Chapter 14 Aphasia

The chapter discusses the prototypical clinical syndromes of aphasia, their essential components, their natural history, and their lesion correlates over that natural history. The classic aphasia syndromes discussed in the chapter are Broca's aphasia, Wernicke's aphasia, conduction aphasia, transcortical motor aphasia (TCMA), transcortical sensory aphasia (TCSA), global aphasia, mixed transcortical aphasia (MTA), anomic aphasia, and aphasic alexia and agraphia. Acute clinical profiles where they converge and diverge from the chronic, prototypical syndromes, how they evolve into the chronic syndromes, and the implications for redundancy and recovery are also discussed in the chapter. The essential linguistic capacities are described as they are revealed by clinical studies and by functional studies. Finally aphasia treatment with the implications for redundancy and plasticity are discussed. Various therapy approaches have been shown to facilitate language recovery. Some therapies are aimed directly at the language impairment with progressive stimulation and shaping of responses. The only therapy that is labeled effective by the American Academy of Neurology is Melodic Intonation Therapy for severe nonfluent aphasia. A major component of effective language therapy may be education of patient and family to use of adaptive behaviors. This may reduce communication frustration, caregiver stress, and dependence.