Aphasia

Aphasia is a language disorder that can result from anything that involves the brain such as stroke, head injury, virus, infection, tumor or seizures. It is usually the result of damage to the left side of the brain, which is the side that controls speech and language. It affects a person's ability to use language, not his/her thinking or intelligence. Language is not just talking -- it includes both understanding the words you hear or read, as well as writing. Although we usually think of aphasia with adults who have had a stroke, children who lose the language that they have already developed are considered aphasic, too. School-aged children affected by aphasia oftentimes have a more difficult time than adults because of the overwhelming language demands made on them in school. These may include listening to a lecture, answering questions, reading, taking notes and writing papers. Aphasia can affect listening, talking, reading and writing in any combination and at different levels of severity.

AUDITORY COMPREHENSION
Auditory comprehension means how well you understand what you hear. The child or adolescent with aphasia may have trouble with auditory comprehension. The words that he / she hears don't make sense. He may only understand part of what is said to him; he may "catch" a few scattered words or a phrase. Other children may have trouble in conversation or have difficulty trying to follow when several people are talking. It is also difficult for the aphasic child/adolescent to understand people when they talk too rapidly. Most of the time, understanding or processing information is slower than normal, so that if he is listening to a conversation or lecture, he may still be trying to process the first sentence said to him while the person speaking has already gone on to the next sentence, or even topic. Sometimes it may seem like the child or adolescent does understand when he really does not. For example, he may nod and smile frequently when others talk or ask questions, appearing to comprehend the language. He may actually be responding to what's going on around him or to facial expressions and tone of voice.

VERBAL EXPRESSION
Verbal expression is how we express our ideas, thoughts and needs through language. Aphasia can affect the child or adolescent's ability to speak in a number of ways. Sometimes, he / she may be non-verbal -- unable to speak at all. Or the words may not make any sense. The child may find it difficult to think of the word he wants to say or may say one word when he means another. He may speak only in single words or short phrases. If he is speaking in sentences, the words may be in the wrong order or grammatically incorrect. Speech may be "empty," with a lot of vague words but not specific nouns or verbs. Usually, the easiest words for the aphasic to say are the ones that come automatically, like his name, "Fine" or "Okay" in response to "How are you?," counting or saying the days of the week.

READING COMPREHENSION
Reading comprehension includes how well you understand the words you read. It is not how well you can read aloud. The child or adolescent may have difficulty getting meaning from the words he / she reads. He may only recognize very familiar words such as his name or family member's names. He may understand one sentence at a time, but not a whole paragraph. As with auditory comprehension, sometimes it may appear that the child is understanding what he is reading, but may only be looking at the words or using extra cues from pictures rather than comprehending the words on the page. For the young child who acquires aphasia during the period when children are learning to read and write, reading comprehension must continuously be monitored. Initially, reading and writing are spatial / perceptual tasks, controlled by the right side of the brain. Over time, this shifts to the left hemisphere when reading and writing become language functions.

WRITING
Writing is an expressive language ability and can also be affected by aphasia. In many cases, if the child / adolescent has a paralysis or weakness of the right side and is right handed, he / she may now have to write with his / her left hand. The aphasia, however, is what affects the ability to spell and formulate a written phrase or sentence. Sometimes the child may be able to copy words but not write them spontaneously or he may be able to write single words but be unable to put them together to form a sentence. As stated earlier, with the child who is just learning to write and spell, this skill will later become a language function and should be monitored for any difficulty with spelling or formulation of phrases and sentences.

SUGGESTIONS FOR COMMUNICATION
Since every aphasic is different and every child is at a different level of development, it is important to know what the child /a dolescent's skills were before he / she acquired his / her aphasia. There are some general suggestions that can be followed to help with communication in basic conversation. However, for more complex situations such as classroom learning, individualized plans should be made by a speech-language pathologist to assist with learning.

AUDITORY COMPREHENSION

  • First of all, create the best environment possible. If the television is on, turn it off. It is much easier for the child to understand what is being said if there are no distractions or background noise.
  • Talk face to face.
  • Speak at a normal volume - don't shout.
  • Be sure you have the child / adolescent's attention before beginning an instruction.
  • Give the child plenty of time to understand your words.
  • Pause often between sentences to "let the words get through."
  • Use short sentences containing one idea rather than a lengthy, run-on sentence. Give one-part commands one at a time, rather than a two- or three-part direction.
  • Use all the visual cues you can. Use a gesture along with a verbal command, or show pictures of the things you're talking about.
  • Remember that even though words may not be understood, facial expressions and tone of voice may be. Highly emotional issues should not be discussed in the child or adolescent's presence. This is particularly true if he is able to pick out fragments of a sentence that would be misunderstood out of context.

VERBAL EXPRESSION

  • Give the child / adolescent plenty of time to respond.
  • Try not to talk for or interrupt the child unless he gets frustrated or asks for help.
  • If the child cannot think of the word he wants to say, encourage him to use another word, describe what he is talking about, point out what he is talking about, gesture or even draw or write, if possible.
  • Avoid frustrating him or her with such remarks as "You said it yesterday. You can say it again." Oftentimes, he may not be able to say something he said even minutes before.
  • If the child or adolescent attempts to express something and you cannot understand, ask yes or no questions or clarifying questions until he lets you know that you have understood. If this fails, say to him, "I'm sorry, but I can't understand. Maybe we can try again later."

In general, attempt communication when the child or adolescent is fresh or feeling good. Communication, language will be worse if he is tired, so don't expect as much out of him until he is rested.

Aphasia is a very complex disorder. The more that the family, friends and teachers know and understand about aphasia, the more effectively they will be able to communicate.