Expressive aphasia

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 29, 2016
StartDiseasesExpressive aphasia

Expressive aphasia is also known as Broca's aphasia. It is a language disorder that is caused by damage to the speech centers of the brain. Depending upon a variety of factors, some recovery may occur from this impairment.

Contents

Definition & Facts

Expressive aphasia occurs when a person loses part or all of their ability to produce spoken and written language. In cases where the person is still speaking, their grammar will be impaired and they will leave certain words out of their speech. This produces what is called "telegraphic speech."

In severe cases, the person may only express single word sentences. The comprehension of language is not greatly impaired in expressive aphasia. Expressive aphasia is caused by damage to the frontal parts of the brain. This can include damage to the left posterior inferior frontal gyrus and the inferior frontal operculum.

Symptoms & Complaints

A person with expressive aphasia has difficulty getting across their thoughts, ideas, and messages to other people. This presents itself in speech, writing, and gestures. Everyday tasks such as talking on the phone and writing letters are impaired. People who have this impairment may have some of the following signs and symptoms:

  • Slow, halting speech
  • Difficulty expressing certain words such as the names of objects, places, or people
  • The content of their speech becomes simplified and may only contain nouns and verbs.
  • Spelling or grammatical errors
  • Using the wrong word. For instance, they may say 'chair' instead of 'table.'
  • Difficulty in constructing sentences
  • Being able to write or speak fluently but including nonsense words or lacking meaning. 

Causes

The most typical cause of expressive aphasia is a stroke. Strokes are caused by a lack of oxygen to a part of the brain. Usually this part of the brain is Broca's area, the area of the brain involved in speech production. However, expressive aphasia has been noticed in cases where the stroke affects another part of the brain. Trauma to the brain can also be responsible for expressive aphasia. Brain tumors and cerebral hemorrhages have also been implicated. 

Diagnosis & Tests

There are tests and procedures that are used to diagnose expressive aphasia. The following are some of the tests used:

These tests can identify the aphasia and what type of aphasia the patient is suffering from. Other means of diagnosis are MRI scans and questionnaires/interviews.

The doctor will test the ability of the patient to produce terms for common objects, carry on everyday conversation, use words properly, and answer questions concerning something that they heard or read. Also, they will test for language repetition skills and the ability to do basic reading and writing. The doctor may also check the patient's ability to swallow

Treatment & Therapy

There is currently no universal treatment for expressive aphasia. The treatment is customized for every individual patient based upon their condition and needs. Many patients will spontaneously gain back much of their linguistic ability in the period of time directly following their brain injury.

Most patients will be treated for a few hours a day. They are both given speech therapy and taught ways of compensating for any lack of linguistic ability. This can take the form of drawing or learning to use phrases that are simpler. The following are current treatments for expressive aphasia:

  • Singing and melodic intonation therapy - This form of therapy works because the right brain hemisphere can help to compensate for damage in the left brain hemisphere. Many patients who cannot speak properly can still sing properly. This ability is used to develop the language centers in the right brain hemisphere.
  • Constraint-induced movement therapy - In this form of therapy, the patient is forced into using their remaining verbal abilities through activities that focus on them. Certain games are played which compel the patient to use the verbal abilities that they are left with. 
  • Pharmacotherapy - Although it is a new type of therapy that has not yet been fully researched, certain drugs have been used in the treatment of expressive aphasia. Such drugs as bromocriptine and piracetam have been used.
  • Transcranial magnetic stimulation - TMS is a treatment where magnetic fields are generated to create electrical currents in particular brain regions. This is thought to stimulate that part of the brain and reactivate it. 
  • Treatment of underlying forms (TUF) - This is a linguistic therapy for expressive aphasia. It begins by using simpler forms of problem sentences and then transforming them into more complicated forms.

Prevention & Prophylaxis

With respect to many causes of expressive aphasia, there is nothing that can be done to prevent their occurrence. This is particularly the case with traumatic brain injuries which occur due to accidents.

However, with respect to the brain injuries that come about as a result of a stroke, the injury can be prevented by preventing the stroke in the first place. Here are some ways that a person can reduce their risk of stroke:

  • Lower blood pressure - High blood pressure is the biggest contributor to the risk of stroke in both sexes. The ideal goal for blood pressure is a reading of less than 120/80.
  • Maintaining a healthy weight - Obesity is a major risk factor for strokes. The goal is to maintain a body mass index of 25 or less.
  • Regular Exercise - Not only does exercise reduce weight and blood pressure, but also it can directly reduce the risk of a stroke.
  • Moderate drinking - Drinking alcohol reduces the risk of stroke, but the consumption of too much alcohol can increase the risk of stroke.
  • Diabetes treatment- High blood sugar damages blood vessels after a while. This makes it more likely that a blood clot will form in them. Type 2 diabetes can be prevented through proper healthy diet and exercise. Diet and exercise can also help a person who already has diabetes. Medication may be needed as well.