Friday, September 29, 2006


I don't have many pet peeves related to aphasia. (The vast majority of my SLP pet peeves are related to dysphagia). But there are a few comments that never fail to irk me regarding aphasia.

* "He (or she) needs a communication board" -- usually said regarding a patient with severe aphasia. Because aphasia (an acquired language disorder) affects ALL language modalities to some extent -- speaking, listening, reading and writing -- a patient with aphasia severe enough to markedly impair verbal communication is usually unable to spell out words, either by writing or by using an alphabet board. A few can use a picture board to point out what they want or need, but I can count on one hand the number of patients I've had that could do that reliably without needing a significant amount of training.

* (In a doctor's note): "Patient is severely aphasic but understands and writes without difficulty." Well, either the comprehension and writing tasks weren't difficult enough to show higher-level impairments, or else the patient isn't aphasic at all. Again, aphasia affects ALL language modalities. Some modalities may be more impaired than others (for instance, receptive language -- reading and auditory comprehension -- may be relatively preserved compared with expressive language -- writing and speaking), but the patient will have some deficits in all areas. Despite frequent attempts at education, I still have doctors/nurses/PTs/OTs/etc. saying to me, “I think Mr./Mrs. So-and-so may have some receptive aphasia too,” in a tone implying that it’s something unusual and a “good catch” to have been realized, or else looking at me in surprise when I say that the patient with severe Broca’s aphasia does NOT have normal comprehension. And what about the patient with documented “aphasia” all over the chart, who really isn’t aphasic at all? How does that happen? In one such case in a nutshell, dysarthria so severe that the patient was nearly anarthric (consonant sounds /m/ and /h/ and shwa vowel comprising the entire phonetic inventory), combined with residents who apparently did not read the speech pathologist’s daily progress notes stating, “patient is NOT aphasic, patient has severe dysarthria.”

* "He (or she) has expressive aphasia." Well, simple enough, and often true; so why does it bother me? Because, at least where I work, this phrase represents the reduction of aphasia to a simple dichotomy: expressive/receptive. A patient has trouble talking? That’s expressive aphasia. They don’t understand what you say? That’s receptive aphasia. Never mind that by these definitions, every single aphasic person would have “expressive aphasia,” since word-finding difficulties must be present to make a diagnosis of aphasia. And what about, say, a severe Wernicke’s aphasia? Clearly that would be “severe receptive aphasia,” but then how are you supposed to label the resulting word salad that comprises the patient‘s expressive communication? Moderate? Severe? Moderate to severe? If you can’t understand anything the patient says due to all the neologisms and paragrammatisms, that would make them severe, right? But they’re fluent, so doesn’t that count for something? Hmph. Personally, I’m a big fan of classifying aphasias into the aphasic syndromes (anomic, Broca‘s, Wernicke‘s, transcortical motor, transcortical sensory, conduction, and assorted subcortical aphasias). The syndromes are shorthand for conveying a constellation of symptoms. Of course, not every aphasia you run into fits neatly into a syndrome. And not everyone, especially non-SLPs, knows what the syndromes are -- so I usually wind up doing all sorts of verbal gymnastics to be as clear as possible. But overall, I think that labelling clear-cut aphasic syndromes as such conveys a lot more information than a simple “expressive” or “receptive”.


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