Imagine that suddenly everybody around you starts talking in a language you do not know; you are not able to understand what they are saying, and you cannot make them understand what you are saying. You are scared, you do not know what to do and you realize that you are in hospital. Unknown people (apparently doctors and nurses) approach you, they speak but you are neither able to ask nor understand what they are saying. Gradually, you realize that it is not the world but it is you that has changed. You do not know it, but you have become aphasic.
From that moment on, a long uphill road before starting to speak again awaits you.
Any mental activity, such as speaking, remembering a fact that has just happened or recognizing a person, depends on the normal activity of parts of the brain more or less delimited and defined that come into action when we speak, listen or remember a fact. Aphasia is a language disorder due to the injury of the so-called
"language areas".
The aphasic person is affected by the consequences of brain damage, usually located in the left hemisphere of the brain.
Human language is the most refined and the most flexible system of human communication; it allows us to talk about things that are present, past or future, of real or invented things, using only a few dozen sounds with which thousands of words are formed, linked to each other by some grammatical rules.
Depending on the degree of the lesion, aphasia causes varying degrees of speaking, understanding, reading and writing disorders. There are people with
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aphasia who are not able to read or write, speak or understand, but the proximity of the areas assigned to these functions and their functional relationships means that in most cases aphasia manifests itself as a disorder of all linguistic functions.
Today, there is no single classification of aphasic disorders; most doctors and speech therapists, however, refer to a classification of aphasic disorders based on errors that the subjects commit in various verbal behaviors (speaking, writing, understanding, reading and repeating). The most serious clinical forms included in this classification are:
Global aphasia: with this type of aphasia speech is not fluent, so much so
that words are suppressed and the comprehension of language is also compromised. Global aphasia is defined as a severe alteration of language, since the production of speech, processing and understanding is affected. This type of aphasia occurs in the first period after a brain injury.
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Broca’s aphasia: writing, reading and simple spontaneous language are
seriously compromised. Speech is almost telegraphic and the few sentences are often devoid of complete meaning and lacking articles, prepositions and adverbs.
Wernicke aphasia: Damage in the Wernicke region generates disorder in
language production and comprehension; in fact, the patient elaborates a particular linguistic code, sometimes incomprehensible. Obviously, he or she makes mistakes, for example, by saying "pear" instead of "bear"
(phonemic paraphasia) or being completely wrong by saying "candle"
instead of "machine" or "monkeys" instead of "pigeons" (verbal paraphasia).
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Anomic aphasia: this is a particular type of fluent aphasia that is
characterized by the patient's inability to find the exact terms to express him/herself or complete the sentence. The sensation reported by the patient is like “always having the word on the tip of the tongue".
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2.1 Rehabilitation, the role of the speech therapist and the prospects of recovery
Although rehabilitation can start even earlier, in the first few weeks after the traumatic event, the aphasic picture is extremely variable and it is difficult to decide on how to intervene. After 3-4 weeks, it is possible to make an in-depth evaluation that can be used as a starting point for a motivated rehabilitation. The effectiveness of rehabilitation depends on numerous factors, the most obvious of which are the specialist’s competence, the active participation of the aphasic person and his or her family, and the intensity and duration of the treatment.
Before starting to treat a new patient, the speech therapist should explain to the family what aphasic disorder is, discuss the specific difficulties of their dear one, and how it is possible to improve communication.
The speech therapist (for rehabilitation you need the cognitive speech therapist who takes care of the memory functions, and the speech language therapist who deals with aphasia, therefore with speech disorders) must obviously have longstanding hands on experience and broad knowledge of this disorder, and know exactly when and how to intervene.
We still do not know what characteristics of aphasic deficit of patients can significantly influence the recovery of language, but involving them in conversations is certainly positive. To ensure this conversation is useful and not too burdensome for the aphasic person, certain strategies must be implemented. It is important to:
contact the aphasic person directly;
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not to use too long and complex sentences;
not to ignore what the patient says even if it is wrong or incomplete;
ask simple questions and give the aphasic person time to understand and formulate the answer
Although aphasia never regresses quickly and suddenly, in most patients this disorder tends to improve spontaneously over time. It is now believed that the chances of recovery depend essentially on the extent of the injury and the initial severity of the aphasia. The importance of the extent of injury is due to the fact that the necrotized part of the brain does not regenerate. After an initial period of settling, the lesion remains unchanged and does not shrink, but our central nervous system has a certain plasticity, and it is thanks to this plasticity that the functional recovery is due.
WHEN TO CONSIDER THE POSSIBILITY OF A SCHOOL AND/OR WORK REINTEGRATION?
This moment varies from case to case, although in general it is possible to establish quite early on during the rehabilitation process, if the patient will have the opportunity to resume his or her school or work activities. However, reintegration must not happen too quickly; this would risk preventing the person from exploiting his or her full potential for recovery.
In fact, the following are to be considered:
The consequences that the brain damage has had on the person;
Living conditions and psychic balance prior to brain damage;
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Resources present in the person's living environment.