Aphasia, dysarthria and apraxia of speech and the differences

On our website we have  several pages about language and speech:

• Aphasia - receptive
• Aphasia - expressive
  
• Dysarthria
  
• Speech apraxia
  
• Akinetic mutism
  
• Foreign accent syndrome
  
• Communication problems due to other causes

Table of contents of this page

1. What is aphasia?
2. Types of aphasia explained in a flowchart
3. Problem understanding language and problem producing language
4. What causes you to get aphasia?
5. Damage in Broca's area - motor speech center Expressive aphasia
6. Damage in Wernicke's area - sensory speech center Receptive aphasia
7. How does aphasia manifest itself?
8. Is recovery possible?
9. Does someone with aphasia understand me?
10. Tips for aphasia
11. Word-finding problems
12. The different word-finding problems
13. Speech apraxia
14. Dysarthria
15. Characteristics of dysarthria
16. Foreign Accent Syndrome
17. Differences explained between different types of aphasia in a video
18. More videos about aphasia + René Fransen explains something about aphasia
19. Help with aphasia
20. Aids for aphasia
21. Akinetic mutism

1. What is aphasia?

Aphasia is a language disorder caused by brain damage that impairs communication. 

Aphasia is not a speech disorder.

2. Types of aphasia explained in a flowchart (image)

3. Problem understanding and producing language

Saying one thing, meaning another: this is a daily reality for people with aphasia. This means that the person can no longer say what he or she wants to say.
There is a problem with understanding and producing the language.
People can no longer access their language, cannot use the words, or do not understand the language very well.
The person is less able to use the language than before. It does not happen that aphasia is exactly the same in two people. Aphasia is different for everyone.

4. What causes aphasia?

Aphasia usually occurs after a hemorrhage or other injury in the left hemisphere of the brain, because that is where the language area is located in 90% of humanity. Dementia can also cause people to develop aphasia.
However, the location of the injury appears to be less decisive than previously thought. 

Classification is no longer done, but what disorders and limitations exist are examined. New research shows that word meanings are spread throughout the brain. read more about brain and language

The terms Broca's aphasia (difficult speaking, language use) and Wernicke's aphasia (disturbed language comprehension, also in listening and reading) are used less than before because there is often a mixed image: the Global aphasia.

5. Damage in Broca's area/motor speech center

Broca's area

People with brain damage who have this disorder have problems with both spontaneous speech and with repeating words or sentences.

• Speech is often halting and stuttering.
  
• They have to search for words or an initial letter.
  
• They are aware of their own aphasia. That is very frustrating.
• Sentences are in telegram style. Short and shortest version.
  
• Short sentences of the conversation partner are well understood.
  
• Letters in a word are sometimes accidentally mixed up.

They also have difficulty understanding grammatical aspects of language: also called agrammatism.
This is evident not only from language expression, but also from understanding sentences. For example, the sentence 'the boy ate the cookie' will cause fewer problems than the more complex sentence 'the boy was kicked by the girl'.
The second sentence is more difficult, because the structure of the sentence determines that it is not the boy but the girl who delivers the kick. If the patient is asked to repeat this sentence, he or she will probably say, "boy kicks girl."

6. Damage in Wernicke's area/sensory speech center

The part of the brain that plays a role in understanding language is named after its discoverer Carl Wernicke.

Wernicke area

This area is also called the sensory speech center.
Disorders or damage in Wernicke's center can lead to dyslexia and sensory aphasia.
The spoken language of Wernicke patients usually sounds fluent, but lacks meaning. Wernicke's center is typically located in the left temporal lobe of the brain.
Fragments of words are spoken without context.
Fragments of sentences are spoken without any context.

7. How does aphasia manifest itself?

Aphasia is different for everyone. The severity and extent of aphasia depend, among other things, on the location and severity of the brain injury, the person's previous language ability and personality.
Some people with aphasia can understand language well, but have difficulty finding the right words or building sentences.
Some people with aphasia reverse letters in a word.
Others speak a lot, but what they say is difficult or impossible to understand for the conversation partner; these people often have major problems understanding language.
The language ability of most people with aphasia falls somewhere between these two extremes. Please note: someone with aphasia generally has full intellectual capacity!

8. Is recovery possible?

There is almost always some spontaneous recovery of language after the onset of aphasia. Rarely, if ever, is that recovery complete.
However, with a lot of practice, trying again and again and persevering, some improvement can often be achieved.
The person who can help with practicing the language is the speech therapist. A speech therapist provides language therapy, among other things.
With this therapy, being able to communicate again is paramount. The conversation partner can help improve communication.
The treating speech therapist can provide instructions for this. The speech therapist also pays attention to reading and writing.

9.Does someone with aphasia understand me?

Research showed that people with aphasia in general, regardless of severity or nature of aphasia, have difficulty understanding spoken language. Regardless of their intelligence.
At best, a person just needs more time to understand a spoken sentence.
It often happens that the person with aphasia is assumed to have understood everything, while in reality he or she may have only understood half of it correctly.

10. Tips for aphasia

• Treat the person calmly and with respect.
  
• Speak in calm, short, simple, unambiguous sentences.
  
• Let the person choose how she or he wants to communicate.
• Sometimes something can be better interpreted with hand gestures or written down or pointed out.
  
• Use the appropriate tools for aphasia, such as a reference book or aphasia apps.
  
• Ensure eye contact.
  
• Ask for clarification. Who? How? Where? What? When?
  
• Give rest if it doesn't work out.

11. Word-finding problems

Word-finding problems can manifest themselves in different ways, but one characteristic is common:
The intended word is present in the person's brain but is not found.
This usually involves a temporary closure of access. New research shows that word concepts are spread throughout the brain.

Words with multiple meanings are also located in different places in the brain. As a result, it can also take longer before a word is interpreted or found. Read more..

12. The different word-finding problems

• The target word is not found.
  
• The right word is not reached. The speaker does notice that other words come to mind. All this has to do with different damage in other places in the brain.
  
• Sometimes the sound of the word seems to be found.
  
• Sometimes another synonym seems to be found.
  
• Sometimes a completely different word seems to be found.
  
• The person makes a mistake during the actual speech and replaces the intended word with another that is similar in one of the ways just described.

13. Apraxia of speech

Apraxia of speech is a language problem with purposeful speech.
People who have this problem start to falter or cannot start speaking properly.
The articulation focuses on which direction the muscles of the mouth and jaw should move.
Sometimes sounds are not pronounced properly, which reduces intelligibility. For more information see here. 

14. Dysarthria

Dysarthria literally means: difficulty in articulating. This may be due to coordination problems or muscle paralysis around the mouth.
Dysarthria can occur as a symptom of certain neurological disorders, such as a Cerebro Vascular Accident (CVA, better known as stroke), a brain tumor, brain damage as a result of a (traffic) accident, or a disease such as Multiple Sclerosis (MS), 
Parkinson's and Amyotrophic Lateral Sclerosis (ALS).

Dysarthria can develop suddenly (for example after a stroke) or gradually in the case of a progressive disease.
The brain disorder can affect the muscles necessary for articulation. Paralysis, reduced strength or reduced coordination may occur.
The muscles of the lips, tongue, palate and vocal cords can no longer be used properly. Speech becomes unclear, monotonous, nasal and the voice is weak.
People speak with irregular pauses. In short, there is little control when speaking.

15. Characteristics of dysarthria

• Slurred to unintelligible speech
  
• Change in speaking pace: the person talks faster and faster or speaks very slowly and in a dragging manner
• Monotonous speech: everything is said in one tone and words in a sentence receive insufficient or no emphasis
  
• Too high or too low voice
  
• The voice may sound hoarse or very soft
  
• Shallow and powerless breathing or very audible inhaling and exhaling
  
• The involuntary repetition of syllables, parts of words or phrases
  (not to be confused with stuttering)
  
• Speech may sound halting due to the separate pronunciation of syllables or the syllables may blend too much into each other.
  

The severity of the dysarthria and which features are prominent differ from person to person. This depends on the location and size of the brain injury.

16 Foreign Accent Syndrome (FAS)

On a special page we explain the foreign accent syndrome. After a brain injury, changes can occur in the motor cerebral cortex, in the areas responsible for the control of speech motor skills, causing a person to have a foreign accent.
speak. Read more..

17. Forms of aphasia explained

A video explaining the difference between between different types of aphasia.

18. Videos about Aphasia

René Fransen explains in text how he sees aphasia:
Aphasia
a) Talking '1 on 1' is not an issue. I talk to all people, in the neighborhood, at the gym, with strangers.
Simple things, weather or nice bike, my CVA/Aphasia.
Sometimes people notice: nothing is wrong.
Before my stroke, he was a quiet man.
AFTER my CVA, I talk too much , make jokes and crack jokes.
Fortunately I have no shame .

b)Visit
Birthdays, dosing, max 6 people.
Too much, go outside or to the toilet.

Flight behavior

c) Discussion groups
DIFFICULT, people sometimes talk quickly, talk 'criss/cross': can't keep up and can't understand a word
Tired....
I understand, people fall for old rhythm.

d) Presentations for a group: NO point.
Reason: people listen to my talk and I am the 'boss' in control

Greetings, Rene"

René also has his own page on this site.
Click here for his story

19 Help with Aphasia

On this website you can find information about help with aphasia.

20. Aids for people with Aphasia

On the website of the National Aphasia Association you can find a lot of information.