A-phasie means "without language" - the term derived from the Greek already describes the clinical picture. Aphasia is characterized by impaired speech that occurs as a result of acquired brain damage. Affected are in principle all areas of language: understanding, speaking, reading and writing. The most common cause of adult aphasia is a stroke resulting from a cerebral infarction or cerebral hemorrhage.
What is aphasia?
By definition, aphasia is the loss of already acquired language skills - in small children with corresponding disorders it is therefore not called aphasia, but speech development disorder. In older children, aphasia mainly occurs as a result of an accident involving brain injury (traumatic brain injury).
Language center in the brain
For the understanding of the language heard and seen, as well as for the formation of a language, several regions in the brain (usually the left half of the brain) must cooperate - in addition to the anatomical structures such as the tongue and the larynx:
- The motor linguistic center (Broca Language Center) is located in the frontal lobe of the cerebral cortex. This coordinates the speech muscles.
- The parietal lobe is home to the sensory speech center (Wernicke Language Center). This is indispensable to remember words and word sounds heard.
- The occipital lobe contains the optical speech center. Among other things, this is responsible for recording and understanding the language that has been read.
Aphasia types and their symptoms
Depending on which brain areas are affected, four different types of aphasia are distinguished, which express themselves differently:
Amnestic aphasia: The person concerned understands very well, his reading and writing is not or hardly affected. When he speaks, he often has to search for suitable words or rewrite missing words. That delays his speech flow. This is why outsiders often erroneously infer from slow speech to slow thinking. A mild manifestation of this form of aphasia is called dysphasia.
Broca aphasia: The person concerned usually understands well, but can only speak with difficulty - often in short, choppy sentences with many pauses in speech ("telegram style").
Wernicke's aphasia: In this case, speech understanding is partially impaired. For example, the aphasic only understands single words, but not the context. The affected person speaks fluent and fast, but confused letters or whole words and often makes mental leaps. Often the utterances hardly make sense (word deafness).
Global aphasia: In this aphasia form, several language-related areas are affected, making it the most impaired disorder. The communication is difficult for the person concerned, the speech understanding is greatly disturbed. If anything, only the simplest sentences are understood. Mostly only word parts are spoken, which are often lined up in repetitions.
Unfortunately, speech impairment often causes people with aphasia to be perceived as mentally impaired by their environment. This is not true. It is important to know that their logical thinking as well as their ability to conceive and judge works just as well as with healthy people.
Aphasia: other disorders
Since aphasia is usually the result of a stroke, there are often other impairments. These also depend on the affected brain region and the size of the damaged brain area. Common symptoms include paralysis of one half of the body, which can result from mild impairments of fine motor skills (such as potato peeling) to severe gait disturbances. Also swallowing disorders (dysphagia) often occur.
The aphasia is often accompanied by a dysarthria (also: dysarthrophonia), in which not the speech understanding, but the speech itself, so the speech movement is disturbed. Although the speech muscles - for instance of the mouth and tongue - are intact, they are no longer controlled correctly and synchronously by the responsible brain centers. This leads to the fact that the sounds can no longer be formed correctly - the language sounds washed out, incomprehensible or slow. Many sufferers complain that they are often thought to be drunk.
Agnosia and apraxia as additional problems
Not infrequently an agnosia, the inability to recognize a sensory perception, although the sense organs, such as eyes, ears and sense of touch, work. In acoustic agnosia (sound deafness) sounds and noises are not recognized, in optical agnosia (soul blindness) the seen can not be identified as a corresponding object.
In apraxia, voluntary gestures and movements are no longer performed correctly, although there is no paralysis and the sensory perception is unimpaired. So action sequences can not be imitated, for example, to repeat a sentence or to imitate a grimace.
In addition, for example, balance problems, sensory disorders as well as concentration and memory disorders can occur.
Aphasia: diagnosis and therapy
Diagnosis involves a detailed neurological examination to accurately detect all disorders and their cause. This is important for the therapy and the course of the disease. Depending on the location and size of the injury, the aphasia may completely or partially regress, but it may also happen that severe impairments remain. Therefore, it is important to recognize the aphasia as such as well as its extent and shape and differentiate it from other disorders such as dysarthria. In the German-speaking region, the Aachen Aphasia Test (AAT) is used.
Central to the treatment of aphasia is speech therapy (speech therapy). This supports the spontaneous recovery of language skills in the initial phase, and later serves to train and optimally use existing communication options.
A good starting point for information and self-help groups, for example, the Federal Association Aphasia (), even maintains its own website for aphasia in children.