Editing Aphasia (section)

==== Boston classification ====
{| class="wikitable sortable"
|+ Major characteristics of different types of aphasia according to the Boston classification<ref name="Ref4 from the Broca's area article">{{Cite web|url=http://www.atlantaaphasia.org|title=What is Aphasia|year=2006|publisher=Atlanta Aphasia Association|access-date=2008-12-01}}</ref><ref>{{Cite book|title=Acquired Speech and Language Disorders| vauthors = Murdoch BE |date=1990|publisher=Springer, Boston, MA|isbn=9780412334405|pages=60–96|language=en|doi=10.1007/978-1-4899-3458-1_2|chapter = Bostonian and Lurian aphasia syndromes}}</ref>
! Type of aphasia
! [[Speech repetition]]
! Naming
! Auditory comprehension
! Fluency
|-
| [[Expressive aphasia]] (Broca's aphasia)
| Moderate–severe
| Moderate–severe
| Mild difficulty
| Non-fluent, effortful, slow
|-
| [[Receptive aphasia]] (Wernicke's aphasia)
| Mild–severe
| Mild–severe
| Defective
| Fluent paraphasic
|-
| [[Conduction aphasia]]
| Poor
| Poor
| Relatively good
| Fluent
|-
| [[Mixed transcortical aphasia]]
| Moderate
| Poor
| Poor
| Non-fluent
|-
| [[Transcortical motor aphasia]]
| Good
| Mild–severe
| Mild
| Non-fluent
|-
| [[Transcortical sensory aphasia]]
| Good
| Moderate–severe
| Poor
| Fluent
|-
| [[Global aphasia]]
| Poor
| Poor
| Poor
| Non-fluent
|-
| [[Anomic aphasia]]
| Mild
| Moderate–severe
| Mild
| Fluent
|}
* Individuals with [[receptive aphasia]] ([[Wernicke's area|Wernicke's]] aphasia), also referred to as fluent aphasia, may speak in long sentences that have no meaning, add unnecessary words, and even create new "words" ([[neologism]]s). For example, someone with receptive aphasia may say, "delicious taco", meaning "The dog needs to go out so I will take him for a walk". They have poor auditory and reading comprehension, and fluent, but nonsensical, oral and written expression. Individuals with receptive aphasia usually have great difficulty understanding the speech of both themselves and others and are, therefore, often unaware of their mistakes. Receptive language deficits usually arise from lesions in the posterior portion of the left hemisphere at or near Wernicke's area.<ref name="Manasco" /><ref>{{cite journal | vauthors = DeWitt I, Rauschecker JP | title = Wernicke's area revisited: parallel streams and word processing | journal = Brain and Language | volume = 127 | issue = 2 | pages = 181–191 | date = November 2013 | pmid = 24404576 | pmc = 4098851 | doi = 10.1016/j.bandl.2013.09.014 }}</ref>{{Reference page|71}} It is often the result of trauma to the temporal region of the brain, specifically damage to [[Wernicke's area]].<ref>{{Cite news|url=https://www.nidcd.nih.gov/health/aphasia|title=Aphasia|date=2015-08-18|work=NIDCD|access-date=2017-05-02|language=en}}</ref> Trauma can be the result from an array of problems, however it is most commonly seen as a result of stroke<ref name=":0">{{Cite web|url=http://www.asha.org/Practice-Portal/Clinical-Topics/Aphasia/Common-Classifications-of-Aphasia/|title=Common Classifications of Aphasia|website=www.asha.org|language=en|access-date=2017-05-02}}</ref>
* Individuals with [[expressive aphasia]] ([[Broca's area|Broca's]] aphasia) frequently speak short, meaningful phrases that are produced with great effort. It is thus characterized as a nonfluent aphasia. Affected people often omit small words such as "is", "and", and "the". For example, a person with expressive aphasia may say, "walk dog", which could mean "I will take the dog for a walk", "you take the dog for a walk" or even "the dog walked out of the yard." Individuals with expressive aphasia are able to understand the speech of others to varying degrees. Because of this, they are often aware of their difficulties and can become easily frustrated by their speaking problems.<ref name="Brookshire 2007">{{cite book |author=Brookshire R |url=https://archive.org/details/introductiontone0000broo_i6r7|title=Introduction to neurogenic communication disorders|edition=7th|year=2007|location=St. Louis, MO|publisher=Mosby|isbn=978-0-323-07867-2}}{{page needed|date=August 2023}}</ref> While Broca's aphasia may appear to be solely an issue with language production, evidence suggests that it may be rooted in an inability to process syntactical information.<ref>{{cite journal | vauthors = Embick D, Marantz A, Miyashita Y, O'Neil W, Sakai KL | year = 2000 | title = A syntactic specialization for Broca's area | journal = Proceedings of the National Academy of Sciences of the United States of America | volume = 97 | issue = 11| pages = 6150–6154 | doi = 10.1073/pnas.100098897 | pmid = 10811887 | pmc = 18573 | bibcode = 2000PNAS...97.6150E | doi-access = free }}</ref> Individuals with expressive aphasia may have a speech automatism (also called recurring or recurrent utterance). These speech automatisms can be repeated lexical speech automatisms; ''e.g.'', modalisations ('I can't&nbsp;..., I can't&nbsp;...'), expletives/swearwords, numbers ('one two, one two') or non-lexical utterances made up of repeated, legal, but meaningless, consonant-vowel syllables (e.g.., /tan tan/, /bi bi/). In severe cases, the individual may be able to utter only the same speech automatism each time they attempt speech.<ref name="Code">{{cite journal | author = Code C | year = 1982 | title = Neurolinguistic analysis of recurrent utterances in aphasia | journal = Cortex | volume = 18 | issue = 1 | pages = 141–152 | doi = 10.1016/s0010-9452(82)80025-7 | pmid = 6197231 | s2cid = 4487128 | doi-access = free }}</ref>
* Individuals with [[anomic aphasia]] have difficulty with naming. People with this aphasia may have difficulties naming certain words, linked by their grammatical type (''e.g.'', difficulty naming verbs and not nouns) or by their [[semantic]] category (''e.g.'', difficulty naming words relating to photography, but nothing else) or a more general naming difficulty. People tend to produce grammatic, yet empty, speech. Auditory comprehension tends to be preserved.<ref name="Squire 2009">{{cite encyclopedia |editor=Squire LR |author1=Dronkers NF |author2=Baldo JV |title=Language: Aphasia|encyclopedia=Encyclopedia of neuroscience |year=2009 |pages=343–348|doi=10.1016/B978-008045046-9.01876-3 |isbn=978-0-08-045046-9}}</ref> Anomic aphasia is the aphasial presentation of tumors in the language zone; it is the aphasial presentation of Alzheimer's disease.<ref>{{cite book|title=Aphasia| vauthors = Alexander MP, Hillis AE | chapter = Chapter 14 Aphasia |series=Handbook of Clinical Neurology|year=2008<!--|access-date = 2013-06-09 -->| isbn=9780444518972|editor=Georg Goldenberg |editor2=Bruce L Miller |editor3=Michael J Aminoff |editor4=Francois Boller |editor5=D F Swaab|edition=1|volume=88|pages=287–310|doi=10.1016/S0072-9752(07)88014-6|pmid=18631697|oclc=733092630}}</ref> Anomic aphasia is the mildest form of aphasia, indicating a likely possibility for better recovery.<ref name="Squire 2009" />{{Additional citation needed|date= April 2022|reason= source does not mention possibility for better recovery}}
* Individuals with transcortical sensory aphasia, in principle the most general and potentially among the most complex forms of aphasia, may have similar deficits as in receptive aphasia, but their repetition ability may remain intact.
* Global aphasia is considered a severe impairment in many language aspects since it impacts expressive and receptive language, reading, and writing.<ref>{{cite journal |author1=Demeurisse G. |author2=Capon A. | year = 1987 | title = Language recovery in aphasic stroke patients: Clinical, CT and CBF studies | journal = Aphasiology | volume = 1 | issue = 4| pages = 301–315 | doi=10.1080/02687038708248851}}</ref> Despite these many deficits, there is evidence that has shown individuals benefited from speech language therapy.<ref name="Basso 2011">{{cite journal | vauthors = Basso A, Macis M | title = Therapy efficacy in chronic aphasia | journal = Behavioural Neurology | volume = 24 | issue = 4 | pages = 317–325 | year = 2001 | pmc = 5377972 | doi = 10.1155/2011/313480 | pmid = 22063820 | doi-access = free }}</ref> Even though individuals with global aphasia will not become competent speakers, listeners, writers, or readers, goals can be created to improve the individual's quality of life.<ref name="Brookshire 2007" /> Individuals with global aphasia usually respond well to treatment that includes personally relevant information, which is also important to consider for therapy.<ref name="Brookshire 2007" />
* Individuals with conduction aphasia have deficits in the connections between the speech-comprehension and speech-production areas. This might be caused by damage to the [[arcuate fasciculus]], the structure that transmits information between [[Wernicke's area]] and [[Broca's area]]. Similar symptoms, however, can be present after damage to the [[insular cortex|insula]] or to the [[auditory cortex]]. Auditory comprehension is near normal, and oral expression is fluent with occasional paraphasic errors. Paraphasic errors include phonemic/literal or semantic/verbal. Repetition ability is poor. Conduction and transcortical aphasias are caused by damage to the white matter tracts. These aphasias spare the cortex of the [[language center]]s, but instead create a disconnection between them. Conduction aphasia is caused by damage to the arcuate fasciculus. The arcuate fasciculus is a white matter tract that connects Broca's and Wernicke's areas. People with conduction aphasia typically have good language comprehension, but poor speech repetition and mild difficulty with word retrieval and speech production. People with conduction aphasia are typically aware of their errors.<ref name="Brookshire 2007" /> Two forms of conduction aphasia have been described: ''reproduction conduction aphasia'' (repetition of a single relatively unfamiliar multisyllabic word) and ''repetition conduction aphasia'' (repetition of unconnected short familiar words.<ref>{{Cite journal|last1=Shallice|first1=Tim|last2=Warrington|first2=Elizabeth K.|date=October 1977|title=Auditory-verbal short-term memory impairment and conduction aphasia|journal=Brain and Language|volume=4|issue=4|pages=479–491|doi=10.1016/0093-934x(77)90040-2|pmid=922463|s2cid=40665691|issn=0093-934X}}</ref>
* Transcortical aphasias include transcortical motor aphasia, transcortical sensory aphasia, and mixed transcortical aphasia. People with transcortical motor aphasia typically have intact comprehension and awareness of their errors, but poor word finding and speech production. People with transcortical sensory and mixed transcortical aphasia have poor comprehension and unawareness of their errors.<ref name="Brookshire 2007" /> Despite poor comprehension and more severe deficits in some transcortical aphasias, small studies have indicated that full recovery is possible for all types of transcortical aphasia.<ref>{{cite journal | vauthors = Flamand-Roze C, Cauquil-Michon C, Roze E, Souillard-Scemama R, Maintigneux L, Ducreux D, Adams D, Denier C | display-authors = 6 | title = Aphasia in border-zone infarcts has a specific initial pattern and good long-term prognosis | journal = European Journal of Neurology | volume = 18 | issue = 12 | pages = 1397–1401 | date = December 2011 | pmid = 21554494 | doi = 10.1111/j.1468-1331.2011.03422.x | s2cid = 26120952 }}</ref>