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Aphasia
Aphasia is a language disorder that results from damage to the brain typically from a stroke or certain brain injuries. It is a communication disorder that heavily impairs a person’s ability to speak, write or understand language therefore will result in difficulty finding the right words to say, trouble forming sentences or understanding words that are spoken to them. There are three main types of aphasia: Broca’s aphasia, Wernicke’s aphasia, and Global aphasia. Broca’s aphasia patients have severe trouble with producing language as their affected region is on the Broca’s area of the brain, but they have limited trouble comprehending speech. Wernicke’s aphasia patients have severe trouble comprehending speech with the legion being on the Wernicke’s area of the brain, but they little trouble saying words. Whilst those with global aphasia often have difficulty with both speaking and understanding speech. The individuals that are diagnosed with aphasia obviously face difficulties however they still experience and understand the world around them. They often use methods of non-verbal communication such as gestures and facial expressions to help them communicate and express themselves. Aphasia also has an effect on visual language however, the use of formulaic expressions in communication is regularly maintained. As an example, a person with Broca’s aphasia may not be able to ask someone when their birthday is, but they possibly will be able to sing happy birthday to them.

When someone is diagnosed with aphasia, one or more ways of interaction in the brain have been affected and are not working correctly. It is completely unrelated to the actual mechanics of speech but the cognition itself, but the person can have both problems, for example, if the brain has haemorrhaged and affected a large portion of the brain resulting in speech mechanics being affected.

Symptoms of Aphasia
Aphasia has a different effect on everyone, but most persons with aphasia have trouble expressing themselves or understanding things that they read or hear. If an individual suffers from gradual damage to the brain such as a certain condition that worsens over time, like a lesion to the brain such as a tumour or dementia, the symptoms will progress progressively. However, if it has been caused by an abrupt injury to the brain, like severe damage to the head or a stroke, the signs will most likely develop straight after the injury has occurred.

A person with Broca’s aphasia will struggle communicating their thoughts to others with their speech, writing and gestures being affected. This will cause major problems with simple everyday tasks such as using the phone or speaking to their family. People with Broca’s aphasia may experience:


 * Difficulty forming a sentence
 * Struggling to say certain words
 * The ability to only use basic speech such as simple nouns and verbs
 * Implementing words that make no sense into their speech

Whilst an individual with Wernicke’s aphasia will have difficulty understanding things that they hear or read. It is also possible that they experience issues understanding gestures and

pictures. This can lead to everyday behaviours such as having conversations with family, watching television, or listening to the radio becoming an issue. People with symptoms of Wernicke’s aphasia may experience:


 * Trouble understanding people talking to them


 * Trouble reading written text
 * Misunderstanding meanings of words and gestures
 * Being completely unaware of their difficulties comprehending speech and their own mistakes talking

Treatment
With regards to treatment, if the damage to the brain is slight, it may be possible to recover communication skills without the use of treatment. However, those with a more severe form of aphasia, will most likely undergo speech therapy to try and restore their language and increase their communication experiences. According to Brady et al (2016) aphasia patients who received speech and language therapy had clinically and statistically significant benefits to their functional communication when compared to aphasia patients who did not. Robey (1998) also determined that the recommended length of treatment in order to make substantial language gains is two hours per week. When viewing specifically Wernicke’s aphasia, Bakheit et al. (2007) determined that the lack of consciousness to their language impairments can substantially affect the rate therapy benefits them.

However, when looking at Broca’s aphasia, it is clear that the individual is better suited when they participate in appropriate therapy and treatment seems to be necessary in the acute period. Similar to Wernicke’s aphasia, two hours of language rehabilitation per week yield the most effective results.

Those with global aphasia are often referred to as having permanent aphasic syndrome which prohibits them from making significant language improvement and comprehension when they receive therapy. It is possible that they may maintain their gestural communication abilities which can be used as a way to communicate with people in a setting that is natural to them. With regards to global aphasia, treatment options are limited. However, the daily routines and quality of life can be improved when the individual learns to have reasonable goals for their recovery.

There is no universal treatment for aphasia due to the nature of the disorder and how different each individual case can be. It is very rare that two cases of aphasia are identical which indicates that treatment has to be provided specifically for the individual. Treatment for aphasia can range from trying to improve an individual’s functional communication to improving the accuracy of their speech. Group therapy lets individuals work on their conversation skills with other aphasia patients, where they may not be able to do that in one-to-one therapy sessions.

Effect on Mental Health
The impact of a diagnosis of aphasia can have a profound effect on an individual’s mental health. Due to effective communication being a key component of functioning day-to-day, those with aphasia may struggle with social difficulty, experience feelings of frustration and distress, and in most severe cases depression. It is estimated that around 25% of those diagnosed with aphasia are diagnosed with depression. Furthermore, the family of the individual with aphasia, according to Worral et al (2016), are at a high risk of experiencing depression. Many of the families that reach out for extra help will often describe their loved one as ‘depressed’. Those who developed aphasia due to a stroke at the front of the brain have been found to correlate with the diagnosis of depression. This is due to that part of the brain containing receptors and pathways that are responsible for certain neurochemicals that affect a person’s mood.

In addition to the emotional toll aphasia can have on an individual, it often has practical implications as well. As an example, those with aphasia may have trouble carrying out everyday tasks such as shopping which easily can cause feelings of low self-esteem and vulnerability. Furthermore, if they are unable to perform practical challenges such as read labels or follow instructions, it may lead to a lack of independence.

Many people with aphasia experience anxiety and stress upon communicating with others as they may be worried about being misunderstood or judged when trying to converse. The relationships that they had before diagnosis will be affected substantially as they will not be able to communicate with them as they once could. This often leads to feelings of anxiousness about trying to maintain these relationships and if they are the same as they were before. According to Fotiadou et al (2014), clinicians should aim to incorporate social approaches to rehabilitation and try to find ways to maintain their existing social network. Social media also seems to be key in acting as a therapeutic outlet and a different method of communication as they can stay connected to a wider network of people.

The majority of therapists who deal with clients with aphasia are used to seeing emotional issues, but most do not feel comfortable trying to counsel those who show traits of depression. Research by Simmons-Mackie et al (2011) suggested that language therapists may even avoid emotional issues during treatment, due to not feeling qualified. These are valuable chances to provide support to the individual. For most people with aphasia, their speech therapist is the person they confide in the most and who they communicate with the most often, therefore it is crucial that they are fully equipped to deal with their clients emotional needs.

Social isolation is a key factor in the development of many mental illnesses and it does not change in those with aphasia (Comer et al, 2011). Many persons with aphasia can be isolated from their community due to a lack of aphasia resources, lack of professional experience and knowledge about aphasia and adjustment to their new lifestyle. People may want to help the individual with aphasia however they often do not know what to do. This will lead to the individual with aphasia be less willing to try and interact with those around them thus leading to being more isolated and experiencing an affected mood.