Broca’s Aphasia: Learning to Speak

Aphasia is an impairment of language that affects a person’s ability to produce and comprehend speech as well as read or write. Aphasia most commonly results from stroke, the leading cause of adult disability in the United States. A stroke can occur anywhere in the brain, and depending on wherScreen Shot 2016-02-10 at 11.51.41 AMe damage occurs, aphasia presents differently. The left side of the brain serves as the location of most language functions. Speech comprehension occurs in the left posterior brain—Wernicke’s area—and speech production occurs in the left frontal lobe—Broca’s area. Today, I want to focus on Broca’s aphasia and the road to recovery.

When damage occurs to only Broca’s area, people can still understand speech, yet they have trouble forming and speaking words. Limiting speech to utterances of around four words, Broca’s aphasia is also referred to as non-fluent aphasia and is one of the most severe versions of this condition. During a TEDx Talk, Dr. Julius Fridrikkson specifies that non-fluent aphasia does not damage a person’s intellect but his ability to speak. Losing the capacity to communicate with others and to express one’s wants, needs, and ideas can be a challenging and isolating experience. Dr. Fridrikkson says:

“Of all of the chronic conditions that we have, aphasia probably robs people of their freedom and independence more than any other disorder.”

Recovering from aphasia is a long, grueling process, often with limited results. The rehabilitation process begins quickly after stroke. A patient works with a speech pathologist on language drills. In accordance with the severity of the brain damage, people begin with practicing short, single-syllable words and work up to more complex words or phrases. There’s no speech rehabilitation that heals all people, but I want to share two therapy techniques that have shown success and highlight the complexity of the brain.

Audio-Visual Speech Therapy

This rehabilitation technique is rooted in the knowledge that Broca’s region does not only function for speech production but is also active when a person watches the articulators—the mouth, tongue, and lips—of a person who is speaking. While rehabilitation focused on saying words and producing speech can be arduous, frustrating, and draining, rehabilitation centered on patients watching and listening to a therapist speak can help activate the remaining, non-damaged areas in the left frontal lobe. When practicing audio-visual speech, patients can mimic the therapist’s speech. Even if a person with Broca’s aphasia can only say a few words, she can mimic someone else’s speech in real time when speaking slowly. Current technology allows patients to execute audio-visual speech by watching a mouth on an iPod. While audio-visual speech is not a ticket to fluency, it is a step towards improved communication, better understanding aphasia and more successful rehabilitation.

Watch Dr. Julius Fridrikkson and audio-visual speech in action the Tedx Talk: “Enabling Fluent Speech in Non-Fluent Aphasia”                   

Melodic Intonation Therapy

Similar to the idea that those with Broca’s aphasia cannot speak on their own but can speak when mimicking someone else, melodic intonation therapy (MIT) is based on a phenomenon that many people with non-fluent aphasia cannot speak but can still sing. Elements of singing such as melody and rhythm are thus incorporated into speech rehabilitation. Patients practice tapping out short phrases to a melody and rhythm. Patients begin with useful, common phrases of just 2-3 syllables and work their way up to 5 or more syllable phrases. Though MIT has shown success, debate still exists over why and what neural circuitry is involved. What is agreed upon is that singing uses both the left and right hemispheres of the brain; aphasiacs use their healthy right hemisphere to sing. With continued research, hopefully more and more patients will go from singing to speaking.

 Watch a clip of Senator Gabby Giffords’s road to recovery following severe left hemisphere brain damage. At 2:40, she struggles to say the word “light,” but then goes on to sing “this little light of mine” with her speech pathologist. She taps and intones “give me a kiss” at the end of the video.

To learn more about the many kinds of aphasia or aphasia in more detail, visit the National Aphasia Association website!

Additional reading:

“From Singing to Speaking: Its Amazing to See” Stroke Connection Magazine, September/October 2005

Norton, A., Zipse, L., Marchina, S., & Schlaug, G. (2009). Melodic Intonation Therapy: Shared Insights on How it is Done and Why it Might Help. Annals of the New York Academy of Sciences, 1169, 431–436.

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