Global Aphasia: symptoms, causes and treatment

Imagine that we woke up one morning, or after suffering an accident, and suddenly we find that everyone starts talking in a strange language . The worst of all is that it is familiar, but we do not understand what they want to tell us.

We try to communicate, but we realize that we do not say what we want. The others insist, they look at us and they keep talking to us even though we do not understand what they are trying to communicate to us. And we also can not make ourselves understood. Although it may seem like a science fiction movie, is what people who suffer from global aphasia live .

The concept of aphasia

Aphasias are the set of speech and language disorders caused by brain injury , which occur in adults with a language that had previously been consolidated.

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This type of disorders can affect very different aspects of language, among which we can find verbal fluency, ability to articulate, understanding of language, repetition, grammar, literacy or denomination. The different aspects affected will depend on the injured area.

Broadly speaking, one of the main classifications of these disorders is the one proposed by Goodglas and Kaplan, in which they are divided into different types depending on whether or not they have a good level of verbal fluency, comprehension and repeatability. The best known are Broca's aphasia and Wernicke's aphasia, each with its own damaged and preserved aspects. But nevertheless, there is a type of aphasia in which there are alterations in all areas of language, known as global aphasia .

Global aphasia: main characteristics

Global aphasia is the most severe form of aphasia , because all or a large part of the different aspects of the language are affected and altered by a brain injury.

The people who suffer from it have severe difficulties both in comprehension and in oral expression and generally also written. Similarly, subjects affected by global aphasia have a poor capacity for imitation. If they are capable of emitting oral language, they frequently use a telegraphic and stereotyped area, with few possibilities to establish communication through verbal language. They can also come to understand certain words or verbs.

In addition to this they tend to be unable to write or to limit themselves to an automatism such as the ability to sign. Reading is also affected. It is possible that at the written level they can reproduce a text by copying it, although guided by the forms and not by their content. The ability to articulate, the verbal fluency and the use of the lexicon and grammar are severely diminished and impaired .

Because the lesion that causes global aphasia is massive, other symptoms usually appear such as ideomotor apraxia (they do not know how to use objects for their authentic purpose) and ideatory (they present inability to follow sequences of action in the correct order), hemiplegia or paralysis of half body. Global aphasia per se does not cause any difficulty on a cognitive level, with intelligence and most executive functions being preserved. However, it is possible that they present cognitive and intellectual difficulties due to neuronal damage, limiting them even more.

Causes

The causes of aphasia, as we have commented previously, are due to the presence of injuries in the areas that control the language , their connections to each other or the connections with other brain nuclei that allow linguistic information to be integrated with the motor, or that have been destroyed.

In the case of global aphasia, it is necessary that major damages occur in the whole of the left hemisphere, in which the areas that process the language are found, or in the area surrounding the perisylvian cortex. They are damaged or disconnected from the rest of the brain, both Broca's area and Wernicke's area, their connections with each other or connections with other areas that allow the processing or execution of speech.

What exactly causes these injuries can vary greatly, ranging from head trauma or lacerations to strokes, brain tumors or neurodegenerative diseases.

Difficulties caused by this disorder

The consequences of global aphasia and the symptoms it causes are very limiting for the person suffering from it . As social beings that we are, our life is structured based on the assumption that we are capable of communicating. That is why not being able to express oneself can cause

At the social level, global aphasia greatly hinders the possibility of establishing affective relationships with our peers.Although his social skills and his interest in establishing contact with others are preserved, the patient has severe difficulties to be understood unless he has alternative methods. It is common that before the injury could communicate orally correctly, the environment go to try to communicate with shouting (interpreting that he has lost hearing) or interpreted as lack of interest lack of communication by the subject. It is important to understand that the subject hears perfectly, being its difficulty to interpret the language.

Laboriously this problem also generates difficulties, as well as academically. Learning, at least by the usual means, is complicated unless adapted strategies are used, such as the use of pictograms or the use of physical procedures.

At the level of the individual, this disorder can be lived with real dread . After all, the subject is suddenly unable to understand what they are trying to tell him or to make himself understood through the usual mechanisms, and unsuccessful attempts by him and the environment to reestablish oral communication can end up causing high anxiety and depression to the individual. The subject can feel isolated, locked inside himself, until the treatment begins to be effective or alternative forms of communication are found.

Possible treatments

The treatment to be used in case of global aphasia focuses on the recovery of functions altered by brain injury and / or the adoption or learning of alternative communication methods. It is also essential psychological and social support that allow the patient and their environment to understand and accompany the patient in the process that is suffering.

It is important to keep in mind that many brain injuries can evolve in ways that reduce damage. This is what happens, for example, when there is a trauma or a stroke, in which the blood can drown part of the brain connections but leaves an area of ​​ischemic penumbra that can recover from the accident. In this way, many patients can see how the effects of the lesion progressively diminish. In some cases, this may cause a global aphasia to be more localized.

The use of language therapy and speech therapy is common, being used to improve and optimize the linguistic competence that the affected person could maintain. The use of augmentative language techniques, or the use of visual material as pictograms with which the patient can communicate in an alternative way, is also frequent.

It is important to stimulate the patient without overloading him, so that he can gradually relearn and polishing skills without getting saturated. Psychoeducation is very important for both the patient and the environment, since it is necessary to understand that cognitive abilities are (unless there are other affectations beyond global aphasia) preserved and the difficulties of aphasia for the subject.

Bibliographic references:

• Belloch, Sandín and Ramos (2008). Manual of Psychopathology. Madrid. McGraw-Hill. (Vol 1 and 2) Revised edition.
• Goodglass, H. & Kaplan, E. (1986). The evaluation of aphasia and related disorders. Ed. Panamericana Medical. Madrid.
• Daroff, R.B .; Jankovic, J .; Mazziotta, J.C. & Pomeroy, S.K. (2016) ,. Bradley's Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; chap 14.
• Santos, J.L. (2012). Psychopathology. CEDE Preparation Manual PIR, 01. CEDE. Madrid.

Aphasia: At a Loss for Words (April 2024).