Focus on Severe Aphasia 
Editor's Note - Sharon Rennhack:  
If you find this newsletter helps you and  it gives  you important information and treatment and practice ideas, please be sure to share with others on Facebook and in other social media communities. 

In this month's edition, we discuss severe aphasia as a result of stroke/TBI.    

Severe aphasia may refer to non-fluent speech, often described as global or Broca's aphasia in which speech has few words and is very dysfluent.  Unfortunately, because of the accompanying apraxia and other factors such as asymbolia, these people cannot utilize alternative methods of communicating such as devices and apps.  Severe aphasia may also refer to a fluent aphasia, often described as Wernicke's aphasia, where a person may have severe comprehension difficulties and be unable to grasp the meaning of spoken words, yet be able to produce fluent and connected speech which is unfortunately empty of intelligible content speech.   
According to Bill Connors, "At AphasiaToolbox®, we have made tremendous breakthroughs in helping people who cannot talk due to severe aphasia, to begin to communicate again. One client was only able to say a constantly repeated nonsense phrase (giddygiddygiddy) when attempting to speak;  and,  this client -  who was unable to answer YES-NO questions for a number of years, has begun to spontaneously say clear phrases and sentences and to answer 'uuhhhuhh' and 'NO' to those YES-NO questions after 4 months of treatment and practice, according to his wife who is his aphasiatoolbox-trained practice coach."   Bill added, "We are so very pleased that our approaches and the smart practice by our clients help people recovering from severe aphasia;  this means that  the clients who are  working with us do not need communication boards, augmentative apps, or even pointing to communicate their basic needs." 
For a personal demonstration of how these progressive, neuroplastic treatment and practice techniques, developed and refined by aphasiatoolbox® professionals, are helping people with severe aphasia become people recovering from aphasia, contact My Speech Recovery .
In this edition,  we include: 
 - a series of videos created by Bill Connors from previous newsletters covering ideas for people with severe aphasia;    
 -  studies/articles on   severe aphasia    
-  current news on stroke/aphasia 
Bill Connors and the staff of  aphasiatoolbox have a combined 80+ years helping people with aphasia recover, including severe aphasia and apraxia.  For more information, ideas and tools about aggressively traveling the recovery pathway, contact Bill Connors .       
When you have questions about aphasia,  the answer is aphasiatoolbox®.  We ARE aphasia recovery. 

For information on how we can expedite your recovery using the most effective and affordable tools,  contact us at ; OR click here to  schedule a free consultation  and select a 30 minute phone call with our an aphasia recovery expert. 
 How we help severe aphasia

The following   videos - created over the past 4 years by Bill Connors,  help clients with severe aphasia/apraxia.  
1.  What is Telepractice? //  How can it help me?  
2.  What is the Motor Reconnect Apraxia ProtocolViking Protocol?  
January 2015  
3.  How is  the aphasiatoolbox program different? 
4. What is Sentence Patterning?  
 5.   What  is empowerment for people with aphasia? 
 News/Studies on Severe Aphasia 
1.  Co-verbal gestures among speakers with aphasia: Influence of aphasia severity, linguistic and semantic skills, and hemiplegia on gesture employment in oral discourse
The use of co-verbal gestures is common in human communication and has been reported to assist word retrieval and to facilitate verbal interactions. 2015

2. The neural basis of hand gesture comprehension: A meta-analysis of functional magnetic resonance imaging studies
Gestures play an important role in face-to-face communication and have been increasingly studied via functional magnetic resonance imaging.  2015

3. Non-verbal communication in severe aphasia: Influence of aphasia, apraxia, or semantic processing?
Patients suffering from severe aphasia have to rely on non-verbal means of communication to convey a message. However, to date it is not clear which patients are able to do so. Clinical experience indicates that some patients use non-verbal communication strategies like gesturing very efficiently whereas others fail to transmit semantic content by non-verbal means. Concerns have been expressed that limb apraxia would affect the production of communicative gestures. Research investigating if and how apraxia influences the production of communicative gestures, led to contradictory outcomes.  2012

4.  Gesturing by speakers with aphasia: how does it compare?
RESULTS:  Gestures produced by speakers with more severe aphasia were less informative than those by speakers with moderate aphasia, yet they were not necessarily uninformative. Speakers with more severe aphasia also tended to use fewer representation techniques (mostly relying on outlining gestures) in co-speech gesture than control participants, who were asked to use gesture instead of speech. It is important to note that limb apraxia may be a mediating factor here.   2013

5.  Augmentative and Alternative Communication (AAC) Assessment for People with Aphasia
Many people with aphasia fail to regain sufficient speech and language skills to meet their communication needs. With more than one million people with aphasia in the US alone, chances are most people reading this know at least one person affected by the disorder. While many go on to regain functional speech and language skills, some remain unable to communicate well enough catch up with a neighbor, talk about bills with a spouse, ask a question in a store, play with a grandchild, or tell their healthcare providers about side effects or symptoms. It's hard to really imagine how devastating and isolating this experience may be.  2013

6.  Measuring Progress in Severe Aphasia
There are many different types of aphasia, and each type of aphasia can have different levels of severity-mild, moderate, and severe. Severity is a measure of how the speech and language (reading, writing, understanding, speaking) have been affected by the brain injury.

In severe aphasia, all speech and language input (reading, understanding) and output (gesture, speaking, writing) systems have been affected to the point that the person has retained very little ability in any of these areas. Speech may be limited to making sounds or to saying the same words over and over for everything (stereotypic speech). Examples of this are "baba bababa ba" or "that's it, that's it" or "sometimes water".  2013

Current News about Stroke/Aphasia

Motor speech disorders include two primary categories, apraxia and dysarthria. In order to produce speech, every person must coordinate a range of muscles and muscle groups, including those controlling the larynx with the vocal cords, the lips, the tongue, the jaw and the respiratory system. Movements must be planned and sequenced by the brain and then put into motion in milliseconds with the correct timing and force of movement as the relevant muscles execute planned movements that create running speech. 2017

Background and Purpose: Acquired apraxia of speech (AOS) is a motor speech disorder caused by brain damage. AOS often co-occurs with aphasia, a language disorder in which patients may also demonstrate speech production errors. The overlap of speech production deficits in both disorders has raised questions regarding if AOS emerges from a unique pattern of brain damage or as a sub-element of the aphasic syndrome. The purpose of this study was to determine whether speech production errors in AOS and aphasia are associated with distinctive patterns of brain injury.  2015

Language disturbances (aphasia) are common after stroke and can manifest as difficulty identifying the correct word to use (semantic problems) and/or difficulty pronouncing words (phonemic problems). Speech therapy has long been a standard of post-stroke care and can improve aphasia. However, the neurological basis of therapy-mediated recovery is poorly understood, and researchers do not know why some patients improve with therapy while others show little response.  2017

A stroke at the age of 50 robbed Kent Allen of his ability to speak and walk in October 2015.
On his long road to recovery, he's been asked which he'd rather be able to do again without impediment.
"The most frustrating thing out of the entire stroke has been not being able to communicate," said his wife, Stephanie Allen, a nurse. "Absolutely he wants the physical side back, but to not be able to communicate, it's like you're locked inside yourself.",  2017

Fifteen years ago, Maura Silverman was a frustrated speech therapist watching patients with aphasia get discharged from services before they were ready. Insurance companies made the call, leaving her with little say in the matter. So Silverman took matters into her own hands and founded the Triangle Aphasia Project, an organization dedicated to serving people with aphasia., 2017

Humans use all five sense to assess the world around them. Now, there's evidence that the system our uses to establish how much to trust these senses is the same across the board.  2017

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