Aphasia: Types, Causes, Brain Areas, and Treatment Strategies

Define aphasia

An acquired language disorder affecting speaking, comprehension, reading, writing, and word retrieval.

Domains affected by aphasia

Speaking, auditory comprehension, reading, writing, word retrieval, syntax, pragmatics.

Aphasia impact on identity

Alters social roles, independence, relationships; affects self-concept and life participation.

Annual incidence of aphasia in U.S.

~180,000 new cases per year.

Why prevalence varies

Studies differ in criteria, chronicity, sample populations, access to care.

% who know aphasia is a language disorder

Only 7-9%.

Causes of aphasia

Stroke, TBI, tumor, infection, surgery, neurodegenerative disease (PPA).

Crossed aphasia

Aphasia from right-hemisphere damage in a strongly right-handed person.

Fluent vs nonfluent speech

Fluent = normal rate/prosody; Nonfluent = effortful, agrammatic, halting.

Semantic paraphasia

Meaning-based error (e.g., "dog" → "cat").

Phonemic paraphasia

Sound-based error (e.g., "dog" → "tog").

Neologism

Nonword substitution (e.g., "frandle").

Circumlocution

Talking around a word (e.g., "the thing you write with" for pen).

Perseveration

Repeating a previous response.

Impairment vs person-centered treatment

Impairment = language deficits; Person-centered = identity, participation, goals.

Broca's area function

Speech production, syntax, motor planning.

Wernicke's area function

Comprehension and lexical-semantic access.

Artery most linked to aphasia

Left Middle Cerebral Artery (MCA).

ACA territory

Medial frontal/parietal; leg motor-sensory.

MCA territory

Lateral frontal, parietal, temporal; language.

PCA territory

Occipital and inferior temporal; reading and vision.

Dual stream model

Ventral "what" = meaning; Dorsal "how" = repetition, phonology.

Cognitive skills linked to language

Attention, executive function, working memory, processing speed.

Poor repetition + good comprehension

Conduction aphasia.

Lesion size vs location

Size = severity; Location = type of aphasia.

Broca's aphasia

Nonfluent, agrammatic, good comprehension, poor repetition.

Global aphasia

Severe deficits in all modalities.

Transcortical motor aphasia

Nonfluent with GOOD repetition.

Broca's features

Agrammatism, effortful speech, impaired repetition, good comprehension.

Global lesion

Large perisylvian lesion (L MCA).

TMA vs Broca's

TMA has preserved repetition.

Nonfluent cognitive symptoms

Reduced initiation, apraxia of speech, working memory deficits.

Case: "boy... cookie... fall..."

Broca's aphasia (agrammatic).

Dialect vs disorder

Difference = dialect rule; Disorder = violates all linguistic systems.

Multilingual assessment complexity

Different proficiencies, premorbid language use, code-switching.

Importance of language history

Determines baseline, dominance, expectations.

Translation vs validation

Tests must be normed & culturally validated, not just translated.

Wernicke's aphasia

Fluent, empty speech; poor comprehension; poor repetition.

Conduction aphasia

Fluent, good comprehension, poor repetition.

Transcortical sensory aphasia

Fluent, poor comprehension, GOOD repetition.

Wernicke features

Empty speech, jargon, paraphasias, poor comprehension.

Why anosognosia occurs

Self-monitoring disruption from posterior temporal lesion.

SLP role acute care

Screening, education, early assessment, care planning.

Spontaneous recovery peak

First 3 months post-stroke.

Logopenic PPA

Word-finding + repetition deficits.

NFV PPA

Agrammatism/apraxia of speech.

Semantic PPA

Loss of word meaning; surface dyslexia.

PPA vs stroke aphasia

PPA is progressive; stroke aphasia is sudden.

Core features of PPA variants

Semantic = meaning loss; NFV = grammar/AOS; Logopenic = repetition + phonology.

Why reassess PPA regularly

Symptoms change; update goals/treatment.

RAISE framework

Supports collaboration, education, and functional planning.

ICF model

Framework addressing impairment, activity, participation, environment, personal factors.

A-FROM domains

Participation, personal identity, severity of aphasia, environment.

ALA assessment

Measures QOL, participation, environmental barriers.

Impairment vs participation assessment

Impairment = naming/comp; Participation = real-life communication.

WAB cutoff

93.8 AQ.

AQ vs LQ vs CQ

AQ = core language; LQ = AQ + reading/writing; CQ = LQ + praxis/visuospatial.

BNT measures

Confrontation naming.

Why CLQT includes visuospatial

Language + cognition interact.

PALPA purpose

Tests psycholinguistic processes (phonology/semantics/reading routes).

Low repetition + high comprehension

Conduction aphasia OR Logopenic PPA.

ALFA interpretation

Medication label difficulty suggests exec/reading struggles; check writing preserved.

LPAA core values

Life participation, all affected included, personal/environment factors, measurable gains, lifespan support.

FOURC model

Choose goal → Create solutions → Collaborate → Complete/continue.

Reciprocal scaffolding

Client teaches clinician; boosts communication + competence.

Meaningful context treatment

Treatment embedded in real-life situations.

Stimulation approach

Hierarchical language stimulation; meaningful tasks.

RET

Treatment for expanding utterances through elaboration + repetition.

VNeST target

Verb networks (agents/patients/arguments).

PCA target

Phonological components of words.

SFA purpose

Strengthens semantic networks → improves naming.

Expert trap

Clinician assumes they know best; overlooks client priorities.

Collaborative goal setting

Increases motivation, autonomy, relevance.

GAS levels

+2 much better; +1 better; 0 expected; -1 less; -2 much less.

Sample restaurant GAS goal

0 = orders 1-2 items with mod cues; +2 = orders full meal independently.

Cue types

Semantic, phonemic, orthographic, gestural, tactile.

Best first cue type

Semantic cue → preserves independence.

Cue hierarchy example

Max = model; Mod = semantic cue; Min = phonemic cue; Independent attempt.

Discourse analysis

Evaluates connected speech; sensitive to subtle changes.

Functional communication assessments

CADL, FACS, CETI.

CPIB

Measure of participation impact.

Participation vs impairment goals

Participation = life roles; Impairment = linguistic accuracy.