Aphasia in stroke: A story of distress and suffering
Aphasia literally means inability to speak, but actually, sometimes it is worse than that. In medical terms aphasia is a disorder of language, affecting the comprehension (understanding of words) or speech production along with inability to read and write. Therefore, in aphasia, patient may be not able to understand what others are saying or patient is able to understand but, himself not able to convey his thoughts to others by verbal speech. The former condition is known as sensory aphasia or Wernike’s aphasia (After the name of scientist who described it) and later condition is known as motor aphasia or Broca’s aphasia. Patients with sensory type of aphasia are not able to understand what other person is saying. They may understand by signs used by the other person but not by speech. They may be able to speak sentences which have no meaning, may add un-necessary words or create make-up words in there speech. This type of speech is known as Jargon’s speech. Patient’s with motor type of aphasia are able to understand the speech of others but have difficulty in speaking long phrases, often omit small words and have to put great efforts to speak. But in routine practice, neurophysicians encounter global aphasia most commonly where both sensory and motor aphasias are present to-gether.
Left side of brain is responsible in most of the individuals for language function. Any damage to the temporal lobe of brain leads to sensory aphasia, whereas damage to frontal lobe, causes motor aphasia. The reason why some patients are not able to speak while others unable to understand speech depends upon the part of brain affected. Any injury to these parts of brain can lead to aphasia.
The most common cause of aphasia is stroke. The other causes can be head injury, tumours or infections of brain. As stroke is a very prevalent disease in our society, therefore aphasic patients mostly fall in this category.
Multifarious problems are associated with stroke but aphasia is quite awful, especially global aphasia. Here the problem is collective as both patient and care taker suffers due to lack of communication. Patient without weakness of limbs tries to tell his needs by gestures of limbs but the patient with limb weakness, though want to tell his needs but can’t able to do so. Therefore he gets more distressed and agitated. His self-confidence dwindles away and vicious cycle of misery and helplessness starts. These patients get depressed and detach themselves from family and society.
Similarly, it’s not easy for the family members or care takers to understand the needs and sentiments of patient. Even though they are dedicated for well being of patients and want to help and serve, but due to this lack of communication they are helpless too. Condition is worse with patients who are almost bed bound due to hemi-paresis (weakness of half of body) following stroke. These patients are unable to tell their basic needs of life, like hunger, urinary urge, pain etc. Therefore these patients have to be intermittently asked for food, urination and passage of stools. Caretaker and relatives have to therefore prepare themselves for regular washing and cleaning of soiled clothes. These patients also get injured easily as unable to tell their pain with initial feeble frictional injuries. The magnitude of problem can’t be gauged by any scale, and it’s the patient and their relatives only, who can understand the insult of aphasia. Finally, morbidity and mortality both increase in aphasic patients due to lack of nutrition and proper care.
There are also several myths associated with aphasic patients. Some say it as curse of god. According to them, voice of patient is been taken from him for his sins. Some regards it as supernatural effect of spirits or wraith. Due to these beliefs, relatives of patient sometimes involve in non-conventional therapy or sometimes neglect the condition at all. Few patients also consult ENT or Throat specialists for this condition, as they were unaware of the real cause. Here, we need to have a clear view point about the diseases of throat causing voice problem. Patients with throat problem may also have difficulty in production of voice, known as “Aphonia”, but they have clear concept of language. They can understand and speak words accurately with some hoarseness or nasal tone while producing sound. Many people are unaware of the seriousness of aphasia, and take it lightly and believe that speech will come automatically without treatment. These myths regarding aphasia, need to be eliminated by proper education about the condition to common population and relatives of patients suffering from this condition.
Rectification of aphasia is not easy but remedy of this gruesome condition is possible. Speech therapy is the best tool for amendment of aphasia. The three important domains of speech therapy are language section, cognition section and functional skills section. Language section includes words understanding and naming, then sentence structuring and completion. Cognition section includes comprehension, general knowledge and memory. Functional skills section includes learning of functional skills and puzzles. The combined and stepwise approach with these domains results in good recovery of language dysfunction. For treatment of aphasia, patients must visit neurologist and have proper counselling. In last, aphasia is a silent killer, by curbing the language function of a person. With integrated approach of neurologist, speech therapist, caretakers and patient himself, aphasia can be tackled.