Speech disorders after brain injuries were already described in antiquity, but the connections were not systematically investigated until the 19th century. The term aphasia was introduced into medicine by Armand Trousseau in 1864 .
Aphasia occurs after various illnesses ( stroke , traumatic brain injury , cerebral hemorrhage after venous thrombosis, tumors , inflammatory diseases, intoxication ) after language acquisition has been completed. They cause impairments in the individual linguistic modalities ( speaking , understanding , writing and reading ), but also in non-linguistic areas to varying degrees. Linguistic and non-verbal symptoms are combined in a characteristic way, which is why aphasia or aphasic disorders are also referred to as multimodal disorders. The Union Europäische Phoniater (UEP) defined aphasia based on concepts by Oskar Schindler as “a partial or complete loss of one or more linguistic or nonlinguistic, already trained communication skills as a result of a lesion of the brain structures for the coding and / or decoding of any messages Difficulty level, expressive or impressive, on every communication channel ”.
From aphasia as a language disorder delineate are speech disorders such as dysarthria , although speech and language disorder can also occur together. Linguistic planning disorders such as speech practice must also be distinguished .
The interdisciplinary aphasiology deals with the diagnosis and treatment of aphasia. Medical subjects involved are e.g. B. neurology , phoniatrics , further z. B. Linguistics , psychology , neurobiology , speech therapy .
Originally, aphasia referred to a complete loss of speech, while minor impairments were assigned the term dysphasia . Due to practical delimitation problems, the meaning of aphasia was expanded to include all cases of an acquired disorder.
Aphasia is classified differently by different authors (groups). In Germany, the more clinically oriented division of the Aachen School around Walter Huber and Klaus Poeck is the most widely used, not least because it is the result of a standardized diagnostic procedure , the Aachen Aphasia Test (AAT). There are four main types ("standard syndrome ") and several special forms:
|Type||Spontaneous speech||Repeat||Understanding of language||Word finding|
|Amnestic or abnormal aphasia||fluent but paraphasia||slightly impaired||slightly impaired||disturbed, paraphasic|
|Broca's aphasia||disturbed||disturbed||mostly not restricted||limited|
|Wernicke aphasia||fluent (partly logorrhea , neologisms )||disturbed||limited||limited|
These complex syndromes consist of symptom structures; they result from a cluster analysis of co-occurrences of the various symptoms . In addition to these four main types of aphasia, there are rarer special forms such as B. transcortical aphasia , which manifests itself, for example, in the fact that those affected can repeat but cannot speak freely, and conduction aphasia , which usually arises from lesions in the area of the arcuate fasciculus of the dominant hemisphere and for which there is a strong restriction in repeat when otherwise largely intact language skills is characteristic.
Another, finer classification, together with a different diagnostic method, was suggested by Leischner (see literature).
Amnestic or abnormal aphasia
Leading symptom: Difficulty finding words (difficulties in naming objects, etc.). The language is fluent and the target terms can often be paraphrased if there are problems with finding words. The short-term memory is disturbed (e.g. traumatic brain injury ).
The expressive aphasia was formerly known as "motor aphasia", halting, labored spontaneous speech with strong word-finding problems. Existing moderate disorders of speech comprehension , which can sometimes lead to misunderstandings in conversation, are often only discovered during direct testing.
The Wernicke aphasia was formerly also called "sensory aphasia". Fluent language with a lot of semantic paraphasias (confusion of words) and phonematic paraphasias (sound distortions) or neologisms (word creations). Mostly the mistakes are not noticed by those affected. Partly excessive flow of speech ( logorrhea ). Severely restricted speech understanding.
The global aphasia is the most severe form of aphasia, in which hardly loud utterances are possible and also the understanding of speech is severely disrupted. The cause is an extensive lesion that includes the motor and sensory language centers of the dominant hemisphere . Mostly it is a total myocardial infarction in the supply area of the arteria cerebri media .
Aphasia therapy includes different ways of restoring speech and other functions after a loss of speech. The aphasic disorders often have enormous psycho-social consequences. Behavioral approaches to speech therapy for aphasia include a different repertoire of techniques that are model- or symptom-oriented. Due to the various disorders / losses, several disciplines are required in therapy , including a. Speech therapy , music therapy , exercise therapy .
Forms of therapy
- Speech-to-Speech Therapy
Outpatient aphasia therapy usually takes place in speech therapy practices (e.g. with speech therapists , clinical speech scientists, etc.). In some cases there is also the option of carrying out the treatment in an outpatient therapy center or in a clinic with outpatient rehabilitation.
- Music therapy
Music therapy for aphasia can either focus on improving language skills or on the secondary consequences (trauma processing, emotional problems, social isolation, etc.).
- Therapy with the help of media
Computer programs support the work of the therapy. Visually, they replace the presentation of picture cards by the therapist, whereby pictures / terms have to be assigned. The audio support helps to hear and repeat sounds, words and sentences in any order or in sequence. The help through videos shows close-ups of mouth and tongue movements. During inpatient stays, media can be used particularly intensively.
- Teletherapy (intensive)
Therapeutically supervised teletherapy is a special form of computer-aided therapy for high-frequency care of patients after inpatient rehabilitation. Telematics enables the therapist to be in contact with the patient on a daily basis - even over a greater distance. The aim is to bring patients to a higher functional level of performance faster and more sustainably with daily and several times a day therapy units. The exercises (homework) are carried out according to prescription and under the supervision (control) of a therapist. The therapy exercises are transmitted by radio to the therapy station (patient loan equipment) and transferred back to the therapist after the units have been completed. The therapist evaluates the results and adapts the exercises. Indications: neurology, orthopedics, cardiology.
As before, too few treatment hours are offered for aphasic patients in Germany. According to a meta-study by Bhogal and colleagues (2003), disorder-specific therapy must be carried out in a highly intensive manner. Only if more than 5–10 therapy hours are offered per week can one hope for progress in linguistic performance. Such intensive treatment cannot be provided in a resident setting. Only through the use of computer-aided procedures can the intensity be increased in such a way that the target values resulting from the specifications of the meta-study can be achieved. In fact, the teletherapy study was able to show for the first time that the therapy frequency is increased by supervised teletherapy without loss of quality so that patients can demonstrably benefit from it. Tele-rehab aftercare has been available since 2017 .
Chances of success
The success of the therapy depends on many different factors; in old age regeneration processes take place physiologically more slowly. Starting therapy as early as possible is always desirable. The frequency of therapy and the availability of technical aids and the use of media are also important. Sufficient physical activity, lots of practical speaking and even singing are important. In any case, the decisive factor for success is the committed cooperation of the doctor, speech therapist, movement therapist, family and friends.
Self-help groups make an important contribution to accompanying those affected and their relatives. In the Federal Association of Rehabilitation of Aphasics e. V. are regional associations that offer "help for self-help" with local groups in different regions.
Visual scene display (VSD)
Visual scenes consist of text boxes and personal pictures. They are used to hold personal conversations and are intended to make it easier for the person concerned to share personal content.
With Talking Mats, symbols of activities and objects are placed on a mat. The aphasic sort the symbols under so-called option cards. These represent the possible answers to a question, such as yes or no, good or bad. This gives the person concerned the opportunity to communicate, think about their own life and plan their own future. It can be used by specialists (for example in occupational therapy or speech therapy) or in the private sphere.
- Agnosia (inability to recognize and interpret what has been perceived in preserved sensory perceptions)
- Agraphy (neurologically related inability to write)
- Akalkulia (inability to calculate)
- Alexia (neurological inability to read)
- Apraxia (disruption of voluntary, purposeful and orderly movements)
- clinical neuropsychology
- Cognitive dysphasia (language processing disorders due to impaired attention, memory and executive functions)
- Schizophasia ("word salad" as an extreme formal thought disorder in schizophrenia)
- Language center
- E. Rupp, S.Sünderhauf, J.Tesak: Teletherapy for aphasia - results of a study by the Federal Ministry for Research and Education . Presentation at the 7th annual conference of the Society for Aphasia Research and Treatment (GAB), Idstein (Taunus), 1. – 3. November 2007, poster
- B. Seewald, E. Rupp, W. Schupp: Computer-assisted aphasia therapy: The concept of EvoCare therapy . Speech Therapy Forum, March 2004
- Anton Leischner: Aphasia and language development disorders: Clinic and treatment. 2nd Edition. Thieme, Stuttgart 1987, ISBN 3-13-573902-3 .
- Richard J. Brunner : Studies on the linguistic structure of spontaneous speech in aphasia patients and other patients with defined brain lesions against the background of the historical context of aphasia research . Ulm University, 1989
- Gerhard Blanken (Hrsg.): Introduction to linguistic aphasiology. Theory and practice. HochschulVerlag, Freiburg 1991, ISBN 3-8107-5055-7 .
- Luise Lutz: Understanding the silence: About aphasia. 3. Edition. Springer, Berlin 2004, ISBN 3-540-20470-9 .
- Meike Schöler, Holger Grötzbach: Aphasia: Ways out of the language jungle. 2nd Edition. Springer, Berlin 2004, ISBN 3-540-20469-5 .
- Meike Wehmeyer, Holger Grötzbach: Aphasia. Ways out of the language jungle . Springer, 2006, ISBN 978-3-540-34139-0 .
- Jürgen Tesak: Introduction to Aphasiology. 2nd updated edition. Thieme, Stuttgart / New York 2006, ISBN 3-13-111112-7 .
- Jürgen Tesak: Basics of aphasia therapy . Schulz-Kirchner 2007, ISBN 3-8248-0444-1 .
- Walter Huber, Springer, Klaus Poeck: Clinic and rehabilitation of aphasia. An introduction for therapists, relatives and those affected . Thieme, Stuttgart 2006, ISBN 978-3-13-118441-2 .
- Pohlmann, Mareike: The aphasia self-help group: theory and practice - from the founding idea to implementation . VDM, Saarbrücken 2007, ISBN 978-3-8364-1377-0 .
- Luise Lutz: MODAK - modality activation in aphasia therapy . Springer, 2009, ISBN 978-3-540-89538-1 .
- Sibylle Wahmhoff: Inner speaking. Psycholinguistic investigation on aphasic patients . Beltz, Weinheim / Basel 1980, ISBN 3-407-58087-8 , (= Pragmalinguistics , Volume 23, also dissertation under the title: Aphasiological studies on inner speech at the Philosophical Faculty of the University of Freiburg im Breisgau 1978).
- Michael Hagner : Aphasia. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. De Gruyter, Berlin / New York 2005, ISBN 3-11-015714-4 , pp. 74 f.
- Elke Weißgärber: Living with Aphasia , Spiess, V (1999), ISBN 978-3-89166-986-0
- Günter Wirth: Speech disorders, speech disorders, children's hearing disorders . ISBN 3-7691-1137-0 , p. 568
- Arnd Krüger : History of movement therapy, in: Preventive medicine . Springer, Heidelberg Loseblatt Collection 1999, 07.06, pp. 1–22.
- Homepage of the German Federal Association for Speech Therapy e. V.
- German Music Therapy Society
- Kassel theses on music therapy
- Sünderhauf, S., Rupp, E., Tesak, J .: Supervised teletherapy for aphasia: results of a BMBF study. Logopädie Forum, No. 1, 2008, accessed online: July 17, 2018 (  ) /
- Ludwig Maximilians University of Munich Dissertation, E. Rupp, July 2, 2010: Advances in the treatment and diagnosis of central neurogenic language disorders
- Requirements of the German pension insurance for tele-rehab aftercare, information for rehab facilities, accessed on July 17, 2018 (  ) /
- The aphasia self-help movement in Germany: A partner of speech therapy . In: Forum Logopädie , 2004
- Jump up David R. Beukelman, Karen Hux, Aimee Dietz, Miechelle McKelvey, Kristy Weissling: Using Visual Scene Displays as Communication Support Options for People with Chronic, Severe Aphasia: A Summary of AAC Research and Future Research Directions . In: Augmentative and Alternative Communication . tape 31 , no. 3 , July 3, 2015, ISSN 0743-4618 , p. 234–245 , doi : 10.3109 / 07434618.2015.1052152 ( tandfonline.com [accessed May 9, 2019]).
- Joan Murphy, Sally Boa: Using the WHO-ICF with Talking Mats to Enable Adults with Long-term Communication Difficulties to Participate in Goal Setting . In: Augmentative and Alternative Communication . tape 28 , no. 1 , 2012, ISSN 0743-4618 , p. 52-60 , doi : 10.3109 / 07434618.2011.653828 ( tandfonline.com [accessed May 9, 2019]).
- E. Rupp, S.Sünderhauf, J.Tesak: Teletherapy for aphasia - results of a study by the Federal Ministry for Research and Education. Presentation at the 7th annual conference of the Society for Aphasia Research and Treatment (GAB), Idstein (Taunus), 1. – 3. November 2007, Internet access: July 17, 2018 (  ) /