Aphasia broca: The disorder produced by injury to Broca’s area, which is located in the left frontal lobe and exerts control of expressive language.
The term aphasia is applied to refer to a disorder whose origin is neurological and that implies a loss of the communication ability of the person who suffers from it. This limitation in terms of communicative ability may be due to the inability to express through language as well as the inability to understand said language.
There are different types of aphasia and the classification made of this will depend on the symptoms that appear associated with the condition of this disorder. During this article, we will focus specifically on aphasia broca.
Aphasia broca is also called expressive or motor production aphasia and causes in the individual who suffers from it a difficulty in the ability to communicate, the degree of which can be moderate or severe. These communication difficulties arise as a result of an alteration in the ability to express language.
What is aphasia broca?
Aphasia broca directly affects spoken language. Among the characteristics of people who suffer from it, we can highlight the fact that these people are not able to form complete and correctly articulated sentences and, therefore, neither to express themselves fluently, although comprehension is relatively preserved.
According to the classic classifications of aphasias, these are categorized according to the brain region in which the lesion that causes them is located. Taking this model into account, we can say that aphasia broca arises as a consequence of a lesion in Broca’s area.
The brain region known as Broca’s area is located in the left frontal lobe and is considered the nucleus that controls expressive language. In this area, specifically, capacities such as:
- Order the phonemes when making a word.
- The organization of words within a sentence.
- The semantic integration of the content to be expressed.
- Motor planning necessary for the expression of language.
Symptoms of aphasia broca
We have already commented previously that this type of aphasia mainly affects the expression of language and therefore its manifestations are closely related to the production of speech.
People with this disorder often have many problems finding words and forming sentences properly, which leads to poor communication. In addition, there is also a lack of prosody in oral communication and affectation in writing.
The way people with aphasia broca speak is often referred to as telegraphic speech. With this colloquial name, the fact of the existence of a speech with many pauses is made clear, mostly due to the difficulty in articulating words without content, so we are faced with a language composed almost exclusively of nouns and verbs.
The severity of symptom presentation correlates directly with the severity of the injury produced. There will be cases, in which the severity is less and there is a slight anomie and a reduction in verbal fluency; in other more serious cases, the person may even be unable to say a word.
Functionally, the regions involved in Broca’s aphasia are also involved in motor skills, so it is not surprising that this disorder is also associated with some deficit of this type. Within these motor impairments we can highlight:
- Hemiparesis : It consists of the appearance of localized paralysis in only one half of the body.
- Apraxia : It is manifested by the appearance of deficits in purposeful movements.
- Dysarthria : Set of motor deficits that affect the movements necessary for the correct articulation of language.
As a summary and in order to clarify the symptoms of this disorder, we can establish the following as the main symptomatological manifestations:
- Lack of fluency in the creation and emission of spontaneous language.
- Existence of manifest alterations in the written language.
- Listening and reading comprehension are maintained.
- There is a deficit in word repetition.
- Presence of anomie. This symptom involves difficulty remembering the names of objects.
- Difficulty remembering specific words.
- Possible presence of associated motor alterations, such as: dysarthria, apraxia and hemiparexia.
Why does aphasia broca occur?
One of the main causes of the appearance of aphasia broca is after suffering some type of stroke, such as cerebral ischemia or hemorrhage. This accident usually occurs in the left hemisphere of the brain, which is closely related to language. There is a significant probability of involvement, especially when this accident directly affects the middle cerebral artery.
Other possible causes that can produce Broca’s aphasia can be: head injuries or the presence of a brain tumor in that specific area of the brain.
If the damage caused by these different affectations is limited solely and exclusively to Broca’s area, then only mild linguistic and motor symptoms will appear. The symptomatology worsens when the involvement extends to surrounding areas such as the anterior insula, the precentral gyrus or the opercular region.
On the other hand, we can also find manifestations associated with aphasia broca in the clinical picture of some neurodegenerative disorders :
• Non-fluent type primary progressive aphasia : We are faced with a progressive deterioration of oral expression. In the early stages of the disease, the person who suffers from it does not present other characteristic signs of complaint. In relation to language, it stands out mainly for the lack of fluency and the appearance of difficulty in ordering sentences properly and also for anomie.
• Alzheimer : In addition to the characteristic symptoms of this disease related to cognitive impairment, reduced spontaneous language and anomie also appear.
• Parkinson : You can see a decrease in oral fluency, language with syntactic simplicity and in some cases, difficulties in constructing sentences in an adequate way.
How is the diagnosis of aphasia broca made?
The diagnosis of aphasia broca must be made through an evaluation carried out by a qualified professional, who will use neuropsychological tests created for this purpose, both general and specific.
When these types of evaluations are carried out aimed at detecting aphasia in general and aphasia broca, in particular, it is important not to lose sight of two parameters that can have a major influence on the oral communication capacity of the person evaluated:
• Cultural level and educational level : This is a variable that influences the subject’s ability to communicate. For example, a higher cultural level will mean, in general, a more fluid communication, with a greater amount of lexicon and with a better capacity for expression.
• Symptoms and extent of the injury that has occurred : The person undergoing the evaluation may present cognitive deficits that are associated with more diffuse injuries, for example, the presence of difficulties in terms of memory and attention. can affect the individual’s ability to communicate.
To carry out an exhaustive evaluation that ends up leading to a correct diagnosis of aphasia broca, it is necessary to assess various areas of language. It is necessary to establish which of them are affected and, based on this, establish what type of aphasia we are dealing with.
The areas of exploration that we referred to earlier are the following.
- Spontaneous speech
It is the capacity that allows us to initiate and maintain discourse. Within this area the main attention is focused on the evaluation of verbal fluency. This concept is conceived as a continuum and is defined by two main conditions:
• Non-fluent speech : It arises as a result of a difficulty in the emission of language. The person who suffers from it finds it very difficult to emit short sentences, so the communicative action supposes a great effort and fatigue. It is usually a speech that is characterized by some prosodic parameters being affected, such as rhythm and timbre, as well as alterations in the syntactic construction of sentences.
• Fluent or hyperfluid speech : In this parameter we would include the ability to emit normal language or above average and that is accompanied by prosody and articulation that are considered normal. In these cases the alterations have more to do with the content that is expressed within speech, these alterations are known as paraphasias. These paraphasias can be of two types:
- Semantic : When a word is used that is wrong, but belongs to the same category as the correct word.
- Phonological : Changes of syllables or letters within the same word.
If we are dealing with a case of aphasia broca, we will be able to appreciate the type of speech that occurs in the non-fluent.
We are faced with a skill whose evaluation is considered quite complicated. Its main difficulty lies in the fact that erroneous responses or non-responses may be motivated by other factors such as limitations in language production and not in comprehension, which is what is intended to be evaluated.
Precisely in order to avoid this confusion, the ideal is to use tests for which linguistic production is not necessary. Being able to establish if the comprehension is preserved or on the contrary it is altered.
Patients with aphasia broca retain their comprehension abilities.
This ability involves many underlying processes: decoding the auditory information received from another interlocutor, searching for the phonological code that corresponds to the received message, and reproducing the result of the two previous processes through correct linguistic articulation.
The affectation in some of the three processes that we have commented previously would suppose the presence of alterations in the capacity of repetition of the evaluated individual.
The tests to which the person is subjected to determine the presence or not of aphasia broca is the repetition of letters, words and pseudo-words. If this capacity is altered, we are faced with a case of aphasia broca.
- Naming ability
This, as its name suggests, is the ability to name. We see an element and after accessing our lexical bank we find a linguistic element that defines it, its name. For patients who are affected by Broca’s aphasia, this process is highly complicated.
- Automatic sequences
Automated sequences are a basic element in the creation of the language. They are learned sequences like days of the week or numbers. Although they also include aspects of affective and automatic language, such as expressions or taglines. This type of language tends to remain preserved in most aphasias.
What does the intervention consist of?
The fact that a person suffering from aphasia broca is able to recover or minimize the deficits produced by this disorder depends to a large extent on the severity of the symptoms that they present.
When this aphasia is in its initial phase, there may be a spontaneous recovery and a restructuring of the brain areas to try to compensate for the deficits that have occurred.
The main objectives of a rehabilitation intervention in this sense are:
- Improving verbal and written language skills.
- Facilitate the participation of the affected person in daily communication with those around him.
- Try to reach a communication that is effective, even if the language used is simple.
- Achieve a substantial improvement in the patient’s quality of life.
In this type of intervention, the main weight falls on the figure of the speech therapist, although it is also necessary to highlight the role played by the neuropsychologist in the treatment. The latter completes the work of the former by training the cognitive areas that have a direct influence on the ability to communicate (attention, memory…)
Recovery will be subject to the different areas of the language, since, for example, comprehension and repetition seem easier to recover if we compare them with naming and fluency.
Depending on the individual characteristics that a person presents, a specific intervention plan is established for them. The following tasks are included in this plan:
- Neuropsychological stimulation : It involves the training of basic cognitive skills involved in the process of communication and language.
- Naming activities : These exercises are performed with the aim of reducing anomie. Facilitating keys are used, these can be semantic, such as the category to which the word we are looking for belongs; or phonological, for example, the first letter of the target word.
- Exercises aimed at working on the correct construction of sentences.
- Getting to increase the size of the expressions used by the patient : It begins with a single element and then more are added in order to create a richer and more effective communication.