Fluent Aphasia

In My Head...5 (2009) (detail), multimedia by Anne Jones. Click this link to check out more of her cool artwork!

Fluent Aphasia

The Fluent aphasias consist of the following:  Wernicke’s aphasia, Transcortical sensory aphasia, Conduction aphasia, and Anomic aphasia. Fluent here means that the words come tumbling out, but not always the right words.  And for the folks that have Conduction aphasia and/or Anomia, the right words may be very hard to find.

A person with just Anomia will be able to construct sentences well enough, but will find the words hard to access.  A person with Wernicke’s aphasia will usually present with what many people call “word salad”.  Imagine having all the words that you want to make up a sentence, then having some of those words taken away at random, then shake the words into random order, maybe add the twist of misspeaking a few words (paraphasia), and finally just make up some new words (neologisms) and throw those in for the random ones that got taken away.  Now, if you can picture all of that, then you have a pretty good idea of what a person with Wernicke’s aphasia sounds like.

Finally, a person with conduction aphasia will… wait a second. While I could, in good keeping with this informative piece, go on and on about what to expect that is different.  Instead I’ll link the Wikipedia definition here, and I’ll tell you the truth.  I hardly ever see this type of aphasia.  First, I don’t really look terribly hard for this because to me (boots on the ground clinician, not a researcher) this sort of distinction usually isn’t all that helpful in therapy.  Knowing whether or not a patient has Fluent vs. Non-Fluent is essential.  Knowing whether it’s some other type is less essential, though I know there are some who cherish the distinctions.  In a rehabilitation hospital, I usually get from 4-20 some odd days with my patients.  Often the diagnosis is mixed with other problems and disorders.  Rarely is it a pure aphasia of any sort.  Maximizing therapeutic intervention is my goal.  However, if someone reading this has more experience with conduction aphasia and would like to help add to the post, then I’d be glad to edit the post to reflect your different experience with this.

Testing

There are several tests that I use and highly recommend: The Western Aphasia Battery (WAB),  Boston Diagnostic Aphasia Exam (BDAE), and the Boston Naming Test (BNT).  I would stress here that there are likely plenty of other great tests, but I don’t use them regularly or have easy access to them (without begging for funds to buy yet another aphasia test).  See the page on Non-Fluent Aphasia for a description of the first two tests.  The last one listed, the Boston Naming Test, is a great test for assessing how well someone can name objects.  My only gripe with this test is that it doesn’t always work well with people who have English as a Second Language.  This is a small gripe considering that it wasn’t designed to be given to non-English speakers (at least not to my knowledge).  I mistakenly assumed that since it was just a series of line drawings, that someone’s primary language wouldn’t really mean that much.  Well, I was wrong.  I’ve given this to Spanish language speakers, Marshallese speakers, Polish speakers, and Laos speakers.  Invariably things get lost in translation with pictures as well as words.  Without digressing too much into translation difficulties and aphasia, I just wanted to bring up the fact that the BNT does not fix all your testing woes as a therapist when you are working with patients that primarily speak a language other than English.

Therapy

Therapy, in my experience, with fluent aphasias is either a lot easier or a lot harder than the non-fluent aphasias.  For the most part, I would assert that it is harder for certain in the beginning of therapy, and it only gets a lot easier if the patient can move out of the severe range and into the moderate to mild range. The importance of getting down to the mild or moderate severity range is true for both Fluent and Non-fluent aphasia.  Unfortunately, that is usually a variable that we all have little control over.  That is driven primarily by the size of the initial stroke and/or the amount of spontaneous recovery that happens. [Check out this link for a cool article on spontaneous recovery].

Therapy tips include:

• Establish a sign that lets the person with fluent aphasia know that they need to be quiet and listen.  (Do this quickly or therapy will be out of control).
• If reading skills are intact (or partially intact) make sure and use this to your advantage.  Many times the patient will have auditory processing problems, but will be able to read text fairly well.  Pair listening exercises (1,2, or 3 step directions; Basic and Complex Yes and No questions; Item identification or picture identification) with text to help with scaffolding.
• Item identification drills involve placing between 2 and 6 or more objects within the field of view of the person with aphasia.  Then, you name the item you want the person to find (e.g.- “Show me the __________”).  To make this same drill harder, you can add prepositions into the mix (e.g.-“Before you point to _________, point to ____________”; “Put the ____________ on top of the ______________”; “Place the ___________ under the ____________ then point to the ___________________”; etc.).
• Automatic speech drills are often good to improve correct fluency or allow more voluntary control by tapping into long-term procedural memory.  Examples include:  counting 1-20, naming the days of the week, naming the months of the year, the pledge of allegiance, and some highly familiar nursery rhymes.
• Group aphasia therapy may also prove helpful, as it can reinforce listening, turn-taking, and non-verbal communication skills.
• Communication Boards may also be of benefit.  These are usually very patient specific and you will likely need the help of an SLP to set this up initially and train you on the best use of it.

While this list above is in no way comprehensive or applicable to every patient out there, I do hope that it helps give people a nudge in the right direction.  Best of luck with your therapy out there! Please post your questions or comments; they will help me and others.  If you have specific questions feel free to send them to medicalspeechpathology@gmail.com.

Specific Therapy techniques and ideas for Anomia will appear in a new page under aphasia in the future!