Transcription:
What is Aphasia?

Prakash Chandran: Today, we're learning about aphasia, a disorder that affects how you communicate and joining us today is Dr. Dana Moser. She's the Associate Professor and Director of the Communication Sciences and Disorders Master's Program in Speech Language Pathology at University of Arkansas for Medical Sciences.

This is UAMS Health Talk, The Podcast from the University of Arkansas for Medical Sciences. My name is Prakash Chandran. So Dr. Moser, great to have you here today. Thank you so much for your time. Let's get started with the basics. What exactly is aphasia and how is it diagnosed?

Dr. Dana Moser: Thank you. Aphasia is an acquired neuro neurogenic language disorder that affects about 2 million Americans. Yet many people don't know about it. So what does acquired neurogenic language disorder mean? This means that a person has developed typical language abilities, and then due to brain damage, either through injury or disease, a person loses some of their ability to communicate. Effectively language is a complex symbol system in which we use words and grammar to communicate ideas.

There are various parts of the brain that work together to allow us to communicate our ideas effectively. In aphasia part of the language system becomes damage, which causes the person to experience difficulty with producing or understanding spoken language. And, or written language. In other words, they may have trouble getting the words out in a conversation, or when they're trying to write they may also have trouble understanding what's being said to them or understanding written information.

Prakash Chandran: Is aphasia something that basically is it a progressive disease that happens over time? Or is it something that just comes on all of a sudden, and then someone notices it?

Dr. Dana Moser: It can be both depending on what the etiology is. So whatever is causing the dysfunction in the brain. If it's something like stroke, It will have an acute onset. So they'll notice the symptoms immediately. If it's something that's caused by a degenerative disease, then that would have a gradual onset. And so, it may not be noticeable at first and then it gets increasingly worse.

Prakash Chandran: So I wanna expand on that a little bit. You mentioned it's caused by injury or disease. And one of the things that you just mentioned there was stroke or some sort of degenerative disease. Talk a little bit about the most common causes of aphasia.

Dr. Dana Moser: Okay. The number one cause of aphasia is stroke, particularly strokes that occur in the left hemisphere with the brain and a stroke is just when there is a problem with adequate blood flow to the brain. So this could be due to a blockage or a rupture in the blood flow to the brain, which then leads to localized cell death. About 25 to 40% of stroke survivors will acquire aphasia. Some other common causes are head injury, brain tumors, infections, and degenerative diseases. Anything that causes damage to the brain can cause aphasia

Prakash Chandran: Okay, understood. And it kind of reminds me, my wife sometimes suffers from ocular migraines and one of the, I guess, symptoms is difficulty to kind of express what you wanna say. Right? There's kind of what feels like she's trying to say something, but she can't find the words. That's what it actually expresses as, is this related to aphasia or is this different?

Dr. Dana Moser: Well, so what you're describing is anomia, which is a very common symptom of aphasia. I would actually say that if you don't have anomia, you don't have aphasia. That's not to say that if you have anomia you have aphasia. So your, what your wife would be experience would be very temporary when she's having that migraine episode. Persons with aphasia, it would be constant struggle.

Prakash Chandran: Okay. So that's an important distinction. It's not an episodic type event. It's actually something that happens. And you continually struggle with it. Is that correct?

Dr. Dana Moser: That's correct.

Prakash Chandran: Okay. And is there a spectrum in terms of aphasias severity? Is there like, you know, some lightweight aphasia where you're maybe having trouble finding the words versus you're really unable to discern text and speech?

Dr. Dana Moser: Sure. So in the event that your main impair. Really is just the word finding we call that anomic aphasia. And with each type of aphasia, there is a range of mild to severe. So you could have very severe anomia, which would make it very difficult for you to communicate words, if you couldn't think of any words, for example. Right? So when you talk about type and severity, those are two different distinctions. Broadly speaking, there are two main categories of aphasia and these are fluent and non fluent.

And so, someone with non fluent aphasia may only speak a few words at a time. They may not be able to speak in sentences and come up with the words that they wanna say. Like we were just describing. Someone with affluent ashpasia, may say many words and have the contour of a sentence that you can make out. But the words that they are saying are not conveying their thoughts correctly. So the words that they're using are the wrong words, or they're just empty words that don't contain any meaning.

Prakash Chandran: Okay. Understood. And I imagine that this is typically recognized by a friend or a family member. Is that correct?

Dr. Dana Moser: Yeah, it depends on the etiology again. So for example, if someone were to have a stroke, they may notice speech problems. They might also notice changes in their vision or their motor abilities. And so there may be multiple things that are happening that someone. Thinks oh, something's wrong. And if you think someone's having a stroke, you should definitely get medical attention immediately because that can make a difference in their recovery. But to your point, if you were admitted to the hospital for a stroke because so many people who have a stroke do have aphasia, a physician would do kind of an initial assessment as to whether or not this person requires an assessment by a speech language pathologist.

And they would order that assessment. And a speech language pathologist would then do an assessment just basically to determine whether or not this person's speaking fluently, if they're able to understand simple words and sentences you know, can they read, write, Provide you with basic information, type of conversation with you. And that would be kind of the initial screening process. If the screen reveals that a more in depth assessment is done, then that will occur at the appropriate time, depending on the person's medical status.

Prakash Chandran: Now is aphasia once diagnosed something that can be cured?

Dr. Dana Moser: So, that's a tricky question. So I guess I would say there's not a cure per se. If you have a aphasia due to an acute injury, like a stroke a traumatic brain injury, a gunshot wound, something like that, the typical progression of the disorder is that you'll be worse at the time that the injury occurs. And then as the brain heals most individuals will show pretty marked improvement. You know, depending on how severe the injury is. But many people. I would say at least a third will end up having a chronic aphasia. This means that they do not fully recover and they have to adjust to living with aphasia.

Prakash Chandran: Okay. So, I'm trying to think of a corollary here. When you injure yourself physically, there's typically like physical rehabilitation that you go through or some sort of therapy to try to improve or accelerate your ability to get back to what you would consider normal. Is there something like that for aphasia where there's treatment or therapy? So even though it can't be cured, is there like therapeutic things that can be done to help improve their ability to discern language and speech?

Dr. Dana Moser: Yes, absolutely. So speech language pathology is the speech and language correlate to something like physical therapy, which people may be more familiar with. And so a speech language pathologist would do a diagnostic Did you determine what your language abilities are. And then depending on what your goals are, your family's goals. They could develop a targeted intervention plan. Where you receive therapy. So this can occur in inpatient. This could occur at a subacute, like a rehabilitation hospital. You could also get it an outpatient, but basically the speech language pathologist would be working with the person with aphasia to help improve their overall communication.

So, one thing that I do wanna point out is that In addition to affecting someone's language, aphasia can greatly affect someone's quality of life and their ability to do the things they wanna do, because language is how we connect and interact with the world around us. And so as speech language pathologists, our goal is to increase language function, but also to increase communication effectiveness and participation in life. And so, The speech language pathologist may be working to improve a particular loss function to restore that function, but they might also be helping the client to find ways to compensate for those loss functions.

For example, someone could learn to use writing or gestures to supplement their spoken language or a communication board that could have words or pictures that they could point to show communication partner, you know what they're wanting to say.

Prakash Chandran: So I want to kind of expand on something that you just said in terms of what you're helping do, and that is helping people participate in life. I imagine that there is an emotional component to aphasia, right? If people cannot express themselves the way they want or they're coming across in a way that makes them feel incomplete, I think that it's important for people to know that there is a pathway to participating again and to getting better. So can you speak broadly to the emotional aspects of it and maybe about the program at UAMS that helps people.

Dr. Dana Moser: Sure. Well, first of all, there is a high incidence of depression following stroke in general. You know, with the injury that occurs to the brain. But there is an additional component which comes from isolation and frustration and all of those things. And most of the people that I've worked with with aphasia they will, they can tell you about their journey and that they experienced loss. And then that they kind of had to adapt and reinvent themselves. And and so, I've heard some really beautiful stories .

There are things that you can do even outside of the person with a phage of themselves, you know, creating an environment, that's more conducive to communication, helping to train their communication partners to know how to assist them in a better way. So just doing simple things like you know, creating a acquired quieter environment where aren't distractions. Keeping your words simple, and your sentences simple. Talking in a flow, but normal rate.

You don't wanna slow it down so much that it's not natural because the rate and contour of our speech conveys information in addition to the words themselves, but slowing down the rate and actually pausing. Can help them have additional time to process the sentences that you're saying. And then also just asking questions. I mean, it can even be yes or no questions just to ensure that they understood the message you're saying, and that you're understanding what they're saying.

Writing down keywords. And then I think one of the biggest things is to just be patient, allow more time to respond and to know that the person's intellect is good. They're just having trouble grabbing those words and you know, expressing the thoughts that they have in their brain.

Prakash Chandran: Yeah, I'm so glad that you covered that. I think it's so important just to bring awareness to what others can do to help those with aphasia. So this is all fascinating information. And just to kind of bring it back to the services that UAMS has to offer with people with aphasia. Could you speak to those?

Dr. Dana Moser: Sure. Within our department we have a outpatient clinic and I would highly recommend in addition to individual therapy, persons with aphasia participate in aphasia group. Particularly if they have chronic aphasia. Aphasia groups allow persons with aphasia to interact with each other practice communication strategies, and just have support of others with aphasia. We have services at our clinic, the UAMS CHP speech language and hearing clinic. That allows us to provide individual therapy, several different aphasia groups, and then we also offer free speech and hearing screenings periodically. Thank you.

Prakash Chandran: That all sounds incredible. Well, Dr. Moser really thank you so much for your time today. And for sharing with us a little bit more about aphasia. I think this is something that more people need to be aware of, and I really appreciate your. That was Dr. Dana Moser, Associate Professor and Director of the Communication Sciences and Disorders Master's Program in Speech Language Pathology at the University of Arkansas for Medical Sciences.

Thanks for checking out this episode of UAMS Health Talk for more information on this topic and to access the resources mentioned, please visit uamshealth. com. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. My name's Prakash Chandran, thanks so much for listening and we'll talk next time.