Global aphasia: symptoms, causes and treatment

Imagine waking up one morning, or after an accident, and all of a sudden we find out that everyone starts talking in a strange language. Worse yet, it is familiar to us, but we don’t understand what they mean to us.

We tried to communicate, but realized we weren’t saying what we wanted. Others insist, stare at us, and keep talking to us even though we don’t understand what they are trying to communicate to us. And we also failed to make ourselves understood. Although it may look like a sci-fi movie, this is what people with global aphasia experience.

The concept of aphasia

Aphasias are all speech and language disorders caused by brain damage, Which occur in adults with a tongue that had already been consolidated before.

    These types of disorders can affect many aspects of language, including fluency, the ability to articulate, language comprehension, repetition, grammar, literacy, and naming. The different aspects affected will depend on the injured area.

    Generally speaking, one of the main classifications of these disorders is the proposition of Goodglas and Kaplan, in which they are divided into different typologies according to whether or not they present a good level of verbal fluency, comprehension and ability. of rehearsal. The best known are Broca’s aphasia and Wernicke’s aphasia, each with its own damaged and preserved aspects. however, there is a type of aphasia in which alterations occur in all areas of language, known as global aphasia.

    Global aphasia: main characteristics

    Global aphasia is the most severe form of aphasiaBecause all or most of the different aspects of language are affected and changed by brain injury.

    People who suffer from it have serious difficulties in listening and speaking and generally writing. Likewise, subjects with global aphasia exhibit poor imitation ability. If they are able to emit oral language, it is common for them to use the telegraphic and stereotyped area, being little of their possibilities to establish communication by means of verbal language. They may also be able to understand certain words or verbs.

    On top of that, they tend to be unable to write or limit themselves to an automatism such as the ability to sign. Reading is also affected. It is possible that at the written level, they can reproduce a text by copying it, although guided by the forms and not by their content. Articulation skills, verbal fluency, and the use of vocabulary and grammar are severely impaired and impaired..

    Because the injury that causes global aphasia is massive, other symptoms often appear such as ideomotor apraxia (they do not know how to use objects for their true purpose) and ideational (they have an inability to follow the sequences of ‘action in the correct order), hemiplegia or paralysis of the half-body. The global aphasia in itself does not pose any difficulty at the cognitive level, the intelligence and most of the executive functions being preserved. However, they can present cognitive and intellectual difficulties due to neuronal damage, which further limits them.

    the causes

    The causes of aphasia, as mentioned above, they are due to the presence of lesions in the areas that control the tongue, Their connections with each other or with other brain nuclei which allow linguistic information to be integrated into the motor, or which have been destroyed.

    In the case of global aphasia, damage of great importance must occur throughout the left hemisphere, in which the areas that process the tongue are located, or in the area surrounding the cortex. The Broca and Wernicke areas, their connections to each other, or the connections to other areas that allow processing or performance of speech, are damaged or disconnected from the rest of the brain.

    The exact causes of these injuries can vary widely, from head injuries or lacerations to strokes, brain tumors or neurodegenerative diseases.

    Difficulties caused by this disorder

    The consequences of global aphasia and the symptoms it causes are very limiting for the person who suffers from it.. As social beings that we are, our life is structured around the assumption that we are able to communicate. This is why not being able to speak can cause

    At the social level, global aphasia greatly hinders the possibility of establishing emotional relationships with our fellow human beings. Although his social skills and interest in interacting with others are preserved, the patient has serious difficulties making himself understood if he does not have other methods. It is common that before the injury can be communicated orally correctly, the environment will try to communicate by shouting (interpreting that they have lost their hearing) or interpret the ‘lack of communication as a lack of interest. subject”. It is important to understand that the subject feels perfectly, his difficulty being that of interpreting the language.

    At work, this problem also generates difficulties, as well as academically. Learning, at least by the usual means, is complicated unless adapted strategies such as the use of pictograms or the use of physical procedures are used.

    At the level of the individual himself, this disorder can be experienced with real panic. After all, the subject is suddenly unable to understand what he is trying to say or to be understood by the usual mechanisms, and unsuccessful attempts by him and the environment to reestablish oral communication can end up causing strong anxiety. and depression in the individual. The subject may feel isolated, closed in on himself, until treatment begins to be effective or alternative forms of communication are found.

    possible treatments

    Treatment for global aphasia focuses on the recovery of functions impaired by head trauma. and / or adopting or learning alternative communication methods. It is also essential the psychological and social support which allows the patient and his environment to understand and support the patient in the process he is undergoing.

    It is important to note that many brain lesions can evolve in a way that reduces the damage. This is the case, for example, with a trauma or a stroke, in which the blood can drown part of the brain connections but leaves an area of ​​ischemic penumbra which can recover from the accident. In this way, many patients can see how the effects of the injury gradually diminish. In some cases, this can lead to a change from global aphasia to more localized aphasia.

    The use of language therapy and speech therapy is common, being used to improve and optimize language skills that the affected person might maintain. It is also common to use augmentative language techniques or the use of visual material such as pictograms with which the patient can communicate in an alternate manner.

    It is important to stimulate the patient without overloading him, so that he can gradually relearn and polishing skills without saturation. Psychoeducation is very important both for the patient and for the environment, as it is important to understand that cognitive skills are (unless there are other impairments beyond global aphasia) preserved and difficulties related to aphasia for the subject.

    Bibliographical references:

    • Belloch, Sandín and Ramos (2008). Manual of psychopathology. Madrid. McGraw-Hill. (Vol. 1 and 2) Revised edition.
    • Goodglass, H. and Kaplan, I. (1986). Assessment of aphasia and associated disorders. Pan American Medical Ed. Madrid.
    • Daroff, RB; Jankovic, J .; Mazziotta, JC and Pomeroy, SK (2016),. Bradley’s Neurology in Clinical Practice. 7th ed. Philadelphia, PA: Elsevier; chap 14.
    • Sants, JL (2012). Psychopathology. CEDE PIR preparation manual, 01. CEDE. Madrid.

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