Aphasias . Conceptually Aphasia is considered a language disorder as a consequence of a brain injury that interferes with the coding or decoding functions or both at the same time, and a commitment to reading and writing can also be observed .
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- 1 Historical Review
- 2 The Aphasias
- 1 Sensory aphasias
- 2 Motor aphasias
- 3 Motor aphasias
- 3 Characteristic symptoms of aphasic syndrome
- 4 Most frequent causes of aphasias
- 5 Diagnosis
- 1 Neurodiagnostic techniques
- 6 Aphasic forecast, most important indicators
- 7 Orientations aimed at the aphasic and personal in their care in the first phase of the disease
- 8 Orientations for the family
- 9 Sources
- 10 External links
The history of aphasias begins with the approaches made by Paul Brocá , a famous French surgeon and anthropologist who shook the time of the l86l when he claimed to find in one of his patients who had an expressive language impairment , an injury in the third third of the third left frontal gyrus. This can be said to be the first definitive scientific contribution to the study of aphasias.
These studies on aphasias were reinforced years later by Wernicke, who found a lesion in one patient in the posterior third of the left superior temporal gyrus, which presented disorders in language comprehension. Wernicke called this sensory aphasia as opposed to Brocá’s motor aphasia. Then follows an escalation of discoverers, including Charcot, Bastián and others who highlighted their nasociacionistas theories.
These found opponents standing out, S. Freud, who in l88l publishes a work in which he draws attention to the importance of the functional relations of language . Jackson also makes known the need to consider the function of language not only from the anatomoclinical point of view, but as a more complex process, and that aphasias had to be addressed in its functional aspect through the patient’s clinical psychological psychological analysis.
In addition, writings by Pierre Marie appear in l906 . Later other authors are distinguished in the matter such as: Head, Golstein, Alajouanine and others who studied the phonetic disintegration .
These different trends of classical conceptions in the field of aphasiology are grouped into three lines:
- Associationists: Initiated by Wernicke.
- Anatomical clinics: as featured author_ Pierre Marie,
- Functional: like the Jackson case.
Currently, this field works in a multiprofessional way, since the study of this science is made up of neurologists, psychologists, linguists, speech therapists and other specialties committed to developing and continuing the work that is collected from the neurosychological studies provided by Vigosky. , Luria and all her followers.
Luria’s explanation regarding aphasias is the most widely applied in the country in recent years based on the formation of complex mental processes that includes language .
Luria, considers two types of aphasias like the rest of the authors, but bases her classification as follows, distinguishing several forms within each of them.
- Sensory itself or gnostic acoustics
- Acoustic amnestic
- Dynamic Front
- Sensory aphasia proper: it occurs in the sectors of the posterior third of the first convolution of the left temporal lobe, the processes of analysis and synthesis of the identification of the sounds of the language are carried out. This structure of the cortex is identified as a phonemic ear ; its function consists in the analysis and audioarticulatory synthesis; If these sectors of the cerebral cortex are injured, the differentiation system of verbal sounds is disturbed, presenting this type of aphasia.
- Acoustic amnestic aphasia: arises as a result of injury to the mid sectors of the convex part of the left temporal lobe related to auditory and visual analyzers, in addition to being related to the limbic system. The cardinal symptom of this aphasia is verbal amnesia manifested by word search.
- Semantic aphasia: it is related to parieto-temporal-occipital lesions of the left lobe and its clinical expression is given by anomies and difficulty with the logical grammatical construction among other symptoms.
- Afferent motor aphasia: The damage in this aphasia is located in the postcentral zone, lower third of the first left parietal circonvolution, kinesthetic area responsible for oral praxis, the articulema is formed, which are the cerebral articulatory schemes responsible for the organization, control and constancy of the articulatory movements of speech. When this area is damaged, there is a kinesthetic disorganization of the articulatory movements of speech. The main symptoms that we find in patients with this pathology are: the patient looks at the mouth of the speaker, improves with the visual articulatory image, changes in literacy, among others.
- Efferent motor aphasia: here an alteration of the kinetic structure or motor program of verbal expression is observed, and it is clinically expressed by a breakdown in oral fluency when an injury occurs in the pre-rolandic sectors of the left hemisphere. It is clinically characterized by an impossibility of oral deployment in any order.
- Dynamic aphasia: what is known as loss of spontaneity or oral initiative is presented and here the psycho-regulatory function of language is fundamentally disrupted with a clinical translation of lack of motivation or initiative in preaching.
Characteristic symptoms of aphasic syndrome
In studies carried out in relation to the clinical investigation of aphasia, it has been confirmed that it should not be limited to the individual effects of perception, memory , language and writing , etc. that constitute a certain syndrome. The way in which each function is affected, the pattern of the disorders and what is the common factor that unites the different systems must be taken into account, since everything is functionally integrated. The main symptoms present in the framework of a great aphasic syndrome and the importance of recognizing them as an important part of the disease.
- Agnosias: inability to recognize the different sensory information in the environment, which may be: visual, auditory, kinesthetic, etc.
- Apraxia : inability to execute movements aimed at a certain purpose due to lack of afferential information.
- Paraphasias: modifications in the structure of words characterized by the replacement of phonemes, syllables or words. They are classified into:
Literals: one phoneme is changed for another Syllabic: one syllable is replaced by another Verbal: the complete change of the word occurs while preserving the same meaning. Morphological: The word is replaced with a change in meaning.
- Perseverations: uncontrollable repetitions of a syllable or word that interrupts the utterance of the oral act.
- Stereotypy: a form of perseveration that consists of the repetitive and constant use of a word or phrase as the only form of oral expression.
- Anomie: inability to name objects.
- Logorrhea: profuse, uncontrolled, fluid verbal emission, with or without joint disorders, often without communicative content.
- Parognosia: incorrect understanding of the meaning of words,
- Neologisms: verbal expressions without any conventional meaning.
- Jengafasia: unintelligible mode of expression devoid of significant value, loaded with neologisms, parafasias and logorrhea, preserving the intonation melody of the language and with anosognostic elements.
- Anosognosia: condition of non-awareness on the part of the patient of his oral difficulties.
Most frequent causes of aphasias
In the etiology of aphasia they arise more frequently of such brain vascular, reporting a high number of patients with this etiology despite the deployment conducted by the National Health System in order to promote models of life healthier in man , through the dissemination of different campaigns to improve the level of health; notwithstanding the habit of smoking, stress , hypertension and other indicators ingrained within a societyincreasingly complex and developed, they demonstrate a very close relationship in the onset of the disease. With the presence of any of the forms that it presents, whether thrombotic, embolic or hemorrhagic, if the patient manages to survive them, aphasias can be observed among the present sequelae.
Trauma skull -encefálicos are the fourth leading cause of death today and most are accompanied by oral disorders. The consequences in the communication in its beginnings can appear severely but they manage to remit spontaneously or to get to observe a high recovery of the process in contrast to other etiologies. The tumors brain, infectious pictures of the type of encephalitis , the toxic causes, processes Degenerative bark, the aneurysmal malformations, hemorrhagic diathesis and finally, all neurologically affect the functional system of the language in the cortex.
The diagnosis of aphasic is based on two aspects:
- The data offered by the medical history.
- Results in the application of a neuropsychological test.
In the anamnesis, a whole series of data is collected, generally supplied by the patient’s family member, which allows not only diagnostic but also prognostic considerations. Among them, those that should not be missing as a fundamental source of information include: age, sex , race , hemispheric dominance, etiology of the lesion , time of evolution of the disease, complementary studies, and with special interest in skull Rx , CT , MRI, audiometry , laryngoscopies, and any other complementary research. In addition, the investigation is completed with the personal and family pathological history, toxic habits, occupation or profession, cultural level and any other information of interest in this regard.
The second condition to consider is the results of the evaluation of the speech clinic that results from the application of a neurosychological battery. The correct execution of these aspects will allow achieving the desired diagnosis more easily.
In relation to the neurosychological exploration applied in these cases, there is an extensive number of tests, the authors of which, through personal formulas and techniques, create the basis for the measurement of the different modalities of language . In Cuba, in recent decades, the Lurian guidelines are followed for working with the aphasic patient.
In his book Traumatic Aphasia, this author explains his exploration methodology and provides abundant and substantial information on the semiological values of the exploratory findings, emphasizing the advantage represented by the study of very limited injuries caused by firearms in brains. young people where the rest of the areas of the cortex are in a more optimal functional state than in those alterations due to vascular pathologies typical of older ages.
Taking into account the characteristics of suitability, feasibility and utility that a neurosychological battery requires, it determines the two basic poles of language: the encoding and decoding form.
The different modalities of the expressive or coding language are the following:
- Spontaneous language
- Automatic language
- Repetitive language
- Denominative language
- Discursive language
Spontaneous language , allows the patient to be placed in the fluent or non-fluent category. All aphasia exploration batteries have attempted to achieve an objective measure of this category. The fluence measurement can be made based on the length of the sentence, capacity for expression in the form of dialogue and monologue.
Many are the authors who offer different measurement techniques but it is also done by evaluating the patient’s forms of expression in dialogue and monologue quantitatively and qualitatively.
Automatic language , the patient is asked to mention numbers, days, months of the year or any other modality where the language manifests automatically, in a way that follows a direct meaning and try to try it in reverse to assess the ability of this function on a more voluntary level.
Denominative language , it is very sensitive when there are symptoms such as anomie. Possible gnostic or visual disorders should be considered in this test. It is done through three items or subtests.
- An object or figure is presented in the patient’s field of view and asked to identify it.
- We make an oral description of an object which must name or nominate.
- A set of objects of the same category are grouped in order for the patient to name them.
Repetitive language , here the auditory stimuli enter strongly. It is very sensitive to auditory perception. The correct execution of a repetition task requires an acoustic analysis of the stimulus and the correct reproduction through the articulatory function. If some of these processes are altered, the repetition will be ineffective.
Discursive language , is a very rich test of semiological information and can guide previously evidenced disorders: anomies, paraphasias, problems with syntax. This allows evaluating the qualitative characteristics of the speech and the verbal capacity of the patient.
Aphasic forecast, most important indicators
The prognosis of these patients is subject to a series of preliminary indicators that are obtained as data from the medical history, among them the most significant.
Age is considered one of the most important because despite the fact that language as a mental function is definitely consolidated in the adult man, it does not happen in the same way in children where the function is in full development. If he is injured at these stages, the prognosis is much more favorable.
Etiology of the lesion, corresponds to the extension and etiology of the process that affects the brain . Those causes that have a static nature, such as craniocerebral traumas, will have a better prognosis in relation to those that do it slowly and progressively, such as tumor processes.
Time of evolution of the disease, the orientations directed to the family nucleus and to all the personnel that surrounds the patient on the way to lead to the aphasic in a first stage of the disease, or the application of a specific therapy, will allow a recovery in a time shorter in relation to those who come late to consultations. It is easy to understand the importance of an early stimulation in them, where it is necessary to organize the level of consciousness that is required for the restoration of damaged intra and inter-psychic systems. Organized consciousness allows the information that reaches the cortex to be activated and organized through the analytical-synthetic functions, allowing reactivation of the processing of cortical activity.
Sequelae is a factor to take into account, since aphasias are mostly accompanied by disabling diseases that limit the patient motorically and make him dependent on his general development, such as hemiplegias , quadriplegias , hearing loss , sensory deficits, tracheostomies , disorders behavioral and others.
Emotional states, when wanting to re-establish a rehabilitation program of any kind, the patient’s psychic sphere must be considered, guaranteeing that he is adequately prepared to receive it. Most aphasic patients are unfortunately affected in this regard, presenting an emotional imbalance that affects the further development of rehabilitative therapy. In these cases we must previously seek their psycho-emotional stability in such a way that this allows us a more dynamic and safe therapy.
Type of aphasia, due to its condition of damage in the decoding function, sensory aphasias will have a more reserved prognosis than motor ones, although this is the level of involvement of the injury.
Family support, aphasias affect the emotional and social life of the patient. This makes the presence of marked states of emotional imbalance require the presence and support of people who stimulate him in his environment and facilitate him to eliminate the emotional blockage present, thus helping him to restart his new life.
The family plays a very important role in this aspect by facilitating and supporting it to confront this new psycho-social status.
Attention of the multidisciplinary team, this entity will mostly be accompanied by other conditions to which the required care must be provided. It is important that the interconsultations are carried out with the medical and paramedical specialties that will guarantee the physical and emotional stability of these cases.
Orientations aimed at the aphasic and personal in their care in the first phase of the disease
In order to know and interpret the new behavior shown by the aphasic patient, it must be known that the present functional disorders can be due to two causes:
- Temporary loss of activity in certain brain areas.
- Destruction of brain tissues.
In the first case, the therapeutic action should be aimed at specifically reducing functional inhibition; in the second aspect, work is done to reintegrate the damaged functional complex.
The treatment of aphasic, especially in very early stages, should be aimed at organizing the consciousness of the patient. It must be comprehensively focused, taking part in it according to Professor Cabanas’ proposals, all the personnel of the hospital and institutional center, everyone who is interrelated from very early stages must know the importance of proper management of the patient where it exists in many cases an unorganized conscience with marked communication disorders . They must be given physical and psychological attention, helping them in their general development, establishing an emotional balance and eliminating anxiety disorders.
Guidelines that generally must be known and applied in any aphasic rehabilitation program to improve and organize consciousness and its new relationship of life in therapeutic indications:
- Always show relaxation and calm before the patient, at this stage do not ask questions that require complex answers, do not pressure them to say complete words or phrases.
- Speak each word slowly and correctly, if possible relate them to the object shown and limit ourselves to these sensory stimulations until I receive more specific technical instructions.
- Never push him or make fun of the emission of bad words or stereotypical forms of communication .
- Faced with fatigability, of which they are very susceptible, change the task or recess it.
- Avoid references to times before or after your illness .
- Never asking him to speak, this will come from the patient as his psychological physical condition improves and he begins to develop a personal and specific rehabilitation program for his illness.