In 2010, a 50-year-old woman from Bengaluru collapsed in a grocery store. Fellow shoppers rushed her to hospital. The woman’s husband was told that she had a stroke and needed emergency surgery to remove a clot in her brain.
Although the surgery was a success, the woman lost her ability to speak or comprehend words and could barely speak a few sentences.
“I still remember the day in the ICU,” says the woman’s husband, who gave his name as Sundaran. “Although she could recognise me, she couldn’t speak or express that she was in pain. That day was the most shocking experience of my life,” recollects Sundaran. “Doctors told me that she wouldn’t be able to understand what you tell, and she might stop speaking eventually. But I kept my hopes up that she would speak again one day.”
Language processing impaired
The woman’s stroke caused a neurological condition called aphasia, where the language perception part of the brain gets damaged, impairing the brain’s language processing function – that is, how language is understood and reciprocated.
“There are two important parts of language processing: syntax and articulation,” explains Dr Mritunjai Singh, a neurologist from the All India Institute for Medical Sciences, Rishikesh. “Syntax refers to the understanding and processing of speech, while articulation means providing motor instructions to ‘speak’ the intended sentence. Aphasia is a condition where the brain is impaired in the understanding and expression of language.”
While stroke is the primary cause of aphasia, other progressive neurodegenerative conditions, like Alzheimer’s, can also lead to aphasia. “In such chronic conditions, aphasia gradually [worsens] with time,” says Dr Singh.
According to statistical data on stroke in the International Journal of Speech-Language Pathology, new cases of aphasia in a given period are around 0.02–0.06 per cent in developed countries.
A diverse condition
Aphasia can manifest into more than one type, depending on the degree of language impairment, says Dr Singh.
- Broca’s aphasia occurs when Broca’s area — the region responsible for reciprocating speech in the brain – suffers damage. As a result, the person can understand what is being spoken but cannot engage in active speech. Their expressions are impaired as they use the minimum of words to express and communicate with broken sentences, as Sundaran’s wife experienced.
- When the brain region that receives and processes language, called the Wernicke’s area, is affected, the individual cannot understand speech. This condition, called Wernicke’s aphasia, leads to the inability to understand language.
- Sometimes another situation arises: one can understand what is heard or being said, but the brain cannot interpret them into meaningful speech. This kind of aphasia is caused when the nerves connecting the two regions, Broca and Wernicke, are damaged and, therefore, unable to conduct information correctly, causing conduction aphasia. As a result, the individual struggles to respond to questions and cannot reply with meaningful speech, although they understand what they hear. Nevertheless, they can make independent, meaningful sentences of their will.
- In global aphasia, an individual neither understands nor reciprocates speech. They mostly remain silent.
Assessing the problem
A speech-language pathologist’s role is crucial in diagnosing aphasia, says Radhika Poovayya, speech pathologist from Samvaad Institute of Speech and Hearing, Bengaluru. “A set of comprehensive language tests is used to diagnose and confirm aphasia and the extent of the disorder. These are in-depth analyses that study speech, naming, repetition, comprehension, reading, and writing,” she explains.
In addition, techniques like magnetic resonance imaging or MRI are helpful to only understand the cause of the condition, like the cause of stroke or part of brain damage, adds Dr Mritunjai Singh.
Speech therapy to the rescue
Speech therapy is vital in improving speech and communication abilities in people with aphasia, although it cannot cure the condition. Dr Singh says aphasia is a symptom, not a disease in itself. It usually does not require treatment, but understanding and supporting the person to read and understand language again are essential.”
Various speech therapies are available to improve essential communication abilities for people with aphasia. Whereas in chronic conditions like Alzheimer’s, or brain damage, providing treatment to the primary cause of the condition diminishes aphasia.
“There are several people to whom we have given speech therapy daily for a couple of years, and now they can speak fairly fluently in meaningful sentences,” avers Poovayya.
She also says there is a deficit of trained speech pathologists in India and that people are unaware of the usefulness of speech therapy for aphasia. “Speech therapies are based on the intact functioning of the brain, and building on it to rewire the brain’s language function,” she says.
Sundaran’s wife was taught language through music and writing. “Broca’s aphasia does not impair the reading, writing ability and musical understanding. Hence we used that to our advantage and started speech therapy by musically forming sentences and making them write and read,” cajoling the brain to gradually regain its language function,” says Poovayya.
Now the happy end: Sundaran was not disappointed. He says his wife has regained her ability to speak, and her condition is improving with time.
