Aphasias are pathological states in which language is altered as a result of a brain injury. It is one of the most studied pathologies at the brain level. However, regarding the aphasia of driving there is still much to discover.
The Broca's aphasia and the Wernicke's aphasia They are the most popular and most frequent, and perhaps the most researched. Throughout the article we will discuss the characteristics of driving aphasia and it can be seen how there is still debate about the affected areas at the brain level.
- 1 Introduction to aphasia driving
- 2 Table of Alterations in Driving Aphasia
- 3 Neuroanatomy of conduction aphasia
- 4 Evaluation and Intervention
Introduction to driving aphasia
Driving aphasia is one of the least frequent aphasias. According to Pedersen (2004), it affects 6-7% of the population with respect to the rest of aphasias. In this type of aphasia understanding is preserved but the repeatability is altered. You can also see a fluent language but with frequent presence of phonetic paraphases. A paraphasia consists in replacing syllables or words behind unintentionally. For example, instead of saying "scissors," the patient could say "iseras."
"Aphasia is a language disorder acquired as a result of brain damage, which usually compromises all its modalities: expression and comprehension of oral language, writing and reading comprehension".
-Gonzalez and Hornauer-Hughes-
Patients are aware of these. parafasias phonetics and themselves try to correct themselves, what is known as approach behavior or aiming behavior. Following the previous example: "bise ... tise ... tiselas ... scissors! (Arnedo, Bembibre and Triviño, 2013).
González and Hornauer-Hughes (2014), state that "Aphasia can be caused by one of the following causes: cerebrovascular accident (CVA), traumatic brain injury (ECT), tumor (TU), infections and neurodegenerative diseases".
Table of Alterations in Driving Aphasia
The following is a summary table of the main alterations of driving aphasia (Arnedo, Bembibre and Triviño, 2013):
- Conversational language - Fluid but with presence of paraphasies.
- Denomination - Altered
- Repetition- Very upset
- Out loud reading - Altered
- Writing - Altered
- Auditive comprehension - Preserved
- Reading comprehension - Preserved
- Sensitivity - Altered
- Hemianopia - absent
- Agnosia - absent
- Hemiparesis - Absent or slight
- Dysarthria - absent
- Dysphagia - absent
- Apraxia - Ideomotive
Driving aphasia neuroanatomy
Scientific research is still in search of the specific injury caused by driving aphasia. The theory with more weight is a disconnect between the area of Broca and the area of Wernicke because of a arcuate fascicle lesion. However, it is still in full development.
"The role of the arched fascicle can be noticeably more complex than the simple transmission of information between the Wernicke and Broca areas."
The main controversy about this theory is that there have not yet been published cases of driving aphasia with damage only in the arc fascicle, but cases with such injury have been described without the symptoms of aphasia.
However, Catani and Mesulam (2008) affirm that there is more and more data on the belonging of the arched fascicle to the upper longitudinal fascicle. In this way, it would involve not only the arched fascicle but also the adjoining structures. The upper longitudinal fascicle is composed of three perisilvian segments:
- Lower beam or direct segment. It is the arched fascicle. It joins the posterior area of the superior temporal gyrus (Wernicke's area) with the inner frontal gyrus (Broca's area).
- Upper horizontal beam or anterior indirect segment. Unite the lower parietal cortex with the frontal operculum, with the lower pre-dental and frontal gyri.
- Posterior beam or posterior indirect segment. It joins the superior temporal gyrus (Wernicke area) with the inferior parietal cortex.
Another subsequent study by Bernal and Ardila (2009) seems to indicate that the arched fascicle connects directly with premotor areas but indirectly with the Broca area through the premotor cortex (involved in language programming).
Despite all the ongoing research to clarify which specific areas are involved in driving aphasia, there is no doubt that the arcuate fascicle is an important structure in this pathology.
Evaluation and Intervention
After conducting the initial interview, the Aguilar team (2010) highlights the use of "an evaluation protocol made up of the guidance, language, verbal memory, praxias and gnosias subtests of the Barcelona Neuropsychological Exploration Integrated Program ".
The main objective is to try to restore functional speech. In this case they are used replacement and restoration techniques.
The objective of these techniques is to enhance conserved language skills. At the same time, any form of communication that may be present is also worked on. The therapist must also teach the patient's environment to communicate correctly and appropriately with him. One of the most important goals is to involve the family in therapy. This helps the patient to improve communication.
Are also used family stimuli (that information with which the patient has been in contact throughout his life) and functional stimuli They are useful for communicating the most basic needs.
Among the restoration techniques you can find those that correspond to the compression and language expression as well as other types of expression. Both in the comprehension and expression of language, phonological, lexical-semantic and syntactic are worked on.
- Phonological level Work on discrimination of phonemes and minimum pairs of words.
- Lexical-semantic level. Word discrimination works.
- Syntactic Level Discrimination of words-function and words-content. Order tracking, as well as tasks to answer yes or no.
- Phonological level Combination of syllables and phonemes, reproduction of phonemes with visual and visual support, and phonological dictation.
- Lexical-semantic level. Reproduction of automatisms and denomination by visual and auditory confrontation.
- Syntactic Level Use of words "wild card" and circumlocutions.
Other types of expression
Use of gestures and onomatopoeia. For example, the patient chooses an image and must describe it through gestures while issuing an onomatopoeia for the therapist to guess.
Gradually, scientific research provides more data on brain disorders. Data that will serve to improve the quality of life of people affected by these types of pathologies. What is a challenge now, perhaps in a few years will lead to a simpler solution. That is why it is so important to encourage research so that it can have an impact on everyone's benefit.
- Aguilar, O., Ramírez, B., Acevedo, J. and Berbeo, M. (2010). Conduction aphasia as a result of a left parieto-temporooccipital anaplastic astrocytoma: case study.Universitas Psychologica, 10 (1), 163-173.
- Arnedo, M., Bebibre, J. and Triviño, M. (2013). Neuropsychology: Through clinical cases. Madrid: Pan American Medical Editorial.
- Bernal, B, and Ardila, A. (2009). The role of the arcuate fasciculus in conduction aphasia. Brain 132, 2309-2316.
- Catani, M, and Mesulam, M. (2008). The arcuate fasciculus and the disconnection theme in language and aphasia: history and current state. Cortex, 44, (8), 953-961.
- González, V. and Hornauer-Hughes, A. (2014). Aphasia: a clinical perspective. Magazine Hospital Clínico Universitario de Chile, 25, 291-308.