​When Brain Injuries Interfere with the

Ability to Communicate
by Sophia Bong
A community’s language can be expressed in writing, speech, and sign language. Language allows us to communicate our thoughts and feelings and turn them into words for others to understand. But if the intricate web of the language control-centers – the brain’s switchboard, so to speak – becomes disrupted by stroke, trauma, or dementia, people can find themselves at a literal loss of words to express their thoughts or understand the thoughts of others. This is what it can be like for a person with Aphasia. 

A person stricken with Aphasia remains as intelligent as they were prior to the disorder, but might have various forms of their language skills affected when trying to communicate with others. Imagine being surrounded by people that speak a foreign language that you do not speak, and you don’t understand what anyone is saying to you; nor do they understand you. That is similar to what a person with Aphasia experiences – a lack of word comprehension. 

One million people in the US currently are diagnosed with Aphasia; eighty thousand new cases are diagnosed each year. More than one-third of all stroke patients suffer from Aphasia. It is more prevalent than Parkinson’s Disease or MS, but is less widely known by the general population. 

There are two main types of Aphasia: 

The first one is called non-fluent expressive Aphasia (Brocas), named after Dr. Paul Brocas who discovered and later named the specific control-center in the brain in 1861. A person with Brocas Aphasia knows what they want to say, yet has difficulty communicating through words, sign language, or writing. This causes them to tend to have long hesitations between words and make grammatical errors with wrong word substitutions (Paraphasia). In spite of their own expression being severely impaired and their inability to use or understand language correctly, they actually tend to have good comprehension of what is being said to them. 

The second form of Aphasia is called fluent receptive Aphasia (Wernicke), named after a neurologist who discovered its function 10 years after the Brocas discovery. The difference between these two areas and how they affect a person’s ability to communicate is that, unlike a personal with expressive Aphasia, people with receptive Aphasia doesn’t usually recognize their own speech errors, and consequently use words that lack meaning. They not only have trouble recognizing their own error, but also have severely impaired ability to understand others’ communication. 

Besides brain trauma and stroke, there is also another cause for Aphasia: Dementia. The one type of Aphasia not caused by brain trauma or stroke is called Primary Progressive Aphasia (PPA). It is considered a form of Dementia, in which language loss is the first symptom. The goal in treating PPA is to maintain language function for as long as possible before other symptoms of dementia eventually occur. 

When Aphasia is acquired from a brain trauma or stroke, language  improvement might be achieved through speech therapy. However there is no treatment to reverse PPA. 

To better understand how Aphasia happens let’s look at the anatomy and physiology of the brain as it relates to language. The “language loop” is in the left hemisphere of the brain. For many years, scientists believed that the Wernicke’s area interpreted the language of others, then relayed this information, via a dense bundle of fibers, to the Broca’s area, which in turn generated a response. Due to advancements in brain imaging, scientists have revealed a third region of the brain that is involved. 

This region is the inferior parietal lobule, also known as the “Geschwind’s Territory.” This area was named after the neurologist, Norman Geschwind,  who discovered its importance in the 1960s. The Geschwind Territory consists of angular gyrus and supramarginal gyrus (ridges or folds between two clefts on the cerebral surface in the brain) and is connected to the other two areas by large bundles of nerve fibers. Its function is to classify and label things, which is a prerequisite for forming concepts and thinking abstractly. 

This language loop is found in the left hemisphere in about 90 per cent of right-handed persons and 70 per cent of left-handed persons. This loop is also found at the same location in deaf persons who use sign language. Damage to this loop explains why deaf people also are affected by Aphasia. 

Even brain areas that control movement are connected to language. Functional MRI studies found that when we hear action words like “run” or “dance,” parts of the brain responsible for movement light up as if the body were actually running or dancing. Our other cranial hemisphere also contributes to language, enhancing the rhythm and intonation of our speech. These non-language areas sometimes assist people with Aphasia in compensatory ways. 

The light at the end of the tunnel is speech therapy. There are various modalities used, based on which part of the language loop is affected, and its severity. Recovery can be a slow process for the individual with Aphasia. 

Some suggestions for communicating with people suffering from Aphasia: 

- Keep your language simple emphasizing key words.

- Use visuals, gestures and technology to assist in comprehension.
- Limit distractions; background noise is a problem for most people with   Aphasia.
- Try to avoid open-ended questions; instead, structure you conversation to be yes /    no questions, either/or, and multiple-choice questions.
-  Friends and family need to praise and encourage all attempts at speech by        the affected person, and give them the time they need to find their words. 

Remember that the intellects of Aphasia victims has not been affected – only  their ability to express/comprehend words. And one piece of advice to those affected by Aphasia: be prepared for situations that may arise during your recovery process. Keep a paper handy for some basic expressions or statements you can write on it and you can show people. 

Take your speech therapy seriously. It does help. Studies have shown that the more intensely you work, recovery rates come faster.