Understanding aphasia

We often take language and the power to speak with no consideration. For patients with aphasia, that is an especially difficult and frustrating impairment. Aphasia is the lack of the power to talk or understand written or spoken language.

There are three predominant types of aphasia.

1. In , or , the patient understands normally, but his speech is slow, disfluent and he cannot express himself. The name comes from Broca’s area within the brain, which connects to oral and laryngeal motor neurons and controls spoken language (Clark, 2022). Broca’s aphasia is commonly related to damage to the left frontal lobe.
2. or , is an impairment through which the patient has abnormal understanding of fluent speech. The name comes from Wernicke’s area within the brain, which receives information from the auditory cortex after which assigns meanings to words (Clark, 2022). The patient doesn’t understand words and this is commonly related to damage to the temporal lobe.
3. is a mix of receptive and expressive aphasia.

Causes of Aphasia (Clark, 2022)

The commonest explanation for aphasia is ischemic stroke. Other causes include hemorrhagic stroke, tumor, brain abscess, encephalitis or other central nervous system infections, and traumatic brain injury. Less common causes include multiple sclerosis and encephalomyelitis. Transient aphasia may occur with transient cerebral ischemia (TIA), migraine, and seizures. Progressive aphasia could also be an indication of a neurodegenerative disease.

Language Assessment (Bickley et al., 2021)

Aphasia may first be detected during an assessment of a patient’s mental status. When assessing, pay particular attention to their speech and language, including expression, perception and understanding of words. When talking to the patient, listen to the next features of his speech.

• : Is the patient talkative or reserved? Does the patient speak spontaneously or only answer direct questions?
• : Is the patient’s speech fast, slow, loud or soft?
• : Are the patient’s words clear?
• : Does the patient display normal speech flow and rate and use words appropriately?
  • Are there any fluctuations or gaps within the flow and rhythm of the words?
  • Does the patient exhibit abnormal inflections (i.e. monotony)?
  • Does the patient use explanations that replace phrases or sentences with a word that the patient cannot consider, e.g. “what are you sitting on” as a substitute of “chair?”
  • Does the patient use paraphasias when words are malformed, incorrect, or made up?

Assessment for Aphasia (Bickley et al., 2021)

If the patient’s language is abnormal, lacking meaning, or lacks fluency, the patient ought to be assessed for visual, hearing, intelligence, and academic impairments that will affect his or her responses. Then complete the next aphasia assessment:

• • Ask the patient to perform a one-step command, reminiscent of “Stick out your tongue.”
  • Then do this two-step command: “Point to your ear, then point to your foot.”
• • Ask the patient to repeat a sentence of one-syllable words, reminiscent of: “No ifs, ands, or buts.”
• • Ask the patient to call the parts of speech.
• • Ask the patient to read the paragraph aloud.
• • Ask the patient to spontaneously write a sentence.
  • If the patient can write a sentence appropriately, he doesn’t have aphasia.

These questions will help determine what variety of aphasia your patient can have. Please note that each one patients with newly identified aphasia should undergo a structural brain scan reminiscent of magnetic resonance imaging (MRI) (Clark, 2022).

Nursing Considerations (Hinkle, 2021)

Use the next communication strategies when caring for patients with aphasia.

• Stand nose to nose with the patient and make eye contact.
• Speak clearly, slowly and with a traditional tone of voice.
• Use short phrases and pauses to offer the patient time to know what’s being said.
• Limit the conversation to practical and specific matters.
• Use gestures, images, objects and writing.
• When the patient uses and holds an object, say what the article is to assist the patient match the words to the article or motion.
• Use the identical words and gestures each time you give instructions or ask a matter.
• Try to reduce loud noises and noises. Too much background noise can distract the patient or make it obscure the conversation.

Bickley, L. S., Szilagyi, P. G., Hoffman, R. M., & Soriano, R. P. (2021). Bate’s guide to physical examination and interviewing (thirteenth ed.). Wolters Kluwer Health: Philadelphia.

Clark, D. G. (2022, June 7). Approach to a patient with aphasia. https://www.uptodate.com/contents/approach-to-the-patient-with-aphasia

Hinkle, J. (2021). Brunner and Suddarth’s textbook of medical-surgical nursing (fifteenth edition)^vol ed.). Wolters Kluwer Health. https://wolterskluwer.vitalsource.com/books/9781975161057