Speech Therapy and Primary Progressive Aphasia
Primary progressive aphasia, or PPA, is a neurological syndrome in which language capabilities become progressively impaired over time. Unlike other forms of aphasia that come as a result of brain injury or stroke, PPA is caused by neurodegenerative diseases like Alzheimer’s Disease or Frontotemporal Lobar Degeneration. This comes as a result of degeneration of brain tissues necessary for speech and language. Typically, the first symptoms are problems with language and speech, though there are other issues associated with underlying disease like memory loss that may occur later.
PPA usually begins as a subtle disorder of language, and progresses to a nearly total inability to speak when it reaches the most severe stage. The nature of the language deficit can be different from one patient to the next. The initial language disturbance could be fluent aphasia because the patient may experience normal or increased rate of word production, or it could be non-fluent aphasia, in that speech becomes more of an effort and the person produces fewer words overall. Less common varieties begin with the inability to find words and a progressive deterioration of comprehension and naming.
Manifestations of PPA vary depending on the part of the left hemisphere of the brain that was damaged, or which parts suffer the damage as the disease continues to degenerate the brain. This is much the case with aphasia that comes as a result of brain injury or stroke. It is entirely possible that a patient will not have any issues understanding speech at first, but with time, nearly all patients will reach mute status – unable to understand either the written or spoken word.
When dealing with a progressive disease such as PPA, it is necessary to continue modifying the speech rate and pausing to assure the patient that he or she will be understood for as long as possible. Motor exercises only cause more fatigue, resulting in further deterioration of speaking.
Speech language pathologists can be helpful to those with disabilities like PPA. They can work with patients to conserve speech clarity and swallowing. They can also help develop alternative ways of communicating, so that even as the disease progresses, they can communicate with friends and family. They can also help patients and their families obtain identification cards and other materials to help explain the patient’s condition to people who don’t know about it.
Though much of the SLP’s job will focus on preserving speech clarity for as long as possible, as the condition progresses, they will focus on teaching non-verbal communication techniques, including pointing to pictures and gesturing to help the patient express themselves.