1 APHASIA CASE STUDY Introduction One of the most significant and heavily studied neurological disorders that affect the linguistic skillsof an individual is Aphasia. Damage to specific brain regions owing to an accident or trauma is identified as the primary cause behind aphasia. While chiefly a brain related disorder, the main characteristic feature of aphasia is the patient’s inability to formulate orcomprehend language. Aphasia is not delimited by age and can be identified in individuals across all stages of lifespan and in all demographic conditions (Stahl & Van Lancker Sidtis, 2015). In this case study report, the condition of a 72 year old aphasic is identified and analysed through a series of study data that has been generated after multiple standardised testing of his condition. Literature review According to Damasio (1992), aphasia is defined as the inability to formulate or comprehend language owing to some form of damage to specific brain regions.Aphasic patients have difficulty with forms of verbal expression, auditory comprehension, written expression, reading comprehension, reading aloud and gesturing. Some common side effects of aphasia also include Dysarthria (slurred or slow speech) and apraxia of speech (cognitive – motor disorder resulting in non production of speech).Cruice et al. (2003) asserts that aphasia impartssignificantnegativeimpactonapatient’swellbeing,independence,social participation as well as the overall quality of life, often associating the patients with severe instances of depression and anxiety disorders. The also highlight some specific characteristics associated with aphasia which include negative impacts on daily performance (like talking on the phone, reading a magazine, interacting with people in general), problems performing basic family roles, management of household and leisure activities as well as suffering from instances of distress, isolation lack of self esteem and depression.
2 APHASIA CASE STUDY Papathanasiou, Coppens and Potagas (2013, Ch. 2) haveidentified and highlighted eight different types of aphasia. They have classified each type of aphasia into two categories namely fluent and non fluent, and indicated which aspects from either comprehension, repetition and naming are unaffected by these aphasia types. The four types of aphasia under the nonfluent category include Global, Broca’s, Motor transcortical and Mixed transcortical aphasia. Under the fluent category, the four types of aphasia are Wernicke’s Sensory transcortical,conductionand anomic.Comprehensionisretainedin bothBroca’sand conduction aphasia, repetition is retained in mixed and sensory transcortical aphasia, whereas both are retained in motor and anomic aphasia. Data Analysis The patient in consideration is 71 year old and suffered embolic infarct in the left middle cerebral artery secondary to infective endocarditis. The patient suffers from aphasia as well as right hemiplegia, which means that he is able to walk but his right arm is not functional. Initial diagnosis indicated that the patient suffered fromsevere expressive aphasia where he had almost no spoken outputeven though his comprehension was well preserved. The patient is a monolingual English speaker and worked as a typesetter before the stroke. Post retirements he lives with his wife and dog and loves to read, browse the internet and walking his dog. His interests are a clear indicator of the fact that in order to perform effective assessment of his condition, elements ofWAB-R test along with pyramids and palm trees, Comprehensive Aphasia Test (CAT) (Howard, Swinburn & Porter, 2010) as well as psycholinguistic assessments of language processing in Aphasia. For all the tests, the patient displayed more or less mixed results with a few instances where the patient performed significantly above the cut off level whereas in others he was mostly unproductive. In most of the tasks that required comprehension (spoken word, written
3 APHASIA CASE STUDY word and sentence comprehension), the patient’s performance was decent and showed low to no levels of discrepancy. However in most of the production tasks (spoken picture naming, word fluency, written picture naming) which also included reading, repetition, writing (functionalassessment),thepatientperformedmostlypoorlywithmultiplecasesof unproductive output. The data collected from the patient indicates towards a few specific points. Firstly, the patient has problems withspeech and basic language productionbut has almost no problem withspeechandlanguagecomprehension.Evenduringtheinstancesofhisspeech production, he was nonfluent and the little that he was able to produce was effortful. Same was the case with repetition. These are clear indicators of the condition of Broca’s aphasia. From acognitive neuropsychology approach (Ellis & Young, 2013), the patient’s case can be properly justified based on the reports of his medical condition. As the medical report highlights, the patient had suffered head trauma (stroke), more specifically known as embolic infarct (Roller, 1982). The condition happens when a blood clot happens at one part of the body and travels to the brain via the bloodstream and can result in a stroke by blocking a major artery, in the patient’s case which happened in the left middle cerebral artery. This was identified as the primary cause behind the stroke and has resulted in the patient suffering from aphasia. One key approach that is relevant in this scenario is the use of single case studies alongside dissociation to study and test existing theories of cognitive functions (Maher, 2017). This was exemplified in the case of the patient where it was highlighted from the studies and standardised tests thathis linguistic and meta linguistic abilities displayed certain key traits of general lacking and deviation from the norm. His speech production was the most affected area indicating that the case of broca’s aphasia is the one the patient can be diagnosed with.
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5 APHASIA CASE STUDY Conclusion Living with Aphasia can be a tough undertaking for most people where the daily functions suffer major setbacks in terms of performance. Communication in general is the one area that is most significantly affected in most patients. Given that communication is one of the most important aspect of daily life, aphasics suffer a lot when this factor is negatively affected. Therefore, it is important to properly diagnose and prepare for a sound rehabilitation plan for the patient in order to ease his process of transmission to a more normalised lifestyle.
6 APHASIA CASE STUDY References Cruice, M., Worrall, L., Hickson, L., & Murison, R. (2003). Finding a focus for quality of life with aphasia: Social and emotional health, and psychological well- being.Aphasiology,17(4), 333-353. Damasio, A.R. (February 1992). "Aphasia".N Engl J Med. 326 (8): 531–9. doi:10.1056/NEJM199202203260806. PMID 1732792 Ellis, A. W., & Young, A. W. (2013).Human cognitive neuropsychology: A textbook with readings. Psychology Press. Howard, D., Swinburn, K., & Porter, G. (2010). Putting the CAT out: What the Comprehensive Aphasia Test has to offer.Aphasiology,24(1), 56-74. Maher, L. M. (2017). Broca’s Aphasia and Grammatical Processing.The Oxford Handbook of Aphasia and Language Disorders, 145-160. Papathanasiou, I., Coppens, P., & Potagas, C. (2013). Aphasia and related neurogenic communication disorders. MA: Jones & Barlett Learning Roller, R. L. (1982). Recurrent embolic cerebral infarction and anticoagulation.Neurology,32(3), 283-283. Stahl, B., & Van Lancker Sidtis, D. (2015). Tapping into neural resources of communication: formulaic language in aphasia therapy.Frontiers in psychology,6, 1526.