Aphasia Soft Ware - Bungalow Software

Aphasia Tutor 1: Words 

Aphasia treatment software that improves recognition and retrieval of letters and words.

Easiest Lesson

Level 1: Letter Matching 

Hardest Lesson
Level 6: Picture Naming

[More Aphasia Tutor pictures]

Program shows the patient a letter, word, or picture and the patient responds by choosing or typing an answer. If the answer is incorrect, program gives the patient helpful hints.

Aphasic patients use it independently, thanks to special features, starting with relearning the alphabet then identifying objects by matching a word to a picture. At the highest levels, patient types the name for everyday things like "apple" or "watch" or "clock".

This program is also available in Spanish.

Contains over 700 exercises in 8 difficulty Levels:

Letter Matching

Shows a letter and patient selects the matching letter from a multiple-choice list. [View]

Letter Copying

Similar to #1, but patient must type answer.[View]

Word Matching

Pick the matching word from several choices. [View]

Word Copying

Higher level version of #2. Practice with basic keyboard operation. [View]

Picture-Word Matching, Nouns 

User must pick the word for the picture. [View]

Picture Naming Nouns, 

Fill-in.Patient identifies the picture by typing it's name. [View]

Picture-Word Matching, Verbs: [View]

Picture Naming, Verbs: Fill-in. [View]

Benefits
Boosts patient self esteem
Unlimited self-paced speech therapy practice.
Practical preparation for "the real world"
Saves speech pathologists' time by automatically tracking progress.

Features

Like all Bungalow programs, Aphasia Tutor 1 provides hints and feedback to help guide the patient to the right answer. Our approach is "Success with as little assistance as needed." The goal is for the patient to do it as independently as possible.

Hints
User can click on the Hints button or press the <control> key on the keyboard to receive a hint in the fill-in-the-blank levels. E.g., if the answer was "Spoon" the hint would be "s_ _ _ _"

Clear feedback for correct/incorrect answers.

Use the mouse or keyboard
Multiple difficulty levels beginning with multiple choice single-letters, all the way to fill-in-the-blank words.

Spanish version
Available in a Spanish version that has the cues and answers in Spanish. Patient would pick a Spanish word for "orange" (naranjo) or type that in as the answer.

Deluxe Version Features

These features are available in the Deluxe and Pro versions of the program.
Get more therapy with extra difficulty options. Show the first letter of the answer or reduce the number of choices to make the program easier, or give fewer hints to make it harder. 

Motivate the patient by showing them how well they're doing with automatic progress tracking which saves the results of each session are saved, to a file. You can print this or copy it into other documentation. Limited to a single patient. For unlimited patients, see Pro version 

Make faster progress with repetition practice.
Repeat the first 20 questions 5 times, or repeat as many questions as you like as many times as you like. You can also control the length of the lesson without repetition, such as having a 25 exercise lesson. (Bungalow programs have so many exercises we've found that even one lesson can be too much for a patient to do in one sitting. 

Do memory training. You can set the program to display the cue to display temporarily or until they press any key. Then the cue disappears, and the question appears.

Appropriate for:
Word retrieval (aphasia)
Letter recognition
Word recognition
Written naming (anomia)
Visual scanning
Typing
Reading

"Aphasia Tutor's multiple difficulty levels and feedback ensure success...The patient never walks away from the program discouraged."

Candace Gordon, Speech Therapist, Clinic Supervisor, Portland State Speech and Science Program.

"We found a level for every patient we tried Aphasia Tutor with."

Peggy S., Speech-Language Pathologist, Duluth, MN

Easier and more productive

"Thank you for all the support....people like you made life much easier."

Helen Talley, caregiver
Read Helen's letter.


Does the patient need to hear the words and cue?

Try Aphasia Tutor 1+: Words Out Loud
It has all the features of the regular Aphasia Tutor 1 and it also speaks the cues and the answers.
[click here for more info]


Professional Version Features

Pro version has all the features of the Deluxe (above) plus it:
Tracks progress for each patient
Makes paperwork a breeze! You just open the patient's Bungalow file and paste in their scores (results) from several sessions to demonstrate progress during therapy.
Automatically remembers settings for each patientSo, when Mr. Jones comes back in for his next visit, you just select Mr. Jones and the program remembers how he did last time, what lesson he was using, and what settings you used for him.
Two Computer license Licensed for 2 PCs at one address (one building) and for multiple patients (users) on each PC. Contact us for discounts on multiple Pro licenses.

Download a free trial or buy a trial CD with all the programs on this website (over 1 million exercises).

Buy programs or view prices on our shopping cart page.

Computer Requirements
Microsoft Windows (Any version from 1998 to present: 98, NT, 2000, XP, Vista, and Windows 7),
32 MB or more memory
About 80 MB Hard Drive space
Color screen (monitor)
Recommended: a Sound Card (which most computers have already. If you have speakers they are plugged into the Sound Card.)

On Line Rehab for people with Aphasia - Aphasia Tool Box.com

 Welcome to aphasiatoolbox.com

Aphasiatoolbox.com – the world leader in online rehabilitation for people with aphasia/apraxia. We offer individualized recovery plans for clients and comprehensive services for Speech-Language Pathologists. Want results ? Click below.

We offer the best evidenced based therapy and aphasia rehabilitation approaches in the field. We help individual clients who have aphasia/apraxia and their families build their own recovery paths. We also help speech language pathologists who are looking to offer cutting edge aphasia therapy to clients and build their own telepractice. Please select one of the following links to learn more about our services.

No more tired, meaningless drills and worksheets! We designed our Brain Compatible Aphasia Treatment (BCAT) and Motor Reconnect Apraxia (MRAP) programs to take advantage of neuroplasticity-the brain’s proven ability to reconnect and repair itself. Now you can incorporate BCAT and MRAP into your individual practice or treatment.

Aphasia treatment is no longer a to which place you go - a clinic. It is now something you do - active interaction with expert clinicians. The staff of aphasiatoolbox.com can work with you in the comfort of your home. Click below to see how easy this is to do.

Aphasia therapy - So To Speak

Aphasia therapy

http://slpslwstl.wordpress.com/2012/05/26/aphasia-therapy/

26 MAY

APHASIA!

If you’re working with adults you’re PROBABLY working on aphasia. There are maaany types of aphasia. If you use the WAB, which there is a good case you will, then you will give your patients any one of eight aphasia diagnoses (Broca’s, Wernicke’s, Transcortical Motor, Transcortical Sensory, Global, Isolation, Conduction, Anomic). Most aphasias  be classified as fluent (receptive) or non-fluent (expressive). And there are other aphasias out there like primary progressive, alexia, agraphia etc. AND the way you classify aphasia will depend on your “theory” of aphasia.

I say all of this, but really you won’t see “pure” aphasias often – I would say many are mixed. You’ll see patients with a variety of difficulties that manifest themselves in all sorts of exciting ways.

AND QUITE FRANKLY – sometimes the diagnosis is SORTA irrelevant. To me – I’m not treating a diagnosis. I’m treating the issue. Just because someone has Broca’s aphasia doesn’t necessarily mean that the treatments typically used for Broca’s aphasia will work for this patient.

So what do you do with these patients – who may have difficulty speaking, understanding, reading, writing, spelling and a plethora of other troublesome word related tasks?

I’ll try to narrow it down a bit.

The patients I saw MOST OFTEN were having difficulty with word finding. I’ve had one patient with global aphasia and one patient with Wernicke’s. My externship had a very cool “Evidence Based Aphasia Clinic” which analyzed the aphasic characteristics of patients enrolled in the clinic, and then looked at EVIDENCE BASED protocols for treating aphasias. WHICH IS SO SMART. 

Everyone should do this. Not just with aphasia. With all things. One day I’d like to have at least one legit journal article printed off that explains why I do what I do with each kind of disorder that I focus on.

Back to what I was saying – What do we do with these patients? With a global aphasia you’ll likely be trying to find some kind of multi-modality communication system that will be consistently and appropriately utilized in the patient’s life. These are tough patients but you’ll find a way to communicate. One of my most favorite patients had global aphasia. She was the sassiest.

Wernicke’s? Wernicke’s aphasia is really cool. 

There is a “Treatment for Wernicke’s Aphasia“ which works, but is extremely tedious and exhausting for EVERYBODY. Be sure to break up your sessions if you attempt it. The idea is you put out six photos (of 12 photos total) of everyday photos and first – hand the patient a card with a word on it. The patient matches the word to the picture. The patient then reads the word or verbally identifies the picture. The patient then repeats the word after you. Then you ask the patient to identify the picture with just a verbal cue. There is no scaffolding or cueing, but obviously for training purposes and for success purposes you’ll want to cue and prompt as necessary at the beginning. When I find the source for this I’ll share it – I’m not sure where I hid it. You can also do Response Elaboration Training, Cloze Procedures, Melodic Intonation Therapy, and I’m sure a number of other procedures.

And the biggie – word finding. This is going to change with each patient. I really enjoy category naming and teaching HOW to do this efficiently. I think often we say to a patient “Name all of the animals you can!” and then they have a hard time and we write down how many they got and then we tell them to name some other things. THIS IS NOT GOOD THERAPY.

Teach, don’t test, people.

So some ways we can deal with naming and word finding is to do semantic mapping tasks and semantic feature analysis. You can TEACH patients how to categorize by really thinking about how our brain works. How is our brain organized? Do we just have a jumble of animals in our brain all willy nilly? If someone asked YOU to name as many animals as you could what would you do? I often tell patients to subcategorize. Tell me animals, but first tell me farm animals, then zoo, pets, woodland, ocean, flying, etc. Tell me vegetables but envision yourself at the grocery store. And also consider – are you asking the patient to name CONCRETE items or ABSTRACT? Example time. Concrete: Animals. Abstract: Red things. Our brain is not organized by color.

Other tasks for word finding: synonym and antonym generation. And not just ONE word. Tell the patient to think of THREE antonyms. This gives you a good idea of where they are as far as what is difficult and what sorts of scaffolding is required. Can you give a patient a FIM score without really pushing them and figuring out what is hard? (No.)

Unscrambling tasks. Idiom defining.  Homonym explanation. Word defining. Seriously – ask a patient with a word finding disorder to define the word “tree”. Try that one. I really recommend the WALC books and Cognitive Reorganization if you work with aphasia often.

Now, I’m going to do the last edit of my thesis because I’ve been…not doing it.

NP: Anna Begins – Counting Crows

Australian Aphasia Association

Australian Aphasia Association

About Aphasia Aphasia is a language difficulty caused by damage to the brain. People with aphasia may have difficulty with: talking listening (understanding what others say) reading writing using numbers using gestures People with aphasia are competent and intelligent. Aphasia may affect: everyday communication relationships everyday living  Aphasia may also be called: dysphasia (dis - phaze - yuh) anomia (difficulty finding words)  What causes aphasia? Aphasia is caused by stroke or other damage to the language centres of the brain. Head injury, tumours, or infections and inflammation in the brain may be other causes.  Remember: Aphasia affects every person differently. Some people have only mild difficulties, others have very severe communication problems. People with aphasia are competent and intelligent. People with aphasia still have thoughts, opinions and emotions. People with aphasia can still solve problems. People with aphasia can still hear and see. People with aphasia can still make decisions. People with aphasia often know what they want to say, but have difficulties getting their messages out. It is important to know that aphasia is not a loss of intelligence. Aphasia affects not only the person with aphasia, but also their families and friends, and people in their community.  Strategies to help people with aphasia to communicate and participate in everyday life Remember to treat people with aphasia as the intelligent adults they are. Give people with aphasia lots of time to speak and to understand what has been said. Use plain English. Avoid speaking too fast. Accept when people with aphasia use ways of communicating other than speech such as gestures, writing or drawing. Maintain a sense of humour. The following strategies may also help: Ask questions that can be answered with a YES or NO (however, be aware that sometimes people with aphasia confuse these responses). Talk in short, clear sentences. Don't patronise. Reduce background noise and distractions. Allow the person with aphasia to speak for himself/herself. Include the person with aphasia in conversation. Talk to the person with aphasia, NOT their companion. Don't correct mistakes made by the person with aphasia. When needed, check you have understood each other. Use gestures, writing or drawing.

Aphasia Support Group

Welcome to AphasiaNow

A site by people living with aphasia, for people with aphasia

.

Our vision is to be an aphasia-friendly website, and to provide a weekly support group in Gloucestershire/UK:

• to be a site that will encourage aphasic people to share experiences and pass on their aphasia expertise,
• join with aphasic people to campaign to improve services,
• develop independence and to lead fulfilling lives despite aphasia,
• raise awareness of how aphasia affects people and their families. We need to raise awareness in the general public and in those whose work brings them into contact with aphasic people.

Aphasia Now Resources / Reovery

• AphasiaNow offer information and news about aphasia and try to provide better opportunities and aphasia related resources.
• AphasiaNow also provides information for aphasic people and their families.
• AphasiaNow can only achieve its aims if people with aphasia use the site.
• But, if you have a professional interest in aphasia, you will also find the site interesting and useful.

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Aphasia support groups

Gloucestershire, UK

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A Stroke of Genius

On-line art gallery by people with aphasia

more ..

Volunteer with us

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With us you can have a rewarding experience as a volunteer ..

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Read more about Aphasia

> What is Aphasia / Dysphasia

Aphasia Now Founders

> Our Therapists & Volunteers

Aphasia Recovery: Support groups & therapies

> get involved

Aphasia Therapy Software, aids, computers

> Aphasia News: Local, National & International

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Questions? Fragen? Prejuntas? Frågor?

Contact us in English. Deutsch. Español. Svenska.

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Aphasia Treatment in Stroke

Aphasia Treatment in Stroke

Important Information About Aphasia Treatment After Stroke

From Jose Vega M.D., Ph.D., former About.com Guide

Updated July 23, 2008

About.com Health's Disease and Condition content is reviewed by the Medical Review Board

“

”

Photo © A.D.A.M.

Aphasia treatment is an extremely important aspect of life after a stroke which has affected someone's ability to speak. In general terms, aphasia is a disturbance in the production, processing, or understanding of language due to brain damage, most commonly from stroke. Although multiple forms of treatment exist for the different types of aphasia, only a few of them have been studied rigorously enough to have proven efficacy. As a result, most forms of aphasia treatment are based on theoretical grounds which await further testing to prove their benefits. However, based on their experience with patients, most speech pathologists and physicians attest to the benefits of aphasia therapy.

General Principles

Several principles of therapy have been shown in small studies to improve the outcome of therapy.

• Regardless of the type of therapy used, the outcome is better if the intensity of therapy is increased. In other words, a given number of hours of therapy will yield a much better outcome if they are given in a few sessions over a few days rather than in many sessions over many days.
• The effectiveness of aphasia therapy increases when therapists use multiple forms of sensory stimuli. For instance, auditory stimuli in the form of music, and visual stimuli in the form of pictures, drawings, are routinely used during aphasia therapy sessions.
• Gradual increases in the difficulty of language exercises practiced during a given therapy session improves the outcome.

Listed below are some well-known forms of aphasia treatments.

Cognitive Linguistic Therapy

This form of therapy emphasizes the emotional components of language. For example, some exercises require patients to interpret the characteristics of different emotional tones of voice. Others require them to describe the meaning of highly descriptive words or terms such as the word "happy." These exercises help patients practice comprehension skills while focusing on understanding the emotional components of language.

Programmed Simulation:

This type of therapy uses multiple sensory modalities, including pictures and music, introduced in a gradual progression from easy to difficult.

Stimulation-Fascilitation Therapy:

This form of aphasia therapy focuses mostly on the semantic and syntactic parts of language. The main stimulus used during therapy sessions is auditory stimulation. One of the main assumptions of this type of therapy is that improvements in language skills are best accomplished with repetition.

Group Therapy:

This type of therapy provides a social context for patients to practice the communication skills they have learned during individual therapy sessions, while getting important feedback from therapists and other aphasics. Family treatment strategies have a similar effect, while also facilitating the communications of aphasics with their loved ones.

PACE (Promoting Aphasic's Communicative Effectiveness):

This is one of the best-known forms of pragmatic therapy, a form of aphasia therapy that promotes improvements in communication by using conversation as a tool for learning. PACE therapy sessions typically involve an enacted conversation between the therapist and the patient. In order to stimulate spontaneous communication, this type of therapy uses drawings, pictures, and other visually-stimulating items which are used by the patient to generate ideas to be communicated during the conversation. The therapist and the patient take turns to convey their ideas.

The difficulty of the materials used to generate conversation is increased in a gradual fashion. Patients are encouraged to use any means of communication during the session, which allows the therapist to discover communication skills that should be reinforced in the patient. The therapist communicates with the patient by imitating the means of communication with which the patient feels most comfortable.

Pharmacotherapy:

This is one of the most appealing forms of aphasia therapy although its efficacy has yet to be proven. The list of medications tried so far include piracetam, bifenalade, piribedil, bromocriptine, idebenone and dextran 40, donezepil, amphetamines and several antidepressants. Although the evidence is not very strong, it appears that at least donezepil, piribedil and amphetamines might have some degree of efficacy in aphasia treatment. The latter appears to be especially helpful at enhancing the benefits of traditional non-medication based therapy, as some studies have shown a better outcome of therapy when patients are given amphetamines before therapy sessions.

Transcranial Magnetic Stimulation (TMS):

Although this modality of treatment is seldom used, its efficacy is under intense investigation. TMS consists of aiming a magnet directly at a part of the brain which is thought to inhibit language recovery after stroke. By suppressing the function of that part of the brain, recovery is enhanced. The type of magnetic therapy that has been tried in aphasia rehabilitation is the "slow and repeated" version of TMS. A few small studies have had encouraging results, but a large, well-controlled study is still needed to ensure the efficacy of this form of treatment.

Sources: Jordan Lori and Hillis Argye; Disorders of speech and language: aphasia, apraxia and dysarthria; Current Opinion in Neurology 2006 19 (6): 580-585.
Cicerone et al., Evidence-based cognitive rehabilitation: Updated Review of the literature from 1998 to 2002 Archives of Physical Medicine and Rehabilitation 2005 Vol 86; 1681-1692.
Froma P Roth and Colleen K. Worthington treatment resource manual for speech and language pathology 2nd edition Delmar, Albany N

Aphasia Treatment

Many cases of aphasia can improve with treatment. However, a complete restoration of communication levels is not always possible.

Speech and language therapy (SLT) is the main treatment for aphasia. SLT is a general term used to describe different techniques that can help improve a person’s ability to communicate.

SLT for aphasia aims to:

• help the person relearn communication skills that have been lost or damaged (if this is possible)
• make the best use of the person’s remaining communication abilities
• find new ways of communicating

Speech and language therapy

There is no single best way to treat aphasia, however, most experts agree a course of SLT tends to be more successful if it is based on the following:

Dose and intensity

Research has shown one of the most important things affecting the success of SLT is the time spent doing it (the dose). The more hours spent doing SLT, the more successful it is likely to be.

Research also shows that a short-term course of intensive SLT, for example, eight to 10 hours a week over a couple of months, is usually more effective than a longer, less intensive course, for example, one to two hours a week for five or six months.

However, not everyone has the energy to participate in intensive therapy, particularly elderly people recovering from a stroke.

Gradual build up

SLT works best when the therapist sets modest goals and then moves on to more complex goals. For example, they might start with naming a specific person, before describing their relationship with that person.

Personalised

Research shows that people are more engaged when using teaching material and aids with a personal significance.

For example, using photographs of people or situations that a person would remember is more effective than using stock photographs.

Provide alternatives

It is important for a therapist to discuss potential alternative communication methods, such as simple gestures, more complex sign language, or technology, such as electronic speech synthesisers.

This can be particularly useful in primary progressive aphasia, as the person and their loved ones may have time to learn how to use the methods while they are still able to speak fairly well, preparing for a time when they will have more difficulty.

Group work

It can be beneficial for someone with aphasia to work in a group with other people with the condition. As well as providing a good opportunity to practice communication skills, it can also lessen the feelings of loneliness and isolation experienced by many people with aphasia.

SLT can be carried out by trained and supervised volunteers. The Stroke Association provides training for volunteers. See The Stroke Association website for details about volunteering.

SLT techniques

Promoting Aphasics' Communicative Effectiveness (PACE)

Promoting Aphasics' Communicative Effectiveness (PACE) uses conversation to improve a person’s communication skills.

The therapist will use a picture or drawing to stimulate a conversation, while the person with aphasia is encouraged to use any means of communication to respond.

Early PACE sessions focus on simple topics of conversation, such as where the person was born. As the sessions progress, the topics of conversation become more complex and abstract, including for example, the person’s favourite film and why they like it.

Melodic intonation therapy (MIT)

Melodic intonation therapy (MIT) is often used in the treatment of non-fluent forms of Broca's aphasia.

Many people with aphasia do not have difficulties when singing. This may be because the parts of the brain used when singing are different to those used when speaking.

During MIT sessions, a person with non-fluent aphasia is encouraged to hum and to sing words or phrases that they find difficult to recall, while tapping out a rhythm. This technique has been shown to increase the number of words a person can recall.  

Computerised script training (CST)

Computerised script training (CST) uses scripts that simulate real-life conversations and social activities, allowing a person with aphasia to practise their communication skills.

This is usually carried out in hospital under the supervision of a speech and language therapist or assistant. However, a recent study has shown that CST may be effective when it is self-managed, with only a small amount of guidance.

Constraint-induced aphasia therapy (CIAT)

Constraint-induced aphasia therapy (CIAT) is a type of SLT designed for people with long-term (chronic) aphasia.

People with chronic aphasia may adopt a number of basic compensatory strategies to help them communicate, for example:

• pointing
• gesturing (but not complex sign language)
• making sound effects, such as saying "brrrrm" for car

These strategies may be useful in the short term, but relying on them can lead to a person with aphasia forgetting previously learnt communication skills and delaying their recovery.

CIAT usually involves a short course of intensive therapy during which a therapist aims to identify these types of compensatory strategies and encourages more complex ways of communicating. This may not necessarily be full speech, but may include methods that force the brain to make use of its language centre, such as drawing or using communication tools, such as a speech synthesiser.

Transcranial stimulation

Transcranial stimulation is a type of painless treatment that may benefit some people with aphasia.

There are two types of transcranial stimulation:

• transcranial direct current stimulation (tDCS) – where electrodes (small metallic discs) are placed on the surface of the scalp and a small electrical current is passed through them
• transcranial magnetic stimulation (TMS) – where magnetic coils are placed above the scalp which create short-lasting electrical currents in the brain below the stimulation site

It has been suggested that both tDCS and TMS may help stimulate parts of the language centre that have been damaged and encourage a certain degree of recovery and repair. Initial research has found these types of treatment may help people to improve their ability to remember names of certain objects, people and places.

As transcranial stimulation is a new method of treatment, access is currently limited to people willing to take part in a clinical trial. Read more about clinical trials and Clinical trials for aphasia.

Medication

Researchers have also been studying the effects of medication for improving the language skills of people with aphasia.

One type of medication that has proved reasonably effective in some people with Broca's aphasia, when used in combination with SLT, is called bromocriptine.

It is thought bromocriptine may help stimulate sections of the brain’s language centre, leading to an improvement in communication skills.

Another medication that has proved effective in improving language skills, particularly the ability to name objects, people and places correctly, is called donepezil.

Donepezil increases levels of a chemical called acetylcholine in the brain. This is thought to lead to an increase in cognitive ability (the ability to think, reason and plan).

Again, it is likely that access to these sorts of treatment will only be available in clinical trials.

Communicating with a person with aphasia

If you live with, or care for, a person with aphasia, you may be unsure about the best way to communicate with them. You may find the following advice helpful.

• After speaking, allow the person plenty of time to respond. If a person with aphasia feels rushed or pressured to speak, they may become anxious, which can affect their ability to communicate.
• Use short, uncomplicated sentences and do not change the topic of conversation too quickly.
• Avoid asking open ended questions. Closed questions that have a yes or no answer are better.
• Avoid finishing a person’s sentences or correcting any errors in their language. This may cause resentment and frustration for the person with aphasia.
• Keep any possible distraction to a minimum, such as background radio or TV noise.
• Use paper and a pen to write down any key words, diagrams or pictures to help reinforce your message.
• If you do not understand something that a person with aphasia is trying to communicate, do not pretend that you do understand. The person may find this type of behaviour patronising and upsetting. It is always best to be honest about your lack of understanding.
• Try to remember that despite their change in speech pattern, the person’s personality is unchanged. They may appear emotionally distant or abrupt, but how they speak to you does not necessarily reflect how they feel about you.

APHASIA

Aphasia (/əˈfeɪʒə/, /əˈfeɪziə/ or /eɪˈfeɪziə/; from ancient Greek: 'aphatos' meaning[1] ἀφασία (ἄφατος, ἀ- + φημί), "speechlessness"[2]) is a disturbance of the comprehension and formulation of language caused by dysfunction in specific brain regions.[3] This class of language disorder ranges from having difficulty remembering words to losing the ability to speak, read, or write. This also affects visual language such as sign language.[4] Aphasia is usually linked to brain damage, most commonly by stroke. Brain damage linked to aphasia can also cause further brain diseases such as cancer, epilepsy and Alzheimer's disease.[5]

Acute aphasia disorders usually develop quickly as a result of head injury or stroke, and progressive forms of aphasia develop slowly from a brain tumor, infection, or dementia.[6][7] The area and extent of brain damage or atrophy will determine the type of aphasia and its symptoms. Aphasia types include expressive aphasia, receptive aphasia, conduction aphasia, anomic aphasia, global aphasia, primary progressive aphasias and many others (see Category:Aphasias). Medical evaluations for the disorder range from clinical screenings by a neurologist to extensive tests by a Speech-Language Pathologist.[6][8]

Most acute aphasia patients can recover some or most skills by working with a Speech-Language Pathologist. This rehabilitation can take two or more years and is most effective when begun quickly. Only a small minority will recover without therapy, such as those suffering a mini-stroke. Improvement varies widely, depending on the aphasia's cause, type, and severity. Recovery also depends on the patient's age, health, motivation, handedness, and educational level.[6]

Classification [edit]

Classifying the different subtypes of aphasia is difficult and has led to disagreements among experts. The localizationist model is the original model, but modern anatomical techniques and analyses have shown that precise connections between brain regions and symptom classification do not exist. The neural organization of language is complicated; language is a comprehensive and complex behavior and it makes sense that it is not the product of some small, circumscribed region of the brain.

No classification of patients in subtypes and groups of subtypes is adequate. 

Only about 60% of patients will fit in a classification scheme such as fluent/nonfluent/pure aphasias. There is a huge variation among patients with the same diagnosis, and aphasias can be highly selective. For instance, patients with naming deficits (anomic aphasia) might show an inability only for naming buildings, or people, or colors.[9]

Localizationist model [edit]

Cortex

The localizationist model attempts to classify the aphasia by major characteristics and then link these to areas of the brain in which the damage has been caused. The initial two categories here were devised by early neurologists working in the field, namely Paul Broca and Carl Wernicke. Other researchers have added to the model, resulting in it often being referred to as the "Boston-Neoclassical Model".

• Individuals with expressive aphasia (also called Broca's aphasia) were once thought to have frontal lobe damage, though more recent work by Dr. Nina Dronkers using imaging and 'lesion analysis' has revealed that patients with Expressive aphasia have lesions to the medial insular cortex. Broca missed these lesions because his studies did not dissect the brains of diseased patients, so only the more temporal damage was visible. Dronkers and Dr. Odile Plaisant scanned Broca's original patients' brains using a non-invasive MRI scanner to take a closer look.[10] Damage to a region of the motor association cortex in the left frontal lobe (Broca's area) disrupts the ability to speak.[11] Individuals with Expressive aphasia often have right-sided weakness or paralysis of the arm and leg, because the frontal lobe is also important for body movement.
• 
  
• In contrast to Expressive aphasia, damage to the temporal lobe may result in a fluent aphasia that is called receptive aphasia (also known as Sensory aphasia and Wernicke's aphasia). Patients suffering from receptive aphasia, unlike Broca's aphasia patients, produce speech without any grammatical problem. However, because the Wernicke's area which is responsible for language comprehension is damaged, receptive aphasia patients cannot convey the meaning. These individuals usually have no body weakness, because their brain injury is not near the parts of the brain that control movement.
• 
  
• Working from Wernicke's model of aphasia, Ludwig Lichtheim proposed five other types of aphasia, but these were not tested against real patients until modern imaging made more in-depth studies available. The other five types of aphasia in the localizationist model are:

1. Auditory verbal agnosia (also known as Pure Word Deafness)
2. Conduction aphasia
3. Apraxia of speech (now considered a separate disorder in itself)
4. Transcortical motor aphasia (also known as Adynamic aphasia and Extrasylvian motor aphasia)
5. Transcortical sensory aphasia

• Anomic aphasia, also known as anomia or dysnomia, is another type of aphasia proposed under what is commonly known as the Boston-Neoclassical model, which is essentially a difficulty with naming.

• Global aphasia, results from damage to extensive portions of the perisylvian region of the brain. An individual with global aphasia will have difficulty understanding both spoken and written language and will also have difficulty speaking. This is a severe type of aphasia which makes it quite difficult when communicating with the individual.[12]

• Isolation aphasia, also known as mixed transcortical aphasia, is a type of disturbance in language skill that causes the inability to comprehend what is being said to you or the difficulty in creating speech with meaning without affecting the ability to recite what has been said and to acquire newly presented words. This type of aphasia is caused by brain damage that isolates the parts of the brain from other parts of the brain that are in charge of speech.[13] The brain damages are caused to left temporal/parietal cortex that spares the Wernicke's area. Isolation aphasia patients can repeat what other people say, thus they do recognize words but they can't comprehend the meaning of what they hear and repeat themselves. However, they can not produce meaningful speech of their own.[14]

Progressive aphasias [edit]

Primary progressive aphasia (PPA) is associated with progressive illnesses or dementia, such as frontotemporal dementia / Pick Complex Motor neuron disease, Progressive supranuclear palsy, and Alzheimer's disease; which is the gradual process of losing the ability to think. It is characterized by the gradual loss of the ability to name objects. People suffering from PPA may have difficulties comprehending what others are saying. They can also have difficulty trying to find the right words to make a sentence.[15][16][17] There are three classifications of Primary Progressive Aphasia : Progressive nonfluent aphasia (PNFA), Semantic Dementia (SD), and Logopenic progressive aphasia (LPA)[18]

Progressive Jargon Aphasia is a fluent or receptive aphasia in which the patient's speech is incomprehensible, but appears to make sense to them. Speech is fluent and effortless with intact syntax and grammar, but the patient has problems with the selection of nouns. They will either replace the desired word with another that sounds or looks like the original one, or has some other connection, or they will replace it with sounds. Accordingly, patients with jargon aphasia often use neologisms, and may perseverate if they try to replace the words they can't find with sounds. Commonly, substitutions involve picking another (actual) word starting with the same sound (e.g. clocktower - colander), picking another semantically related to the first (e.g. letter - scroll), or picking one phonetically similar to the intended one (e.g. lane - late).

Fluent, non-fluent and "pure" aphasias [edit]

The different types of aphasia can be divided into three categories: fluent, non-fluent and "pure" aphasias.[19]

• Receptive aphasias, also called Fluent aphasias, are impairments related mostly to the input or reception of language, with difficulties either in auditory verbal comprehension or in the repetition of words, phrases, or sentences spoken by others. Speech is easy and fluent, but there are difficulties related to the output of language as well, such as paraphasia. Examples of fluent aphasias are: Receptive aphasia, Transcortical sensory aphasia, Conduction aphasia, Anomic aphasia[19]

• Expressive aphasias, also called Nonfluent aphasias, are difficulties in articulating, but in most cases there is relatively good auditory verbal comprehension. Examples of nonfluent aphasias are: Expressive aphasia, Transcortical motor aphasia, Global aphasia[19]

• "Pure" aphasias are selective impairments in reading, writing, or the recognition of words. These disorders may be quite selective. For example, a person is able to read but not write, or is able to write but not read. Examples of pure aphasias are: Pure alexia, Agraphia, Auditory verbal agnosia[19]

Primary and secondary cognitive processes [edit]

Aphasias can be divided into primary and secondary cognitive processes.

• Primary aphasia is due to problems with cognitive language-processing mechanisms, which can include: Transcortical sensory aphasia, Semantic Dementia, Apraxia of speech, Progressive nonfluent aphasia, and Expressive aphasia
• Secondary aphasia is the result of other problems, like memory impairments, attention disorders, or perceptual problems, which can include: Transcortical motor aphasia, Dynamic aphasia, Anomic aphasia, Receptive aphasia, Progressive jargon aphasia, Conduction aphasia, and Dysarthria.[20]

Cognitive neuropsychological model [edit]

The cognitive neuropsychological model builds on cognitive neuropsychology. It assumes that language processing can be broken down into a number of modules, each of which has a specific function.[21] Hence there is a module which recognises phonemes as they are spoken and a module which stores formulated phonemes before they are spoken. Use of this model clinically involves conducting a battery of assessments (usually from the PALPA, the "psycholinguistic assessment of language processing in adult acquired aphasia ... that can be tailored to the investigation of an individual patient's impaired and intact abilities" [22]), each of which tests one or a number of these modules. Once a diagnosis is reached as to where the impairment lies, therapy can proceed to treat the individual module.

Causes [edit]

Aphasia usually results from lesions to the language-relevant areas of the frontal, temporal and parietal lobes of the brain, such as Broca's area, Wernicke's area, and the neural pathways between them. These areas are almost always located in the left hemisphere, and in most people this is where the ability to produce and comprehend language is found. However, in a very small number of people, language ability is found in the right hemisphere. In either case, damage to these language areas can be caused by a stroke, traumatic brain injury, or other brain injury.

Aphasia may also develop slowly, as in the case of a brain tumor or progressive neurological disease, e.g., Alzheimer's or Parkinson's disease. It may also be caused by a sudden hemorrhagic event within the brain. Certain chronic neurological disorders, such as epilepsy or migraine, can also include transient aphasia as a prodromal or episodic symptom.[24]

Aphasia can result from herpesviral encephalitis. The herpes simplex virus affects the frontal and temporal lobes, subcortical structures and the hippocampal tissue which can trigger aphasia.[25]

Aphasia is also listed as a rare side effect of the fentanyl patch, an opioid used to control chronic pain.[26] Adverse side effects including chronic aphasia can be caused by cortico-steroids.^[citation needed^]

Management [edit]

There is no one treatment proven to be effective for all types of aphasias. 

The reason that there is no universal treatment for aphasia is because of the nature of the disorder and the various ways it is presented, as explained in the above sections. 

Aphasia is rarely exhibited identically, implying that treatment needs to be catered specifically to the individual. Studies have shown that although there isn't consistency on treatment methodology in literature, there is a strong indication that treatment in general has positive outcomes.[27]

A multi-disciplinary team, including doctors (often a physician is involved, but more likely a clinical neuropsychologist will head the treatment team), physiotherapist, occupational therapist, speech-language pathologist, and social worker, works together in treating aphasia. For the most part, treatment relies heavily on repetition and aims to address language performance by working on task-specific skills. The primary goal is to help the individual and those closest to them adjust to changes and limitations in communication.[27]

Treatment techniques mostly fall under two approaches:

1. Substitute Skill Model - an approach that uses an aid to help with spoken language, i.e. a writing board
2. Direct Treatment Model - an approach which targets deficits with specific exercises[27]

Several treatment techniques include the following:

• Visual Communication Therapy (VIC) - the use of index cards with symbols to represent various components of speech
• Visual Action Therapy (VAT) - involves training individuals to assign specific gestures for certain objects
• Functional Communication Treatment (FCT) - focuses on improving activities specific to functional tasks, social interaction, and self-expression
• Promoting Aphasic's Communicative Effectiveness (PACE) - a means of encouraging normal interaction between patients and clinicians. In this kind of therapy the focus is on pragmatic communication rather than treatment itself. Patients are asked to communicate a given message to their therapists by means of drawing, making hand gestures or even pointing to an object.[28]
• Other - i.e. drawing as a way of communicating, trained conversation partners[27]

More recently, computer technology has been incorporated into treatment options. A key indication for good prognosis is treatment intensity. A minimum of 2–3 hours per week has been specified to produce positive results.[29] The main advantage of using computers is that it can greatly increase intensity of therapy. These programs consist of a large variety of exercises and can be done at home in addition to face-to-face treatment with a therapist. However, since aphasia presents differently among individuals, these programs must be dynamic and flexible in order to adapt to the variability in impairments. Another barrier is the capability of computer programs to imitate normal speech and keep up with the speed of regular conversation. Therefore, computer technology seems to be limited in a communicative setting, however is effective in producing improvements in communication training.[29]

Several examples of programs used are StepByStep, Linguagraphica, Computer-Based Visual Communication (C-VIC), TouchSpeak (TS), and Sentence Shaper.[29]

Melodic intonation therapy is often used to treat non-fluent aphasia and has proved to be very effective in some cases.[30]

Zolpidem, a drug with the trade name of Ambien, may provide short-lasting but effective improvement in symptoms of aphasia present in some survivors of stroke. The mechanism for improvement in these cases remains unexplained and is the focus of current research by several groups, to explain how a drug which acts as a hypnotic-sedative in people with normal brain function, can paradoxically increase speech ability in people recovering from severe brain injury. Use of zolpidem for this application remains experimental at this time, and is not officially approved by any pharmaceutical manufacturers of zolpidem or medical regulatory agencies worldwide.