Robert A. Volin, Ph.D., CCC-SLP, Associate Professor at the Speech-Language Pathology Department of the School of Health Sciences and Practice (New York Medical College) talks with us about aphasia.
Aphasia is specifically a language disorder, as opposed to disorders of thinking, such as problems with attention, executive functions, memory, etc. But what is language?
Think about this. We have concepts or thoughts in our brain. These concepts are neural events, they are some electrochemical pattern in time and in space that we experience as a concept. A cup of coffee, when am I going home, who is beautiful… simple or complex, neural events. How do you turn a neural event into something that someone else can recognize? How do you get something from one brain to the other? You need a symbolic system, and that's what language is.
The person who has aphasia is essentially the same person that he or she was before they had the brain insult. But this person has lost some aspect of the control of language. For example, she may have lost the ability to express herself while she still has pretty good comprehension. Or she might have lost semantic meaning, even though speech flows easily.
Another language skill that is typically affected in aphasia is the categorizing function. We organize our knowledge into categories such as "mammals, fruits, sport teams," etc. People with aphasia often have that categorizing function disrupted As a result, we often see a contraction in within-category vocabulary. Or we might see categorical substitutions such as "mother" for "wife".
There are many other levels of performance that can be affected in aphasia. Have you ever tried to think of a word, and you can't retrieve it but you know it begins with a "P"? We have concepts that are related to words, but they are not equal to words, for example the sound it starts with, whether it has two syllables, what it rhymes with, and much more. Any of these can be disrupted too with aphasia.
Therapy for aphasia can take many, many forms. First of all, we look very closely at the patient's environment to see what communications they need to express most (or need immediately), and we try to find solutions for them and their communication partners. Instead of words people can use gestures, draw pictures, use augmentative communication devices, you name it. Later, we use these solutions, and perhaps others to develop communication more generally. The essence of the communicative work is to develop every possible means of expression, not just the typical talking and writing. The more inventive the patient and the therapist can be, the better for both, because the "best" way will be a little different for each person.
Aphasia therapy is about much more than language. Its central goal is to help people to re-enter their lives. A stroke is devastating, but life goes on. I'm constantly amazed and inspired by the quiet courage that people with aphasia display as they work to reconstruct their lives. Even with that courage, people need support The folks they love are there for them, and very often we speech therapists are privileged to help them to adjust. For that reason, we often work with patients and their families together.