Aphasia: what does it mean?

Three years ago, after my stroke and six and a half weeks in BIRU (Brain Injury Rehabilitation Unit), I received a release report which said I had suffered “very dense global aphasia (receptive and expressive)”. Wikipaedia says that global aphasia is a “severe form of nonfluent aphasia that affects both receptive and expressive language skills”, and: 

This type of aphasia often results from a large lesion of the left perisylvian cortex and is associated with damage to Broca's area, Wernicke's area, and insular regions which are associated with aspects of language. Global aphasia profoundly impairs oral and written language production as well as auditory and written comprehension, yet a person with global aphasia may still be able to express themselves through facial expressions, gestures and intonation. 

National Aphasia Association says that global aphasia is the most severe form of aphasia, and that

[p]eople with global aphasia cannot speak many words and sometimes don’t understand speech. They cannot read or write. People may have global aphasia for a short period of time following a brain injury or stroke, and then move into a different type of aphasia as their brain health begins to improve. 

 

I knew how that felt. That had hit me after my brain aneurysm surgery, and now, three years later, sometimes I feel I can speak very well, but other times I forget words, feel far too tired.

So what are the other different types of aphasia? Broca’s, Wernicke’s, anomic and primary progressive are the types listed other than global. I read an article very recently from NAA which was advertised on their Facebook page as “beginning a series, discussing famous people with aphasia”. Ralph Waldo Emerson was their first, and I was intrigued.

Over the last couple of years I’ve included a few quotes from Emerson on the Reibus website quotes page. Emerson had lived from 1803 to 1882. I enjoyed what he wrote and what I quoted from him. He seemed so thoughtful. Back then I didn’t have any knowledge about Emerson having aphasia, until I read the NAA article. 

In 2010 Ronaldo A. Bosco, ‎Glen M. Johnson and ‎Joel Myerson put together the Collected Works of Ralph Waldo Emerson, Volume VIII: Letters and Social Aims. In the introduction Bosco said about Emerson’s stroke that:

Albert J von Frank identifies Emerson’s condition as ‘Broca’s aphasia’, a form of non-fluent aphasia known in Emerson’s time to be caused by a stroke, and specifically characterized today by the sufferer’s inability to speak  more than occasional short phrases which come slowly and may or may not be meaningful or appropriate to the situation in which they are used.

I looked further at other people who have suffered aphasia.

In 2013, Maria Konnikova wrote an article for Scientific American entitled The man who couldn t speak and how he revolutionized psychology. This was about a 30 year old person, Louis Victor Leborgne. Konnikova started her article by saying that

Pierre Paul Broca

When he was 30 years old, Louis Victor Leborgne lost the ability to speak—or speak in any matter that made any sort of sense. Upon being admitted to Bicêtre, a suburban Paris hospital that specialized in mental illness, he could utter only a single syllable: Tan. That syllable came with expressive hand gestures and varying pitch and inflection, to be sure. But it was the only syllable Leborgne could pronounce. By the time he arrived at the hospital, he had been unable to speak properly for some two to three months. And even though his family thought the condition might be temporary—he had, after all, been dealing with epilepsy successfully for many years—he would remain there until his death, 21 years later. 

After 17 years in the institution, Leborgne met a doctor, French man Pierre Paul Broca, who became interested in what he saw in Leborgne. He labelled Leborgne’s loss of articulated language as “aphémie, or aphimia” – which is now known as Broca’s aphasia.

I found a blogsite, StrokeNet Message Board, of stroke survivors who had been asked who had anomic aphasia. Lydia Cevedo, who started this blog in 2011, said:

I have been diagnosed with Anomic Aphasia and yes, I will probably have it the rest of my life. At least it is mild. There are things I can do to cope, like the idea Sam and Logan had of putting the names of things I son't [sic] have words for on them around the house. That will help me, when I am speaking, to identify objects "properly" and can help to remove frustrations on everybody's parts. I can also fall back on gestures and teling [sic] one what the thing does or what it is used for when I can't find the word to name it. There are also audio books instead of reading, as I have some minor problems with that. Sam also suggested he could read to me.

The respondents described their symptoms as very close to what I now suffer. Yes, I started with global, and as I “recover” I have an ongoing disability with anomic – possibly for the rest of my life.

Wernicke’s aphasia is also called fluent aphasia. On You Tube I watched a video with a discussion with Byron Peterson, a stroke survivor with fluent aphasia. He had been interviewed by Megan Sutton, and was considered to “speak with typically effortless speech with impaired meaning and poor comprehension”. Byron’s story was told by his wife, Donna on the TactusTherapy website. She wrote

In the first six months, Byron’s speech was mostly “word salad” – a mix of nonsense words typical of Wernicke’s aphasia. If I could hear two or three real words in a sentence, I was elated. He didn’t understand most of what I said, so we communicated through gestures and drawing. Soon Byron’s speech started including more swear words, even though this was not how he normally spoke…  Fortunately, the swearing soon subsided. Then Byron’s speech started to include more substitutions. For a long time whenever Byron could not say or find a word, he said “the leg.” The first two years, he had difficulty walking due to reduced feeling in his right leg. As his leg returned to normal, his speech substitution became “the hand,” perhaps because he has 3 numb fingers in his right hand. To this day it is still “the hand” or “the hand of the hand”.

If you would like more information, read the full story in the Tactus Therapy website, linked above.

Articles I looked through for primary progressive aphasia laid PPA with Alzheimers and dementia in older people. The University of California, San Fransisco, said in their report that

Primary progressive aphasia (PPA) is caused by degeneration in the parts of the brain that control speech and language (the left, or ‘dominant,’ side of the brain in the frontal, temporal and parietal regions). This type of aphasia begins gradually, with speech or language symptoms that will vary depending on the brain areas affected by the disease. For example, in one type of PPA, people may initially have trouble producing speech, or articulating, whereas in another variant, word-finding and comprehension problems are more pronounced. PPA has three variants: nonfluent/agrammatic, logopenic and semantic. These syndromes result from a variety of underlying diseases, but frontotemporal lobar degeneration (FTLD) (both tau and TDP-43 subtypes) or Alzheimer’s disease are most often the cause.

The Journal of Dementia Care in 2016 had an article written by Jane Twigg, supported by Jenny La Fontaine. Twigg had earlier had PPA, but it was ongoing and now called progressive non-fluent aphasia (PNFA). If you suffer from PPA or have had PNFA diagnosed, read this to see if you can find help. 

There are many people whose stroke never seems to be mentioned with aphasia in articles, but they suffered much after their stroke. Russell Gilbert was a very funny man of Australia’s TV, a star of the programmes Hey Hey It’s Saturday and The Comedy Company. In 2015 Gilbert’s partner, Rochelle Nolan of 19 years, committed suicide, and Gilbert couldn’t seem to deal with that. He had a brain aneurysm ruptured only two weeks after her death, and he had a massive stroke from that surgery, with aphasia which he is still undergoing speech therapy for recovery. There are no articles which list which aphasia he has.

His sister Ellie said:

From day dot, he’s come leaps and bounds. The stroke has affected his speech quite badly. It is a jigsaw puzzle. He has to rewire his brain to go from ‘A’ to ‘Z’ again. At the moment, it’s going from ‘A’ to ‘J,’ and back to ‘B.’ He’s got a long way to go. 

Back in May 2016 he was doing four therapy sessions each week, and seemed to be doing well. Mick Molloy arranged the Gala 4 Gilbo event at the Palais Theatre in Melbourne on 17 July 2016. I haven’t been able to find anything on Russell Gilbert since then. I hope he’s progressing through recovery. 

The bass player of the blues and jazz band, The Muggs, Tony deNardo, suffered a severe haemorrhagic stroke in September 2001. He was, according to the Muggs website, “completely paralyzed on his right side and unable to speak”. They went on to tell that

Tony deNardo

On December 8th, 2002, DeNardo had a fund-raiser at the Cadieux Café (in eastside Detroit) to raise money to send him to California for some medical treatment that he hoped would speed his recovery. That night turned out to be magical; everybody who's anybody showed up for the fund-raiser…

DeNardo was still unable to play his bass guitar, so, when suggested to him in early 2003, he bought a Fender Rhodes Mark I and learned how to play his bass lines on the keyboard.

DeNardo has, since then, incredibly recovered so much after his many months paralysed and under aphasia which had stopped him from talking. There are no mentions in any of the articles which aphasia he had, but music which filled his life also fills mine with the choir I now belong to.

There are many people like Louis Victor Leborgne or Byron Peterson or Jane Twigg or Russell Gilbert or Tony deNardo. Or me. Read this, build your interest, read the articles, read books and know about aphasia. We all need help to recover, or to deal with our ongoing aphasia.

Like me.