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 Research Question
In what ways can the family members of individuals with Broca’s aphasia provide positive supports that enhance the treatment and recovery process?

Foundation Questions
*  What is Broca’s Aphasia?
*  What types of treatment are typically required?

Tentative Point
Once this assignment is completed, I hope to provide information to families about how they can help their loved one recover from Broca’s aphasia.

Genre
1.  Webliography-  This will be used to provide information about myself to the people who view this website.  It will also provide them with websites where I found useful information.
2. Poem-  This will be in the voice of a client with Broca's aphasia.  He will be describing to his family how he is feeling.
3.  Power Point-  This will be in the voice of a speech-language pathologist.  It will be used to provide information to families about the importance of supportive relationships during recovery.  It will also tell them how they can provide support and assist in the recovery of their loved one who has Broca’s aphasia.
4.  Journal-  This will be in the voice of a client with Broca's aphasia.  It will be used to provide information to the public about how the person is feeling.  It will discuss how he feels about therapy and the obstacles that face him everyday.  I chose this genre to provide insight on how the client feels.  I think this would help many families understand what their loved one is going through.
5.  Pamphlet-  This will be in the voice of a speech-language pathologist.  It will be used to provide information about Broca's aphasia to the public.  I chose this so that I could provide the basics about Broca's aphasia to people who just being introduced to the disorder.
6.  Interview Transcript-  This will be in the voice of the speech-language pathologist and the wife of someone with Broca’s aphasia.  It will be used to inform the wife about what she can do to help out with his recovery.  I chose this because it will allow me to provide some techniques that help with recovery.
7.  Email-  This will be in the voice of the wife of a man with Broca's aphasia.  She will be providing information that has helped her to someone she met who is also the wife of someone with Broca's aphasia.  I chose this because I thought it would be a good way to pull all the information together.
 
Integration of Genres
I plan to use the email genre to pull everything together.  This will be composed of emails between two women who both have husbands with Broca's aphasia.  They will be providing support to each other by sharing information that they have found useful.  In the emails there will be links that will direct you to each genre.
 
Tentative Resources
Ballard, K.J., &Thompson, C.K. (1999). Treatment and generalization of complex sentence production in agrammatism. Journal of Speech, Language, and Hearing Research, 42, 690-707.  Retrieved September 30, 2005, from ERIC database (EJ589550).

Bose, A., Square, P.A., Schlosser, R., & Van Lieshout, P. (2001).  Effects of prompt therapy on speech motor function in a person with aphasia and apraxia of speech.  Aphasiology, 15, 767-785.  Retrieved October 3, 2005, from Academic Search Premier database (5416096).

Conley, A., & Coelho, C.A. (2003). Treatment of word retrieval impairment in chronic Broca’s aphasia.  Aphasiology, 17, 203-211.  Retrieved September 26, 2005, from PsycINFO database (9472865).

Drew, R.L., Ruby, L., & Thompson, C.K. (1999).  Model-based semantic treatment for naming deficits in aphasia.  Journal of Speech, Language  & Hearing Research, 42, 972-990.  Retrieved October 3, 2005, from Medline database (2130756).

Fodor, J.D. (1999).  How can I communicate with a relative who’s had a stroke? Washington, DC: Linguistic Society of America [Brochure]. Retrieved September 26, 2005, from ERIC database (ED426606).

Hickey, E., Bourgeois, M., & Olswang, L. (2004). Effects of training volunteers to converse with nursing home residents with aphasia. Aphasiology, 18, 625-637.  Retrieved September 29, 2005, from PsycINFO database (12968970).

Hickok, G., Bellugi, U., & Klima, E.  (2002). Sign language in the brain.  Scientific American, 12, 46-53.  Retrieved October 3, 2005, from Academic Search Premier database (10684233).

Katz, W.F., Bharadwaj, S.V., Carstens, & Burkhard. (1999). Electromagnetic articulography treatment for an adult with Broca’s aphasia and apraxia of speech. Journal of Speech, Language & Hearing Research, 42, 1355-1367.  Retrieved September 29, 2005, from PsycINFO database (1999-15413-007). 

Luterman, D.M. (1996).  Counseling persons with communication disorders and their families (3^rd ed.). Austin, TX: Pro-Ed.

Murray, L., Ballard, K., & Karcher, L. (2004). Linguistic specific treatment: Just for Broca’s aphasia?  Aphasiology, 18, 785-809.  Retrieved October 3, 2005, from Academic Search Premier database (14132588).

National Aphasia Association (1999, June 22).  Aphasia: The facts.  Retrieved October 16, 2005, from http://www.aphasia.org/facts.php

Shipley, K.G., & McAfee, J.G. (2004).  Assessment of neurologically based communicative disorders.  K. Conerly, J. Byington, & D. Buddle (Eds.), Assessment in speech-language pathology: A resource manual (3^rd ed., pp. 336-396).  Clifton Park, NY: Delmar Learning.

Wambaugh, J.L., West, J.E., & Doyle, P.J. (1998).  Treatment for apraxia of speech: Effects of targeting sound groups.  Aphasiology, 12, 731-744.  Retrieved October 3, 2005, from Academic Search Premier database (6832563).

I am a man with a drooping right side

 

I wonder if I will ever be able to tell my family how much I love them

 

I hear the words coming out of my mouth

 

I see the words coming out of my mouth

 

I want to communicate

 

I am a man with a drooping right side

 

I pretend the stroke has not changed my life

 

I feel the grief I cause my family

 

I touch their hearts in every way I can to show my appreciation

 

I worry that my wife will not love me the way she used to

 

I cry at the thought of living without her

 

I am a man with a drooping right side

 

I understand that my life will never be the same

 

I say to myself ”Everything will be ok, just keep trying”

 

I dream that one day I will open my mouth and the words will flow easily

 

I try as hard as I can in speech therapy

 

I hope it will help

 

I am a man with a drooping right side

 

September 4, 2005

I woke up this morning and the sun was shining through my window. I used to love to wake up on mornings like this because I would go jogging in the park, but now it makes me want to just lay in bed. If it wasn’t for Mary I probably would have done just that today. But like always she had me up and moving by 7. I didn’t have to be at speech therapy until 11am but it takes longer for us to get everything together since my stroke. I enjoy speech therapy because the speech therapist seems to really understand how I’m feeling, she is very supportive and tries to help in anyway she can. Today she even worked with Mary. She was giving her tips on how to make communicating with me easier. During therapy I tried so hard. I got really frustrated with myself because I knew I was not saying things correctly. They were right in my head, but when I tried to say them they just would not come out the way I wanted. By the time I got home I was so exhausted I had to take nap.

November 24, 2005

Today was Thanksgiving so the kids and their families came over for dinner. I was really glad to see everyone. It was hard to feel included in the conversations though. They often would ask Mary questions that should have been directed to me. I still understand what is going on, it is just hard for me to get my thoughts out. I wish they would be more patient with me. At one point Suzy said “Why’s grandpa talk so funny?” I tried to pretend this didn’t bother me, but I could feel the tears forming in my eyes. I sat down to watch football with Mike after dinner. It had been our tradition since he was little. This year it was a little awkward because for the majority of the time we sat in silence. I couldn’t even cheer when my favorite team scored a touchdown. The game ended a little while ago and everyone went home. I was sad to see them leave, but I am exhausted.

Broca’s Aphasia
The Basics

What is Broca’s Aphasia?

Broca’a aphasia is a language disorder that causes difficulty with expressive language while maintaining the ability to read and understand speech. (National Aphasia Association [NAA], 1999)

Characteristics

- Effortful speech

- Telegraphic phrases

- Presence of apraxia

- Naming problems

- Slow speech

- Poor intonation

- Poor writing

- Good auditory comprehension

(Shipley and McAfee, 2004)

Causes

Broca’s aphasia occurs when damage is done to the area of the brain known as Broca’s area.  Broca’s area is located in the left hemisphere on the inferior section of the frontal gyrus (see illustration).  Damage to Broca’s Area is most commonly due to a stroke, but can also be caused by head trauma, brain tumors, or infections. (NAA, 1999)

(Note: A picture of the brain will appear here with Broca's area highlighted.  It would not show up on here.)

            Broca’s Area -------------------è

 

Treatment

There is no cure for Broca’s aphasia.  Surgery can be effective if the damage is caused by a tumor.  When damage is caused by a stroke there is some spontaneous recovery during the time immediately following the stroke.  Speech therapy is the most common treatment for Broca’s aphasia.  Speech therapy helps the client to make the most of the remaining skills and learn to compensate when needed (NAA, 1999).

For More Information

National Aphasia Association- http://www.aphasia.org/

American Speech Language Hearing Association- http://www.asha.org/

(Note: In this interview Kim is a speech-language pathologist and Mary is the wife of a man who has Broca’s aphasia.)

 Kim: Good morning Mary.  How are you doing today?

Mary: Pretty good.  How about you?

Kim: I’m doing good.  Paul is doing really well in therapy.  He is trying very hard and I can already see some improvements.  I finished therapy a little early with him today so that I could talk with you.  I know it is hard to communicate with him right now and I thought I would share some tips with you that would make it a little easier.

Mary: Oh that would be great!  I love him so much and will do anything to help.

Kim: That is good to hear.  Supportive relationships are very important during recovery.  Studies have found that the more empathy the family members have the faster the recovery process will be. (Robertson and Suinn as cited in Luterman, 1996)

Mary: Well if that is the case he should be healed by now (laughs).

Kim: (laughs) Unfortunately, it’s not quite that easy.  There are a lot of things that come into play.  It will help though.  So today I’m going to go over some simple things that you can do to take the burden of communication off of him.  Then, at the end we will practice using the techniques.  If you have any questions feel free to ask them at anytime.

Mary: Sounds good.

Kim:  Ok.  The first thing you can do is make sure you have his attention before you begin speaking. (National Aphasia Association [NAA], 2005)   You can do this by calling out his name, making eye contact, or if you are beside him you could gently touch his arm, anything that will let him know that you are talking to him.

Mary: That’s pretty simple I think I can handle that.

Kim: It will also help if you can eliminate any background noise, like the television or radio, when communicating. (NAA, 2005) 

Mary:  That will be hard because he loves to watch television, especially football.

Kim:  Well you don’t want to take anything away that he enjoys so maybe avoid talking during that time.  And you don’t have to completely stop watching television.  Just when you have something important to tell him or you feel like talking with him turn the TV down or off.  When driving it is also a good time for you to communicate and it will make it easier for him if the radio is not on.

Mary: Ok that will work.

Kim: When talking to him you don’t need to speak louder, but it will help if you can keep your sentence structure simple and talk slower.  It will also help if you emphasize important words.   However, you don’t want to talk down to him, keep the conversation at an adult level. (NAA, 2005)

Mary: What do you mean keep the sentence structure simple?

Kim: A lot times people with aphasia use the content words to figure out what is being said.  They assume that the words follow the basic word order of English, which is the person or thing performing the action comes first, then the action, and lastly the thing that is acted on.  For example, “The dog stole the steak.” (Fodor, 1999).

Mary: So if I was telling him I saw his granddaughter I would say “I saw Suzy.”

Kim: Exactly.

Mary: Ok.

Kim: It will also help him to understand you if you use gestures and visual aids.  If you see he did not understand you, you can also repeat what you said. (NAA, 2005)

Mary: Ok.  So what can I do to help him speak better?

Kim: Well, you want to allow him to use other ways of communicating when he is having trouble.  He could try writing, drawing, gestures, and facial expressions.  If you ask him choice questions you could write out choices and let him point to the correct one.  It is also good to ask him yes/no questions.  Sometimes these responses come out ok because they are automatic. (NAA, 2005)

Mary: Yeah, I’ve noticed when he does not have to think about what he is going to say it comes out better.  I think that will really help.

Kim: When he does try to speak make sure you give him plenty of time.  Try not to speak for him.  If you see he is having a lot of trouble and getting frustrated ask him if he would like some help (NAA, 2005).

Mary: So if he wants my help I can help him?

Kim: Yes, definitely.  If he wants your help, do whatever you can.  Just make sure he wants your help before you speak for him.  You want to make communicating a pleasant experience.  Praise all attempts at speaking and do not criticize or correct what he says.  His speech is not going to be perfect. (NAA, 2005)

Mary: Ok.  I think he’s been getting frustrated with me because I’m a little overprotective of him now.  I just don’t want anyone to make fun of him.  Should I be so protective of him?

Kim: No, you want to let him be as independent as possible.  Try to go about your normal activities.  You do not want to keep him away from people because that can cause him to feel depressed and left out. (NAA, 2005)

Mary: Oh, well we do not want that.

Kim: No, you want him to be included in the family and live as close to a normal life as possible.  So, why don’t you try the things I’ve told you today and let me know how it works.  If encounter any problems or think of any questions please contact me, you have my number.

Mary: Ok, thank you so much!  I really think these tips will help Paul and I be able to communicate better.

Kim: I hope so.  You have a good weekend.

Mary: You too.  Bye.

Kim: Bye.

December 5, 2005

From: mrscanterbury@yahoo.com

Subject: Question about Broca’s

To: marymack@hotmail.com

Hi Mary!  My name is Cindy Canterbury.  A friend at work, Melanie Simpson, gave me your e-mail address because she thought you might be able to provide me with some information about Broca’s aphasia.  My husband suffered from an ischemic stroke 2 months ago and has been diagnosed with Broca’s aphasia.  She was telling me about Paul and everything you two have been through.  I thought it would be nice to talk to someone who would understand what I am going through.  If you have any information you could e-mail me I would really appreciate it.  I’m searching for all the information I can so that I can get a better understanding of his problem.      

Desperate for Information,

Cindy Canterbury

December 8, 2005

 

 

From: marymack@hotmail.com

Subject: Re: Question about Broca’s

To: mrscanterbury@yahoo.com

Cindy,

Melanie had told me about your husband and said you might contact me.  I understand COMPLETELY what you are going through.  I am sending you some information that I have found useful.

First, I suggest that you check out this pamphlet.  It has a lot of basic information about Broca’s Aphasia.  It provides you with a definition, characteristics, causes, and treatment. 

I hope the next things can bring you some insight into how your husband may be feeling.  I never realized how aphasia was effecting my husband’s emotions until I was snooping (typical woman right?) and found his journal that his speech-language therapist told him to write in.  He had included a poem that broke my heart.  I knew he wanted to communicate, but I did not realize how much it bothered him.  I guess I hadn’t put myself in his shoes.  As much as I hate to admit it, I was sort of selfish because I was so upset for myself.  I felt like I had lost my husband.  What made it worse, was anytime I was upset he was the one I turned to, and now I could not cry on his shoulder because he needed me.  I was searching online and found a power point presentation (this will be a link once I finish the power point) that Kim Lucas, a speech-language therapist in training, had made for one of her classes.  It discusses the importance of supportive relationships in the recovery of aphasia.  This helped me to realize that I needed to be strong and help Paul through this.  That is when I personally met with his speech-language pathologist to see what I could do to help.  She gave me lots of tips on how I could make communicating easier for Paul.

I realize that you are in a very difficult situation and it is very important that you also have lots of support.  If you would like to meet and have a cup of coffee we can talk some more. 

Hope the information helps,

Mary Mack

 

 

Date: December 15, 2005

From: mrscanterbury@yahoo.com

Subject: Thank You So Much

To: marymack@hotmail.com

Sorry it has taken me so long to reply.  It has been kind of hectic with Christmas being so close and I wanted to look at all the information you sent before I wrote you back.  Everything was very helpful and I appreciate you sharing some of your personal experiences.  I would really like it if we could get together and talk sometime.  I am sure you will be busy during the holidays so I’ll let you pick a date.  I am pretty much available anytime after 4pm.  I’m really looking forward to talking with you. 

Thanks again,

Cindy