person's writing will resemble their speech and will be effortful, lacking cohesion, and containing mostly content words.<ref name="Chapey 2008 8">{{Cite book|title=Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders|last=Chapey|first=Roberta|publisher=Lippincott Williams & Wilkins|year=2008|isbn=978-0-7817-6981-5|location=Philadelphia, PA|page=8}}</ref> Letters will likely be formed clumsily and distorted and some may even be omitted. Although listening and reading are generally intact, subtle deficits in both reading and listening comprehension are almost always present during assessment of aphasia.<ref name=":1" /> | ||
Because Broca's area is anterior to the [[primary motor cortex]], which is responsible for movement of the face, hands, and arms, a lesion affecting Broca's areas may also result in [[hemiparesis]] (weakness of both limbs on the same side of the body) or [[hemiplegia]] (paralysis of both limbs on the same side of the body).<ref name=":1" /> The brain is wired contralaterally, which means the limbs on right side of the body are controlled by the left hemisphere and vice versa.<ref>{{Cite journal|last=Teasell|first=Robert|date=2003|title=Stroke recovery and rehabilitation.|journal=Stroke|volume=34 | issue = 2 |pages=365–366|doi=10.1161/01.str.0000054630.33395.e2|pmid=12574538|doi-access=}}</ref> Therefore, when Broca's area or surrounding areas in the left hemisphere are damaged, hemiplegia or hemiparesis often occurs on the right side of the body in individuals with Broca's aphasia. | Because Broca's area is anterior to the [[primary motor cortex]], which is responsible for movement of the face, hands, and arms, a lesion affecting Broca's areas may also result in [[hemiparesis]] (weakness of both limbs on the same side of the body) or [[hemiplegia]] (paralysis of both limbs on the same side of the body).<ref name=":1" /> The brain is wired contralaterally, which means the limbs on right side of the body are controlled by the left hemisphere and vice versa.<ref>{{Cite journal|last=Teasell|first=Robert|date=2003|title=Stroke recovery and rehabilitation.|journal=Stroke|volume=34 | issue = 2 |pages=365–366|doi=10.1161/01.str.0000054630.33395.e2|pmid=12574538|doi-access=}}</ref> Therefore, when Broca's area or surrounding areas in the left hemisphere are damaged, hemiplegia or hemiparesis often occurs on the right side of the body in individuals with Broca's aphasia. | ||
Severity of expressive aphasia varies among patients. Some people may only have mild deficits and detecting problems with their language may be difficult. In the most extreme cases, patients may be able to produce only a single word. Even in such cases, over-learned and rote-learned speech patterns may be | Severity of expressive aphasia varies among patients. Some people may only have mild deficits and detecting problems with their language may be difficult. In the most extreme cases, patients may be able to produce only a single word. Even in such cases, over-learned and rote-learned speech patterns may be retained<ref name=":5">{{cite web|url=http://www.csuchico.edu/~pmccaff/syllabi/SPPA336/336unit7.html|title=Specific Syndromes: The Nonfluent Aphasias|work=Neuropathologies of Language and Cognition|access-date=2006-05-10|archive-url=https://web.archive.org/web/20060427043927/http://www.csuchico.edu/~pmccaff/syllabi/SPPA336/336unit7.html|archive-date=2006-04-27}}</ref> – for instance, some patients can count from one to ten, but cannot produce the same numbers in novel conversation. | ||
===Manual language and aphasia=== | ===Manual language and aphasia=== | ||
| Line 47: | Line 48: | ||
===Overlap with receptive aphasia=== | ===Overlap with receptive aphasia=== | ||
In addition to difficulty expressing oneself, individuals with expressive aphasia are also noted to commonly have trouble with comprehension in certain linguistic areas. This agrammatism overlaps with receptive aphasia, but can be seen in patients who have expressive aphasia without being diagnosed as having receptive aphasia. The most well-noted of these are object-relative clauses, object Wh- questions, and topicalized structures (placing the topic at the beginning of the sentence).<ref name="Friedmann">{{cite book | last1 = Friedmann | first1 = Naama | last2 = Gvion | first2 = Aviah | last3 = Novogrodsky | first3 = Rama | chapter = Syntactic Movement in Agrammatism and S-SLI: Two Different Impairments | editor = Adriana Belletti | title = Language Acquisition and Development: Proceedings of GALA2005 | publisher = Cambridge Scholars Press | year = 2006 | location = Newcastle, UK | pages = 197–210 | url = http://www.language-brain.com/docs/Friedmann_Gvion_Novogrodsky_movementSLI_agrammatism.pdf | access-date = 2024-02-21 | archive-url = https://web.archive.org/web/20141211030552/http://www.language-brain.com/docs/Friedmann_Gvion_Novogrodsky_movementSLI_agrammatism.pdf | archive-date = 2014-12-11 | In addition to difficulty expressing oneself, individuals with expressive aphasia are also noted to commonly have trouble with comprehension in certain linguistic areas. This agrammatism overlaps with receptive aphasia, but can be seen in patients who have expressive aphasia without being diagnosed as having receptive aphasia. The most well-noted of these are object-relative clauses, object Wh- questions, and topicalized structures (placing the topic at the beginning of the sentence).<ref name="Friedmann">{{cite book | last1 = Friedmann | first1 = Naama | last2 = Gvion | first2 = Aviah | last3 = Novogrodsky | first3 = Rama | chapter = Syntactic Movement in Agrammatism and S-SLI: Two Different Impairments | editor = Adriana Belletti | title = Language Acquisition and Development: Proceedings of GALA2005 | publisher = Cambridge Scholars Press | year = 2006 | location = Newcastle, UK | pages = 197–210 | url = http://www.language-brain.com/docs/Friedmann_Gvion_Novogrodsky_movementSLI_agrammatism.pdf | access-date = 2024-02-21 | archive-url = https://web.archive.org/web/20141211030552/http://www.language-brain.com/docs/Friedmann_Gvion_Novogrodsky_movementSLI_agrammatism.pdf | archive-date = 2014-12-11 | isbn = 978-1-84718-028-5 |oclc=133524617 | display-editors = etal}}</ref> These three concepts all share phrasal movement, which can cause words to lose their thematic roles when they change order in the sentence.<ref name="Friedmann" /> This is often not an issue for people without agrammatic aphasias, but many people with aphasia rely heavily on word order to understand roles that words play within the sentence.<ref>{{Cite journal |last1=Bates |first1=Elizabeth A. |last2=Friederici |first2=Angela D. |last3=Wulfeck |first3=Beverly B. |last4=Juarez |first4=Larry A. |date=1988-03-01 |title=On the preservation of word order in aphasia: Cross-linguistic evidence |journal=Brain and Language |language=en |volume=33 |issue=2 |pages=323–364 |doi=10.1016/0093-934X(88)90072-7 |pmid=3359173 |s2cid=23236428 |issn=0093-934X}}</ref> | ||
==Causes== | ==Causes== | ||
| Line 53: | Line 54: | ||
=== More common === | === More common === | ||
* [[Stroke]] or brain [[Oxygen saturation (medicine)|anoxia]]. | * [[Stroke]] or brain [[Oxygen saturation (medicine)|anoxia]]. | ||
* Brain tumor | * [[Brain tumor]] | ||
* Brain trauma | * Brain trauma | ||
**seizure (more temporary, reversible aphasia) | |||
=== Less common === | === Less common === | ||
| Line 69: | Line 71: | ||
In most cases, expressive aphasia is caused by a stroke in Broca's area or the surrounding vicinity. Broca's area is in the lower part of the [[premotor cortex]] in the language dominant hemisphere and is responsible for planning motor speech movements. However, cases of expressive aphasia have been seen in patients with strokes in other areas of the brain.<ref name=":1" /> Patients with classic symptoms of expressive aphasia in general have more acute brain lesions, whereas patients with larger, widespread lesions exhibit a variety of symptoms that may be classified as [[global aphasia]] or left unclassified.<ref name="Bakheit" /> | In most cases, expressive aphasia is caused by a stroke in Broca's area or the surrounding vicinity. Broca's area is in the lower part of the [[premotor cortex]] in the language dominant hemisphere and is responsible for planning motor speech movements. However, cases of expressive aphasia have been seen in patients with strokes in other areas of the brain.<ref name=":1" /> Patients with classic symptoms of expressive aphasia in general have more acute brain lesions, whereas patients with larger, widespread lesions exhibit a variety of symptoms that may be classified as [[global aphasia]] or left unclassified.<ref name="Bakheit" /> | ||
Expressive aphasia can also be caused by trauma to the brain, [[tumor]], | Expressive aphasia can also be caused by trauma to the brain, [[tumor]], [[cerebral hemorrhage]]<ref name="Ozeren">{{cite journal|last=Orzeren|first=A|author2=F Koc|author3=M Demirkiran|author4=A Sonmezler|s2cid=23023504|year=2006|title=Global aphasia due to left thalamic hemorrhage|journal=Neurology India|volume=54|issue=4|pages=415–417|doi=10.4103/0028-3886.28118|pmid=17114855|doi-access=free}}</ref> and by [[extradural abscess]].<ref name="Commondoor">{{cite journal|author1=Commondoor, R.|author2=Eisenhut, M.|author3=Fowler, C.|author4=Kirollos, R. W.|author5=Nathwani, N.|name-list-style=amp|year=2009|title=Transient Broca's Aphasia as Feature of an Extradural Abscess|journal=Pediatric Neurology|volume=40|issue=1|pages=50–53|doi=10.1016/j.pediatrneurol.2008.06.018|pmid=19068255}}</ref> | ||
Understanding [[lateralization of brain function]] is important for understanding which areas of the brain cause expressive aphasia when damaged. In the past, it has been believed that the area for language production differs between left and right-handed individuals. If this were true, damage to the homologous region of Broca's area in the right hemisphere should cause aphasia in a left-handed individual. More recent studies have shown that even left-handed individuals typically have language functions only in the left hemisphere. However, left-handed individuals are more likely to have a dominance of language in the right hemisphere.<ref name="Purves" /> | Understanding [[lateralization of brain function]] is important for understanding which areas of the brain cause expressive aphasia when damaged. In the past, it has been believed that the area for language production differs between left and right-handed individuals. If this were true, damage to the homologous region of Broca's area in the right hemisphere should cause aphasia in a left-handed individual. More recent studies have shown that even left-handed individuals typically have language functions only in the left hemisphere. However, left-handed individuals are more likely to have a dominance of language in the right hemisphere.<ref name="Purves" /> | ||
==== Uncommon causes ==== | ==== Uncommon causes ==== | ||
Less common causes of expressive aphasia include primary [[Autoimmune encephalitis|autoimmune phenomenon]] and autoimmune phenomenon that are secondary to cancer (as a [[paraneoplastic syndrome]]) have been listed as the primary hypothesis for several cases of aphasia, especially when presenting with other psychiatric disturbances and focal neurological deficits. Many case reports exist describing paraneoplastic aphasia, and the reports that are specific tend to describe expressive aphasia.<ref>{{Cite journal|last=McKeon|first=Andrew|date=April 2013|title=Paraneoplastic and Other Autoimmune Disorders of the Central Nervous System|journal=The Neurohospitalist|volume=3|issue=2|pages=53–64|doi=10.1177/1941874412453339|issn=1941-8744|pmc=3726118|pmid=23983888}}</ref><ref>{{Cite journal|last1=Yeung|first1=Darwin F|last2=Hsu|first2=Rose|date=2014-08-05|title=Expressive aphasia in a patient with chronic myelomonocytic leukemia|journal=SpringerPlus|volume=3| | Less common causes of expressive aphasia include primary [[Autoimmune encephalitis|autoimmune phenomenon]] and autoimmune phenomenon that are secondary to cancer (as a [[paraneoplastic syndrome]]) have been listed as the primary hypothesis for several cases of aphasia, especially when presenting with other psychiatric disturbances and focal neurological deficits. Many case reports exist describing paraneoplastic aphasia, and the reports that are specific tend to describe expressive aphasia.<ref>{{Cite journal|last=McKeon|first=Andrew|date=April 2013|title=Paraneoplastic and Other Autoimmune Disorders of the Central Nervous System|journal=The Neurohospitalist|volume=3|issue=2|pages=53–64|doi=10.1177/1941874412453339|issn=1941-8744|pmc=3726118|pmid=23983888}}</ref><ref>{{Cite journal|last1=Yeung|first1=Darwin F|last2=Hsu|first2=Rose|date=2014-08-05|title=Expressive aphasia in a patient with chronic myelomonocytic leukemia|journal=SpringerPlus|volume=3|article-number=406|doi=10.1186/2193-1801-3-406|issn=2193-1801|pmc=4130962|pmid=25126489 |doi-access=free }}</ref><ref>{{Cite journal|last1=Will|first1=A.|last2=Akalin|first2=Murat|date=2012-04-24|title=Paraneoplastic Limbic Encephalitis with NMDA Receptor (NR1) Antibodies in Breast Cancer (S08.007)|url=http://n.neurology.org/content/78/1_Supplement/S08.007|journal=Neurology|language=en|volume=78|issue=1 Supplement|article-number=S08.007|doi=10.1212/WNL.78.1_MeetingAbstracts.S08.007|issn=0028-3878|url-access=subscription}}</ref><ref name=":9">{{Cite book|url=https://books.google.com/books?id=H5XLSPrCtB4C&q=paraneoplastic+aphasia&pg=PA8|title=Paraneoplastic Syndromes|last1=Darnell|first1=Robert|last2=Darnell|first2=Robert B.|last3=Posner|first3=Jerome B.|date=2011-08-22|publisher=Oxford University Press, USA|isbn=978-0-19-977273-5|language=en}}</ref><ref>{{Cite journal|last=Lancaster|first=Eric|date=April 2015|title=Continuum: The Paraneoplastic Disorders|journal=Continuum (Minneapolis, Minn.)|volume=21|issue=2 0|pages=452–475|doi=10.1212/01.CON.0000464180.89580.88|issn=1080-2371|pmc=4443809|pmid=25837906}}</ref> Although most cases attempt to exclude micro-metastasis, it is likely that some cases of paraneoplastic aphasia are actually extremely small metastasis to the vocal motor regions.<ref name=":9" /> | ||
Neurodegenerative disorders may present with aphasia. [[Alzheimer's disease]] may present with either [[fluent aphasia]] or expressive aphasia. There are case reports of [[ | Neurodegenerative disorders may present with aphasia. [[Alzheimer's disease]] may present with either [[fluent aphasia]] or expressive aphasia. There are case reports of [[Creutzfeldt–Jakob disease]] presenting with expressive aphasia.<ref>{{Cite journal|last1=Mahboob|first1=Hafiz B.|last2=Kaokaf|first2=Kazi H.|last3=Gonda|first3=Jeremy M.|date=2018-02-14|title=Creutzfeldt-Jakob Disease Presenting as Expressive Aphasia and Nonconvulsive Status Epilepticus|journal=Case Reports in Critical Care|volume=2018|article-number=5053175|doi=10.1155/2018/5053175|issn=2090-6420|pmc=5832162|pmid=29666711|doi-access=free }}</ref><ref>{{Cite news|url=https://www.aphasia.org/aphasia-resources/primary-progressive-aphasia/|title=Primary Progressive Aphasia - National Aphasia Association|work=National Aphasia Association|access-date=2018-11-26|language=en-US}}</ref> | ||
==Diagnosis== | ==Diagnosis== | ||
| Line 83: | Line 85: | ||
A physician is typically the first person to recognize aphasia in a patient who is being treated for damage to the brain. Routine processes for determining the presence and location of lesion in the brain include [[magnetic resonance imaging]] (MRI) and [[CT scan|computed tomography]] (CT) scans. The physician will complete a brief assessment of the patient's ability to understand and produce language. For further diagnostic testing, the physician will refer the patient to a speech-language pathologist, who will complete a comprehensive evaluation.<ref name=":2">{{Cite web|url=https://www.nidcd.nih.gov/health/aphasia|title=Aphasia|website=National Institute on Deafness and Other Communication Disorders|date=March 6, 2017|access-date=2024-02-21}}</ref> | A physician is typically the first person to recognize aphasia in a patient who is being treated for damage to the brain. Routine processes for determining the presence and location of lesion in the brain include [[magnetic resonance imaging]] (MRI) and [[CT scan|computed tomography]] (CT) scans. The physician will complete a brief assessment of the patient's ability to understand and produce language. For further diagnostic testing, the physician will refer the patient to a speech-language pathologist, who will complete a comprehensive evaluation.<ref name=":2">{{Cite web|url=https://www.nidcd.nih.gov/health/aphasia|title=Aphasia|website=National Institute on Deafness and Other Communication Disorders|date=March 6, 2017|access-date=2024-02-21}}</ref> | ||
In order to diagnose a patient with Broca's aphasia, there are certain commonly used tests and procedures. The [[Western Aphasia Battery]] (WAB) classifies individuals based on their scores on the subtests; spontaneous speech, auditory comprehension, repetition, and naming.<ref name=":1" /> The [[Boston Diagnostic Aphasia Examination]] (BDAE) can inform users what specific type of aphasia they may have, infer the location of lesion, and assess current language abilities. The Porch Index of Communication Ability (PICA) can predict potential recovery outcomes of the patients with aphasia. [[Quality of life (healthcare)|Quality of life]] measurement is also an important assessment tool.<ref>{{Cite web|url=https://www.csuchico.edu/~pmccaffrey/syllabi/SPPA336/336unit9.html|title=The Diagnosis of Aphasia|last=McCaffrey|first=Patrick|date=1999|website=The Neuroscience on the Web Series|publisher=California State University, Chico|access-date=2017-11-08|archive-date=2007-06-15|archive-url=https://web.archive.org/web/20070615055430/https://www.csuchico.edu/~pmccaffrey/syllabi/SPPA336/336unit9.html | In order to diagnose a patient with Broca's aphasia, there are certain commonly used tests and procedures. The [[Western Aphasia Battery]] (WAB) classifies individuals based on their scores on the subtests; spontaneous speech, auditory comprehension, repetition, and naming.<ref name=":1" /> The [[Boston Diagnostic Aphasia Examination]] (BDAE) can inform users what specific type of aphasia they may have, infer the location of lesion, and assess current language abilities. [[The Porch Index of Communication Ability|The Porch Index of Communication Ability (PICA]]) can predict potential recovery outcomes of the patients with aphasia. [[Quality of life (healthcare)|Quality of life]] measurement is also an important assessment tool.<ref>{{Cite web|url=https://www.csuchico.edu/~pmccaffrey/syllabi/SPPA336/336unit9.html|title=The Diagnosis of Aphasia|last=McCaffrey|first=Patrick|date=1999|website=The Neuroscience on the Web Series|publisher=California State University, Chico|access-date=2017-11-08|archive-date=2007-06-15|archive-url=https://web.archive.org/web/20070615055430/https://www.csuchico.edu/~pmccaffrey/syllabi/SPPA336/336unit9.html}}</ref> Tests such as the Assessment for Living with Aphasia (ALA) and the Satisfaction with Life Scale (SWLS) allow for therapists to target skills that are important and meaningful for the individual.<ref name=":1" /> Aphasia Diagnostic Profile helps in evaluating different language modalities.<ref>{{Citation |last=Patterson |first=Janet |title=Aphasia Diagnostic Profiles |date=2011 |work=Encyclopedia of Clinical Neuropsychology |pages=223–225 |url=https://link.springer.com/rwe/10.1007/978-0-387-79948-3_859 |access-date=2026-03-24 |publisher=Springer, New York, NY |language=en |doi=10.1007/978-0-387-79948-3_859 |isbn=978-0-387-79948-3|url-access=subscription }}</ref> | ||
In addition to formal assessments, patient and family interviews are valid and important sources of information. The patient's previous hobbies, interests, personality, and occupation are all factors that will not only impact therapy but may motivate them throughout the recovery process.<ref name=":2" /> Patient interviews and observations allow professionals to learn the priorities of the patient and family and determine what the patient hopes to regain in therapy. Observations of the patient may also be beneficial to determine where to begin treatment. The current behaviors and interactions of the patient will provide the therapist with more insight about the client and their individual needs.<ref name=":1" /> Other information about the patient can be retrieved from medical records, patient referrals from physicians, and the nursing staff.<ref name=":2" /> | In addition to formal assessments, patient and family interviews are valid and important sources of information. The patient's previous hobbies, interests, personality, and occupation are all factors that will not only impact therapy but may motivate them throughout the recovery process.<ref name=":2" /> Patient interviews and observations allow professionals to learn the priorities of the patient and family and determine what the patient hopes to regain in therapy. Observations of the patient may also be beneficial to determine where to begin treatment. The current behaviors and interactions of the patient will provide the therapist with more insight about the client and their individual needs.<ref name=":1" /> Other information about the patient can be retrieved from medical records, patient referrals from physicians, and the nursing staff.<ref name=":2" /> | ||
In non-speaking patients who use manual languages, diagnosis is often based on interviews from the patient's acquaintances, noting the differences in sign production pre- and post-damage to the brain.<ref name="ReferenceA"/> Many of these patients will also begin to rely on non-linguistic gestures to communicate, rather than signing since their language production is hindered.<ref>{{Cite journal |last1=Hogrefe |first1=Katharina |last2=Ziegler |first2=Wolfram |last3=Wiesmayer |first3=Susanne |last4=Weidinger |first4=Nicole |last5=Goldenberg |first5=Georg |date=2013-09-01 |title=The actual and potential use of gestures for communication in aphasia | In non-speaking patients who use manual languages, diagnosis is often based on interviews from the patient's acquaintances, noting the differences in sign production pre- and post-damage to the brain.<ref name="ReferenceA"/> Many of these patients will also begin to rely on non-linguistic gestures to communicate, rather than signing since their language production is hindered.<ref>{{Cite journal |last1=Hogrefe |first1=Katharina |last2=Ziegler |first2=Wolfram |last3=Wiesmayer |first3=Susanne |last4=Weidinger |first4=Nicole |last5=Goldenberg |first5=Georg |date=2013-09-01 |title=The actual and potential use of gestures for communication in aphasia |journal=Aphasiology |volume=27 |issue=9 |pages=1070–1089 |doi=10.1080/02687038.2013.803515 |s2cid=145152352 |issn=0268-7038}}</ref> | ||
==Treatment== | ==Treatment== | ||
| Line 98: | Line 100: | ||
A patient may have the option of individual or group treatment. Although less common, group treatment has been shown to have advantageous outcomes. Some types of group treatments include family counseling, maintenance groups, support groups and treatment groups.<ref>{{Cite journal |last1=Fama |first1=Mackenzie E. |last2=Baron |first2=Christine R. |last3=Hatfield |first3=Brooke |last4=Turkeltaub |first4=Peter E. |date=August 2016 |title=Group Therapy as a Social Context for Aphasia Recovery: A pilot, observational study in an acute rehabilitation hospital |journal=Topics in Stroke Rehabilitation |volume=23 |issue=4 |pages=276–283 |doi=10.1080/10749357.2016.1155277 |issn=1074-9357 |pmc=4949973 |pmid=27077989}}</ref> | A patient may have the option of individual or group treatment. Although less common, group treatment has been shown to have advantageous outcomes. Some types of group treatments include family counseling, maintenance groups, support groups and treatment groups.<ref>{{Cite journal |last1=Fama |first1=Mackenzie E. |last2=Baron |first2=Christine R. |last3=Hatfield |first3=Brooke |last4=Turkeltaub |first4=Peter E. |date=August 2016 |title=Group Therapy as a Social Context for Aphasia Recovery: A pilot, observational study in an acute rehabilitation hospital |journal=Topics in Stroke Rehabilitation |volume=23 |issue=4 |pages=276–283 |doi=10.1080/10749357.2016.1155277 |issn=1074-9357 |pmc=4949973 |pmid=27077989}}</ref> | ||
===Augmentative and | ===Augmentative and alternative communication=== | ||
{{ | {{main|Augmentative and alternative communication}} | ||
Augmentative and | |||
[[Augmentative and alternative communication]] (AAC) can be used to support or replace verbal communication for individuals with aphasia.<ref name="Beukelman2007">{{cite journal|last=Beukelman|first=D. R.|author2=Fager, S.|author3= Ball, L.|author4= Dietz, A.|year=2007|volume=23|issue=3|title=AAC for adults with acquired neurological conditions: A review|journal=Augmentative and Alternative Communication|pages=230–242|doi=10.1080/07434610701553668|pmid=17701742 |s2cid=27916391 |doi-access=free}}</ref> This includes communication using tools such as memory books, drawing, photography, written language and [[speech-generating devices]].<ref name="Beukelman2007"/> | |||
===Melodic intonation therapy=== | |||
{{See also|Music therapy for non-fluent aphasia}} | |||
[[Melodic intonation therapy]] was inspired by the observation that individuals with non-fluent aphasia sometimes can sing words or phrases that they normally cannot speak. "Melodic Intonation Therapy was begun as an attempt to use the intact melodic/prosodic processing skills of the right hemisphere in those with aphasia to help cue retrieval words and expressive language."<ref>{{cite journal|title=A Case Study of the Efficacy of Melodic Intonation Therapy|journal=Music Perception |volume=24|issue=1 |year=2006 |pages=23–36 |issn=0730-7829 |doi=10.1525/mp.2006.24.1.23 |author=Wilson Sarah J|url=http://espace.library.uq.edu.au/view/UQ:186051/UQ186051_OA.pdf }}</ref> It is believed that this is because singing capabilities are stored in the right hemisphere of the brain, which is likely to remain unaffected after a stroke in the left hemisphere.<ref name='Schlaug'>{{cite journal|doi=10.1525/mp.2008.25.4.315|title=From Singing to Speaking: Why singing may lead to recovery of expressive language function in patients with Broca's Aphasia|journal=Music Perception|year=2008|first=Gottfried|last=Schlaug|author2=Sarah Marchina|author3=Andrea Norton|volume=25|issue=4|pages=315–319|pmid=21197418|pmc=3010734}}</ref> However, recent evidence demonstrates that the capability of individuals with aphasia to sing entire pieces of text may actually result from rhythmic features and the familiarity with the lyrics.<ref name='Stahl a'>{{cite journal|last1=Stahl|first1=Benjamin|last2=Kotz|first2=Sonja A.|last3=Henseler|first3=Ilona|last4=Turner|first4=Robert|last5=Geyer|first5=Stefan|title=Rhythm in disguise: why singing may not hold the key to recovery from aphasia|journal=Brain |volume=134|issue=10 |year=2011 |pages=3083–3093 |issn=0006-8950|doi=10.1093/brain/awr240 |pmid=21948939 |pmc=3187543}}</ref> | [[Melodic intonation therapy]] was inspired by the observation that individuals with non-fluent aphasia sometimes can sing words or phrases that they normally cannot speak. "Melodic Intonation Therapy was begun as an attempt to use the intact melodic/prosodic processing skills of the right hemisphere in those with aphasia to help cue retrieval words and expressive language."<ref>{{cite journal|title=A Case Study of the Efficacy of Melodic Intonation Therapy|journal=Music Perception |volume=24|issue=1 |year=2006 |pages=23–36 |issn=0730-7829 |doi=10.1525/mp.2006.24.1.23 |author=Wilson Sarah J|url=http://espace.library.uq.edu.au/view/UQ:186051/UQ186051_OA.pdf }}</ref> It is believed that this is because singing capabilities are stored in the right hemisphere of the brain, which is likely to remain unaffected after a stroke in the left hemisphere.<ref name='Schlaug'>{{cite journal|doi=10.1525/mp.2008.25.4.315|title=From Singing to Speaking: Why singing may lead to recovery of expressive language function in patients with Broca's Aphasia|journal=Music Perception|year=2008|first=Gottfried|last=Schlaug|author2=Sarah Marchina|author3=Andrea Norton|volume=25|issue=4|pages=315–319|pmid=21197418|pmc=3010734}}</ref> However, recent evidence demonstrates that the capability of individuals with aphasia to sing entire pieces of text may actually result from rhythmic features and the familiarity with the lyrics.<ref name='Stahl a'>{{cite journal|last1=Stahl|first1=Benjamin|last2=Kotz|first2=Sonja A.|last3=Henseler|first3=Ilona|last4=Turner|first4=Robert|last5=Geyer|first5=Stefan|title=Rhythm in disguise: why singing may not hold the key to recovery from aphasia|journal=Brain |volume=134|issue=10 |year=2011 |pages=3083–3093 |issn=0006-8950|doi=10.1093/brain/awr240 |pmid=21948939 |pmc=3187543}}</ref> | ||
The goal of Melodic Intonation Therapy is to utilize singing to access the language-capable regions in the right hemisphere and use these regions to compensate for lost function in the left hemisphere. The natural musical component of speech was used to engage the patients' ability to produce phrases. A clinical study revealed that singing and rhythmic speech may be similarly effective in the treatment of non-fluent aphasia and apraxia of speech.<ref name='Stahl b'>{{cite journal|last1=Stahl|first1=Benjamin|last2=Henseler|first2=Ilona|last3=Turner|first3=Robert|last4=Geyer|first4=Stefan|last5=Kotz|first5=Sonja A.|title=How to engage the right brain hemisphere in aphasics without even singing: Evidence for two paths of speech recovery|journal=Frontiers in Human Neuroscience |volume=7 |issue=35 |year=2013 |pages=1–12 |issn=1662-5161 |doi=10.3389/fnhum.2013.00035|pmid=23450277|pmc=3583105|doi-access=free }}</ref> Moreover, evidence from [[randomized controlled trial]]s is still needed to confirm that Melodic Intonation Therapy is suitable to improve propositional utterances and speech intelligibility in individuals with (chronic) non-fluent aphasia and apraxia of speech.<ref name='van der Meulen a'>{{cite journal|last1=van der Meulen|first1=I.|last2=van de Sandt-Koenderman|first2= M. W.|last3=Heijenbrok-Kal|first3=M. H.|last4=Visch-Brink|first4=E. G.|last5=Ribbers|first5=G. M.| title=The efficacy and timing of Melodic Intonation Therapy in subacute aphasia.|journal=Neurorehabil. Neural Repair|year= 2014|volume=28|issue=6|doi=10.1177/1545968313517753|pmid=24449708|pages=536–544|s2cid=6495987}}</ref><ref name='Zumbansen a'>{{cite journal|last1=Zumbansen|first1=Anna|last2=Peretz|first2=Isabelle|last3=Hébert|first3=Sylvie| title=Melodic Intonation Therapy: Back to Basics for Future Research.|journal=Frontiers in Neurology|year= 2014|volume=5|issue=7| | The goal of Melodic Intonation Therapy is to utilize singing to access the language-capable regions in the right hemisphere and use these regions to compensate for lost function in the left hemisphere. The natural musical component of speech was used to engage the patients' ability to produce phrases. A clinical study revealed that singing and rhythmic speech may be similarly effective in the treatment of non-fluent aphasia and apraxia of speech.<ref name='Stahl b'>{{cite journal|last1=Stahl|first1=Benjamin|last2=Henseler|first2=Ilona|last3=Turner|first3=Robert|last4=Geyer|first4=Stefan|last5=Kotz|first5=Sonja A.|title=How to engage the right brain hemisphere in aphasics without even singing: Evidence for two paths of speech recovery|journal=Frontiers in Human Neuroscience |volume=7 |issue=35 |year=2013 |pages=1–12 |issn=1662-5161 |doi=10.3389/fnhum.2013.00035|pmid=23450277|pmc=3583105|doi-access=free }}</ref> Moreover, evidence from [[randomized controlled trial]]s is still needed to confirm that Melodic Intonation Therapy is suitable to improve propositional utterances and speech intelligibility in individuals with (chronic) non-fluent aphasia and apraxia of speech.<ref name='van der Meulen a'>{{cite journal|last1=van der Meulen|first1=I.|last2=van de Sandt-Koenderman|first2= M. W.|last3=Heijenbrok-Kal|first3=M. H.|last4=Visch-Brink|first4=E. G.|last5=Ribbers|first5=G. M.| title=The efficacy and timing of Melodic Intonation Therapy in subacute aphasia.|journal=Neurorehabil. Neural Repair|year= 2014|volume=28|issue=6|doi=10.1177/1545968313517753|pmid=24449708|pages=536–544|s2cid=6495987}}</ref><ref name='Zumbansen a'>{{cite journal|last1=Zumbansen|first1=Anna|last2=Peretz|first2=Isabelle|last3=Hébert|first3=Sylvie| title=Melodic Intonation Therapy: Back to Basics for Future Research.|journal=Frontiers in Neurology|year= 2014|volume=5|issue=7|page=7|doi=10.3389/fneur.2014.00007|pmid=24478754|pmc=3904283|doi-access=free }}</ref> | ||
Melodic Intonation Therapy appears to work particularly well in patients who have had a unilateral, left hemisphere stroke, show poor articulation, are non-fluent or have severely restricted speech output, have moderately preserved auditory comprehension, and show good motivation. MIT therapy on average lasts for 1.5 hours per day for five days per week. At the lowest level of therapy, simple words and phrases (such as "water" and "I love you") are broken down into a series of high- and low-pitch syllables. With increased treatment, longer phrases are taught and less support is provided by the therapist. Patients are taught to say phrases using the natural melodic component of speaking and continuous voicing is emphasized. The patient is also instructed to use the left hand to tap the syllables of the phrase while the phrases are spoken. Tapping is assumed to trigger the rhythmic component of speaking to utilize the right hemisphere.<ref name='Schlaug' /> | Melodic Intonation Therapy appears to work particularly well in patients who have had a unilateral, left hemisphere stroke, show poor articulation, are non-fluent or have severely restricted speech output, have moderately preserved auditory comprehension, and show good motivation. MIT therapy on average lasts for 1.5 hours per day for five days per week. At the lowest level of therapy, simple words and phrases (such as "water" and "I love you") are broken down into a series of high- and low-pitch syllables. With increased treatment, longer phrases are taught and less support is provided by the therapist. Patients are taught to say phrases using the natural melodic component of speaking and continuous voicing is emphasized. The patient is also instructed to use the left hand to tap the syllables of the phrase while the phrases are spoken. Tapping is assumed to trigger the rhythmic component of speaking to utilize the right hemisphere.<ref name='Schlaug' /> | ||
| Line 135: | Line 118: | ||
A pilot study reported positive results when comparing the efficacy of a modified form of MIT to no treatment in people with nonfluent aphasia with damage to their left-brain. A randomized controlled trial was conducted and the study reported benefits of utilizing modified MIT treatment early in the recovery phase for people with nonfluent aphasia.<ref>{{cite journal|last1=Conklyn|first1=D|last2=Novak|first2=E|last3=Boissy|first3=A|last4=Bethoux|first4=F|last5=Chemali|first5=K|title=The Effects of Modified Melodic Intonation Therapy on Nonfluent Aphasia: A Pilot Study|journal=Journal of Speech, Language, and Hearing Research|date=2012|volume=55|issue=5|pages=1463–1471|doi=10.1044/1092-4388(2012/11-0105)|pmid=22411278}}</ref> | A pilot study reported positive results when comparing the efficacy of a modified form of MIT to no treatment in people with nonfluent aphasia with damage to their left-brain. A randomized controlled trial was conducted and the study reported benefits of utilizing modified MIT treatment early in the recovery phase for people with nonfluent aphasia.<ref>{{cite journal|last1=Conklyn|first1=D|last2=Novak|first2=E|last3=Boissy|first3=A|last4=Bethoux|first4=F|last5=Chemali|first5=K|title=The Effects of Modified Melodic Intonation Therapy on Nonfluent Aphasia: A Pilot Study|journal=Journal of Speech, Language, and Hearing Research|date=2012|volume=55|issue=5|pages=1463–1471|doi=10.1044/1092-4388(2012/11-0105)|pmid=22411278}}</ref> | ||
Melodic Intonation Therapy is used by music therapists, board-certified professionals that use music as a therapeutic tool to effect certain non-musical outcomes in their patients. Speech language pathologists can also use this therapy for individuals who have had a left hemisphere stroke and non-fluent aphasias such as Broca's or even apraxia of speech. | Melodic Intonation Therapy is used by music therapists, board-certified professionals that use music as a therapeutic tool to effect certain non-musical outcomes in their patients. Speech language pathologists can also use this therapy for individuals who have had a left hemisphere stroke and non-fluent aphasias such as Broca's or even apraxia of speech. Its effectiveness has been show in many languages. | ||
===Constraint-induced therapy=== | ===Constraint-induced therapy=== | ||
| Line 152: | Line 133: | ||
The following drugs have been suggested for use in treating aphasia and their efficacy has been studied in control studies. | The following drugs have been suggested for use in treating aphasia and their efficacy has been studied in control studies. | ||
* [[Bromocriptine]] – acts on [[ | * [[Bromocriptine]] – acts on [[catecholamine]] systems<ref name='de Boissezon'>{{cite journal|doi=10.1016/j.bandl.2006.07.004|title=Pharmacotherapy of aphasia: Myth or reality?|journal=Brain and Language|year=2007|first=de Boissezon|last=Xavier|author2=Patrice Peran|pmid=16982084|volume=102|issue=1|pages=114–125|s2cid=38304960}}</ref> | ||
* [[Piracetam]] – mechanism not fully understood, but most likely interacts with cholinergic and glutamatergic receptors, among others<ref name='de Boissezon' /> | * [[Piracetam]] – mechanism not fully understood, but most likely interacts with cholinergic and glutamatergic receptors, among others<ref name='de Boissezon' /> | ||
* [[Cholinergic]] drugs ([[ | * [[Cholinergic]] drugs ([[donepezil]], [[aniracetam]], [[bifemelane]]) – act on [[acetylcholine]] systems<ref name='de Boissezon' /> | ||
* [[Dopaminergic]] [[psychostimulants]] | * [[Dopaminergic]] [[psychostimulants]] ([[dexamphetamine]], [[methylphenidate]])<ref name='de Boissezon' /> | ||
The most effect has been shown by piracetam and amphetamine, which may increase [[Neuroplasticity|cerebral plasticity]] and result in an increased capability to improve language function. It has been seen that piracetam is most effective when treatment is begun immediately following stroke. When used in chronic cases it has been much less efficient.{{sfn|Berthier|2005}} | The most effect has been shown by piracetam and amphetamine, which may increase [[Neuroplasticity|cerebral plasticity]] and result in an increased capability to improve language function. It has been seen that piracetam is most effective when treatment is begun immediately following stroke. When used in chronic cases it has been much less efficient.{{sfn|Berthier|2005}} | ||
| Line 181: | Line 162: | ||
In most individuals with expressive aphasia, the majority of recovery is seen within the first year following a stroke or injury. The majority of this improvement is seen in the first four weeks in therapy following a stroke and slows thereafter.<ref name='Bakheit' /> However, this timeline will vary depending upon the type of stroke experienced by the patient. Patients who experienced an ischemic stroke may recover in the days and weeks following the stroke, and then experience a plateau and gradual slowing of recovery. On the contrary, patients who experienced a hemorrhagic stroke experience a slower recovery in the first 4–8 weeks, followed by a faster recovery which eventually stabilizes.<ref>{{Cite book|title = Introduction to Neurogenic Communication Disorders|last = Manasco|first = M. Hunter|publisher = Jones & Bartlett Learning|year = 2014}}</ref> | In most individuals with expressive aphasia, the majority of recovery is seen within the first year following a stroke or injury. The majority of this improvement is seen in the first four weeks in therapy following a stroke and slows thereafter.<ref name='Bakheit' /> However, this timeline will vary depending upon the type of stroke experienced by the patient. Patients who experienced an ischemic stroke may recover in the days and weeks following the stroke, and then experience a plateau and gradual slowing of recovery. On the contrary, patients who experienced a hemorrhagic stroke experience a slower recovery in the first 4–8 weeks, followed by a faster recovery which eventually stabilizes.<ref>{{Cite book|title = Introduction to Neurogenic Communication Disorders|last = Manasco|first = M. Hunter|publisher = Jones & Bartlett Learning|year = 2014}}</ref> | ||
Numerous factors impact the recovery process and outcomes. Site and extent of lesion greatly impacts recovery. Other factors that may affect prognosis are age, education, gender, and motivation.<ref>{{Cite journal|last=Thompson|first=Cynthia K.|date=2000|title=Neuroplasticity: Evidence from Aphasia|journal=Journal of Communication Disorders|volume=33|issue=4|pages=33 (4): 357–366|pmc=3086401|pmid=11001162|doi=10.1016/s0021-9924(00)00031-9}}</ref> Occupation, handedness, personality, and emotional state may also be associated with recovery outcomes.<ref name=":1" /> | Numerous factors impact the recovery process and outcomes. Site and extent of lesion greatly impacts recovery. Other factors that may affect [[prognosis]] are age, education, gender, and motivation.<ref>{{Cite journal|last=Thompson|first=Cynthia K.|date=2000|title=Neuroplasticity: Evidence from Aphasia|journal=Journal of Communication Disorders|volume=33|issue=4|pages=33 (4): 357–366|pmc=3086401|pmid=11001162|doi=10.1016/s0021-9924(00)00031-9}}</ref> Occupation, handedness, personality, and emotional state may also be associated with recovery outcomes.<ref name=":1" /> | ||
Studies have also found that prognosis of expressive aphasia correlates strongly with the initial severity of impairment.<ref name="Pedersen" /> However, it has been seen that continued recovery is possible years after a stroke with effective treatment.<ref name="Meinzer" /> Timing and intensity of treatment is another factor that impacts outcomes. Research suggests that even in later stages of recovery, intervention is effective at improving function, as well as, preventing loss of function.<ref name=":8">{{Cite journal|last=Raymer|first=Anastasia|date=February 2008|title=Translational Research in Aphasia: from Neuroscience to Neurorehabilitation|journal=Journal of Speech, Language, and Hearing Research|volume=51|issue=1|pages=259–275|doi=10.1044/1092-4388(2008/020)|pmid=18230850}}</ref> | Studies have also found that prognosis of expressive aphasia correlates strongly with the initial severity of impairment.<ref name="Pedersen" /> However, it has been seen that continued recovery is possible years after a stroke with effective treatment.<ref name="Meinzer" /> Timing and intensity of treatment is another factor that impacts outcomes. Research suggests that even in later stages of recovery, intervention is effective at improving function, as well as, preventing loss of function.<ref name=":8">{{Cite journal|last=Raymer|first=Anastasia|date=February 2008|title=Translational Research in Aphasia: from Neuroscience to Neurorehabilitation|journal=Journal of Speech, Language, and Hearing Research|volume=51|issue=1|pages=259–275|doi=10.1044/1092-4388(2008/020)|pmid=18230850}}</ref> | ||
| Line 188: | Line 169: | ||
==History== | ==History== | ||
[[File:Cerveau de Louis Victor Leborgne dit Tantan 1.jpg|thumb|The brain of Victor Leborgne, a speechless patient who allowed Paul Broca to tie a specific brain region to language]] | |||
Expressive aphasia was first identified by the French neurologist [[Paul Broca]]. By examining the brains of deceased individuals having acquired expressive aphasia in life, he concluded that language ability is localized in the ventroposterior region of the frontal lobe. One of the most important aspects of Paul Broca's discovery was the observation that the loss of proper speech in expressive aphasia is due to the brain's loss of ability to produce language, as opposed to the mouth's loss of ability to produce words.<ref name="Purves" /> | Expressive aphasia was first identified by the French neurologist [[Paul Broca]]. By examining the brains of deceased individuals having acquired expressive aphasia in life, he concluded that language ability is localized in the ventroposterior region of the frontal lobe. One of the most important aspects of Paul Broca's discovery was the observation that the loss of proper speech in expressive aphasia is due to the brain's loss of ability to produce language, as opposed to the mouth's loss of ability to produce words.<ref name="Purves" /> | ||
| Line 209: | Line 193: | ||
== External links == | == External links == | ||
* [https://www.aphasia.org/ National Aphasia Association] | * [https://www.aphasia.org/ National Aphasia Association] | ||
* [ | * [https://aphasiacenter.org/ Aphasia Center of California] in Oakland, California, U.S. | ||
* [https://www.youtube.com/watch?v=1aplTvEQ6ew | * [https://www.youtube.com/watch?v=1aplTvEQ6ew Video] of person with Broca's Aphasia | ||
* "Broca's aphasia. Discovery of the area of the brain governing articulated language", analysis of Broca's 1861 article, on ''[http://www.bibnum.education.fr/sciencesdelavie/neurologie/l-aphasie-de-broca BibNum]'' <small>[click 'à télécharger' for English version]</small>. | * "Broca's aphasia. Discovery of the area of the brain governing articulated language", analysis of Broca's 1861 article, on ''[http://www.bibnum.education.fr/sciencesdelavie/neurologie/l-aphasie-de-broca BibNum]'' <small>[click 'à télécharger' for English version]</small>. | ||
* Appendix: Common Classifications of Aphasia. (n.d.). Retrieved from http://www.asha.org/Practice-Portal/Clinical-Topics/Aphasia/Common-Classifications-of-Aphasia/ | * Appendix: Common Classifications of Aphasia. (n.d.). Retrieved from http://www.asha.org/Practice-Portal/Clinical-Topics/Aphasia/Common-Classifications-of-Aphasia/ | ||