Global Aphasia vs. Expressive Aphasia

The most severe form of aphasia is global aphasia, which arises from significant damage to the brain areas responsible for language processing. Consequently, individuals with this condition have a severely restricted capacity for both understanding and producing spoken language. Furthermore, they cannot read or write.

What does Aphasia mean?

Aphasia is a communication disorder that impacts your ability to convey and understand messages. It results from injury to the part of the brain that governs language expression and understanding. Aphasia makes it impossible for a person to communicate effectively with others. An individual with aphasia might struggle with understanding, speaking, reading, or writing.

Aphasia affects many individuals following a stroke. Men and women alike are affected equally. Aphasia can manifest in individuals of any age. People aged 65 and above are most commonly affected by it. Aphasia can be classified into many different types. They are typically diagnosed depending on which region of the language-dominant hemisphere of the brain is impacted.

Types of aphasia

Aphasia comes in various forms, and an individual may experience multiple types simultaneously. Additionally, they may experience other communication issues simultaneously, like dysarthria or cognitive challenges.

• Expressive aphasia (Broca’s or non-fluent aphasia)
• Receptive aphasia ( Wernicke’s or fluent aphasia)
• Mixed Non-Fluent Aphasia
• Anomic aphasia
• Global aphasia
• Primary progressive aphasia (PPA)

Broca’s Aphasia

Another name for Broca’s aphasia is non-fluent or expressive aphasia. Broca’s aphasia results in a partial loss of language abilities for affected patients. Fluent speech is a challenge for them, and they may only be able to say a few words at once. Their speech is characterized as stopped or effortful because they can only produce a few words at once. Usually, they can understand spoken language effectively and retain the skill of reading; however, their writing abilities may be restricted.

Global Aphasia

Global aphasia is the most serious form of aphasia. This results from damage to several areas of the brain that handle language processing. Patients suffering from global aphasia are only able to produce a limited number of recognizable words. They can understand little to no spoken language. Nonetheless, their cognitive and intellectual abilities that do not pertain to language or speech may remain fully intact. Immediately after a stroke or brain trauma, global aphasia may be evident. This kind of aphasia can get better with brain recovery, but there might be enduring damage.

Mixed Non-Fluent Aphasia

Similar to those with Broca’s aphasia, individuals with this kind of aphasia exhibit speech that is limited and requires considerable effort. Nonetheless, the understanding skills of these patients are more restricted than those of individuals with Broca’s aphasia. While they might possess reading and writing skills, these abilities do not exceed the level of elementary school.

Wernicke’s Aphasia

Wernicke’s aphasia is sometimes known as fluent aphasia or receptive aphasia. This is termed fluent because these people, although they have a limited capacity for understanding spoken language, can produce connected speech without difficulty. Nonetheless, their statements might not be very logical, and they may include irrelevant or incorrect expressions in their sentences. They frequently do not notice that they are using the wrong words. A person with Wernicke’s aphasia will likely experience difficulties with reading and writing, as well as a significant loss of language understanding.

Anomic Aphasia

Someone with anomic aphasia cannot find the appropriate words for what they wish to discuss. They understand grammar and can produce speech, but they struggle to find the right words to talk about what they want. Their speech is often ambiguous, and they may give the impression of “talking around” something they are unable to describe. When it comes to writing, they also struggle with word retrieval.

Primary Progressive Aphasia (PPA)

PPA constitutes a neurological syndrome characterized by the gradual and progressive loss of language use ability. Unlike most other forms of aphasia, which result from strokes, PPA stems from neurodegenerative diseases such as Alzheimer’s Disease. As the tissue in the brain’s language centers deteriorates over time, PPA progresses. This type of aphasia is linked to degenerative disorders, so PPA eventually presents with additional symptoms of dementia or memory loss.

Causes of aphasia

Aphasia occurs due to injury to the side of the brain that governs language, which is typically the left side. It can be triggered by:

• Stroke
• Head injury
• Brain tumor
• Brain infection
• Dementia or Alzheimer’s disease

It is not yet known whether aphasia leads to a total loss of language structure or to difficulties in accessing and using language.

Symptoms of Aphasia

Aphasia symptoms vary according to the type a person has. Broca aphasia is occasionally referred to as an expressive aphasia. Individuals with this kind of aphasia might, for instance, remove the words “and” and “the” from their speech.

They might use brief yet significant sentences when speaking. Usually, they can understand parts of what others say. Individuals suffering from Broca aphasia frequently exhibit weakness or paralysis on the right side of the body, affecting both the arm and leg.

Sometimes, Wernicke aphasia is referred to as receptive aphasia. Individuals who have this kind of aphasia might use lengthy sentences that are difficult to follow, include superfluous words, or invent words. Typically, they find it difficult to understand what others say.

Individuals who suffer from global aphasia find it difficult to communicate or understand language.

Global Aphasia vs. Expressive Aphasia

Global Aphasia

A severe language disorder, global aphasia impacts your capabilities to read, write, speak, and understand language. It is caused by damage to the left side of your brain. Your prognosis differs depending on how severe the brain damage is. Speech therapy can assist you in communicating or expressing your needs and desires.

What does global aphasia mean?

Global aphasia refers to the loss of the majority of your language skills. As a result, you are unable to read, write, speak or understand others’ communications. Aphasia’s most serious manifestation is this one.

This language disorder is caused by brain damage, which often results from a stroke or traumatic brain injury. While your symptoms may improve with time, your prognosis differs. Although global aphasia impacts your language abilities, it does not impact your intelligence.

Symptoms of global aphasia

Global aphasia is characterized by the following symptoms:

Language understanding

• Difficulty understanding others
• Taking more time to understand something said to them
• Difficulty understanding rapid speech
• Difficulty understanding complex grammar

Speaking

• Difficulty speaking or inability to speak
• Using words that lack meaning
• Substituting sounds for words
• Making grammatical errors
• Putting words in the wrong order

Reading

• Difficulty reading or inability to read
• Difficulty recognizing words
• Misunderstanding the meaning of words

Writing

• Difficulty reading or inability to read
• Writing only single words
• Writing grammatically incorrect words
• Misspelling words

Causes of Global aphasia

Stroke is the most prevalent reason for global aphasia. Strokes that impact the brain’s left hemisphere may lead to a decrease or blockage of blood supply to that region. This leads to an oxygen deficiency, which may harm the language processing centers situated there.

Discover additional information about post-stroke aphasia.

Other factors that can lead to global aphasia include:

• Traumatic brain injury
• Brain tumor
• Brain infection
• Brain surgery
• Neurodegenerative conditions, such as Alzheimer’s disease

Diagnosis

A healthcare professional will determine if someone has global aphasia based on the results of a physical examination, a neurological examination, and various tests. Your provider will inquire about your symptoms and health history during the exams, asking you or your caregiver questions. It may be helpful to have someone you trust with you during the exam, as it can be challenging to speak or understand the questions your provider asks.

Your healthcare provider might request imaging tests, such as an MRI (magnetic resonance imaging) or CT scan (computed tomography scan), to check for brain damage.

It might be necessary for you to consult a speech-language pathologist to confirm a diagnosis. Your language skills will be evaluated by a speech-language pathologist to assess how serious your difficulties with processing language are. This assessment also aids in deciding which treatment alternatives to attempt.

Treatment

To address global aphasia, your healthcare provider will suggest speech therapy. You will collaborate closely with a speech-language pathologist during your speech therapy sessions. They will assist you:

• Recapture language and communication skills that were lost.
• Discover different methods of communication.
• Teach your family and caregivers the best ways to communicate with you.

Your provider might suggest the following methods:

Augmentative and alternative communication

• Various methods exist for conveying messages without the use of spoken words. A healthcare provider will instruct you in various methods of communicating your needs and desires. As an example, if you want to go outside, you can use a board with pictures and indicate the image of a tree.

Visual action therapy

• This form of therapy does not rely on verbal communication (words are not required to take part). Your provider will instruct you on gestures (physical movements) to signify objects. Your gestures assist in conveying your message. As an illustration, you could position your fingers as if they were grasping an unseen glass and gesture toward your mouth to indicate that you would like a drink.

Speech and language therapy is the most frequently used treatment for individuals with global aphasia. It aims to achieve the following with assistance from a speech and language therapist:

Enhance communication reestablish speech and language to the greatest extent possible assist individuals in discovering alternative means of communication provide information about the condition to an individual and their relatives Therapy can be conducted in one-on-one sessions, groups, or via computer applications.

• A form of speech-language therapy is melodic intonation therapy (MIT). This therapy uses rhythm and melody to assist individuals in recalling and retaining more words. It can assist with sentence construction as well.

• Music therapy (melodic intonation therapy): A therapist will use rhythms and tunes to activate areas of your brain responsible for language processing. This could enhance your speaking abilities and language understanding.

Furthermore, there are ongoing clinical trials (tests on humans) aimed at discovering new treatment methods for global aphasia and assessing their effectiveness. During clinical trials, you might be eligible to test medications or brain stimulation methods such as transcranial magnetic stimulation.

Prevention

Although it is impossible to stop every cause of global aphasia, you can lower your risk by:

• Managing any underlying medical conditions.
• Implementing protective measures when engaging in activities with a high risk factor.
• Reaching out to emergency services as soon as the first symptoms of a stroke appear in order to reduce brain damage.

Prognosis

• Various factors determine your recovery, such as the degree of brain damage. Your healthcare provider is the best source of advice tailored to your situation.
• Immediately following a stroke or brain injury, symptoms are typically at their worst. In the weeks and months after the event, you might observe an improvement in symptoms.
• While some individuals recover completely, others may experience persistent symptoms for the duration of their lives. Cases of the highest severity necessitate lifelong management.

Expressive aphasia

Expressive aphasia is a condition where individuals may understand speech but struggle to speak fluently themselves. Those with expressive aphasia can produce speech, but it requires effort. They often rely on short phrases and may omit minor connecting words in their sentences.

Additionally, they may use words that are similar to what they intend to say but not precisely correct. This type of aphasia affects more than just speech; it can also hinder a person’s ability to understand directional cues like left and right. While people with this condition can still read, their writing abilities may be limited. Broca’s aphasia is a specific form of expressive aphasia caused by damage to Broca’s area in the brain.

Symptoms of expressive aphasia

The symptoms of expressive aphasia can include:

• A marked reduction in spontaneous speech
• Knowing what to say, but struggling to find the right words
• Speech that sounds choppy and lacks a typical rhythm
• A loss of minor linking words like “and,” “am,” or “the”
• After a lengthy pause and with great exertion, speech follows.
• Impaired ability to repeat phrases

Causes of expressive aphasia

Expressive aphasia is most commonly caused by a stroke impacting Broca’s area, a region of the brain that plays a role in language. It assists an individual in creating sentences and words. As a result, when Broca’s area does not operate properly, it leads to a reduced capacity for fluent communication using words and language.

Other factors that can harm this area of the brain include:

• Infections of the brain
• Tumors in the brain
• Injuries to the brain caused by trauma

Diagnosis

The diagnosis of aphasia may involve an informal assessment of fluency and the capacity to:

Name items adhere to straightforward orders, reiterate brief expressions, literacy and numeracy skills It can also include medical imaging techniques, like an MRI or CT scan. Medical imaging can determine if any brain damage has occurred.

Challenges in communication can lead to feelings of isolation or necessitate significant changes in one’s career and daily routines. This can adversely affect mental health. Aphasia often co-occurs with depression, so healthcare providers may also assess for this condition.

Treatment

The primary form of intervention for individuals with any kind of aphasia is speech and language therapy. Objectives of the treatment include:

• Advancing the application of residual language skills, reestablishing lost language skills to the greatest extent feasible, acquiring alternative means of communication
• An individual can undergo either individual therapy, group therapy, or a combination of the two. While individual therapy caters to a person’s specific needs, group therapy offers individuals an opportunity to practice communication with others. Speech and language therapy can also be provided virtually through video calls.

A speech therapist may attempt some of the following approaches:

• Repetition: A person may be able to regain or bolster their language abilities by practicing useful words or phrases through repetition. Depending on the severity of the initial brain injury, individuals can continue to make progress in this area for years afterward.

Melodic intonation

• This method involves a speech therapist prompting someone to sing their words instead of speaking them. This method can aid communication as it engages a different part of the brain for speaking. Therefore, if someone sings their message, it may result in more fluent speech.
• Object boards: These boards display images of items that an individual may desire or require. A person can communicate by pointing to the objects on the board. Gadgets can also serve a similar purpose.

Aphasia sufferers might find it helpful to join groups and clubs with fellow stroke survivors. This could involve clubs such as those focused on art, drama, or literature. Engaging in social activities might assist individuals in regaining their confidence and reducing feelings of isolation.

Clinical trials are currently exploring new treatments, which include various drug therapies and transcranial stimulation. This entails the stimulation of nerve cells using a magnetic field or electric current.

Summary of Global aphasia vs. expressive aphasia

• Global aphasia is a severe condition caused by widespread damage to the brain’s language-processing areas. Individuals affected by global aphasia struggle with speaking, reading, writing, and understanding language. While strokes are the leading cause of global aphasia, it can also arise from other factors like brain injuries, tumors, and infections.
• There are multiple treatment options for global aphasia. Among these options, doctors usually advise speech and language therapy. Several newer treatment approaches are still under investigation. Individuals with global aphasia should talk to their physicians to establish the most appropriate treatment option for them.
• The most prevalent form of non-fluent aphasia is expressive aphasia. Someone who has this condition can understand spoken language and is aware of their intended message, but their speech consists of fragmented sentences. They might utilize brief, uncomplicated phrases and omit minor words.

• Expressive aphasia can result from conditions that damage Broca’s area in the brain. This hampers the brain’s capacity to turn thoughts into speech. The primary treatment is speech and language therapy.

FAQs

Reference

• Aphasia. (n.d.). Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/aphasia
• Whitecoat. (2020, June 18). 6 types of aphasia. Regional Neurological Associates. https://regionalneurological.com/types-of-aphasia/
• Global Aphasia. (2024, October 29). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/global-aphasia
• Bhowmik, S. (2023, April 28). Global aphasia: All you need to know. https://www.medicalnewstoday.com/articles/global-aphasia#summary
• Brazier, Y. (2023, May 31). Life after stroke: Tips for recovering communication skills. https://www.medicalnewstoday.com/articles/315075