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■ Aphasia is an acquired deficit in language resulting from brain damage. Aphasia is most often
caused by a stroke to the left cerebral hemisphere. Aphasia is not the result of motor,
intellectual, cognitive, or psychological impairment.
■ Language deficits are grossly divided into expressive language deficits and receptive
language deficits.
● Expressive language deficits are characterized by difficulty in formulating or producing
language to communicate an intended meaning. Expressive language deficits are
usually caused by lesions in the anterior left cerebral hemisphere often at or near
Broca’s area.
● Receptive language deficits are characterized by difficulty deriving meaning from verbal
or written language. Receptive language deficits are usually caused by lesions in the
posterior left hemisphere often at or near Wernicke’s area.
■ Signs and symptoms of aphasia include anomia, verbal comprehension deficits, paraphasias,
perseveration, agrammatism, repetition deficits, alexia, and agraphia.
■ Anomia is a word finding deficit.
■ Verbal comprehension deficits are the inability to understand verbal language produced by
others and are deficits of receptive language.
■ Paraphasias are errors of expression that occur at the syllable, word, or phrase level and are
produced unintentionally.
● A phonemic paraphasia is an error made at the phoneme level. A neologistic paraphasia
is an error made when the word produced is entirely different from the word intended
and is 50% or more indiscernible.
● A semantic paraphasia is when one word is substituted for another word that is similar in
meaning.
● An unrelated verbal paraphasia is an error made when one word produced is substituted
for another word that is not similar in meaning.
■ A perseveration is a word that is said repeatedly and inappropriately. A perseverative
paraphasia occurs when a word produced earlier is repeatedly and inadvertently produced by
an individual with aphasia instead of the intended word.
■ Agrammatism is the lack of appropriate grammatical construction of language. Agrammatic
speech is caused by the omission of function words, which are the in-between words used to
frame content words of a sentence. Content words are the words that carry most of the
meaning. Agrammatic speech generally sounds telegraphic because few words are used,
though the words are usually used with efficiency.
■ Repetition deficits are caused by lesions along the arcuate fasciculus. The arcuate fasciculus
consists of white matter pathways stretching between Broca’s area and Wernicke’s area.
■ Alexia is an acquired impairment of reading. Agraphia is an acquired impairment in the ability
to form letters or words for written language.
■ Behaviors related to aphasia include self-repairs, speech disfluencies, struggle in nonfluent
aphasias, and preserved or automatic language.
● Self-repairs occur when a speaker restates or revises a word or phrase to produce it
error free or refine a word’s meaning. Individuals with aphasia are unsuccessful at
self-repair far more often than unimpaired individuals. Multiple unsuccessful attempts at
self-repair often compromise the prosody and speech fluency of individuals with aphasia.
● Speech disfluencies produced by those with aphasia consist of sound, word, part-word,
or phrase repetitions, prolongations, and interjections. These are normal disfluencies
that escalate in frequency to pathologic levels.
● Individuals with nonfluent aphasia often visibly struggle when attempting to produce
expression.
● Preserved language is the intact production of rote and overlearned language. This can
include the ability to recite days of the week or months of the year or to count to 10.
● Automatic language is language that is associated with and produced somewhat
reflexively in response to a stimulus.
■ Some cognitive deficits that can co-occur with aphasia include problems with arousal,
attention, short-term memory, problem solving, inferencing, and executive functioning skills.
■ Some motor deficits that occur alongside aphasia and directly concern the speech-language
pathologist include the dysarthrias, apraxia of speech, and dysphagia.
■ The cortical aphasias are those aphasias that arise as a result of damage to the cortex. The
nonfluent cortical aphasias include Broca’s aphasia, transcortical motor aphasia, and global
aphasia.
■ Broca’s aphasia is the result of damage to the inferior posterior frontal lobe of the left
hemisphere. Individuals with Broca’s aphasia have mostly intact receptive language abilities
with deficits in repetition and expression.
■ Transcortical motor aphasia is a result of damage to the supplementary motor cortex or the
area just anterior to Broca’s area. Individuals with transcortical motor aphasia display mostly
intact receptive language abilities and relatively intact repetition with deficits in expressive
language.
■ Global aphasia is a result of damage to a large area of the zone of language within the left
cerebral hemisphere. Global aphasia is characterized by severe to profound deficits in
expressive language, receptive language, and repetition.
■ The fluent cortical aphasias include Wernicke’s aphasia, transcortical sensory aphasia,
conduction aphasia, and anomic aphasia.
■ Wernicke’s aphasia is a result of lesion to the cortex at or around Wernicke’s area. Wernicke’s
aphasia is characterized by receptive language deficits, fluent but empty speech, and repetition
deficits.
■ Transcortical sensory aphasia is a result of damage just posterior to Wernicke’s area.
Transcortical sensory aphasia presents with deficits in receptive language, relatively intact
repetition, and fluent and often empty speech resembling Wernicke’s aphasia.
■ Conduction aphasia is a result of damage to the supramarginal gyrus of the parietal lobe that
is posterior to the sensory cortex above Wernicke’s area. This damages the arcuate fasciculus
but leaves Broca’s and Wernicke’s areas intact. Conduction aphasia typically presents with
relatively intact receptive and expressive language but with deficits in repetition.
■ Anomic aphasia can result from damage anywhere within the language areas of the left
hemisphere and is characterized by mild to moderate word finding deficits in absence of other
deficits.
■ The subcortical aphasias are those aphasias that arise as a result of or alongside damage to
the subcortex. The subcortical aphasias include thalamic aphasia and striatocapsular aphasia.
■ Thalamic aphasia is a result of an ischemic stroke to the left side of the thalamus. Some signs
include almost fluent speech, significant anomia in spontaneous speech, impaired receptive
language, perseverative semantic paraphasias, normal articulation, hypophonic voice, intact
repetition, and intact grammar.
■ Striatocapsular aphasia is language deficits associated with lesion at the striatum of the basal
ganglia but that occur as a result of a lack of blood flow to the cortical primary language areas.
■ Atypical aphasias include crossed aphasia and the primary progressive aphasias. The primary
progressive aphasias are the result of a degenerative pathology rather than acute pathology
and include progressive nonfluent aphasia and semantic dementia
■ Progressive nonfluent aphasia is a result of degeneration of the frontal lobes, primarily the left
frontal lobe. Some signs include phonemic paraphasias, anomia, grammatical errors, slow
speech rate, simplified syntax, reduced phrase length, and mostly intact receptive language.
■ Semantic dementia is a result of degeneration that begins in the temporal lobes. Some signs
include excessive and disinhibited verbal output, semantic jargon, pragmatic deficits, significant
anomia, and questioning the meaning of words.
■ Crossed aphasia is the condition of having aphasia in right-/handed individuals arising from
right cerebral hemisphere lesion.
■ Assessment of aphasia usually includes the following: a case history, assessment of
functional communication and speech, a standardized aphasia test (or the administration of
formal diagnostic tasks), a cognitive evaluation, and at times a quality-of-life assessment.
■ Screenings for aphasia are useful to quickly determine the presence of aphasia and the need
for a comprehensive follow-up assessment.
■ Aphasia therapy facilitates spontaneous recovery. Spontaneous recovery can occur up to 6
months post onset.
■ The three categories of aphasia therapy are restorative, compensatory, and social.
● Restorative approaches are based on the idea of neuroplasticity. Neuroplasticity is the
ability of a part of the brain to change its function to take on a new role.Restorative
approaches include Schuell’s stimulation therapy, melodic intonation therapy,
constraint-induced therapy, and errorless learning.
● Compensatory approaches enable patients to increase their level of function despite
their deficit.
● Compensatory approaches for aphasia usually take the form of augmentative and
alternative communication (AAC).
● Compensatory approaches can include both low-tech techniques and high-tech AAC
devices. Low-tech techniques include gestures, drawings, and pointing to pictures on a
communication board. High-tech devices include programmable voice-generating
computers such as Lingraphica and apps for the iPhone and iPad.
● Social approaches revolve around increasing an individual’s self-confidence,
opportunities to communicate, and overall sense of value and acceptance as a
communicator.
● Social approaches include communication partner training and group therapy
■ Schuell’s stimulation therapy reestablishes lost language abilities through the use of auditory
stimuli to evoke a response.
■ Melodic intonation therapy is the use of the intact melodic/prosodic processing of the right
hemisphere to cue word retrieval and production in the left hemisphere.
■ Constraint-induced therapy constrains a patient’s ability to compensate for deficits and forces
the person to use the weakened skills, thereby directly exercising and improving the areas of
weakness.
■ Errorless learning therapy is a technique that focuses on reducing the number of errors
produced by patients in therapy by setting the difficulty of therapy tasks very low for the client to
succeed.
■ Communication partner training changes the behavior of those in the environment who most
interact with those with aphasia to facilitate the communication of the person with aphasia.
■ Group therapy is a dynamic setting in which hope, psychosocial emotional support,
pragmatics, self-confidence, and additional goals are addressed with multiple clients and
clinicians present. Group therapy for those with aphasia allows for the targeting of many goals,
such as pragmatics, left unaddressed in individual one-on-one therapy sessions.
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