What is APHASIA: not deafness, not muteness, so what is it?

Even the most eloquent of us, are sometimes rendered speechless momentarily in life’s multitude of events. But what to say of something that affects the brain that lasts longer than a moment, when your speech and language which you take so much for granted becomes in-accessible to you? This condition is called “APHASIA” and generally occurs as a result of stoke or injury to the parts of brain that are responsible for storing your language.

To explain this concept better, let us step back a bit and think about the brain. This organ, this soft, delicate mass of cells called neurons is protected in our thick bony box of skull and controls our whole body: our actions, our movements, responses, senses, what we feel and even what we think, intend, decide. It is the master computer. Since it is small area with so many tasks, many of the parts of the brain evolve in such a way that they become super specialized in a particular function. In other words, most tasks have designated parts of the brain responsible for their function. Just like a switch controls a particular bulb. This is a simplified manner of looking at the brain like a control panel to make it easier to understand it (where as in reality, the control systems are much more complex than this).

Using the simplified metaphor, aphasia can be seen as the language switch going off. Even if the bulb is there, the switch going off means that it can not be lighted. A simple conversation is in fact comprised of several steps: understanding what is being said to you, then processing that information, then thinking of a response, then formulating the answer and using the appropriate words, phrases to answer back…. this whole network of tasks that is contained in designated areas of the brain, and if a stroke or injury damages these areas of the brain, then these seemingly simple tasks can not be done.

Language is an acquired trait of the brain, that is why when a baby is born it learns the language of its surrounding. This is evident from the fact that babies who are brought up in a household with a different language from their birth parents will adopt the language of the household. The acquisition of language requires an intact hearing system, which is linked to language areas of the brain. Whatever the child hears is stored in the language areas, and since the language areas are linked with other areas of the brain, the language is used to give identity and make sense of the world and self. As development proceeds, this learnt language is reproduced by the child, whereby his mouth, tongue and voice box learn to formulate the words, phrases, sentences to express himself.

The two important points that can be clearly seen from this description is that:

  • Our identity and sense of the world and self are closely integrated into our language. In other words, language is not only a tool of expression, rather it is a formative tool in making us what we are, developing our concepts, thinking, opinions….. everything, actually.
  • Language is a complex thing, and a dynamic one. It is not like a dictionary or a glossary of terms that is stored in a part of brain, rather, it comprises active aspects, three of which are
    1. Understanding: ie. Making sense of what is being said (by others and even what we are saying)
    2. Processing: organizing the information received and preparing an appropriate response, utilizing information from the brain including stored vocabulary, experiences and what the person desires.
    3. Expressing: merely stating what one wants to say, or to answer a question requires a person to have an intact language center, and the words need to be formed by the tongue and mouth while sound is expressed from the sound box, comprising the speech. (Not having the intact language center results in aphasia, where as problems with the other components of speech result in other speech deficits like dysphonia, dysarthria, etc…. which are beyond the scope of this article).

It is important to mention that depending on the injury or insult to the part of brain, there are different types of aphasia. For instance, there can be people who mainly have problem in understanding speech and their spoken speech is not affected, this is called Receptive or Sensory Aphasia. On the other hand, some people can understand what is being said to them, but expressing their response is a challenge, this is called Expressive or Motor Aphasia. The people who suffer from both deficits, understanding as well as expressing, are said to suffer from Total or GLOBAL APHASIA.

Aphasia is a difficult neurological condition to explain, and that is why people with aphasia are met with such alienation. People often confuse them for muteness, or deafness, whereas the truth is that their hearing is not affected. Another common public misconception is that people with aphasia should be able to, or learn to communicate with sign language. One way to explain to the lay person of what aphasia is to tell them that it is the “memory loss of language”. Ironically, in aphasic patients, testing the memory is itself a challenge because how can you test memory without language?

Can Aphasia be treated:

In some lucky individuals who have a small area of brain affected, and who receive prompt treatment, their language deficit is completely treated, and they have no residual effects. For others, with larger areas of brain affected, most of language recovery occurs within the first 6 months after the incident, after which the ‘recovery’ is relatively slow. Therefore much emphasis has to be given to proper management of patients with strokes and brain injuries in the initial phases of their event, to minimize further brain damage and to maximize the recovery of language and other faculties. Proper management in this phase of treatment can not be stressed enough, and this should be taken as a very serious commitment on part of doctors, therapists and even patients’ and their relatives.

Unfortunately, many patients are left with lasting effects of aphasia and this makes it very difficult for them to lead independent productive lives. Not only do they find it a challenge to interact with others on a day to day basis, even express their needs or ask for help, it also makes them depressed and frustrated because they feel imprisoned within their minds. What makes this situation even more difficult is that the barrier of language puts hurdles even when and where help can be offered .

There is a lot of research and development going on in leading world centers to try and study how effectively language can be restored even in late stages of injury and stroke. A lot of promising results are seen in these centers. The promise lies in the brain’s incredible ability to transform and acquire new skills, called neuro-plasticity. Harnessing this ability to restore language requires super specialized skills on part of the therapist and a lot of dedication and commitment and motivation on part of patient to endure prolonged, dedicated, time consuming sessions. Late language acquisition is not an easy feat, and results are slow and unpredictable, and only individuals who understand this and persist with it despite all the challenges can get any late benefits.

What can the public do to help people with aphasia:

If you are reading this article then you have done the first step to help people with Aphasia: i.e, you are trying to understand what it is and what challenges it poses. It becomes an intuitive thing after this. Once you are more sensitive to these people, you will find yourself dealing with them better, but just as a guideline, I will enlist a few things:

  • be patient with them, they may take longer to form an answer. Don’t rush them.
  • don’t speak around them in the third person, as if they are not present there or can’t understand you. Even if they really can’t understand you, but including them in your conversation will help them feel accepted.
  • Speak slowly when you are speaking to them. This is very important. Usually people try to say too many things too quickly to put the other person at ease. With people suffering from aphasia, try to use short sentences, easy words and slow pace. You may need to repeat a thing once or twice so they understand it.
  • Speaking loudly will not solve the problem. Remember this is not deafness.
  • Offer to give a pen and paper if you see them struggling to say something, they might be able to write something that makes sense.
  • While it is important that you don’t pretend to understand something they are trying to say, be sensitive about expressing this to them.

ARSHIA. August 4, 2015.


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