Abstract
This chapter provides a brief overview of stroke, aphasia, and aphasia assessment. Additionally, it considers various issues associated with the standardized assessment of aphasia, including problems related to cultural and linguistic biases. The chapter also includes information on working with people who are bilingual, as well as working with interpreters. A hypothetical case study is presented as a teaching avenue to discuss these topics in greater length. This section contains details regarding how both cultural and linguistic barriers associated with the assessment of the patient's aphasia may have influenced the intervention provided by the speech-language pathologist (SLP). Medical terminology and procedures related to stroke intervention are also discussed as it relates to the SLP's plan of care.
TopIntroduction
Overview of Stroke and Aphasia
Stroke is the fifth leading cause of death in the United States (Nichols, 2019). A stroke, also known as a cerebrovascular accident (CVA), occurs when there is a change in blood flow to the brain or the area surrounding the brain, which causes injury to the brain’s cells. A stroke can happen to anyone at anytime, though there are certain risk factors, such as history of heart disease, high blood pressure, poor diet, age, genetics, and race, that may predispose one person over another to be at an increased risk for stroke (American Stroke Association, 2019).
Brain cells have a dedicated function within the brain that in turn correspond to a specific ability; therefore, how each person is affected by stroke is different, based on where the stroke occurred within the brain, and how much of the brain was damaged. According to the American Stroke Association (2019), some people recover completely from a stroke, but more than two-thirds of survivors will have some type of permanent disability as a result of their stroke. Impairments after stroke can be related to visual disturbances, motor movement of one or more extremities, slurred speech, numbness of one or more parts of the body, balance or coordination issues, or numerous other difficulties (Tatemichi, Desmond, Stern, Paik, Sano, & Bagiella, 1994).
Changes related to a person’s language abilities are referred to as aphasia. Aphasia is an acquired disorder due to an injury to the brain and is commonly secondary to stroke (National Institute on Deafness and Other Communication Disorders, 2019). Aphasia can affect any component of language: spoken language expression, auditory language comprehension, reading comprehension, or written expression. It can range in severity from mild to severe. In the most severe cases of aphasia, communication exchanges between the patient and the listener may be almost impossible. Multiple domains of language are typically affected by aphasia, such as naming objects, formulating grammatical sentences, understanding complex directions, or reading paragraphs. Aphasia can be extremely frustrating for some patients as they may know exactly what they want to say, but cannot get the words out to say it. Other patients with aphasia may believe they are speaking perfectly clear and appropriately to their communication partner, when in reality the words coming out of their mouths are merely jargon with no meaningful communicative intent. A person with aphasia often has relatively intact nonlinguistic cognitive skills, though cognitive deficits may co-occur with aphasia (American Speech-Language-Hearing Association [ASHA], 2015).
Key Terms in this Chapter
Communication: Communication is the exchange of information, or the act of conveying meaning.
Nonfluent Aphasia: Nonfluent aphasia is expressive language output that is severely reduced and limited to short utterances, generally less than five words per breath group. Examples of nonfluent aphasia subtypes are Global Aphasia, Mixed Nonfluent Aphasia, Transcortical Motor Aphasia, and Broca’s Aphasia.
Tissue Plasminogen Activator (tPA): tPA is a naturally occurring protein found on endothelial cells, the cells that line blood vessels. It activates the conversion of plasminogen to plasmin, an enzyme responsible for the breakdown of clots. tPA works by preventing the enlargement of blood clots that obstruct the flow of blood in the brain.
Hemiparesis: Hemiparesis is the weakness of one entire side of the body. It can be caused by a variety of medical conditions affecting the central nervous system, such as a stroke. Oftentimes, people who have aphasia may also have a hemiparesis, depending on the location and severity of their injury.
Computed Tomography: CT, refers to a computerized x-ray imaging procedure in which a narrow beam of x-rays is aimed at a patient and quickly rotated around the body, producing signals that are processed by the machine’s computer to generate cross-sectional images of the body.
Verbal Communication: Verbal communication can include aspects related to both linguistic and paralinguistic skills. Linguistics aspects targeted by the SLP may be related to expressive and receptive language abilities. Paralinguistic aspects targeted by the SLP may be related to pragmatics, the use of prosody in conversation, and appropriate use of body language or facial expressions.
Neurological Examination: A neurological examination assesses sensory and motor responses, as well as reflexes, cranial nerves, and mental status to determine whether neurological dysfunction exists. More specifically, it evaluates muscle strength and range of motion, muscle tone and bulk, muscular coordination, sensory function, balance, and gait.