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Dysphasia


Overview :

Approximately one million Americans currently suffer from one of the various forms of dysphasia, and an additional 80,000 new cases occur annually. The term "dysphasia" is more frequently used by European health professionals, whereas in North American the term, aphasia is more commonly preferred. These two terms, however, can be and are used interchangeably. They both refer to the full or partial loss of verbal communication skills due to damage or degeneration of the brain's language centers. Developmental Dysphasia is considered to be a learning disability, but will not be the focus of this article.

Verbal communication is derived from several regions located in the language-dominant hemisphere of the brain. These include the adjacent inferior parietal lobe, the inferolateral lobe, and the posterosuperior temporal lobe, as well as the subcortical connection between these areas. Disease, direct trauma, lesion, or infarction involving one or more of these regions can disrupt or prevent proper language function. Dysphasia does not necessarily prevent proper cognitive function, so the patient can think and feel with perfect clarity. This can be extremely frustrating for the patient, as they cannot express these thoughts and feelings to others.

Dysphasia can occur in a variety of forms, depending on how the communicative disruption manifests. Classically, dysphasia can affect one or more of the basic language functions: comprehension (understanding spoken language), naming (identifying items with words), repetition (repeating words or phrases), and speech. Although there are several subtypes of dysphasias, they most commonly manifest in one of three syndromes: expressive dysphasia, receptive dysphasia, or global dysphasia.

Expressive Dysphasia

Expressive dysphasia, also known as motor dysphasia, produces a conscious and recognizable disruption of a patient's speech production and language output. This includes the impairment of speech initiation, proper grammatical sequencing, and proper word forming and articulation. Although patients can perfectly understand what is said to them, they have great difficulty communicating their thoughts.

BROCA'S DYSPHASIA. Broca's dysphasia is the most common type of expressive dysphasia. It is caused by damage to the lower area of the premotor cortex, located just in front of the primary motor cortex. This region is most commonly referred to as the Broca's area. Speech for patients suffering from Broca's dysphasia may be completely impossible. Others may be able to form single words or full sentences, but only through great effort. "Telegraphing," the omission of articles and conjunctions, may also be exhibited.

TRANSCORTICAL DYSPHASIA. Also known as isolation syndrome, transcortical dysphasia is caused by damage to the language-dominant brain that separates all or parts of the central region from the rest of the brain. There are three sub-classes of transcortical dysphasia, which define the impairments to a patient's ability to repeat words, sentences, and phrases: transcortical motor dysphasia, transcortical sensory dysphasia, and mixed transcortical dysphasia. Additional impairments may occur depending on the extent and location of the damage.

Receptive Dysphasia

Receptive dysphasia, also known as sensory dysphasia, impairs the patient's comprehension and meaning of language. Unlike expressive dysphasia, the patient can speak fluently and articulately, but will utilize meaningless words, nonsensical grammar, and unnecessary phrases to the point of becoming incomprehensible. However, they will be completely unaware of their mistakes. Additionally, the patient will find it difficult to comprehend spoken language and/or word-object relation.

WERNICKE'S DYSPHASIA. Also known as semantic dysphasia, Wernicke's dysphasia is the most common of the receptive dysphasia. It is caused by damage to the Wernicke's area, located in the posterior superior temporal lobe of the language-dominant hemisphere. Although the patient can speak clearly and at length, many of their words, phases, and sentences will be nonsensical in nature. Additionally, they will experience difficulty in understanding spoken language, if not suffer a complete lack of comprehension. Semantic distinctions between words may become mixed up and jumbled, furthering confusion.

ANOMIC DYSPHASIA. Anomic dysphasia, also referred to as amnesic dysphasia, is caused by damage to the temporal parietal area and/or the angular gyrus region. Although very similar to Wernicke's dysphasia, anomic dysphasia is distinguished by its disruption of a patient's word-retrieval skills. They will be unable to correctly name people or objects, causing them to pause or substitute generalized words (like "thing"). Otherwise, the patient will exhibit few, if any, language impairments.

CONDUCTION DYSPHASIA. Also known as associative dysphasia, conduction dysphasia is a relatively uncommon disease (representing only 10% of the cases). Damage to the upper temporal lobe, lower parietal, or connection between the Wernicke's and Broca's areas can result in the inability to repeat words, phrases, or sentences. The patient may also suffer the inability to describe people or objects in the proper terms.

Global Dysphasia

Global dysphasia, the third most common form of dysphasia, results from damage to both the anterior and posterior regions of the language-dominant hemisphere. In global dysphasia, all of the patient's language skills are disrupted; however, some may be disrupted more severely than others.




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