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Aphasia: Diagnostics and Treatment Case Study


Background

Characteristic Symptoms

As a mental disorder, aphasia has characteristic symptoms that impair language and speech proficiency among individuals. The characteristic symptoms of aphasia are evident as they affect the four aspects of communication, namely, verbal expression, auditory comprehension, functional communication, and reading and writing competence (Chapey, 2008). In the aspect of verbal expression, individuals with aphasia have difficulties in expressing some words in an appropriate manner.

For example, aphasic individuals tend to substitute words with other related words, switch sounds by reading words in reverse, and create their words and phrases (Chapey, 2008). Aphasic individuals also have difficulties in forming sentences and communicating verbally in a sensible way for they use a string of words that do not make sense (Wilson, 1999). In the aspect of auditory comprehension, aphasic individuals have difficulties in comprehending verbal language, figurative speech, and jokes. Consequently, aphasic individuals have limited functional communication because they cannot use words appropriately and comprehend what other say (Ogden, 2005).

Fundamentally, aphasic individuals cannot communicate in a normal way because they have comprehension and verbal difficulties. Wilson (1999) asserts that aphasic individuals do experience challenges in reading and writing for they cannot understand concepts, words, and ideas. Moreover, aphasic individuals cannot read and write for they cannot interpret words and sentences and present them in a logical manner.

Neuropathology Associated with the Syndrome

Aphasia is a mental disorder that affects language and speech functions of the brain. Neuropathology shows that aphasia emanates from the damage of the parts in the left hemisphere of the brain such as Broca’s area, Wernicke’s area, and posterior language area (Jordan & Kaiser, 2013). The main cause of aphasia is a stroke while brain injury, neurological disorders, and tumor are minor causes because they damage the brain and impair its functions (Jordan & Kaiser, 2013).

The cause and the site of the brain affected determine the severity of the aphasia. Stroke causes aphasia by damaging Broca and Wernicke’s areas of the brain and impairing speech production and comprehension respectively (Jordan & Kaiser, 2013). Ischemic stroke, which is a form of stroke that occurs due to the blood clot in the brain, is the common cause of aphasia. The blockage of the blood vessels that supply blood to the brain, particularly the left hemisphere, results in the death of brain tissue (Macdonald, 2011).

The form of stroke called hemorrhagic stroke also causes Broca’s aphasia, global aphasia, and Wernicke’s aphasia when the blood vessels burst in the left hemisphere of the brain and causes internal bleeding, which affects tissue and functioning of the brain. Moreover, mechanical injury of the brain or neurological disorders, which damage Broca’s area and Wernicke’s area, causes aphasia (Plowman, Hentz, & Ellis, 2011). In essence, any damage to the left hemisphere results in aphasia among individuals.

Diagnostic Procedures

Halstead screening test comprehensively diagnoses the characteristic symptoms of aphasia. Specifically, Halstead screening test assesses aphasic individuals regarding the extent of fluency, repetition, and comprehension (Salter, Jutai, Foley, Hellings, & Teasell, 2006). Aphasic individuals exhibiting non-fluent characteristics with poor repetition and poor comprehension have global aphasia while those with poor repetition and good comprehension have Broca’s aphasia (Salter et al., 2006).

Moreover, aphasic individuals having non-fluent characteristics with good repetition and poor comprehension have mixed transcortical aphasia whereas those with good repetition and good comprehension have transcortical aphasia. In contrast, aphasic individuals having fluent characteristics with poor repetition and poor comprehension have Wernicke’s aphasia whereas those with poor repetition and good comprehension have conduction aphasia (Salter et al., 2006).

Furthermore, aphasic individuals having fluent characteristics with good repetition and poor comprehension have transcortical sensory aphasia while those with good repetition and good comprehension have anomic aphasia. Hence, assessment of individuals using Halstead screening test provides a robust diagnosis of aphasia.

Treatment Programs

Since aphasia has numerous causes, it has different treatment programs, which are effective in the treatment and management of the condition. Multimodal treatment programs such as vision action therapy (VAT), promoting aphasic’s communicative effectiveness (PACE), and oral reading for language in aphasia (ORLA) are applicable in the management of the condition and improvement of speech and language proficiency (Wallace, Purdy, & Skidmore, 2014). VAT is treatment program used in the treatment of patients with global aphasia because it improves the ability to communicate using gestures (Purdy & Van Dyke, 2011).

PACE is a treatment program that improves speech, comprehension, and functional communication among aphasic patients (Wallace, Purdy, & Skidmore, 2014). ORLA is a treatment program that boosts visual, auditory, and writing capacity of aphasic patients. According to Purdy and Van Dyke (2011) assert that the multimodal communication programs are effective in the treatment and management of aphasia for they collectively enhance various brain functions. Hence, PACE, VAT, and ORLA are some of the multimodal programs that are applicable in the treatment of aphasic patients.

Case Study

Patient History/Background

Martin is a 24-year old aphasic patient who has been battling with aphasia for five years. Since childhood, Martin has been healthy for he has no medical history of major or chronic diseases. However, Martin started experiencing headaches and dizziness, which eventually led to the aphasic symptoms. As Martin was an active and social person, his friends realized that he was no longer active and social as usual, and his and lecturers reported that they observed problems in his writings.

Martin started aphasic symptoms for he lost the ability to communicate fluently in both speech and writing. The aphasic symptoms prompted him to seek medical attention from the same hospital. The clinical assessment using Halstead screening test revealed that Martin has a problem in his Broca’s area part of the brain because he presented aphasic symptoms. Therapist put him on multimodal programs, namely, VAT, PACE, and ORLA for a duration of six months. Currently, Martin is improving well for he is responding well to the treatment programs and continuing with his studies.

Incident that Gave Rise to Aphasia

The incident that gave rise to aphasia is the head injury that Martin sustained while playing football with his friends in the field. When he was 20 years old, Martin sustained the head injury, which caused internal bleeding on the left hemisphere of his head and subsequently caused aphasia. While playing, Martin collided with his friend in a football match they were playing and sustained minor head injuries, which were visible on the surface of the head.

Although his colleagues took him to the hospital, the doctor confirmed that it was a minor injury through a computerized tomography (CT) scan and dressed the visible wound on his head. Although Martin appeared healed during the first three months for the doctor dressed the wound on the head, the internal injury remained unhealed. With time, the internal bleeding caused a blood clot and interfered with the functioning of the brain. Analysis of other possible causes of aphasia showed that the head injury was the only plausible cause because Martin has not suffered a stroke, infection, or cancer. The brain scan confirmed that Martin had a blood clot in the region of the head where he sustained injury.

Presenting Symptoms

The symptoms that Martin presented are headache and dizziness. These symptoms indicated that the problem that Martin was suffering from was in the head for he experienced an unusual headache and dizziness following the injury. Moreover, given that friends noted that Martin was unable to communicate fluently as he used to be, they realized that his mental state was not in good condition. A notable symptom that his colleagues realized is that Martin spoke with lisp, which was quite usually.

Additionally, Martin started communicating in an incoherent manner for he lost fluency gradually and eventually revealed that he had a mental condition, which progressively affected his ability to communicate effectively with people.

As Martin was unable to socialize and communicate effectively, he appeared withdrawn and depressed. Chapey (2008) explains that aphasic individuals grapple with stress and depression because they realize their inability to communicate effectively and socialize with people. Furthermore, according to Faroqi-Shah and Waked (2010), the loss of writing proficiency in terms of grammar and word choices indicate expressive aphasia. In this view, his lecturers noted that Martin performed poorly in the class because he was unable to write grammatical sentences and arrange figures logically.

Tests Conducted and Results

To ascertain the condition Martin, the therapist used Halstead screening test. The therapist undertook comprehensive diagnosis using Halstead screening test by assessing verbal expression, auditory comprehension, functional communication, and reading and writing competence of Martin. The findings revealed Martin had Broca’s aphasia for he had good comprehension but exhibited non-fluent characteristics with poor repetition.

The Broca’s aphasia made him unable to express himself well, comprehend conversations and written texts, communicate effectively, and write coherently. According to Ogden (2005), damage to Broca’s area causes a kind of aphasia called expression aphasia characterized by difficulties in communication and writing. Therefore, Halstead screening test revealed that Martin was suffering from Broca’s aphasia because he exhibited non-fluent characteristics coupled with poor repetition although he had good comprehension ability.

Progress and Recovery

The aphasic condition of Martin has improved over time in response to the treatment programs he underwent. Although Martin had lost his speech and language proficiency in both communicating and writing, the therapeutic programs have helped him to improve. His friends confirm that Martin gradually regained his mental state for he has become a social and lively person. However, Martin is still struggling with speech and language proficiency because he still stammers and speaks with lisp most of the time.

According to his lecturers, Martin has improved significantly based on his academic performance. Since Martin was in the first year of his studies when he sustained the injury, he is currently completing the course successfully despite the challenges he encountered. Thus, the improvement in social life and his academic performance attest that Martin has recovered well over time.

Therapies/Treatments Used and Outcomes

Martin has undergone numerous therapies, which has enabled him to treat and manage aphasia effectively. Following the diagnosis of his condition as Broca’s aphasia, the therapist put him on multimodal programs, namely, VAT, PACE, and ORLA. Martin responded well to VAT because the outcome was that he improved his communication ability through non-verbal communication. Fundamentally, VAT is a treatment approach, which focuses on improving nonverbal cues among aphasic patients (Purdy & Van Dyke, 2011).

Given that Broca’s aphasia affect communication ability, PACE effectively enabled him to communicate effectively with his colleagues. The outcome of PACE was that Martin started becoming active in interacting and communicating with his friends. ORLA was used to improve visual, auditory, and writing abilities of Martin. The outcomes of ORLA were that Martin improved his academic performance. His lecturers observed that the therapy has restored his mental condition, and he was fit to continue with his studies normally. Hence, the multimodal programs effectively treated the aphasic condition of Martin within a period of six months for he was able to communicate and write fluently.

Prognosis and Recommendations

Analysis of the cause, treatment, and response to the treatment shows that Martin will eventually heal from aphasia. Since the doctors diagnosed the cause of his aphasia and employed appropriate treatment interventions, Martin will heal progressively. Plowman, Hentz, and Ellis (2011) assert that the severity of the injury and the degree of aphasia are determinants of prognosis. In this case, since the head injury was not severe and aphasia was diagnosed early, Martin will eventually recover from aphasia.

Moreover, the use of multimodal programs in the treatment of the aphasic condition boosts the recovery process. The use of VAT, PACE, and ORLA programs have proved to be effective in the treatment of the aphasic condition because of the significant positive outcomes exhibited by Martin. Therefore, for a successful recovery, Martin should undergo regular medical checkups and continue with multimodal treatment programs.

References

Chapey, R. (2008). Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders. Philadelphia, PA: Lippincott Williams & Wilkins.

Faroqi-Shah, Y., & Waked, A. (2010). Grammatical category dissociation in multilingual aphasia. Cognitive Neuropsychology, 27(2), 181-203.

Jordan, L., & Kaiser, W. (2013). Aphasia: A social approach. London: Chapman & Hall.

Plowman, E., Hentz, B., & Ellis, C. (2011). Post-stroke aphasia prognosis: a review of patient-related and stroke-related factors. Journal of Evaluation in Clinical Practice, 18(3), 689-694.

Purdy, M., & Van Dyke, J. (2011). Multimodal communication training in aphasia: A pilot study. Journal of Medical Speech-Language Pathology, 19(3), 45-53.

Macdonald, L. (2011). Cerebral vasospasm: Advances in research and treatment. New York: Thieme Medical Publishers.

Ogden, A. (2005). The breakdown of language: Case studies of aphasia. In A. Ogden (Ed.), Fractured minds: A case study approach to clinical neuropsychology (pp. 83-98). New York: Oxford University Press.

Salter, K., Jutai, J., Foley, N., Hellings, C., & Teasell, R. (2006). Identification of aphasia post stroke: A review of screening assessment tools. Brain Injury, 20(6), 559–568

Wallace, E., Purdy, M., & Skidmore, E. (2014). A multimodal communication program for aphasia during inpatient rehabilitation: A case study. NeruoRhabilitation, 35(3), 615-625.

Wilson, A. (1999). Bill: Learning to communicate with symbols five years after a stroke. In A. Wilson (Ed.), Case studies in neuropsychological rehabilitation (pp. 149-158). New York: Oxford University Press.

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