Aphasia: What Physical Therapists can do for their Patients

by Amanda Mamalio, PTRP

feature image aphasia

Read on and Find out What You can do More for your Aphasic Patients

Hard, isn’t’ it?

You flip the chart to find out your patient has aphasia.

How are you going to tell the patient on what to do? How are you going to build rapport with him?

You looked at your patient and he’s either a.) depressed and frustrated at his own mouth, b.) erroneously blathers on and frustratingly wonders why nobody understands him.

Most of all, his family is stressed that he’s in the hospital and have difficulty expressing himself. So they looked up to you.

What should we do? How are we going to talk to him?

What should you do?

Aphasia: The Overview

Let’s KISS first.

No, I’m not talking about a make-out session. I mean “Keep It Simple, Silly.”

Aphasia is a communication disorder caused by brain damage.

It is characterized by impairments in talking, reading, writing and/or listening to speech.

Let’s focus on the over-simplified aphasia infographic. Click to enlarge the image below.

anatomy, oversimplified infographic in aphasia

Note, the infographic above is an oversimplified version. Keep them in mind as we go along.

Before we proceed to Bedside Aphasia Examination, let’s fling you into the ocean and see how you swim. You can see a delightfully entertaining as well as an informative video from someone with aphasia below.

Does she talks with ease or does she talk with difficulty?

Does she say a few words between pauses or a lot?

Does she have varying intonations or were her speech flat?

Do you think she has fluent or non-fluent aphasia?

This is just a way of familiarizing with aphasia, thus the saying ‘fling you into the ocean and see how you swim.’

You can paddle back to the surface now.

 

Bedside Aphasia Examination

You walk along the dreary corridors with the smell of disinfectant searing the inside of your nose.

In your hand, clasps your treatment bag. In your ears, your footsteps echoes. In your mind, all the details you’ve read from the patient’s folder.

It would be the first time that you and your patient would be meeting. Perhaps he was diagnosed with a stroke or TBI. Along that, the doctor’s notes also said he has aphasia.

How are you going to document aphasia?

Simply put (+) aphasia in the OI?

You could.

Unless you want to be an awesome epitome of badassery.

Why you should perform a Bedside Aphasia Examination

Sure, standard aphasia tests are best administered by speech pathologists. But that doesn’t mean us PTs can’t have our own documentations too. BAE offers two things:

1. It gives you a general idea of the patient’s deficits and preserved language functions.

2. It provides a baseline measure for comparison purposes regarding the patient’s progress in rehabilitation.

3. Provide information for the doctor that would make him or her love you. (Bonus!)

Okay, so maybe that's not the type of appreciation you were expecting.

Okay, so maybe that’s not the type of appreciation you were expecting.

The following examples of tests and documentations are simply suggestions for examining the patient’s aphasia. Let your clinical decision-making skills be the final judge in suiting the examination according to your patient’s capabilities and needs.

Spontaneous Speech

You knocked on your patient’s room and entered. You announced who you are and what you will do.

The patient looked at you and spoke.

Your ears almost twitched.

Fluency: Was his words easily spoken?

Amount of Speech: Does he blathers on or leaves out functor words (articles, adjectives, adverbs and conjunctions)? Example, instead of asking “I need to drink water now” he says “Water now.” This is also known as telegraphic speech.

Paraphasia: Does his speech has spontaneous paraphasic errors?

ParaphasiaSpeech initiation: Was there hesitation in talking?

Circumlocutions: Does he say a lot of words before saying what he really wanted to say in the first place?

Prosody: Does he have intonation, pitch and rhythm?

Spontaneous SpeechWith Spontaneous Speech Examination, you can already tell if the patient has possible Fluent or Non-fluent Aphasia.

Fluent Aphasic patients have normal rate and melody and may have paraphasic errors and circumlocutions

Non-fluent Aphasic patients talks in a halting manner, have many pauses in between, possible aprosody and telegraphic speech.

Categories of AphasiaContinue on with the examination to find out the best possible diagnosis of his aphasia.

Comprehension

Before you can give any tests, you need to make sure you and the patient are in the page. Even though you may have an idea if the patient understands you or not, you still need to prove it through paperwork.

You can prove your patient’s ability to comprehend language through Listening and Reading.

Both consists of 1-2 part commands. Two-part commands contains 2 clauses in a sentence, such as “Open your mouth and close your eyes.”

Reading Comprehension can be examined by asking the patient to read a set of commands and follow them.

Example:

Listening Comprehension

Naming Test

Functionality of Naming Capability is one of the differentiating factors in classifying aphasia. Use everyday objects or body parts for patient to identify.

Patients with Broca’s aphasia are typically worse in naming actions than objects.

Writing

Test first if patient has writing apraxia by asking to pretend to write. If the patient’s movements are clumsy in the absence of motor deficit, he may have apractic agraphia rather than aphasic agraphia.

If he throws the pen at you, he might be having a bad day.

If the patient throws the pen at you, he might be having a bad day.

If not, ask the patient to write a sentence. Check for grammar, spelling, word quantity as well as the handwriting itself. This can serve as a baseline for reassessments in the future. If his sentence has omission of functor words (articles, adjectives, adverbs and conjunctions), he may have telegraphic writing.

If you noticed that the patient can only read aloud or write the right side of the word or sentence, he may have neglect aphasia which is usually due to right hemispheric lesions.

Patients with alexia and agraphia are associated with left parietal lesions.

Patients who have alexia without agraphia are associated with left occipital lesions. These patients can spell aloud, write and can identify words spelled at him. Patients who have alexia with agraphia cannot.

Animal Naming Test

This test is more of a measure of the frontal lobe function than of language. However, it gives a rough measure of words spoken spontaneously.

According to the Animal Naming Test of the Boston Diagnostic Aphasia Examination, ask the patient to speak as many animal names as possible under one-minute.

If he suspiciously looks at you while naming a ferocious beast… maybe you should smile more.

Ignore the afros, name all the animals.

Ignore the Afros and name all the animals.

 

Repetition Testing

From the Western Aphasia Battery, you can ask the patient to repeat the phrase ‘The telephone is ringing.’

Aphasias originating from lesions around the Sylvian fissure (Broca’s, Wernicke’s, pure word deafness, global and conduction aphasias) are characterized by abnormal repetition.

Nonperisylvian Aphasias (Anomic, Transcortical Motor and Transcortical Sensory) presents with normal repetition.

For the lazy PT’s bedside screening of patients with aphasia, consult the flowchart. Please click to enlarge.

Flowchart of Aphasia

If you want a suggested copy sample of a Bedside Aphasia Examination, click Bedside Aphasia Examination

Coming Up Next…

Aphasia ain’t scary, you just need to get to know it. Imagine a banging, hot person you have no guts talking to. You just need a wingman to get to know her or him or both. Whatever turns you on.

Stick with me for the upcoming to The 8 Types of Aphasias: Take Her to Dinner, How to Communicate with an Aphasic Patient: Bashing Down the Barriers, and Philippine Speech Therapy Services: Get in the Know. (Titles may change.)

Let me be your wingman 😉

If you think I missed something or should cover something. Let me know.

I'm all ears.

I’m all ears.

 

Want something as awesome as this in your website? Let me help you.

Sources:

1. Kirshner, H. S. (2014, March 27). Aphasia. Retrieved September 2014 from http://emedicine.medscape.com/article/1135944-overview

2. O’ Sullivan, S. & Schmitz, T. (2007). Physical Rehabilitation (5th ed.). Pennsylvania: F. A. Davis Company

3. Braddom, R. (2008). Physical Medicine & Rehabilitation (3rd ed.). Singapore: Elsevier (Singapore) PTE LTD

 

© PT Got Spunk 2014

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