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The recent announcement by the famous American actor Bruce Willis, who made it known that he will no longer act as he is suffering from aphasia, has focused a lot of attention on this common language disorder. Aphasia is a disabling pathological condition with a generally sudden onset, which limits the ability to communicate verbally. Depending on the case, it can affect the ability to produce or understand words, or both, both in written and oral form. And it can be reversible, partially reversible or irreversible.
Some people with aphasia may have difficulty expressing themselves but retain their ability to understand language. Others are able to speak fluently but in a senseless way and, for example, they are unable to understand the words of others or to answer a simple question even if the answer is clear (“How many fingers does a hand have?”). Still others are unable to speak but are able to write or use other communication channels. All cases of aphasia, which can also be very different from each other, still tend to have a significant impact on the daily life, autonomy and relationships of the people who suffer from it.
The epidemiological estimates of aphasia in Italy, lacking direct data, are generally obtained starting from the data on the diseases that represent the main cause: vascular ones, and cerebral stroke in particular. Based on that data, it is calculated that in Italy there are about 200 thousand people suffering from aphasia, with an incidence of about 20 thousand new cases per year of aphasia following stroke according to the most conservative estimates. Other causes can be head injuries or, with more gradual manifestations, brain tumors, dementias or other diseases.
Although it is a relatively widespread disorder, aphasia often has implications on the patient’s life that are not always known to family members and people who find themselves dealing with it, such as refer several treatment institutes, associations and speech therapy clinics that deal with rehabilitation. It happens, for example, that those people mistakenly assume that the ability to think is affected in the aphasic. On the other hand, family members and the people closest to the patient are considered fundamental for the goal of returning – if not to speak as before, which is still possible in some cases – to establish effective communication relationships.
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Aphasia is a ndolarpsychological pathology, therefore it does not concern the speech apparatus or the auditory organ: the ability to articulate words with the voice, in strictly physical terms, is a function generally maintained. What is lacking is the ability to associate words with their respective verbal messages. People with aphasia have a hard time “finding” a certain word when they think about it, or vice versa they are unable to recall what a word means when they read or hear it. Their condition, like they explain speech therapists and other specialists, in a certain sense resembles that of a subject who suddenly finds himself in a context populated by people who speak a language unknown to him.
Aphasias are believed to be caused by lesions in particular areas of the brain, those of the cerebral cortex of the left hemisphere, the most important for language functions. Performing autopsies on many aphasia patients, the French physician and anatomist Paul Broca discovered in the second half of the 19th century that they all had some kind of injury to the frontal lobes on the left side of the brain. “Let’s talk to the left hemisphere”, She said Broca in 1865 introducing the idea of a hemispheric specialization very little popular at the time.
Starting with Broca’s studies, who imagined he had located a “motor center for words”, that area of the left frontal lobe is still called Broca’s area today. The lesions in this area, according to a classical pathogenic interpretation, would be responsible for the so-called motor aphasias, those in which the ability to express oneself in words is lacking but the ability to understand them is present. Aphasias that instead affect the ability to understand the language of others and not necessarily the ability to speak fluently – even if mostly without a logical sense – are also called sensory aphasias. And they are most associated with lesions in the Wernicke area, named after the German psychiatrist and ndolarlogist, Carl Wernicke, who discovered that area of the brain in 1874.
Although considered fundamental for studies on the doctrine of brain localizations, this classic interpretation of the pathogenesis of aphasias has been expanded over the years by taking on new ndolarpsychological perspectives. Thanks also to the availability of increasingly advanced and efficient diagnostic and visualization techniques, prevail for some time now approaches that have focused on the modular organization of language functions and systems – phonology, lexicon, semantics, grammar – and on the presence of many “nodes” at the neural level.
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In recent decades, aphasia has been the subject not only of in-depth studies, which have made it possible to better understand the ndolarphysiological characteristics of this pathology, but also of detailed descriptions in popular and successful literary texts, written starting from the clinical observation of speech therapists. and other specialists. The famous English ndolarlogist and popularizer Oliver Sacks, who dedicated many of his texts to the study of disorders of the production and understanding of spoken and written language, dealt with aphasia in his 1985 book The man who mistook his wife for a hatamong others.
In one of the chapters of the book, Sacks told of some aphasic patients able to interpret verbal language in distorted but surprising ways. Unable to understand the words of other people’s speeches, they progressively became very skilled at grasping other aspects related to non-verbal communication, including gestures, intonation and facial expressions. To the paradoxical point of being able in some cases to grasp the meaning of the speeches and recognize the lies more easily than many non-aphasic people could.
Intonation is also one of the fundamental aspects on which a therapeutic approach generally aimed at aphasics who maintain a good vocabulary and a good auditory understanding focuses. It is called “melodic intonation therapy” and, as told in a long story item in the magazine for cultural studies The Pocketplans to “sing to get around aphasia.”
The dominant hemisphere for speech is usually the left one, in right-handed subjects, and it is there that the lesions underlying some motor aphasias generally occur. The opposite hemisphere, on the other hand, is responsible, among other things, for the prosodic aspects of the word: everything that therefore concerns the phonic, dynamic and melodic characteristics of a specific spoken language, regardless of the articulation of the words. Precisely that modulation of a tonality, in the case of singing therapy, allows to give a different meaning to words and to be able to use them in different contexts.
Speaking of one of his patients who loved to sing, the speech therapist of the Santa Lucia Foundation in Rome Camilla Buitoni told the Pocket-sized that, although hearing understanding in that patient was greatly impaired, she realized that “singing facilitated phono-articulation and made him bring out something that excited him.” In a sense, it is as if melodic intonation therapy allows the patient to construct an alternative neural pathway through the right hemisphere.
To describe the importance of correctly understanding aphasia as a linguistic and non-communicative deficit, Buitoni also told the case of one of his “verbal apraxic” patients who had nevertheless found a way to ask for a cappuccino at the bar by putting his hands on his head. , and the croissant making the gesture of the horns with his hand.