Brain and aphasia

Salahaddin University-Erbil College of Basic Education English Department Brain and Aphasia Khozga Kh. Saber Shayda A. As 'ad Supervised By Muhammed K. Abdulwahab This Research Submitted in Partial Fulfillment of the Requirements for the Degree of Bachelors in English at College of Basic Education, Salahaddin University-Erbil [2015-2016] Word count: [1418] Dedication We would like to dedicate this study to our families, supervisor, and friends. Also we would like to dedicate it to patients with aphasia. Acknowledgements First of all we would like to thank our almighty Allah for helping us to accomplish this study, then our thanks and appreciate to Mr. Muhammed K. Abdulwahab for his valuable guidance while supervising the paper; finely we would like to appreciate the assistance of those who become a part of our study. Table of Contents Contents Section One 7 Introduction 7 1.1 General Background 7 1.2 Research Aims 7 1.3 Research questions 7 1.4 Scope and limitations 7 1.5 Hypotheses 8 Section Two 9 Literature Review 9 2.1 Brain 9 2.1.1 Language areas in the brain 9 2.1.3 Localization view: 14 2.1.4 Language processing 15 2.2 Aphasia 16 2.2.1 Types of aphasia 16 Section Three 21 Methodology 21 3.1 Research aims 21 3.2 Research Method 21 3.3 Data collection instruments 21 3.4 Sampling and Participant 22 3.5 Research issues 22 3.5.1 Ethical considerations 22 3.5.2 Validity and Reliability 22 3.6 Summary 23 Section Four 24 Data Analysis and Discussion 24 4.1 Where the ability to produce, understanding language ability is located? 24 4.2 What are the most common types of aphasia? 24 4.3 What are the impacts of brain impairment on language performance? 25 Section Five 31 4. Conclusion 31 Reference list 32 Appendix 34 Interview questions 34 Observation’s rubric 38 Abstract This research is entitled (Brain and Aphasia) which aims at investigating the relevance between brain and aphasia by providing details about the locations of producing and understanding language ability, in addition to exploring the common types of aphasia in Kurdistan and its influence on language performance. In this study, qualitative methods as a data collection were used; such as semi-structured interview and observation in order to triangulate this research. The majority of the participant (doctors) reported that on the left side of the brain there’s an area called speech center consist of two main part called Broca’s area and Wernicke’s area that has been connected via Arcuate fasciculus. They also reported that the majority of the case are global, Broca’s and Wernicke’s aphasia which have been seen during their experience in hospitals, however, they claimed to have seen few cases about conduction aphasia. The observation cases suffered from one of the aphasiac cases such as global, Wernick and Broca’s however during the observations we have found that if a patient suffers from one of the language abilities (comprehension, production, repetition, reading, writing, and naming objects) the other abilities would be affected more or less depending on the cases. This research consists of five sections. Section one is specified for the introduction which consists of the general information about the research. Then in section two some details about brain and aphasia have been reviewed. Section three presents the Methodology that has been used to collect the data. Section four deals with data analysis and discussion. Finally, in Section Five the study ends up with some concluding point and recommendation about the study. Section One Introduction 1.1 General Background The brain is the central processing unit that controls human being activities. Many types of researchhavebeen conducted on the brain because of its’ crucial roles. In this study some details about the various features of language that people use to produce and understand linguistic messages have been reviewed, which entitled Brain and Aphasia, however, the most common area that related to language function and aphasia with its’ common type due to localized brain damage and impairment of language ability has been explained. 1.2 Research Aims This research aims at investigating the relevance between brain and aphasia by providing details about the locations of producing and understanding language ability, in addition to exploring the common types of aphasia in Kurdistan and its influence on language performance 1.3 Research questions In this research, these questions have tried to answer. Where the ability to produce, understanding language ability is located? What are the most common types of aphasia? What are the impacts of brain impairment on language performance? 1.4 Scope and limitations The research conducted about areas in the brain that related to language functions, and four famous type of aphasia (Broca, wernicke, conduction, and global) that related to language disorder. The research has been conducted Kurdistan region specifically in Erbil (Rzgary and PAR hospitals) 1.5 Hypotheses We hypotheses that specific parts of the brain are responsible for the specific function of language and any dysfunction in these areas will influence language performance. Section Two Literature Review In this section, some points about the brain and its common type for produce and comprehending language has been highlighted. In addition to the most common types of aphasia due to localized brain damage has been reviewed. 2.1 Brain The brain has been defined as; A portion of the central nervous system that is located within the skull. It functions as a primary receiver, organizer, and distributer of information for the body. It composed of cerebral hemisphere; (Left hemisphere which superior for language, rhythmic perception, temporal-order, judgments, mathematical thinking skills, and supervises right side of the body. Right hemisphere which does better in pattern-matching tasks, recognizing faces, spatial orientation, and supervises left side of the body). (Aitchison, 2003; Qarachatany, 2007) 2.1.1 Language areas in the brain A number of researches have been made about the specific parts of the brain that related to language functions. Researchers have discovered that the most important parts are in areas above the left ear it is not only because it controls the right side of the body – and the majority of humans are right- handed but also because it controls language. The brain is divided into two halves, a left hemisphere, and a right hemisphere this is called localization and applies to all animates. In animals that are particularly vocal, such as canaries, dolphins, and chimpanzees, it seems that one hemisphere or another is dedicated to controlling those behaviors and the responses to them (Aitchison, 2003). In human beings, it is the left hemisphere of the brain that usually contains the specialized language areas that develop a special responsibility for language. While this holds true 97% of a right-handed person, about 90% of left-handed people have their language areas in the right hemisphere and as many as 68% of them have some language abilities in both left and right hemisphere the view that talked about functions of each cerebral has been described as brain lateralization. Studies of children have provided some attractive information; if a child has damage to the left hemisphere, the child may develop language in the right hemisphere instead. The younger the child, the better the recovery, so it shows that our brains are capable of adapting to difficult circumstances, if the damage occurs early enough (Boeree, 2004; Field, 2004) Broca’s area Broca’s area also it has been known as (motor speech area) is one of the main areas of cerebral cortex located in the frontal lobe responsible for producing language. This region of the brain controls motor functions involved with speech production. Patients with damage to Broca’s area relatively have got good comprehension but cannot properly form words or produce speech (Seelely et al., 2006).It was discovered in 1861 by French neurosurgeon Paul Broca while examining the brain of patients with language difficulties (Yule, 2010).It located in a frontal part of the left hemisphere of the brain; it lies specifically in the third frontal convolution, just anterior to the face area of the motor cortex and just above the sylvian fissure. The Broca’s area is connected to other regions of the brain including Wernicke’s area via Arcuate fasciculus (Ingram, 2007). Figure(1)(Ingram, 2007). In addition to serving a role in speech production the Broca’s area also involved in language comprehension, syntax processing, in motor activities associated with hand movements and in sensorimotor in learning and integration (Bailey, 2015). Wernicke’s area Is one of the main area of cerebral cortex contains motor neurons responsible for understanding language and comprehension it has been known as “posterior speech cortex”? Persons with damage to Wernicke’s area results in a kind of aphasia characterized by fluent but meaningless speech and an apparent inability to comprehend language they have difficulty in understanding what has been said, it’s empty of content (Akmajian et al., 2010; Ingram, 2007).It was described in 1874 by German neurologist Carl wernicke while examining patients who had speech comprehensions difficulties (Yule, 2010). According to the Encyclopedia of Britannica (2014),“Wernicks area is located in the posterior third of the upper temporal convolution of the left hemisphere of the brain.” Figure (2) Wernicks area involved in several functions including language comprehension, semantic processing language recognition and language interpretation (Bailey, 2015). Arcuate fasciculus According to Martin (2006), it was Carl Wernicke (1874) who offered an explanation about Arcuate fasciculus; it’s a bundle of nerve fibers that connects Broca’s area with Wernicke’s areas, any damage to this area would impair the ability to repeat heard words which have been known as conduction aphasia. As has been showing in Yule (2010:158) “Arcuate fasciculus is located between Broca and Wernicke’s area in the left hemisphere of the brain”. Figure (3) Motor cortex It’s a part of the brain that generally responsible for the control of movement over the whole body, close to Broca’s area is the part of motor cortex that controls the articulatory muscles of the face, jaw, tongue, and larynx “evidence that this area involved in the physical articulation of speech comes from work reported in the 1950s by two neurosurgeons, Penfield and Roberts (1959)” (Yule, 2010:159). Figure (4) (Martin, 2006). 2.1.3 Localization view: Throughout its history localization view has been known as a belief that specific aspects of language ability have a specific location in the brain. According to experiments that have been made for language process in the brain has been suggested that the brain activity consists of hearing a word understand it and then saying it, it has been discovered that the word is heard and comprehended via Wernicke’s area. This signal is then sent via the Arcuate fasciculus to Broca’s area where preparations are made for produce the word. A signal is then transferred to a part of the motor cortex to physically articulate the word. (Yule, 2010; Ingram, 2007) Figure (5) (Al Mohammadi, nd) 2.1.4 Language processing Linking language process with specific locations in the brain is difficult because these processes are often not localized in particular areas. In addition, language processing is extremely complex, requiring a broad range of functions, recent researches have shown that our head is like a central language processer both receiving and sending signals, through two channels the articulatory-auditory (speech), and the manual visual (writing). We may refer to this picture as language switchboard. At the center of these input-output events is the brain, capable of reconciling the considerable physical and psychological differences between these events, so that it can recognize and generate the same message in different forms. Figure (6) (Garman, 1990) 2.2 Aphasia Language is much more than words it involves our ability to recognize and use words and sentences, much of this capability resides in the left hemisphere of the brain. when a person has stroke or the other injury that affects the left side of the brain, it typically disrupts their ability to use language thisimpairment of language function are usually due to localized brain damage caused by an accident, a stroke, invasive surgery but some researcher has suggested that it may be the effect of dementia that leads to difficulty in the production or comprehension of speech and the ability to read or write that has been knowing as Aphasia (Field, 2004). As has been explained in John (2004:16) “Evidence from aphasics provides possible insights into the location of language in the brain, and into the constituent parts of language processing, some of which may be lost by an aphasic and others retained. However, it is dangerous to rely too heavily upon evidence from these atypical subjects. We cannot assume that brain damage has wiped out a given aspect of language processing. Information may have been relocated, or a process may have switched to new (and less efficient) channels than those normally employed.” It can be seen from the above mentioned information that the characteristics of each type cause the exact effects very considerably from patient to patient. 2.2.1 Types of aphasia The classification of different type of aphasia is usually based on the primary symptoms of someone having difficulties with language, as has been classified by Martin (2006) Broca, Wernicke, Conduction, Global are the most common types of aphasia, however, within these common types Deep dysphasia (Word repetition deficits), Transcortical sensory aphasia (Impaired comprehension, naming, reading and writing), Transcortical motor aphasia (Transient mutism and telegrammatic, dysprosodic speech) have been mentioned. Here are the descriptions of the most common types of aphasia: Broca’s aphasia According to Garman (1990), Broca’s aphasia which also called non-fluent, expressive or motor aphasia could be defined as a language disorder due to localized brain damage in the left hemisphere. Such damage is often a result of astroke but may also occur due to brain trauma, lesion…etc. Individuals with Broca’s aphasia have trouble speaking fluently, but their comprehension can be relatively preserved they may be able to read but be limited in writing. They have difficulty in producing grammatical sentences, and their speech is limited to short utterances. For example: “Doctor: Why did you come to the hospital? Patient: Ah . . .Monday . . . ah dad and Paul . . . and Dad . . . hospital. Two . . . ah doctors . . . and ah . . . thirty minutes . . . and yes . . . ah hospital. And er Wednesday . . . nine o’clock . . . doctors. Two doctors . . . and ah . . . teeth Yeah . . . fine This example shows that the speech of the patient with Broca’s aphasia is characterized by extreme verbal economy, by an omission of prepositions and definite articles, by little grammatical construction and by abnormal prosody. While patients have unimpaired semantic comprehension”(Martin, 2006:283). However, as has been examined by National Aphasia Association (nd) Patients with Broca’s aphasia have problem in understanding sentence with complex grammatical markers for example the sentence “Mary gave John balloons” may be easy to understand but “The balloons were given to John by Mary” may pose a challenge when the patient try to find who gave the balloons to whom non-fluent, slow and labored, although language comprehension at a simple level remains fairly normal (NAA). Wernicke’s aphasia Wernicke’s aphasia which also has been known as Sensory Aphasia could be defined as a language disorder due to localized brain damage in the left hemisphere. Such damage is often a result of astroke but may also occur due to brain trauma, lesion…etc., it is characterized by syntactically complex and well structured speech, containing function words and correct affixation. Speech is apparently effortless, fluent and rapid. Indeed, someone suffering from this disorder can actually produce very fluent speech but with no sense. Many of Wernicke’s patients claim not to recognize that they have speech difficulties. But there may be severe problems in retrieving vocabulary, with a reliance on general or inappropriate nouns and verbs they have got difficulty in finding the correct word, to overcome their word-finding difficulties, speakers use different strategies such as trying to describe objects or talking about their purpose for example the speaker tries a range of strategies when he can’t come up with the word kitein a picture “it’s blowing, on the right, and er there’s four letters in it, and I think it begins with a C – goes – when you start it then goes right up in the air – I would I would have to keep racking my brain how I would spell that word – that flies, that that doesn’t fly, you pull it round, it goes up in the air”(Yule, 2010:163; Field, 2004). Conduction Aphasia A language disorder associated with damage to Arcuate Fasciculus in which repeating words and phrases are difficult. Individuals with conduction aphasia suffering in pronunciation, not in articulation. Comprehension of spoken word is normally good, but the difficulty is in repeating words and phrases. What the speaker hears and understands cannot be transferred very successfully to the speech production area because of the connection problems between Broca’s area and Wernicke’s area. Conduction aphasics will show relatively well-preserved auditory comprehension, which may even be completely functional. Spontaneous speech production will be fluent and generally grammatically and syntactically correct. Intonation and articulation will also be preserved. The speech will often contain par aphasic errors phonemes syllables will be dropped or transposed and patients with mostly aware of their language problems and will often make attempts to correct their errors. Example 1: Doctor: Snowball Patients: snowall Doctor: Television Patients: vellitision Doctor: ninety-five percent Patients: ninety-twenty percent (Yule, 2010). Example 2: Doctor: Bicycle. Patient: Bicycle. Doctor: Hippopotamus. Patient: Hippopotamus. Doctor: Blaynge. Patient: I didn’t get it. Doctor: Up and down. Patient: Up and down. Doctor: Yellow, big, south. Patient: Yellen . . . Can’t get it (Carlson, 1986 cited in Martin, 2006). Global aphasia This is the most severe form of aphasia and is applied to patients who can produce few recognizable words and understand little or none spoken language means it affects both receptive and productive language skills. Persons with Global Aphasia can neither read nor write. Like in other milder forms of aphasia, individuals can have fully preserved intellectual and cognitive capabilities unrelated to language and speech Perhaps global aphasia describes a generalized inability to (1) comprehend or repeat heard the speech, (2) produce speech, or (3) name objects. However, the production and comprehension of automatic phrases and word sequences such as days of the week, expletives and greetings may be spared. Global aphasia results from an extensive lesion to multiple language-processing areas of the brain, Wernicke’s and Broca’s areas. Global aphasia may often be seen immediately after the patient has suffered a stroke or a brain trauma. Symptoms may rapidly improve in the first few months after a stroke if the damage has not been too extensive. However, with greater brain damage, severe and lasting disability may result (Martin: 2006). Section Three Methodology This section presents an overview of the research methodology. It includes methods and procedures used in this study such as participants, sample, ethical consideration, validity and ratability, and data analysis. 3.1 Research aims This research aims at investigating the relevance between brain and aphasia and exploring the common types of aphasia and its influence on language performance. The questions of this study are: Where the ability to produce, understanding language ability is located? What are the most common types of aphasia? What are the impacts of brain impairment on language performance? 3.2 Research Method The study aimed at collect data in order to answer the research question using qualitative data. “Qualitative data is primary exploratory research it is utilized to gain an understanding of underlying reasons, opinion, and motivation. It provides insights into the problem or helps to develop ideas. It also used to uncover trend in thought and opinions and dive deeper into problems” (Wyse, 2011). 3.3 Data collection instruments In this study, qualitative methods as a data collection were used; such as semi-structured interview and observation in order to triangulate this research. 3.4 Sampling and Participant “The method used to select the participate was ‘purposive sampling’ the method entitled selecting a definite group based on a specific purpose rather than random selection” (Tashakkon & Teddlie, 2009 as cited in Abbas, 2014)The participants of the study were (3)doctors and (10) patients from Rzgary and Par hospital and Salahaddin university, they were both male and female, the doctors were required to answer twelve items of the semi-structured interview, and the patients have been observed via a rubric of six item which related to their language abilities. 3.5 Research issues 3.5.1 Ethical considerations One of the key and primary features of research is ethics because it concerned with the attempt to formulate codes and principles of moral behavior (May 2001 as cited in Abbas, 2014). In this study several main principle has been taken into account for example participants were given, in advance, a consent form which includes most of the terms of ethical issues, the participants were ensured that their name and speech would be secrete, and the data given by the participant would be kept and protect for any publication and the interviewees were informed about the use of a tape recorder and information stored would be destroyed when the data will be transcript. 3.5.2 Validity and Reliability The term of validity is one of the most effective features of any research project which indicates whether data collection is a “true picture of what has been studied” (Walsh, 2000 as cited in Abbas, 2014). (Dowling & Brown (2009) stated that reliable research is achieved when the same study is conducted again in the same environment with the same or different people and with similar outcomes. In the study the outcomes of both the observations and the semi-structured interviews are almost the same, and this research is within the range of the topics scope. 3.6 Summary This section highlighted the approaches, methods, and tools used for data collections and analysis. The reasons behind using each approach and methods were given and the ethicality, sampling, validity and reliability discussed. Section Four Data Analysis and Discussion This section deals with the analysis of the data collected from the semi structured interview and the observations so as to answer the following research question: Where the ability to produce, understanding language ability is located? What are the most common types of aphasia? What are the impacts of brain impairment on language performance? 4.1 Where the ability to produce, understanding language ability is located? It was mentioned earlier in the literature review that areas of producing and understanding language ability located in the left hemisphere of the brain (Garman, 1990). In this study, Participant was asked several questions about the location of producing language in the brain. the majority of the participant argued that on the left side of the brain there’s an area called speech center consist of two main part called Broca’s area ( motor area responsible for production), and Wernicke’s area (sensory area responsible for comprehension) that has been connected via Arcuate fasciculus (a bundle of nerve fiber connects Broca’s and Wernicke’s area). 4.2 What are the most common types of aphasia? As has been classified by Martin (2006) Broca, Wernicke, Conduction, Global are the most common types of aphasia, however, within these common types Deep dysphasia (Word repetition deficits), Transcortical sensory aphasia (Impaired comprehension, naming, reading and writing), Transcortical motor aphasia (Transient mutism and telegrammatic, dysprosodic speech) have been mentioned. The majority of the participants (doctors) agreed that global, Broca’s and Wernicke’s are the cases which have seen during their experience in hospitals while they claimed to have seen few cases about conduction aphasia. 4.3 What are the impacts of brain impairment on language performance? Figure (7) Participant patient performance in comprehension shows that there are no exceptions for excellent cases for comprehension impairment. 30% of the cases were very good at comprehending the language, 20% were normal, 30% were very bad, and 20% were bad. Figure (8) Participant patient performance in Repetition processes shows that there are neither exceptions for “excellent” nor any“ very good” cases for comprehension impairment while 50% of the cases were normal at repeating the items, 20% were very bad, and 30% were just plain bad. Figure (9) Participant patient performance during production test shows that there are no excellent neither bad production impairment performances while 50% of the cases were normal at producing the items, 30% were very bad, and 20% were very good at the test. Figure (10) Participant patient results in reading activities shockingly show that there are neither exceptions for “excellent” nor any “very good” cases for comprehension impairment while 50% of the cases were normal at repeating the items, 20% were very bad, and 30% were just plain bad. Figure (11) Participant patient performance about writing capability shows that there are no exceptions for excellent cases for comprehension impairment while 10% of the cases were very good at during writing, 30% were very bad, 40% were very bad, and 20 were bad. Figure (12) Participant patient performance about Naming objects shows that there are no exceptions for excellent cases while 10% of the cases were very good, 30% were Normal, 20% were very bad, and 40 were just bad. As has been identified through the circles, 10 patients have been viewed for 6 test item that has been conducted by the doctors once someone is affected by any type of aphasia almost all the language ability(comprehension, production, repetition, reading, writing, and naming objects) been impaired. Section Five Conclusion This section deals with presenting some concluding points about the main findings and recommendations of the study. As has been mentioned in the related literature Brain is the central processing unit that controls human being activities, many types of researchhave been conducted on the brain because of its’ crucial roles. In this study some overview about brain and aphasia and its influence on language performance has been reviewed. However the study tried to answer: Where the ability to produce, understanding language ability is located? What are the most common types of aphasia? What are the impacts of brain impairment on language performance? What has been found throughout this study is Communication, which is the core of our relationships as human beings. It’s not only how we interact with the world; it’s how the world interacts with us, Imagine you suddenly lost your ability to understand speech to talk to read and to write… but you had not lost your intelligence, imagine how everyday tasks would suddenly become difficult, where simple pleasures become confusing, a place where your closest friends seemed distant, a place where you could not even share a book with your own child that how an aphasiac feels and go through. The majority of the participant (doctors)reported that on the left side of the brain there’s an area called speech center consist of two main part called Broca’s area and Wernicke’s area that has been connected via Arcuate fasciculus. They also reported that the majority of the case are global, Broca’s and Wernicke’s aphasia which have been seen during their experience in hospitals, however, they claimed to have seen few cases about conduction aphasia. The observation cases suffered from one of the aphasiac cases such as global, Wernick and Broca’s however during the observations we have found that if a patient suffers from one of the language abilities (comprehension, production, repetition, reading, writing, and naming objects) the other abilities would be affected more or less depending on the cases. Furthermore, we recommend that establishing rehabilitation center in KRG would help patients to recover to some extent. Reference list Abbas, Z. (2014) An exploration of the communicative language teaching approach. Hesterellung: LAMBERT Academic Publishing Aitchsion, J (2003) Teach you linguistics. McGraw-Hill companies: London. Al Mohammadi, A (nd) language and the brain. Available at: http://www.google.com/url?q=http://www.kau.edu..sa/Files/000628/files/16238_12language%2520and%2520the%2520Brain.pdf&sa=U&ved=oahUKEwjon6n84rPJAhUQy2MKHTPFD48QFggVMAY&usg=AFQjCNF1lvePkr635zcYoCaCfbSYmz68SA {Accessed at November 28, 2015}. Akmajian, A., Demers, R. A., Farmer, A. K. and Harnish, R. M (2010) LINGUISTICS: An Introduction to Language and Comprehension. 6th ed. London: The MIT Press Bailey, R (2015) Broca’s area. Available at: http://biology.about.com/od/anatomy/p/brocas-area.htm {accessed October 14, 2015) Bailey, R (2015) Wernicke’s area in the brain. Available at: http://biology.about.com/od/anatomy/p/wernicke.htm {accessed October 14, 2015). Barber, Ch (2009) the English Language: A Historical Introduction. 2nd ed. Sheffield: Cambridge University press. Boeree, C, G (2004) speech and the brain. available at http://webspace.ship.edu/cgboer/speechbrain.html [accessed August 18, 2015] Encyclopedia Britanica (2014) wernicks area anatomy. Available at: http://www.britannica.com/science/wernicke-area [accessed October 14, 2015] Field, J (2004) PSYCHOLINGUISTICS: The Key Concept. London: Rutledge. Garman, M (1990) Psycholinguistics. New York: Cambridge University press. Ingram, J, C, L (2007) Neurolinguistics An Introduction to Spoken Language Processing and its Disorder. Australia: Cambridge University press Martin, G, N. (2006) HUMAN NEUROPSYCHOLOGY. 2nd ed. Edinburgh: middle sex university. National Aphasia Association (nd) Broca’s aphasia. Available at: http://www.aphasia.org/aphasia-resource/brocas-aphasia/ {Accessed at March 29, 2016} Qarachatany, K.SH (2007) General Psychology.2nd ed. Hawler: Hajji Hashm publisher. Seelely, R, R., Stephens, T, D. and Tate, P (2006) Anatomy & physiology. 7th ed. New York: McGraw Hill companies. Wyse, S, E 2011) What is Difference between Qualitative Research and Quantitative Research? Available at http://www.snapsurveys.com/blog/what-is-the-diference-between-qualitative-research-and-quantitative-research/{Accessed at March 18, 2016}. Appendix Interview questions Doctor 1. Introduce yourself /your certificate, please 2. What‘s aphasia and its common type? 3. What are the most common symptoms of each type? 4. How many type you face during your experience? 5. Why are they going to be aphasic? 6. Does age affect the recoveries? 7. who’s more vulnerable to suffer aphasia according to gender? 8. Are there certain circumstances that create fluctuations and variations? 9. What medications are going to be used related to the problem? 10. How do you react or respond to the patients’ problem? Does it bother you? 11. What do you do when the situations arise? 12. What do you hope will result from our study? Patients 1. Who are you? 2. Where are you from? 3. Where do you live? 4. Are you in the hospital? 5. is s/he your husband/wife? 6. How old are you? 7. How many children do you have? 8. What’s your favorite food? If the patient has got good comprehension the question may arise: 9. Please tell me about your problem. 10. When did the problem begin? 11. Has your problem changed since it was first noticed/gotten better or worse? 12. How others tried to help you during your difficulties? However while the patients’ interview we have to observe: 1. Comprehension 2. Naming 3. Repetition 4. Reading 5. Writing Interview 1 Neurosurgeon D.A from Par Hospital Inability to speak/ Broca, Wernicke’s, and Global Broca problem in the production of speech, wernicks the comprehension part has been affected, and global the patient is mute. Three as I mentioned before Because of that lesion in the brain which affecting the side of speech The younger the patient, the better the recovery but with old patients mostly they need more time and some time they will not recover. Gender doesn’t affect the recoveries. There 're no medications related to aphasia As neurosurgeons we don’t have physio-therapist, they are recovering cause we removing the lesions and the brain return back to normal but outside they have speech-therapist, and they will train them to recover as soon as possible. Yes of course especially patients who suffer global aphasia. Interview 2 Dr. Majeed Salih Hamad/ Consultant neurologist Aphasia is inability in comprehension & expression of speech The most common type is (motor aphasia) Broca’s aphasia, means the person can understand but unable to talk (express) Broca’s aphasia the patient can understand but unable to express, wernicks aphasia the patient can’t understand the spoken words but can express (incoherent speech), or global aphasia the patient can’t comprehend or express. Broca s aphasia & wernicks aphasia , global aphasia (both centers in brain affected) the cause is damage to the brain center responsible for comprehension (wernicke) or expression (Broca) or both, the most common cause is causing damage to the frontal lobe of the dominant cerebral hemisphere ( Broca’s aphasia) or patriot-temporal lobe ( wernicks aphasia) ,, the other common causes are trauma & tumor (brain tumors ) Yes , the younger ages affecter have better prognosis, recovery is much better & faster The most common cause is stroke & incidence of stroke is more common in men yes , early treatment &care ,decreasing risk factors , speech therapy There is no medical treatment (drug ) specific for aphasia , the treatment is for the underlying cause (i.e., stroke) (lipid lowering agents, antihypertensive drugs, ) & non medical (speech therapy is the most important) There is no specific reaction to aphasia, aphasia is always one of group symptoms (weakness, unconsciousness & threat on the life of the patient) , does it bother me ? It makes the case more complicated inability to understand the patient & difficulty in communication & it’s more depressive to face as a neurologist, we investigate to find the cause behind the condition to decide the most suitable treatment for the cause I hope your study leads to more care for aphasic patients in our community by opening centers for speech therapy ( medical specialty , a type of physiotherapy ) as till now we don't have this specialty in Kurdistan . Interview 3 Dr. Fa’eq Braymok/ specialist neurologist Aphasia is a difficulty or inability to speak, in order to know about aphasia and its common type we have to know about how its work, on the left side of the brain there an area called speech center that 90% of the cases happen there consist of two main part within a connection called Broca’s area ( motor area responsible for production), Wernicke’s area (sensory area responsible for comprehension) and Arcuate fasciculus (a bundle of nerve fiber connects Broca’s and Wernicke’s area) so any problem in these part cause aphasia whether it’s lesion, stroke, or blood supply, we have got 4 common type of aphasia (Broca’s, Wernicke’s , Conduction and Global aphasia) Brocas aphasia (production), Wernicke’s aphasia (comprehension), Conduction aphasia (repetition), Global aphasia (the patients is mute) Three/ Broca’s, Global, Wernicks aphasia Any difficulty to the speech center in the left hemisphere leads them to aphasia The younger the patients, the better the recoveries. The most common cause is stroke & stroke is more common in men Yes, when for the second he get stroked No medications related to aphasia. Yes for sure we should have speech therapy We deal with patients related to the cause Observation’s rubric Excellent Very Good Normal Very Bad Bad Comprehension 30% 20% 30% 20% 4 Production 10% 20% 30% 40% 2 Repetition 50% 20% 30% 2 Reading 20% 50% 30% 1 Writing 10% 30% 20% 40% 3 Naming 10% 30% 30% 30% 3 Total 0 60 180 170 190 30 | Page