Do you know what aphasia is?
Aphasia refers to the ability of speech communication caused by lesions in the cortical language function area in the presence of clear consciousness, normal consciousness, and no dysarthria (dysarthria refers to the weakness or paralysis of the articulatory muscles, altered muscle tone, and poor coordination due to organic damage to the neuromuscular system related to speech expression, causing speech disorders such as inaccurate pronunciation, uneven vocalization, slow speech flow, and rhythm disorders). In the case of aphasia, the patient’s speech communication ability is impaired due to lesions in the cortical language function area, which is characterized by the disability or loss of six basic aspects of spontaneous conversation, listening comprehension, repetition, naming, reading and writing, such as normal diction but impaired expression, normal body movement but impaired writing, normal vision but impaired reading, normal hearing but impaired speech comprehension, etc.
What are the causes of aphasia?
Aphasia can be caused by a variety of brain diseases, such as stroke, traumatic brain injury, brain tumor, brain inflammation, etc. About 1/3 of patients with acute stroke cerebrovascular disease will produce aphasia.
How can we detect speech disorders in our daily life?
Identification is done mainly through the following aspects.
1.Spontaneous conversation During the conversation, pay attention to the volume, intonation and pronunciation of their conversation, whether they are struggling to speak and whether they can express what they have to say.
2.Listen to understand and carry out some verbal instructions. For example, “touch your ears before touching your nose”. Point out the words we say from several objects, pictures or body parts, and use yes/no questions to check forgiveness when some people cannot carry out the instructions due to paralysis.
3. Repetition Ask the subject to “follow me”, “What I say, you say too”. Some people can only repeat the general idea or individual words, while others may repeat with the wrong words. Those with severe dysarthria may repeat something completely different from the original sentence.
4. Naming Ask the person to name the object, picture, body part, or color we are referring to. For example, “What do you write with”, “What color is coal”.
Reading includes reading aloud and comprehending the words read, and any dysfunction in either of these areas can be identified as dyslexia. For example, the word “Shen” may be read as “A”.
6. Writing Writing a name, address, etc., if you cannot write, then you have dyslexia.
Damage to different language areas of the brain may have different clinical manifestations. In clinical practice, we often encounter some cerebrovascular patients who have ipsilateral hemiplegia, but some have aphasia and some do not. This is mainly because the central part of speech is different. There is a medical rule that people who are used to using their right hand to write and hold things are called right-handed, and their language center is in the left hemisphere, which is often called the dominant hemisphere. On the contrary, if one is accustomed to use the left hand, called left-handed, and the language center is in the right cerebral hemisphere, we call his right cerebral hemisphere the dominant hemisphere. If the right hemisphere is damaged, hemiparesis and aphasia will occur in the left limb. When a person with “left-handedness” has left-sided hemiparesis, no aphasia occurs, and when a person with “right-handedness” has right-sided hemiparesis, no aphasia occurs.
How is aphasia classified?
In cerebrovascular disease, motor aphasia is the most common type of aphasia, followed by sensory aphasia. If the two coexist, it is called mixed aphasia. It is caused by a lesion that damages the frontal and temporal lobes of the dominant hemisphere. In addition to the above, there is another type of aphasia, called “naming aphasia”. The patient understands the nature and purpose of the object, but cannot name it. For example, if you point to a toothbrush and ask the patient, “What is this? He will answer “for brushing teeth”. Take a tea pot and ask the patient “What is the name of this”? He said “for drinking water”. The patient understands it in his heart, but he cannot name it, so it is called naming aphasia.
The center of naming aphasia is in the posterior temporal lobe and the superior parietal lobe of the dominant hemisphere, and when this area is damaged, the aphasia described above will occur.
About the assessment methods of aphasia
1. aphasia examination methods commonly used internationally.
Boston Diagnostic Aphasia Examination (BDAE) Western Aphasia Battery Test (WAB).
2.Domestic commonly used aphasia examination methods.
Chinese standard aphasia examination (CRRCAE) Chinese aphasia set test (ABC).
So what are the treatments for aphasia?
Aphasia can seriously affect a patient’s ability to work and quality of life, but clinical symptoms can be improved or alleviated through treatment, and a highly individualized language rehabilitation training program can be developed by combining the results of ancillary examinations, linguistic and neuropsychological diagnosis and evaluation.
1.Traditional or direct method: The patient’s listening, speaking, reading, writing and other speech skills or behaviors are trained using organized assignments;
2.Practical or indirect method: This method focuses only on the improvement of the communication ability, and does not limit the way of communication, nor does it target the specific speech skill or behavior of the patient, but aims at restoring the patient’s real-life communication skills;
3, compensation method: the main use of the contralateral cerebral hemisphere function or extracorporeal equipment to compensate for the lack of speech function method.
Current international research on treatment methods.
1. Transcranial magnetic stimulation (TMS) is a method that is easily tolerated by patients and non-invasively changes the cortical physiology. Repetitive transcranial magnetic stimulation can be a method of treatment for aphasia. However, the therapeutic effect has yet to be studied.
2.Pharmacological treatment: Bromocriptine and levodopa are used to treat acute cerebral infarction with motor aphasia. It is possible that the two drugs can increase the dopamine neurotransmitters in the brain, thus restoring and improving motor aphasia, and the combined effect of the two drugs is complementary and synergistic. However, there is no specific treatment method other than language rehabilitation.
Chinese medicine’s understanding of aphasia and its characteristic treatment
Aphasia is mostly caused by stroke. The kidney is the root of yin and yang. If the kidney is deficient in yin and blood, the blood will be astringent and cause stasis, or if the kidney is deficient in yang and produces internal cold, the cold will cause the blood to coagulate, which will also lead to stasis in the veins and collaterals; if the kidney is deficient in qi and causes phlegm blockage, and the collaterals and collaterals are not functioning, the aphasia or language will be unfavorable. If the liver and kidney yin deficiency, or emotional and mental injuries cause hyperactivity of liver and yang, yang becomes wind and moves phlegm, and wind and phlegm are in the larynx, blocking the orifices and channels, and the meridians lose harmony, then aphasia will occur.
The herbal treatment for aphasia is mainly based on tonifying the kidney, invigorating blood, dispelling phlegm, and clearing the ligaments, including Zheng Tong San, Di Huang Drinking Zi, Xie Yan Dan, Xuan She Paste, and Liu Wei Tang plus or minus.
For the acupuncture treatment of aphasia, the selection of acupuncture points is based on the three meridian points of the heart, kidney and governor’s meridian, together with localized acupuncture points around the mouth. Secondly, it can be combined with the characteristic moxibustion method.
In summary, good results have been achieved with acupuncture, head acupuncture, moxibustion, acupuncture point injection and manipulation by giving full play to the characteristics and advantages of TCM.
Prognosis and care
1.Prognosis
The prognosis of aphasia is generally consistent with the prognosis of the original disease. With the accelerated pace of aging in China, it also produces a tendency for aphasia to become more severe and complicated. Combined with the low brain function brought about by increasing age, there is sometimes an increase in symptoms. Aphasic symptoms may also worsen if there is another stroke or if they are based on progressive disease. The prognosis of aphasia is related to the following factors.
(1) The earlier language training is started, the better.
(2) Primary symptoms: small extent of brain injury, initial stroke, good prognosis, traumatic brain injury better prognosis than stroke.
(3) Comorbidity: those without comorbidity are better than those with comorbidity.
(4) Cerebral hemorrhage causing aphasia has a better prognosis than cerebral infarction.
(5) It is better if intensive training is added for a long time.
(6) Sharpshooter: left sharpshooter or both hands have a better prognosis than right sharpshooter.
(7) Type of aphasia: better prognosis for those with expression disorders than those with comprehension disorders.
(8) Self-training ability: Those with self-training ability and awareness are better.
(9) Desire for recovery: Patients and family members with high desire for recovery training are better.
2.Adjustment of care
Pay attention to the regulation of emotions and keep a happy mood. Diet should be light and nutritious, rich in protein and vitamins, less spicy, cold, fatty and sweet products, avoid smoking and alcohol. Those who have difficulty in swallowing should eat semi-solid food or liquid food to avoid choking and coughing. Language rehabilitation exercises are good for patients to recover their expression ability as soon as possible, but fatigue should be avoided.