Aphasia is the impairment of language, affecting the production or comprehension of speech and the ability to read or write. This type of disorder comes from injury to the brain, most commonly from strokes. There are eight different types of aphasias that stem from brain damage, which mainly affect older individuals. 50% of aphasics can speak fluently but have trouble comprehending and repeating words and sentences, whereas the other 50% have the opposite issue. Focusing specifically on Broca’s and Wernicke’s aphasia, this article will expand on the description of these aphasias, how they affect those around us, and treatments that have been developed.

The left side of the brain is known for language production, which includes areas known as Broca’s and Wernicke’s area. Specifically, the hind part of the third left frontal gyrus, “the temporo-sphenoidal lobe, the posterior half of the upper temporal gyri” are all connected with aphasia, as well as the “left temporal lobe contains the chief speech center” (Recent Work on Aphasia, 1909, p.3). Wernicke’s aphasia (WA) results from damage to the temporal lobe, while damage coming from the frontal lobe results in Broca’s aphasia (BA). These disorders are not easy to deal with, “stroke patients experience high frustration when verbal communication is impaired” (Carota, 2016 p.1). The original physician treating the patient for the brain injury usually diagnoses these disorders. Damage to these areas is examined through magnetic resonance imaging (MRI) and Computed tomography (CT) scans as well as the patients’ understanding of questions and commands being asked of them.

Wernicke’s is the most fluent type of aphasia but those with the disorder produce speech that is incoherent. Discovered by the German neurologist, Carl Wernicke, he was the first to relate this “specific type of speech deficit to damage in a left posterior temporal area of the brain” (NAA, 2017). Of the aphasias, Wernicke’s is known to have an extreme impact on the patient’s verbal expression, as well as difficulties with language comprehension (Carota, 2016, p.1). They “may speak in long, complete sentences that have no meaning, adding unnecessary words and even creating made-up words” (NIH, 2017). After the initial onset of Wernicke’s aphasia, patients usually see improvement of linguistic faculties within the first year. However, more than half of people afflicted traditionally suffer from symptoms extending form the damage without seeing improvement (Carota, 2016, p.2). The behaviors and personalities of people with WA possibly stem from the damage to their associative temporal areas. Lesions and damage to this area results in “paranoid agitation, frustration, anger, aggressiveness, psychosis, euphoric indifference, anxiety and restlessness” (Carota, 2016, p.2).

A study involving a 66 year-old man with persisting WA has had the disorder for about sixteen years. This was caused from an atrial fibrillation induced stroke in the left perisylvian (part of the brian). The patients “comprehension of auditory, written and visually presented material, naming, repetition, reading and writing were severely reduced”. As the disorder persisted, the patient lost ability to “process any kind of communication, even by gesticulation or pantomime (Carota, 2016, p.2). Unfortunately, the man’s aphasia therapy was ceased a few years prior, due to the “recurrence of irritability and anger in coping with linguistic tasks” (Carota, 2016, p.2).

Broca’s aphasia, the other aphasia this article will touch upon, has been widely studied. With studies and articles on this disorder going back to earlier than the 1900’s a decent amount is known on the subject. BA is considered the most common non-fluent aphasia. It is named after Paul Broca who identified the distinct area of the brain that causes this type of aphasia back in 1861. The French scientist discovered the area when he had a “patient who could only say the word tan” (NAA, 2017). With damage in the frontal lobe, those affected by this speech disorder usually have significantly impaired morphosyntax, which is considered a set of rules, which govern linguistic units. “Broca’s aphasics show a profound expressive deficit in the face of relatively good auditory language comprehension” (Blumstein, 1994). They speak in short phrases since they have trouble stringing words together even though they know what they are attempting to say. For example, a sentence may come out as “book (pause) room”, meaning they are referring to a booking being in a room. Due to the left frontal lobe damage some patients even have trouble with “right sided weakness or paralysis of the arm and leg” since the frontal lobe plays a role in motor movement (NIH). In a study done by Duman and colleagues (2016), they looked at the deficits in Turkish individuals with Broca’s aphasia for comprehending counterfactuals. They found that the participants with the disorder had “problems with grammar…difficulty processing counterfactuals due to morphosyntactic complexity… and may have impaired language and cognitive functioning” (Duman et al., 2016).

When trauma occurs in the brain, the body before any therapy even takes place will begin to improve itself. People with aphasia often see dramatic improvements in their language and communication abilities within the first few months, even without treatment. However, the brain cannot fully heal by itself. Currently there is no known cure for Broca’s and Wernicke’s aphasia, much of the brain can grow back tissue around the damaged area, yet no full recovery has ever been recorded. There are, however, therapies and other approaches to WA and BA that can be utilized. Family involvement can also play a crucial role for the patient benefiting from therapy. To make the lives easier of those affected by these disorders, families can attempt to participate in therapy sessions by simplifying language, repeating content words, being patient, and encouraging any form of communication. New therapies are being developed to try and better help patients recover “word retrieval, grammar, prosody, and other aspects of speech” (NIH). Prosody is the variation of melody, “intonation, pauses, stresses, intensity, vocal quality, and accents of speech”  (Morrisey, 2014). These new methods include improving short-term memory, and attention while others work on mental representations. The use of pharmaceuticals is also being explored, in an attempt to work with chemical neurotransmitters in the brain (NIH, 2017).

A study by Carragher and colleagues (2015), they looked into the treatment of syntax production in patients with Broca’s aphasia. They were attempting to find theoretical “treatment focused on the language production skills of participants with post-stroke Broca’s aphasia”. Once a week for 8 weeks, they studied 9 patients with BA along with their main conversation partners. At the end of the 8 weeks there was little evidence of change in the patients everyday conversation. Although, the researchers did find that trained and untrained sentence structure tasks were strongly affected and as were narrative retell tasks. The treatment researched did not produce the most beneficial outcome for patients with BA but the researchers believe that there is potential to “streamline therapy planning and delivery by making use of rich, hybrid therapies to treat individuals with similar symptom profiles but with a range of underlying deficits” (Carragher et al., 2015).

Unfortunately, these aphasias do not stand-alone. Commonly correlated with mood disorders, one that is crucial to keep an eye on and diagnose early is Post-stroke depression (PSD).   PSD is the most frequent mood disorder in early and late phases after stroke onset. “Recent studies indicate that 30% to 40 % of stroke patients suffer from this disorder”, and the prevalence of PSD is even higher in patients with aphasia and around 15% will have suicidal ideation ((Carota, 2016, p.1)). To test mood disorders in stroke patients, caretakers and therapists will employ standardized questionnaires, screenings, or assessments for PSD and other affective disorders such as mania and psychosis. However, these tests cannot be used with patients with WA or other severe aphasias due to the lack in ability to communicate. Neuropsychiatric diagnosis for patients with WA “relies on behavioral observation” (Carota, 2016, p.1).  WA and BA are frustrating disorders for those afflicted and for the family and friends as well.

In conclusion, this article looked into the most fluent and most non-fluent of the Aphasias. Broca’s aphasia, which sounds almost like the word broke, is exactly that, broken speech or difficulty to produce fluent speech. Understanding and comprehension is intact but the person with the disorder struggles with disconnected and slow speech. Wernicke’s aphasia is fluent in prosody and a number of utterances but the speech is disorganized and incoherent. Healing of the damaged sections of the brain may help improve the symptoms of these aphasias, although therapy is usually needed to help patients. The prevalence of other disorders paired with these aphasias is also possible. Aphasics are at risk of post-stroke disorder as well as other mood disorders, due to the frustration of not being able to communicate and other complications that stem from brain injury and strokes. Studies on multiple forms of therapy for patients with Broca and Wernicke’s aphasia are still underway. Some are more successful than others but the discovery of this disorder is still semi new to the medical world. Currently, no cure has been found, so the involvement of speech therapists, psychotherapists, and family and friends are crucial. The assistance and normalization for those with Broca and Wernicke’s aphasia is key to better acceptance and understanding.

Resources

Blumstein, S. (1994). Impairments of Speech Production and Speech Perception in Aphasia. Philosophical Transactions: Biological Sciences, 346(1315), 29-36. Retrieved from http://www.jstor.org.libproxy.unh.edu/stable/56016

Carota, A., Rimoldi, F., & Calabrese, P. (2016). Wernicke’s aphasia and attempted suicide. Acta Neurologica Belgica, 116(4), 659-661. doi:10.1007/s13760-016-0618-1

Carragher, M., Sage, K., & Conroy, P. (2015). Outcomes of treatment targeting syntax production in people with Broca’s-type aphasia: evidence from psycholinguistic assessment tasks and everyday conversation. International Journal Of Language & Communication Disorders, 50(3), 322-336. doi:10.1111/1460-6984.12135

Duman, T,. Nermin, A, & Maviş, L,. (2016) Grammar and cognition: deficits comprehending counterfactuals in Turkish individuals with Broca’s aphasia, Aphasiology, 30:7, 841-861, DOI: 10.1080/02687038.2015.1076926

Morrisey, B,. “Dysprosody.” Dysprosody, 7 Oct. 2014, http://www.speechdisorder.co.uk/dysprosody.html

Moutier, F,. Broca’s Aphasia. (1908). The British Medical Journal, 2(2481), 148-148. Retrieved from http://www.jstor.org.libproxy.unh.edu/stable/25278390

Recent Work On Aphasia. (1909). The British Medical Journal, 2(2541), 714-715. Retrieved from http://www.jstor.org.libproxy.unh.edu/stable/25283471

National Institute of Deafness and Other Communication Disorders, U.S. Department of Health and Human Services, 6 Sept. 2017, “Aphasia.” www.nidcd.nih.gov/health/aphasia.

National Aphasia Association, 2017,. “Aphasia Definitions.”  www.aphasia.org/aphasia-definitions/.