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afasia

After a traumatic brain injury (TBI) or cerebrovascular accident (CVA), the brain undergoes several healing and re-organization processes, which may result in improved language function.

 
Aphasia afects about 2 million people in the US and 220.000 people in Great Britain.
Patients suffering from stroke usually have associated aphasia. In the University of Malaga (UMA), intensive therapy has been created that improves this types of patients. The therapy has been developed in the unit of the CIMES (cognitive neurology and aphasia unit of the Medico-Sanitary Research Center). The director of the unit is teh neurologist Marcelo Berthier.

 
Aphasia is an inability to comprehend and formulate language because of damage to specific brain regions. This damage is typically caused by a cerebral vascular accident (stroke), or head trauma; to be diagnosed with aphasia, a person´s speech or language must be significantly impaired in one (or several) of the four communication modalities following acquired brain injury or have significant decline over a short time period (profressive aphasia).

 
The four communication modalities are:

Auditory comprehension
• Verbal expression
• Reading and writing
• Functional communication
The difficulties of people with aphasia can range from occasional trouble finding words to losing the ability to speak, read, or write; intelligence, however, is unaffected.
Aphasia symptoms can vary based on the location of damage in the brain. Aphasia is most often caused by stroke, but any diseases or damage to the parts of the brain that control language can cause aphasia. Some of these can include brain tumors, traumatic brain injury, and progressive neurological disorders. In acute disorders, such as hedad injury or stroke, aphasia usually develops quickly. When caused by brain tumor, infection, or dementia, it develops more slowly.
Aphasia can also sometimes be caused by damage to subcortical structures deep within the let hemisphere, including the thalamus, the internal and external capsules, and the caudate nucleus of the basal ganglia. Most classifications of the aphasias tend to divide the various symptoms into broad clases. A common approach is to distinguish between the fluent aphasias and the nonfluent aphasias. There is wide variation among people even within the same broad grouping, and aphasias can be highly selective.

 

Major characteristics o different types of aphasia according to the Boston classification:
Individuals with Wernicke´s aphasia: receptive or fluent aphasia, long sentences that have no meaning, unnecessary words, create new words.
Individuals with Broca´s aphasia: frequently speak short, nonfluent aphasia.
Individuals with anomic aphasia: have difficulty with naming.
Individuals with transcortical sensory aphasia: the most general, déficits in receptive aphasia.
Global aphasia: impacts expressive and receptive language, reading and writing.

Cortex:
• Expressive aphasia
• Recepttive aphasia
• Conduction aphasia
• Transcortical motor aphasia and transcortical sensory aphasia

 

The shortage of materials for the rehabilitation o aphasia in Spanish, is an intensive and ecological therapy based on neuroscientific principles called Constrint-Induced Aphasia Therapy (CIAT) , the name of group is REGIA (Intensive Group Rehabilitation o Aphasia).
Name: Regia. Intensive Group Rehabilitation of Aphasia.
Authors: Marcelo L. Berthier; Cristina Green Heredia, Rocio Juarez Ruiz de Mier, J. Pablo Lara and Friedemann Pulvermuller.
Provenance: TEA Editions, 2014
Application: Collective (patients are recommended per group)
Scope of application: Adult aphasic patients.
Duration: three hours a day for two consecutive weeks.
Purpose: Rehabilitation of language.
Material: Manual, 1.100 cards, registration booklets and 4 panels separators.
The therapy consists in giving 30 hours of rehabilitation in two weeks, it is applied by speech therapists, so intensive is more effective than few hours in 6 months. The intensive therapy consists of 2 card sets with 550 cards, each group consists o 3 aphasic patients and a therapist, in each game 12 cards are distributed with drawings o objects, where each patient asks for a letter to another, establishing a communication.

 

 

Combining stem cells with an experimental grug could repair brain damage after suffering a stroke. This has been achieved so far only in mice, but if proven effective in human patients would mean a real revolution in the treatment of thousands of people who suffer a stroke every year.
The study appears in the journal “Nature Medicine”, involves the injection o stem cells into the brain after suffering stroke. By adding this medicine (called 3K3A-APC), it is posible to prolong the life of the stem cells and become neurons. These make functional and structural connections with the nervous system. Activated protein C (APC) is a blood protease with anticoagulant activity and cell-signalling activities mediated by the activation of protease-activated receptor 1 and F2RL1.

 

Recombinant variants of APC, such as the 3k3A-APC have shown benefits in preclinical models of ischemic stroke, brain trauma, multiple sclerosis, amyotrophic lateral sclerosis, sepsis, ischemic and reperfusion injury of heart, kidney and liver, pulmonary, kidney and gastrointestinal inflammation, diabetes and lethal body radiation. Which suggests the potential for APC-based treatment as a strategy for structural repair in the human central nervous (CNS) system.

BrocasAreaSmall
Broca and Wernicke were some of the first to write about aphasia, Wernicke was the first credited to have written extensively about aphasia being a disorder that contained comprenhension difficulties.
Pierre Paul Broca (1824-1880) was a French physician, anatomist and antrhopologist. He is known for his research on Broca´s area , a región of the frontal lobe that has been named after him. Broca´s area is involved región of the frontal lobe that has been named after him, patients with aphasia contained lesions in a particular part of the cortex, in the left frontal región.
Carl Wernicke (1848-1905) was a German physician, anatomist, psychiatrist and neuropathologist. He is known for forms of encephalopathy and Wernicke´s aphasia.

 

Are some precautions which decreasing the risk o stroke, the main cause of aphasia:
• Exercising regularly
• Eating a healthy diet
• Keeping alcohol consumption and tobacco
• Controlling blood pressure
Specific treatment techniques include the following:
• CART: Copy and Recall Therapy
• VIC: Visual Communication Therapy
• VAT: Visual Action Therapy
• FCT. Functional Communication Treatment
• PACE: Promoting Aphasic´s Communicative Effectiveness
• MIT: Melodic Intonation Therapy
• SFA: Semantic feature analysis

 

Bibliography:

 

Bolte Taylor, Jill ; “My Stroke of Insight”, Ed. Penguin Books, 2009

 

WHO Aphasia
http://www.who.int/topics/cerebrovascular_accident/en/

 

Yaoming Wang, Zhen Zhao, Sanket V Rege, Min Wang, Gabriel Si, Yi Zhou, Su Wang, John H Griffin, Steven A Goldman & Berislav V Zlokovic ; “3K3A–activated protein C stimulates postischemic neuronal repair by human neural stem cells in mice” Nature Medicine volume 22, pages 1050–1055 . 2016

 

Berthier, M. L.; Green Heredia, C; Juarez Ruiz de Mier, R; Lara, J.P and Pulvermuller, F; “Rehabilitación Grupal Intensiva de la Afasia”, REGIA; TEA Ediciones, 2014

 

  • Wikipedia

 

Relationed links:

 

REGIA
http://www.web.teaediciones.com/Ejemplos/REGIA_Extracto_manual.pdf
Nature
http://www.nature.com/articles/nm.4154

 

ARPA
https://arpaafasia.es/terapia-experimental-para-dano-cerebral/

 

American speech-language-hearing association
https://www.asha.org/public/speech/disorders/Aphasia/

 

 

 

 

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