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Aphasia Taskforce Aphasia Taskforce California Association of California Association of Superior Court Investigators Superior Court Investigators (CASCI) (CASCI) 2007 Statewide Training 2007 Statewide Training Conference Conference John K. Johnson, M.Phil-DPS John K. Johnson, M.Phil-DPS
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Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Dec 22, 2015

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Page 1: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Aphasia TaskforceAphasia Taskforce

California Association of Superior California Association of Superior Court Investigators (CASCI)Court Investigators (CASCI)

2007 Statewide Training 2007 Statewide Training ConferenceConference

John K. Johnson, M.Phil-DPSJohn K. Johnson, M.Phil-DPS

Page 2: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

AphasiaAphasia

Aphasia is a disorder that results from Aphasia is a disorder that results from damage to language centers of the brain. For damage to language centers of the brain. For almost all right-handers and for about 1/2 of almost all right-handers and for about 1/2 of left-handers, damage to the left side of the left-handers, damage to the left side of the brain causes aphasia. As a result, individuals brain causes aphasia. As a result, individuals who were previously able to communicate who were previously able to communicate through speaking, listening, reading and through speaking, listening, reading and writing become more limited in their ability to writing become more limited in their ability to do so. The most common cause of aphasia is do so. The most common cause of aphasia is stroke, but gunshot wounds, blows to the stroke, but gunshot wounds, blows to the head, other traumatic brain injury, brain head, other traumatic brain injury, brain tumor, and other sources of brain damage tumor, and other sources of brain damage can also cause aphasia.can also cause aphasia.

Page 3: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Who has aphasia?Who has aphasia?

Anyone can acquire aphasia, but Anyone can acquire aphasia, but most people who have aphasia are in most people who have aphasia are in their mid to later years. Men and their mid to later years. Men and women are equally affected. women are equally affected.

It is estimated that approximately It is estimated that approximately 80,000 individuals acquire aphasia 80,000 individuals acquire aphasia each year. About one million persons each year. About one million persons in the United States currently have in the United States currently have aphasia. aphasia.

Page 4: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

What causes aphasia?What causes aphasia?

Aphasia is caused by damage to one or Aphasia is caused by damage to one or more of the language areas of the brain. more of the language areas of the brain. Many times, the cause of the brain injury Many times, the cause of the brain injury is a stroke. A stroke occurs when, for some is a stroke. A stroke occurs when, for some reason, blood is unable to reach a part of reason, blood is unable to reach a part of the brain. Brain cells die when they do not the brain. Brain cells die when they do not receive their normal supply of blood, receive their normal supply of blood, which carries oxygen and important which carries oxygen and important nutrients. Other causes of brain injury are nutrients. Other causes of brain injury are severe blows to the head, brain tumors, severe blows to the head, brain tumors, brain infections, and other conditions or brain infections, and other conditions or trauma of the brain.trauma of the brain.

Page 5: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Causes aphasia Causes aphasia continued:continued:

Individuals with Broca's aphasia have damage Individuals with Broca's aphasia have damage to the frontal lobe of the brain. These to the frontal lobe of the brain. These individuals frequently speak in short, individuals frequently speak in short, meaningful phrases that are produced with meaningful phrases that are produced with great effort. Broca's aphasia is thus great effort. Broca's aphasia is thus characterized as a “non-fluent” aphasia. characterized as a “non-fluent” aphasia. Affected people often omit small words such Affected people often omit small words such as "is," "and," and "the." For example, a as "is," "and," and "the." For example, a person with Broca's aphasia may say, "Walk person with Broca's aphasia may say, "Walk dog" meaning, "I will take the dog for a walk." dog" meaning, "I will take the dog for a walk." The same sentence could also mean "You The same sentence could also mean "You take the dog for a walk," or "The dog walked take the dog for a walk," or "The dog walked out of the yard," depending on the out of the yard," depending on the circumstances. circumstances.

Page 6: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Causes aphasia Causes aphasia continued:continued:

Individuals with Broca's aphasia are Individuals with Broca's aphasia are able to understand the speech of able to understand the speech of others to varying degrees. Because of others to varying degrees. Because of this, they are often aware of their this, they are often aware of their difficulties and can become easily difficulties and can become easily frustrated by their speaking problems. frustrated by their speaking problems. Individuals with Broca's aphasia often Individuals with Broca's aphasia often have right-sided weakness or have right-sided weakness or paralysis of the arm and leg because paralysis of the arm and leg because the frontal lobe is also important for the frontal lobe is also important for body movement. body movement.

Page 7: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Causes aphasia continued:Causes aphasia continued:

In contrast to Broca's aphasia, damage to In contrast to Broca's aphasia, damage to the temporal lobe may result in a fluent the temporal lobe may result in a fluent aphasia that is called Wernicke's aphasia. aphasia that is called Wernicke's aphasia. Individuals with Wernicke's aphasia may Individuals with Wernicke's aphasia may speak in long sentences that have no speak in long sentences that have no meaning, add unnecessary words, and even meaning, add unnecessary words, and even create new "words." For example, someone create new "words." For example, someone with Wernicke's aphasia may say, "You with Wernicke's aphasia may say, "You know that smoodle pinkered and that I want know that smoodle pinkered and that I want to get him round and take care of him like to get him round and take care of him like you want before," meaning "The dog needs you want before," meaning "The dog needs to go out so I will take him for a walk."to go out so I will take him for a walk."

Page 8: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Causes aphasia continued:Causes aphasia continued:

Individuals with Wernicke's aphasia Individuals with Wernicke's aphasia usually have great difficulty usually have great difficulty understanding speech and are understanding speech and are therefore often unaware of their therefore often unaware of their mistakes. These individuals usually mistakes. These individuals usually have no body weakness because have no body weakness because their brain injury is not near the parts their brain injury is not near the parts of the brain that control movement. of the brain that control movement.

Page 9: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Causes aphasia Causes aphasia continued:continued:

A third type of aphasia, global A third type of aphasia, global aphasia, results from damage to aphasia, results from damage to extensive portions of the language extensive portions of the language areas of the brain. Individuals with areas of the brain. Individuals with global aphasia have severe global aphasia have severe communication difficulties and may communication difficulties and may be extremely limited in their ability be extremely limited in their ability to speak or comprehend language.to speak or comprehend language.

Page 10: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Broca’s vs. Wernicke’s Broca’s vs. Wernicke’s AphasiaAphasia

Page 11: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

How is aphasia diagnosed?How is aphasia diagnosed?

Aphasia is usually first recognized by the Aphasia is usually first recognized by the physician who treats the individual for his physician who treats the individual for his or her brain injury. Frequently, this is a or her brain injury. Frequently, this is a neurologist. The physician typically neurologist. The physician typically performs tests that require the individual performs tests that require the individual to follow commands, answer questions, to follow commands, answer questions, name objects, and converse. If the name objects, and converse. If the physician suspects aphasia, the individual physician suspects aphasia, the individual is often referred to a speech-language is often referred to a speech-language pathologist, who performs a pathologist, who performs a comprehensive examination of the comprehensive examination of the person's ability to understand, speak, person's ability to understand, speak, read, and write. read, and write.

Page 12: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

How do you communicate How do you communicate with an aphasia patient?with an aphasia patient?

Some people with aphasia have Some people with aphasia have problems primarily with problems primarily with expressiveexpressive language (what is said) while others language (what is said) while others have their major problems with have their major problems with receptivereceptive language (what is language (what is understood). In still other cases, both understood). In still other cases, both expressive language and receptive expressive language and receptive language are obviously impaired. language are obviously impaired. Language is affected not only in its Language is affected not only in its oral form of talking and understanding oral form of talking and understanding but also in its written form of reading but also in its written form of reading and writing.and writing.

Page 13: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Communicating with an Communicating with an aphasia patient, continued:aphasia patient, continued:

Typically, reading and writing are Typically, reading and writing are more impaired than oral more impaired than oral communication. The nature of the communication. The nature of the problems varies from person to problems varies from person to person depending on many factors person depending on many factors but most importantly on the amount but most importantly on the amount and location of the damage to the and location of the damage to the brain. brain.

Page 14: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Communicating with an Communicating with an aphasia patient, continued:aphasia patient, continued:

Amount and location of the damage, along Amount and location of the damage, along with other factors, e.g., age, educational with other factors, e.g., age, educational level, and health status, also affect the level, and health status, also affect the severityseverity of the problems. Persons with of the problems. Persons with severe aphasia may understand almost severe aphasia may understand almost nothing of what is said to them and say nothing of what is said to them and say little or nothing. At best, their oral little or nothing. At best, their oral communication may be only communication may be only approximations of "yes" and "no" and approximations of "yes" and "no" and maybe common social phrases like "hi" maybe common social phrases like "hi" and "thanks." and "thanks."

Page 15: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Communicating with an Communicating with an aphasia patient, continued:aphasia patient, continued:

Persons with mild aphasia may be able Persons with mild aphasia may be able to carry on normal conversations in to carry on normal conversations in many communication settings. They many communication settings. They may have trouble understanding may have trouble understanding language only when it is long or language only when it is long or complex, or they may have some complex, or they may have some trouble finding the words they need to trouble finding the words they need to express an idea or to explain express an idea or to explain themselves, orally or in written form. themselves, orally or in written form.

Page 16: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Communicating with an Communicating with an aphasia patient, continued:aphasia patient, continued:

Word finding problemsWord finding problems ( ( anomiaanomia ) ) are common in people with aphasia are common in people with aphasia and is most like the common and is most like the common experience of having a word "on the experience of having a word "on the tip of our tongues" but not being able tip of our tongues" but not being able to remember it. The person may to remember it. The person may forget the word forget the word combcomb even though even though he or she can show you how to use it.he or she can show you how to use it.

Page 17: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Communicating with an Communicating with an aphasia patient, continued:aphasia patient, continued:

There are also There are also degrees of aphasia degrees of aphasia between mild and severebetween mild and severe . A . A person may speak only in single person may speak only in single words (e.g., names of objects) or in words (e.g., names of objects) or in short, fragmented phrases. Smaller short, fragmented phrases. Smaller words of speech (e.g., words of speech (e.g., thethe , , ofof , , andand ), ), may be omitted, making the may be omitted, making the message sound like a telegram. message sound like a telegram. Words may be put in the wrong order Words may be put in the wrong order and incorrect grammar may be used. and incorrect grammar may be used.

Page 18: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Communicating with an Communicating with an aphasia patient, continued:aphasia patient, continued:

Sounds and/or words may be Sounds and/or words may be switched. A switched. A bedbed may be called a may be called a tabletable or a or a dishwasherdishwasher a a wish dasherwish dasher . . Or, the person with aphasia may Or, the person with aphasia may make up a word. In some cases, make up a word. In some cases, nonsense (or real) words are strung nonsense (or real) words are strung together quite fluently, but make no together quite fluently, but make no sense to the listener. sense to the listener.

Page 19: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Communicating with an Communicating with an aphasia patient, continued:aphasia patient, continued:

It usually requires extra effort for the It usually requires extra effort for the person with aphasia to understand spoken person with aphasia to understand spoken messages, as if he or she is trying to messages, as if he or she is trying to comprehend a foreign language. The comprehend a foreign language. The person may need extra time to process person may need extra time to process and understand what is being said by the and understand what is being said by the investigator. It may be especially hard to investigator. It may be especially hard to follow very fast speech like that heard on follow very fast speech like that heard on radio or television news. He or she may radio or television news. He or she may misinterpret subtleties of language, e.g., misinterpret subtleties of language, e.g., taking the literal meaning for a figure of taking the literal meaning for a figure of speech like speech like He kicked the bucket.He kicked the bucket.

Page 20: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Communicating with Communicating with aphasia patient, continued:aphasia patient, continued:

Difficulty with one or more of the Difficulty with one or more of the aforementioned skills may lead to aforementioned skills may lead to communication breakdowns and communication breakdowns and frustrating communication for both frustrating communication for both the person with aphasia and the the person with aphasia and the investigator. investigator.

Page 21: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

How is aphasia treated?How is aphasia treated?

In some instances an individual will In some instances an individual will completely recover from aphasia without completely recover from aphasia without treatment. This type of "spontaneous treatment. This type of "spontaneous recovery" usually occurs following a recovery" usually occurs following a transient ischemic attack (TIA), a kind of transient ischemic attack (TIA), a kind of stroke in which the blood flow to the brain stroke in which the blood flow to the brain is temporarily interrupted but quickly is temporarily interrupted but quickly restored. In these circumstances, restored. In these circumstances, language abilities may return in a few language abilities may return in a few hours or a few days. For most cases of hours or a few days. For most cases of aphasia, however, language recovery is aphasia, however, language recovery is not as quick or as complete. not as quick or as complete.

Page 22: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

How aphasia is treated, How aphasia is treated, continued:continued:

While many individuals with aphasia While many individuals with aphasia also experience a period of partial also experience a period of partial spontaneous recovery (in which spontaneous recovery (in which some language abilities return over a some language abilities return over a period of a few days to a month after period of a few days to a month after the brain injury), some amount of the brain injury), some amount of aphasia typically remains. In these aphasia typically remains. In these instances, speech-language therapy instances, speech-language therapy is often helpful. Recovery usually is often helpful. Recovery usually continues over a 2-year period. continues over a 2-year period.

Page 23: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

How aphasia is treated, How aphasia is treated, continued:continued:

Most people believe that the most Most people believe that the most effective treatment begins early in effective treatment begins early in the recovery process. Some of the the recovery process. Some of the factors that influence the amount of factors that influence the amount of improvement include the cause of improvement include the cause of the brain damage, the area of the the brain damage, the area of the brain that was damaged, the extent brain that was damaged, the extent of the brain injury, and the age and of the brain injury, and the age and health of the individual. Additional health of the individual. Additional factors include motivation, factors include motivation, handedness, and educational level. handedness, and educational level.

Page 24: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

How aphasia is treated, How aphasia is treated, continued:continued:

Aphasia therapy strives to improve Aphasia therapy strives to improve an individual's ability to an individual's ability to communicate by helping the person communicate by helping the person to use remaining abilities, to restore to use remaining abilities, to restore language abilities as much as language abilities as much as possible, to compensate for language possible, to compensate for language problems, and to learn other problems, and to learn other methods of communicating. methods of communicating.

Page 25: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

How aphasia is treated, How aphasia is treated, continued:continued:

Treatment may be offered in individual Treatment may be offered in individual or group settings. Individual therapy or group settings. Individual therapy focuses on the specific needs of the focuses on the specific needs of the person. Group therapy offers the person. Group therapy offers the opportunity to use new communication opportunity to use new communication skills in a comfortable setting. Stroke skills in a comfortable setting. Stroke clubs, which are regional support clubs, which are regional support groups formed by individuals who have groups formed by individuals who have had a stroke, are available in most had a stroke, are available in most major cities. major cities.

Page 26: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

How aphasia is treated, How aphasia is treated, continued:continued:

These clubs also offer the opportunity These clubs also offer the opportunity for individuals with aphasia to try new for individuals with aphasia to try new communication skills. In addition, communication skills. In addition, stroke clubs can help the individual and stroke clubs can help the individual and his or her family adjust to the life his or her family adjust to the life changes that accompany stroke and changes that accompany stroke and aphasia. Family involvement is often a aphasia. Family involvement is often a crucial component of aphasia crucial component of aphasia treatment so that family members can treatment so that family members can learn the best way to communicate learn the best way to communicate with their loved one. with their loved one.

Page 27: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

How Can we as How Can we as Investigators Communicate Investigators Communicate with Aphasia Subjects?with Aphasia Subjects?

Follow these simple suggestions:Follow these simple suggestions:

Page 28: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Investigator’s should:Investigator’s should:• Simplify language by using short, Simplify language by using short,

uncomplicated sentences. uncomplicated sentences.

• Repeat the content words or write down Repeat the content words or write down key words to clarify meaning as needed. key words to clarify meaning as needed.

• Maintain a natural conversational manner Maintain a natural conversational manner appropriate for an adult. appropriate for an adult.

• Minimize distractions, such as a blaring Minimize distractions, such as a blaring radio, or TV whenever possible. radio, or TV whenever possible.

• Include the person with aphasia in Include the person with aphasia in conversations when interviewing others in conversations when interviewing others in the area. the area.

Page 29: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Investigator’s should:Investigator’s should:

• Ask for and value the opinion of the Ask for and value the opinion of the person with aphasia, especially person with aphasia, especially regarding legal matters. regarding legal matters.

• Encourage any type of communication, Encourage any type of communication, whether it is speech, gesture, pointing, whether it is speech, gesture, pointing, or drawing. or drawing.

• Avoid correcting the individual's speech. Avoid correcting the individual's speech. • Allow the individual plenty of time to Allow the individual plenty of time to

talk. talk.

Page 30: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Where can I get additional Where can I get additional information?information?

American Speech-Language-Hearing American Speech-Language-Hearing Association (ASHA) Association (ASHA) 10801 Rockville Pike10801 Rockville PikeRockville, MD 20852Rockville, MD 20852Voice: (301) 897-5700Voice: (301) 897-5700Toll-free Voice: (800) 638-8255Toll-free Voice: (800) 638-8255TTY: (301) 897-0157TTY: (301) 897-0157Fax: (301) 571-0457Fax: (301) 571-0457E-mail: E-mail: [email protected]@asha.orgInternet: Internet: www.asha.orgwww.asha.org

Page 31: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Where can I get additional Where can I get additional information?information?

Brain Injury Association of America Brain Injury Association of America 8201 Greensboro Drive, Suite 6118201 Greensboro Drive, Suite 611McLean, VA 22102McLean, VA 22102Voice: (703) 761-0750Voice: (703) 761-0750Toll-free Voice: (800) 444-6443Toll-free Voice: (800) 444-6443Fax: (703) 761-0755Fax: (703) 761-0755E-mail: E-mail: [email protected]@biausa.orgInternet: Internet: www.biausa.orgwww.biausa.org

Page 32: Aphasia Taskforce California Association of Superior Court Investigators (CASCI) 2007 Statewide Training Conference John K. Johnson, M.Phil-DPS.

Where can I get additional Where can I get additional information?information?

National Aphasia Association (NAA) National Aphasia Association (NAA) 7 Dey Street, Suite 6007 Dey Street, Suite 600New York, NY 10007New York, NY 10007Voice: (212) 267-2814Voice: (212) 267-2814Toll-free Voice: (800) 922-4622Toll-free Voice: (800) 922-4622Fax: (212) 267-2812Fax: (212) 267-2812E-mail: E-mail: [email protected]@aphasia.orgInternet: Internet: www.aphasia.orgwww.aphasia.org