Dysphasia: Difficulty with comprehension of spoken or written language
Imagine not being about to sing your favorite song, or not being able to write or say how you feel or what you are thinking. This article will explain what is Dysphasia? A complete guide: What is it, what types are there and their different classifications, causes, treatments, and tips for those who have it.
What is Dysphasia
Dysphasia is a speech disorder in which there is an impairment of the power to use speech, writing, or songs. There is also difficulty with comprehension of spoken or written language.
The word dysphasia comes from the Greek words “dys” meaning abnormal, painful or difficult, and “phasis” which means speech. It is just one in a group of speech disorders. A more severe form of dysphasia is called aphasia. It’s essentially a disruption of thought and language.
What are the differences among dysphasia, aphasia, and dysarthria?
It is difficult to sometimes distinguish the difference between medical names that not only sound somewhat similar but have similar symptoms, too. The biggest factors that make each of these conditions different is the nature and the amount of damage to your communicative abilities.
The cause of dysphasia and aphasia is damage to the brain due to a traumatic brain injury (TBI), like a concussion, a steel rod to the head, or a stroke. Typically both of these conditions mean there will be problems with language use in terms of the productive side (speech/writing abilities) or the receptive side (comprehension abilities). Although they both have similar symptoms, aphasia is a more severe form. This is easy to remember because in English, if a word begins with “dys-”, it implies a partial lack of an ability whereas if the word begins with “a-” and is medical, it implies a complete absence of ability.
The nature of dysarthria is what makes it different. It is a disruption to the muscles on the productive side that is used to produce speech. It does not affect your comprehension or understanding of words or your ability to use grammar correctly.
It is possible to have dysphasia/aphasia and dysarthria at the same time!
Causes of Dysphasia
Dysphasia is caused by a lesion in the dominant hemisphere of our brains. However, everyone’s brain is different. In about 99% of right-handed people, the speech area of the brain is on the dominant left side. In left-handed people, only about 30% have their dominant side, and speech area, on the left side.
The most common cause of dysphoria is cerebrovascular disease, a stoppage of blood flow to the brain. Around 85% of dysphasia cases result from a stroke, a type of cerebrovascular disease. However, only about 1 in 3 people who have a stroke will have dysphasia as a result. Younger people who have dysphasia usually have it due to a head injury of some sort. Other causes can be infections, seizures, transient ischemic attacks (TIA), neurodegenerative diseases (Parkinsons and Alzheimers) and tumors in the brain.
Researchers are interested in studying how dysphasia can affect how our brain processes, stores, and activates languages. Some studies have looked at how those with dysphasia are able to put together different categories of words, like nouns and verbs.
Types of Dysphasia
Brain damage is rarely clear-cut and it can be difficult to know everything that is going on inside our thinkers. There are several types (receptive, expressive, and global) and subtypes, and each type is associated with a different part of the brain.
- Receptive Dysphasia affects language comprehension. This means that people who have a form of it are able to speak without any problem, but they make no sense. They are also unaware that no one is able to understand them.
- Anomic Dysphasia is a milder form. People with this type typically have issues retrieving specific words, like names, nouns, and verbs. This type comes with damage to the temporal and/or parietal lobe of the brain. People who have anomic dysphasia may be able to fluently describe an object, but be unable to remember what the object is called.
- Wernicke’s dysphasia is named after the scientist who found it, Carl Wernicke. Known as Wernicke’s area, it’s located in the back of the temporal lobe and is thought to be where we understand the meaning of words and language. People who have it may be able to speak a language fluently, but be unable to make sense when speaking. They can also have issues understanding spoken language.
- Conduction dysphasia is one of the rarest forms yet discovered and is caused by damage to the parietal lobe of the brain. People who have it can understand and produce speech without a problem, but they might have trouble repeating it.
- Expressive dysphasia affects our speech and language output. This means that those who are affected can have difficulty producing speech, even though they may understand what is being said to them. They are usually aware of their lack of ability to express themselves.
- Broca’s dysphasia, also known as Broca’s aphasia, is one of the most common types. It is named after the scientist, Paul Broca, who discovered a part of the brain, now known as Broca’s area, on the frontal lobe that is responsible for speech production. For those affected, forming words and sentences can be extremely difficult and some may not be able to speak at all. However, they often understand what others are saying without much of a problem. The difference between Broca’s area and Wernicke’s area is that Broca’s involves the production of language while Wernicke’s involves the comprehension of language.
- Transcortical Dysphasia, also known as Transcortical Aphasia and Isolation Dysphasia, is a less common form. To have this type means there was damage to our temporal lobe. It affects the nerve fibers that carry information from our brain’s language centers elsewhere in order to communicate. This information can include tone of voice, facial expressions, and emotional expression.
- Global Dysphasia, also known as Mixed Dysphasia, is a severe form of dysphasia. The damage is located on the left side of the brain in the perisylvian cortex. Typically both the productive and receptive language skills, which are needed for written and oral language, are affected. Auditory and visual comprehension can also be affected. Because the right hemisphere wasn’t affected, people with global dysphasia can still express themselves through gestures, intonation, and facial expressions.
Dysphasia brings with it an array of symptoms and typically no two people have the same symptoms. Some people can have difficulty with speaking well but have the ability to sing a whole song without any difficulty because music is stored in a different part of the brain than where the damage is. Others might have no trouble at all using learned chunks of formulaic language (for example, “hang on a minute”, “like”, “uhm”, and “are you kidding me?”).
It’s important to note that your intelligence is not affected, simply your ability to communicate is. That doesn’t mean that life can’t be difficult, though. For example, telling time and using money can be difficult activities. People don’t always realize that their speech is unintelligible or that it doesn’t make any sense.
People who have dysphasia may have difficulties reading and writing as well as using and comprehending speech. However, the symptoms will vary depending on the location and severity of the brain damage.
Common speaking symptoms include:
- Making grammatical mistakes
- Mixing up syntax (word order)
- Forgetting to use small words like articles and prepositions (at, the, to)
- Speaking in short fragments or single words
- Speaking slowly and/or with great difficulty
- Struggling to find words (anomia)
- Speaking fluently without meaning
- Using words that don’t make sense
- Substituting words or sounds
Common comprehension symptoms include:
- Difficulty understanding complex grammar
- Giving incorrect answers to simple questions
- Difficulty understanding regular and fast speech
- Taking a long time to understand speech
- Misinterpreting meaning (taking figurative language literally)
- Lacking awareness of errors
In order to diagnose, a person needs to be tested. The type of tests depends on the type of dysphasia. There can be a physical exam, an imaging test (MRI scan), a neurological exam, or a speech-language evaluation. The speech-language evaluation will involve a speech-language pathologist (SLP) who will test speech and language skills like the examples mentioned below.
A receptive dysphasia test may involve asking patients to read or listen words and passages and then explain them. It can also involve asking them to follow certain instructions like, “point to the door.”
An expressive dysphasia test could include asking them to name a series of objects and their parts. For example, asking them what the different parts of a watch are (the strap, face, hands, etc.). Another test is to see if the patient can count numbers, recite the days of the week, or expand more about a familiar topic like talking about their family. They can also be tested on their ability to write small dictated or spontaneous, or copy, short passages.
Speech and language therapy is the most recommended treatment option. A speech and language therapist strives to help the person regain as much of their language as possible while also helping them learn how to compensate for their lack of ability to use language or how to use other modes of communication. This use of other forms of communication is called Augmentative and Alternative Communication (AAC) and it’s useful more for those who have forms of expressive dysphasia.
Some small studies have indicated that those who have a language impairment from a traumatic brain injury should use the same treatments as those who have a language impairment due to a stroke. This means that there is no difference in treatment based on the cause.
It’s been proven that people with milder symptoms, in the beginning, are more likely to recover completely. If the level of impairment is severe, there are likely to be no big improvements made in terms of recovery. Around one-third of people who suffer from a form of brain impairment like this will recover fully within three months, but a complete recovery will be unlikely if the symptoms continue more than six months. Nevertheless, it has been proven that people with severe dysphasia can benefit from intensive treatment regimens even after the six month period.
When the language ability returns in someone who speaks English as a second language, it’s likely that the language ability returns in the native language, not in English.
The probability of recovering due to a traumatic brain injury is higher than the chance of recovery from a stroke. Some drugs exist that are thought to improve the ability to learn and recover language after a stroke, but these drugs are still in a very experimental stage. However, that’s not to say that someone who had a stroke cannot improve. According to certain studies, most patients who have some sort of post-stroke language impairment improve to some extent within the first few months.
One study of post-stroke dysphasia found that baseline phonology (how the sounds of speech corresponded with the words spoken) was the linguistic element that was most predictive of recovery at one year. The study also found that age, higher educational level, and hemorrhagic stroke victims (in comparison to ischemic stroke victims) were also all components that can be associated with good one-year outcomes.
Tips to prevent dysphasia
While the condition can’t always be prevented, there are certainly ways to try. Because 33% of stroke victims have dysphasia, it’s important to try to avoid a stroke (among other reasons, of course). It’s good to keep your cholesterol down, ensure you don’t have high blood pressure, no diabetes or heart disease, and that you try to get out of your chair and move around a bit. It’s also important to avoid smoking, which can increase your chances of dysphasia on many levels. In order to prevent a traumatic head injury, try to wear a helmet when on a bike or during any sport with a risk of head injuries.
Do you know anyone who has had dysphasia? What were their symptoms? Let us know in the comments below!