Monday, January 13, 2020
Aphasiology: Disorders and clinical practice Essay
Acquired Aphasia Introduction Abstract            The paper describes aphasia in details and also the challenges that are faced by the individuals who suffer from aphasia. The paper also describes about the executive functioning and what it entail including the relationship between productivity outcomes and executive functions. The paper also highlights the challenges that aphasia patients face in their day to day lives. For instance, how these individuals handle their daily tasks. The paper shows that these patients face a lot of challenges including discrimination since they are misunderstood by many people. Also this paper shows how these patients can undergo therapy treatment as a way of improving their language and also to be educated on how to cope and interact with other people who do not have aphasia. Finally the paper describes the implications of this therapy treatment on aphasia patients.            Aphasia refers to comprehension impairment and language production which is usually led by damage in language constituent brain hemisphere. Aphasia is a family of disorders involving varying impairment degrees in four fundamental areas: Spoken language comprehension Spoken language expression Reading comprehension, and Written expression            An individual who have aphasia usually have comparatively nonlinguistic cognitive skills which is intact like executive and memory function skills even though these and other cognitive discrepancies may co-occur together with aphasia. Sensory deficits like visual and auditory agnosia and visual field deficits may also be present (Bhagal et al, 2003).            The result of aphasia is challenging to predict due to the wide symptoms variability. Aphasia result varies extensively from individual to individual depending on the brain insult severity and the lesion location. The indicator of the long- term recovery which is easily predictable is initial aphasia severity together with lesion size and site. Other factors which are usually considered concerning prognosis consist of the individual’s education level, gender, age among other comorbidities (Retrieved from http://www.aphasia.com/about-aphasia/who-gets-aphasia). When scrutinized properly, however, these factors appear to be weak predictors of the degree of recovery. Assessment of aphasia is goal-oriented, organized appraisal of the variety of pragmatic, linguistic and cognitive components of language. Executive function refers to the abilities and skills which enables individuals to achieve activities which are goal-directed. Prior to a head injury or traumatic brain, these abilities can be adversely affected (Simmons et al, 2010). Executive Functioning and completing a task Completing a task involves some steps as follows: Planning: planning and/ or knowing the steps for a specific activity Initiation: initiating an activity Doing the task: Executing the plans and at the same time self regulating and self monitoring. Evaluating- checking the outcomes of your work. Changing and improving- checking ways of simplifying the task next time and keeping away from any errors.            The above executive functions are used for all types of everyday tasks like shopping, laundry and cooking. In order to complete a task an individual must initiate each step, put in order, follow through and as this continues adjusting and monitoring of actions should be done. Most individuals do these activities without planning or any thought. However, for a person who is suffering from a brain injury he or she may face a challenge while initiating the task in the initial place. Such individuals may not have a thought of going food shopping and doing the washing even if their fridge is empty or there is a pile of laundry which is dirty, these clear cues may not initiate the thought process which makes them start a plan of action (Dickey et al, 2010).            People with acquired aphasia may start an activity however not have thought it through therefore they make errors. A simple illustration would be going for shopping however forgets carrying a shopping list or wallet. Although this can also happen to any individual however it occurs more frequently if an individual have a brain injury. Individuals with acquired aphasia may not learn from past errors and they end up repeating similar mistakes over and over again while they try accomplishing a task (Mesulam, 2001).            An individual with aphasia usually lack insight into their own capabilities to execute tasks, even in a case where individuals make suggestions which are positive. Treatment and rehabilitation usually involves executing systems and strategies to assist individuals with executive functioning difficulties: Daily organizers and planners Home information centre which includes calendars, notice boards etc. Reserve time each day purposed for planning Use a Dictaphone and timers for reminders Using step by step checklists Executive functions and regulating thinking and behavior            Another purpose of executive functions is that they assist individuals to control their behavior to respond and act properly. Problems with self regulation can result to verbalizations and impulsive behavior and may happen in numerous ways: Uttering inappropriate statements or remarks Dominating the conversation Being rude Being unable to stay on topic Continuously talking about a particular subject            With an aid of a duly qualified language and speech therapist some people with aphasia can be trained on picking up on a listener’s facial expressions or reactions thus realizing when they are making error in their communication. Recovery from aphasia may imply re-learning what facial expressions and social conventions signify, however it may imply just re-learning how to react appropriately to particular facial expression for instance, if a certain person say something and his or her communication partner seems to be shocked this may imply that the person have spoken a wrong thing (Hurkmans et al, 2012). Functional communication and executive function in aphasia            Functional communication refers to the capability of receiving and conveying a message, in spite of the mode, to converse successfully and independently in a particular environment. Broca and wernicke perceived language to be different from cognition where they argued that patients who have aphasia are cognitively integral however they deficits in their language. On the other hand, recent studies shows that cognitive impairments like attention, working memory and sequencing are possessed by individuals who have aphasia. Outcomes illustrates that diminished executive function capability may be linked to declined functional communication capability in individuals with aphasia. The executive function usually depends in communication success (Cherney et al, 2011).            According to Davis et al (2004) functional communication and executive function ability are associated closely in individuals with aphasia. Language impairment may not correlate always with real like communication capability. Thus, executive function may be an ideal functional communication ability indicator (Davis, 2004).            In a case where there is impairment of Executive function in aphasia patients, this may be due to the fact that functional communication capability is more impaired than what is indicated by severity of language impairments.            Relationship between executive functions and productivity outcomes following stroke, disability and rehabilitation            This study shows the need of assessing executive functions thoroughly in order to direct cognitive rehabilitation interventions as a result of a stroke. This is different from carrying out a cognitive screening incorporating merely one or two elements of executive functions.            Additionally, the findings show that more comprehensive evaluation of executive functions may be acceptable for younger people that have suffered from stroke. The evaluation will establish their ability to return to productive tasks which include tailor rehabilitation and employment to provide aid to needs consequently.            Future research is suggested in order to study efficacy of approaches which evaluate the interactive and separate influence of fundamental executive functions and cognitive processes. In addition, methodical assessment of rehabilitation practices to help management of individuals of executive dysfunction in everyday’s life is recommended.            Relations between semantic processing, short-term memory deficits and executive function            Allen et al (2012) shows that semantic processing capabilities, semantic short-term memory deficits are highly related to general or specific executive function deficits. A research was conducted involving a total of 20 patients with STM deficits and aphasia were evaluated on basis of semantic processing, short -term retention and both simple and rigid executive function activities. The study found no evidence that semantic STM deficits result due to deficits in executive function (Brady et al, 2012).            Executive function tasks performance was found to relate with some semantic processing tasks performance proposed that a relational combination function may bring about performance on both sorts of tasks. Correlation between some executive function activities and phonological STM was realized where phonological rehearsal and storage play great role in executive function activities with verbal element (Engelter et al, 2006).            Clinical repercussions for the elucidation of the executive function role in language-processing activities and the achievable contributions of executive function deficits and STM in treatment regimes.            Executive function capabilities depend on fundamental cognitive resources. Relational integration- role in discourse            EF role in treatment of language deficits depends on aspect of language which is being treated.            Found no relation between performance and semantic STM on complex and simple executive function activities (Pedersenet al, 1995). Instead they realized that executive function tasks and phonological STM were related in activities that had a verbal element recommends that performance in several executive function activities depends on rehearsing or maintaining phonological codes. Although semantic STM was unrelated to executive function capability, semantic processing tasks performance was connected to the executive function (Moxley, 2002).            After the completion assessment stage, a plan for treatment is obtained from the outcomes of the assessments. Clinician must assess the form of treatment approach they will utilize. It has been investigated that early intervention is more ideal compared to late intervention. The basic goal in aphasia treatment is to improve functional communication so as to participate in tasks of daily living. The main goal of the patient is to recuperate enough language to carry on with their life normally as possible (Faroqui-Shah et al, 2010). Treatment of executive function and language            Impairment based Approach:            This approach uses cognitive processing to find out the processes and components which have been fractioned as a result of brain damage. The approach also uses normal cognitive processing models to come up with the processes and components, which are damaged. Treatment is determined on basis of these outcomes. The approach argues that brain has ability of reorganizing and that reorganization is shaped directly by the environment. There is a perception that language and executive function will return as a successful treatment product (Teasell et al, 2011). Consequence Approach            It is also known as social, functional, psychological, life participation approach. This approach targets the outcomes of life participation impairment and creates treatment goals on basis of these impairments. A therapist who uses consequence approach should comprehend fully the limitations aphasia has on the life of an individual. The consequences approach influences values and principles which are separate it from impairment based approach (Hier et al, 1994).            There is growing support for the notion that executive/attention function skills in people with aphasia are remediable. Moreover, there is a significant relationship between functional communication and executive/attention function in individuals with aphasia. The outcomes recommend that treatment of executive/attention function in aphasia may lead to measurable variations in these skills and in the conversation communication success. References Bhogal, S. K., Teasell, R., & Speechley, M. (2003). Intensity of aphasia therapy, impact on recovery. Stroke, 34, 987-993. Brady, M. C., Kelly, H., Godwin, J, & Enderby, P. (2012). Speech and language therapy for aphasia following stroke. Cochrane Database of Systematic Reviews, 5, CD000425. Cherney, L., Patterson, J., & Raymer, A. (2011). Intensity of aphasia therapy: Evidence and efficacy. Current Neurology and Neuroscience Reports, 11, 560-569. Cherney, L., Patterson, J., Raymer, A., Frymark, T., & Schooling, T. (2010). Updated evidence-based systematic review: Effects of intensity of treatment and constraint-induced language therapy for individuals with stroke-induced aphasia. ASHA’s National Center for Evidence-Based Practice in Communication Disorders. Rockville, MD: American Speech-Language-Hearing Association. Civil Rights Act of 1964  § 7, 42 U.S.C.  § 2000e et seq (1964). Davis, G. A. (2007). Aphasiology: Disorders and clinical practice (2nd ed.). Needham Heights, MA: Allyn & Bacon. Dickey, L., Kagan, A., Lindsay, M. P., Fang, J., Rowland, A., & Black, S. (2010). Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada. Archives of Physical Medicine and Rehabilitation, 91, 196-202. Engelter, S. T., Gostynski, M., Papa, S., Maya, F., Claudia, B., Vladeta, A.G., †¦ Phillipe, A. L. (2006). Epidemiology of aphasia attributable to first ischemic stroke: Incidence, severity, fluency, etiology, and thrombolysis. Stroke, 37, 1379-1384 Faroqui-Shah, Y., Frymark, T., Mullen, R., & Wang, B. (2010). Effect of treatment for bilingual individuals with aphasia: A systematic review of the evidence. Journal of Neurolinguistics, 23(4), 319-341. Framework for Outcome Measurement (FROM). Aphasia Institute. Toronto, Ontario, Canada. OR Kagan, A., Simmons-Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, S., †¦ & Sharp, S. (2008). Counting what counts: A framework for capturing real-life outcomes of aphasia intervention. Aphasiaology, 22(3), 259-280. Hier, D. B., Yoon, W. B., Mohr, J. P. & Price, T. R. (1994). Gender and aphasia in the stroke bank. Brain and Language, 47 , 155-167. Hurkmans, J., de Bruijn, M., Boonstra, A., Jonkers, R., Bastiaanse, R., Arendzen, H., & Reinders-Messelink, H. (2012). Music in the treatment of neurological language and speech disorders: A systematic review. Aphasiology, 26, 1-19. Intercollegiate Stroke Working Party. (2008). National clinical guidelines for stroke (3rd ed.). London, United Kingdom: Royal College of Physicians. Limited English Proficiency – A Federal Interagency Website (2013). Available from www.lep.govLingraphica (n.d.). Who gets aphasia? Retrieved from http://www.aphasia.com/about-aphasia/who-gets-aphasiaMoxley, A. (2002, November 05). Make your grant count: Igniting change through research. The ASHA Leader. Murray, L. L., & Chapey, R. (2001). Assessment of language disorders in adults. In R. Chapey (Ed.), Language intervention strategies in aphasia and related neurogenic communication disorders (pp. 55-126). Philadelphia, PA: Lippincott, Williams & Wilkins. Mesulam, M. (2001). Primary progressive aphasia. Annals of Neurology, 49, 425-432. National Aphasia Association (2011). www.aphasia.orgNational Institute of Neurological Disorders and Stroke. (n.d.). NINDS aphasia information page. Retrieved from http://www.ninds.nih.gov/disorders/aphasia/aphasia.htmNational Stroke Association. (2008). http://www.stroke.orgNational Stroke Foundation (2010). Clinical guidelines for acute stroke management 2010. Melbourne, Australia: Author. Stroke Foundation of New Zealand and New Zealand Guidelines Group (2010). New Zealand Clinical Guidelines for Stroke Management 2010.Wellington, New Zealand: Stroke Foundation of New Zealand. Pedersen, P. M., Jorgensen, H. S., Raaschou, H. O., & Olsen, T. S. (1995). Aphasia in acute stroke: Incidence, determinants, and recovery. Annals of Neurology, 38, 659-666. Plowman, E., Hentz, B., & Ellis, C. (2012). Post-stroke aphasia prognosis: A review of patient-related and stroke-related factors. Journal of Evaluation in Clinical Practice, 18, 689-694. Rogers, M. (2004). Aphasia, primary progressive. In R. D. Kent (Ed.), The MIT encyclopedia of communication disorders (pp. 245-249). Cambridge, MA: MIT Press. Taylor-Goh, S. (Ed.) (2005). Royal College of Speech and Language Therapists Clinical Guidelines: 5.12 Aphasia. Bicester, United Kingdom: Speechmark. Simmons-Mackie, N., & Kagan, A. (2007). Application of the ICF in aphasia. Seminars in Speech and Language, 28, 244-253. Simmons-Mackie, N., Raymer, A., Armstrong, E., Holland, A., & Cherney, L. R. (2010). Communication partner training in aphasia: A systematic review. Archives of Physical Medicine and Rehabilitation, 91, 1814-1837. Catalan Agency for Health Technology Assessment and Research (2007). Stroke: Clinical practice guideline (2nd ed.). Barcelona, Spain: Author. Teasell, R. W., Foley, N. C., & Salter, K. (2011). Evidence-based review of stroke rehabilitation (14th ed.). Retrieved from www.ebrsr.comManagement of Stroke Rehabilitation Working Group (2010). VA/DOD clinical practice guideline for the management of stroke rehabilitation. Journal of Rehabilitation Research & Development, 47(9), 1-43. World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author. Bhogal, S. K., Teasell, R., & Speechley, M. (2003). Intensity of aphasia therapy, impact on recovery. Stroke, 34, 987-993. The book reveals the significance of therapy. Intense therapy over a short time frame can improve outcomes of language and speech therapy for stroke patients suffering with aphasia. Brady, M. C., Kelly, H., Godwin, J, & Enderby, P. (2012). Speech and language therapy for aphasia following stroke. Cochrane Database of Systematic Reviews, 5, CD000425. The book shows the evidence of appropriateness of SLT speech and language therapy to patients suffering from aphasia due to stroke in regard to improvement functional communication, expressive and receptive language. Cherney, L., Patterson, J., & Raymer, A. (2011). Intensity of aphasia therapy: Evidence and efficacy. Current Neurology and Neuroscience Reports, 11, 560-569. The book emphasizes the need of determining the intensity of treatment for any treatment program for aphasia. The intensity may vary depending on the specific stimuli, type of intervention and response needed by the patient. Cherney, L., Patterson, J., Raymer, A., Frymark, T., & Schooling, T. (2010). Updated evidence-based systematic review: Effects of intensity of treatment and constraint-induced language therapy for individuals with stroke-induced aphasia. ASHA’s National Center for Evidence-Based Practice in Communication Disorders. Rockville, MD: American Speech-Language-Hearing Association. The book explains the impact of intensity and constraint-induced language treatment to patients with aphasia induced by stroke. Civil Rights Act of 1964  § 7, 42 U.S.C.  § 2000e et seq (1964). The act outlines how people with disorders should not be discriminated against. The law prevents applicants and employees from discrimination in all terms, privileges and conditions of employment. Davis, G. A. (2007). Aphasiology: Disorders and clinical practice (2nd ed.). Needham Heights, MA: Allyn & Bacon. The book outlines the fundamental principles and approaches for assessment of six neurologically based disorders. Every disorder reveals different order of revealing signs of communicative behaviors. The book emphasizes the need of placing the needs according to hierarchy in order to prescribe the appropriate treatment. Dickey, L., Kagan, A., Lindsay, M. P., Fang, J., Rowland, A., & Black, S. (2010). Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada. Archives of Physical Medicine and Rehabilitation, 91, 196-202. The book explains the factors that determine the incidents of stroke-induced aphasia. The book also highlights the clinical and demographic features for stroke patients with or without this disorder. Engelter, S. T., Gostynski, M., Papa, S., Maya, F., Claudia, B., Vladeta, A.G., †¦ Phillipe, A. L. (2006). Epidemiology of aphasia attributable to first ischemic stroke: Incidence, severity, fluency, etiology, and thrombolysis. Stroke, 37, 1379-1384 The book explains the relationship between aphasia and first ischemic stroke. Cardioembolism and advanced age showed a positive relationship, where they have a great risk for this condition. Fluency and severity of aphasia were not influenced by demographic variable. Faroqui-Shah, Y., Frymark, T., Mullen, R., & Wang, B. (2010). Effect of treatment for bilingual individuals with aphasia: A systematic review of the evidence. Journal of Neurolinguistics, 23(4), 319-341. The book is about managing of stroke induced aphasia in a cultural diverse world. There is an increased likelihood of bilingual patients due to the cultural diversity. Framework for Outcome Measurement (FROM). Aphasia Institute. Toronto, Ontario, Canada. OR Kagan, A., Simmons-Mackie, N., Rowland, A., Huijbregts, M., Shumway, E., McEwen, S., †¦ & Sharp, S. (2008). Counting what counts: A framework for capturing real-life outcomes of aphasia intervention. Aphasiaology, 22(3), 259-280. The book reveals the incidents of distinguishing of stroke-induced aphasia. The book explains how stroke patients are more susceptible to this disorder. Hier, D. B., Yoon, W. B., Mohr, J. P. & Price, T. R. (1994). Gender and aphasia in the stroke bank. The book is about the relationship between gender and stroke-induced aphasia. Aphasia incidence is high in females than in males especially to women with infarcts. Brain and Language, 47 , 155-167. The book explains the coordination between brain and language. The book reveals how organization of brain is vital for language. Hurkmans, J., de Bruijn, M., Boonstra, A., Jonkers, R., Bastiaanse, R., Arendzen, H., & Reinders-Messelink, H. (2012). Music in the treatment of neurological language and speech disorders: A systematic review. Aphasiology, 26, 1-19. The book explains the significance of music therapy in rehabilitation of speech disorders. Music is a common treatment of apraxia and aphasia of speech. Music usually stimulate brain functions associated to speech. Intercollegiate Stroke Working Party. (2008). National clinical guidelines for stroke (3rd ed.). London, United Kingdom: Royal College of Physicians. The book highlights the guidelines which clearly provide the necessary management skills for stroke patients. The guide contains the recommendations for language and speech therapy. Limited English Proficiency – A Federal Interagency Website (2013). Available from www.lep.govLEP. gov encourages a cooperative and positive understanding of the significance of language access to federally assisted and federal conducted programs. Lingraphica (n.d.). Who gets aphasia? Retrieved from http://www.aphasia.com/about-aphasia/who-gets-aphasiaThis site explains the factors that make people more prevalent to aphasia. The most common cause is stroke while other symptoms include some neurological conditions, brain tumors, and head injuries. However, the disorder can occur to people of all age brackets, nationalities, races and genders. Moxley, A. (2002, November 05). Make your grant count: Igniting change through research. The ASHA Leader. The article is about the report from an examination carried out between Spanish Latinos and English speakers. The English examination was administered to test their fluency. Murray, L. L., & Chapey, R. (2001). Assessment of language disorders in adults. In R. Chapey (Ed.), Language intervention strategies in aphasia and related neurogenic communication disorders (pp. 55-126). Philadelphia, PA: Lippincott, Williams & Wilkins. The book reveals that there is a relationship between stroke-induced aphasia and ageing. Old people suffering from stroke are more susceptible to the condition. Mesulam, M. (2001). Primary progressive aphasia. Annals of Neurology, 49, 425-432. The book define primary progressive as a focal disorder characterized by gradual and isolated disbanding of language function. The condition starts with anomia, proceeds to impair of grammatical structure finally difficulty in semantics. National Aphasia Association (2011). www.aphasia.orgIts is a non-profit organization that praises research, public education, support and rehabilitation services to aphasia patient and their families. National Institute of Neurological Disorders and Stroke. (n.d.). NINDS aphasia information page. Retrieved from http://www.ninds.nih.gov/disorders/aphasia/aphasia.htmClearly explains the causal effects of this disorder, the symptoms as well as the relationship between stroke and aphasia. National Stroke Association. (2008). http://www.stroke.orgIt is a non-profit organization that helps with research, education and services to the aphasia patients as well as their families. National Stroke Foundation (2010). Clinical guidelines for acute stroke management 2010. Melbourne, Australia: Author. These guidelines explain the appropriate therapy for language and speech. They are guidelines to the clinicians for easy identification of the aphasia stage in order to prescribe appropriate treatment. Stroke Foundation of New Zealand and New Zealand Guidelines Group (2010). New Zealand Clinical Guidelines for Stroke Management 2010.Wellington, New Zealand: Stroke Foundation of New Zealand. The network aims at enhancing the implementation of appropriate treatment in stoke care all over New Zealand by improving the expertise of stroke physicians as well as maximizing their effectiveness. Pedersen, P. M., Jorgensen, H. S., Raaschou, H. O., & Olsen, T. S. (1995). Aphasia in acute stroke: Incidence, determinants, and recovery. Annals of Neurology, 38, 659-666. The book explains the causes, determining factors and recovery methods of aphasia. Stroke is the major contributing factor. Plowman, E., Hentz, B., & Ellis, C. (2012). Post-stroke aphasia prognosis: A review of patient-related and stroke-related factors. Journal of Evaluation in Clinical Practice, 18, 689-694. The book recommends the recovery procedure for people suffering from post-stroke aphasia. Predictive factors are challenging due to their constant variability making prognosis of aphasia recuperation troublesome. Rogers, M. (2004). Aphasia, primary progressive. In R. D. Kent (Ed.), The MIT encyclopedia of communication disorders (pp. 245-249). Cambridge, MA: MIT Press. The book highlights the progressive stages starting with initial to the aphasia stage. It clearly explains aphasia as a communication disorder. Taylor-Goh, S. (Ed.) (2005). Royal College of Speech and Language Therapists Clinical Guidelines: 5.12 Aphasia. Bicester, United Kingdom: Speechmark. These guidelines provide the recommendation for the appropriate care attention to the aphasia patients. The guide explains suitable therapy for speech and language. Simmons-Mackie, N., & Kagan, A. (2007). Application of the ICF in aphasia. Seminars in Speech and Language, 28, 244-253. This approach is used as a rehabilitation method to the people suffering from aphasia. It explains its effectiveness and how to understand the patient response after application of this method. Simmons-Mackie, N., Raymer, A., Armstrong, E., Holland, A., & Cherney, L. R. (2010). Communication partner training in aphasia: A systematic review. Archives of Physical Medicine and Rehabilitation, 91, 1814-1837. The book clearly outline different approaches towards aphasia recovery and treatment. The clinicians should be well endowed with expertise to treat this disorder. Catalan Agency for Health Technology Assessment and Research (2007). Stroke: Clinical practice guideline (2nd ed.). Barcelona, Spain: Author. These guidelines provide the recommendation for appropriate treatment for aphasia. The guide also provide the necessary therapy for speech and language. Teasell, R. W., Foley, N. C., & Salter, K. (2011). Evidence-based review of stroke rehabilitation (14th ed.). Retrieved from www.ebrsr.comHighlights different methods of dealing with this disorder. It poses difficult to prescribe appropriate treatment due to variability of this condition, thus doctors are required to understand different methods of treatment. Management of Stroke Rehabilitation Working Group (2010). VA/DOD clinical practice guideline for the management of stroke rehabilitation. Journal of Rehabilitation Research & Development, 47(9), 1-43. There should be good management of people suffering from aphasia. Cultural diversity is one of the challenges. People should not be discriminated against due to condition, race, religion or any other factor. World Health Organization. (2001). International classification of functioning, disability and health. Geneva, Switzerland: Author. This is a non-profit organization that fights for the rights of people with disabilities. It not only provide support in terms of funding, but also in educating and advising affected people. Source document
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