STUDY - Technical - New Dacian's Medicine
Aphasia
(Classical / Allopathic Medicine)
Aphasia is the
impaired expression or comprehension of written or spoken
language and reflects disease or injury of the brain's
language centers. Depending on its severity, aphasia may
slightly impede communication, or it may make speech
impossible. It can be classified as Broca's, Wernicke's,
anomic, or global aphasia. Anomic aphasia eventually resolves
in more than 50% of patients, but global aphasia is usually
irreversible. (See Identifying types of aphasia.)
ALERT:
If the patient is experiencing aphasia:
- look for signs of increased intracranial pressure, such as pupillary changes, decreased level of consciousness (LOC - Level of Consciousness), vomiting, seizures, bradycardia, widening pulse pressure, and irregular respirations
- assess for signs of stroke
- have emergency equipment nearby
- prepare the patient for surgery, if appropriate.
If the patient doesn't display signs of increased intracranial pressure or stroke, or if his aphasia has developed gradually, perform a focused assessment.
If the patient is experiencing aphasia:
- look for signs of increased intracranial pressure, such as pupillary changes, decreased level of consciousness (LOC - Level of Consciousness), vomiting, seizures, bradycardia, widening pulse pressure, and irregular respirations
- assess for signs of stroke
- have emergency equipment nearby
- prepare the patient for surgery, if appropriate.
If the patient doesn't display signs of increased intracranial pressure or stroke, or if his aphasia has developed gradually, perform a focused assessment.
Identifying types
of aphasia
Broca's aphasia (expressive aphasia):
Broca's aphasia (expressive aphasia):
- Ability to
understand written and spoken language intact
- Nonfluent speech, evidenced by difficulty finding words, use of jargon, paraphasia, limited vocabulary, and simple sentence construction
- Inability to repeat words or phrases
Wernicke's aphasia (receptive aphasia):
- Nonfluent speech, evidenced by difficulty finding words, use of jargon, paraphasia, limited vocabulary, and simple sentence construction
- Inability to repeat words or phrases
Wernicke's aphasia (receptive aphasia):
- Difficulty
understanding written and spoken language
- Inability to repeat words or phrases or follow directions
- Fluent speech but may be rapid and rambling with paraphasia
- Difficulty naming objects (anomia)
- Lack of awareness of speech errors
Anomic aphasiaș
- Inability to repeat words or phrases or follow directions
- Fluent speech but may be rapid and rambling with paraphasia
- Difficulty naming objects (anomia)
- Lack of awareness of speech errors
Anomic aphasiaș
- Ability to
understand written and spoken language intact
- Fluent speech but lacks meaningful content
- Difficulty finding words and circumlocution
- Paraphasia (rarely)
Global aphasia:
- Fluent speech but lacks meaningful content
- Difficulty finding words and circumlocution
- Paraphasia (rarely)
Global aphasia:
- Profoundly
impaired receptive and expressive aphasia ability
- Inability to repeat words or phrases or follow directions
- Speech marked by paraphasia or jargon
HISTORY:
Because of the patient's impairment, you'll likely need to obtain information from his family.
Ask the family about the patient's history of headaches, hypertension, seizure disorders, and drug use.
Ask the family about the patient's ability to communicate and to perform routine activities before the aphasia began.
- Inability to repeat words or phrases or follow directions
- Speech marked by paraphasia or jargon
HISTORY:
Because of the patient's impairment, you'll likely need to obtain information from his family.
Ask the family about the patient's history of headaches, hypertension, seizure disorders, and drug use.
Ask the family about the patient's ability to communicate and to perform routine activities before the aphasia began.
PHYSICAL
ASSESSMENT:
Check for obvious signs of neurologic deficit, such as paresis or altered LOC.
Take the patient's vital signs.
Assess pupillary response, eye movements, and motor function, especially his mouth and tongue movement, swallowing ability, and spontaneous movements and gestures.
Check for obvious signs of neurologic deficit, such as paresis or altered LOC.
Take the patient's vital signs.
Assess pupillary response, eye movements, and motor function, especially his mouth and tongue movement, swallowing ability, and spontaneous movements and gestures.
SPECIAL
CONSIDERATIONS:
When speaking to the patient, don't assume that he understands you. He may simply be interpreting subtle clues to meaning, such as social context, facial expressions, and gestures. To help avoid misunderstanding, use nonverbal techniques, speak to him in simple phrases, and use demonstration to clarify your verbal directions.
When speaking to the patient, don't assume that he understands you. He may simply be interpreting subtle clues to meaning, such as social context, facial expressions, and gestures. To help avoid misunderstanding, use nonverbal techniques, speak to him in simple phrases, and use demonstration to clarify your verbal directions.
PEDIATRIC
POINTERS:
Recognize that the term childhood aphasia is sometimes mistakenly applied to children who fail to develop normal language skills but who aren't considered mentally retarded or developmentally delayed. Aphasia refers solely to loss of previously developed communication skills.
Brain damage associated with aphasia in children most commonly follows anoxia — the result of near drowning or airway obstruction.
Recognize that the term childhood aphasia is sometimes mistakenly applied to children who fail to develop normal language skills but who aren't considered mentally retarded or developmentally delayed. Aphasia refers solely to loss of previously developed communication skills.
Brain damage associated with aphasia in children most commonly follows anoxia — the result of near drowning or airway obstruction.
PATIENT
COUNSELING:
Make sure the patient has necessary aids, such as eyeglasses or dentures, to facilitate communication. Refer the patient to a speech pathologist to help him cope with his aphasia.
Make sure the patient has necessary aids, such as eyeglasses or dentures, to facilitate communication. Refer the patient to a speech pathologist to help him cope with his aphasia.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)