Tue, Apr 12, 2022 page14

• What to know about aphasia, Bruce Willis’ diagnosis 布魯斯威利因它息影：「失語症」是什麼？

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  The news that film star Bruce Willis has retired from acting due to aphasia has shone a spotlight on the poorly understood communication disorder.

  “Aphasia just means that someone has a problem with language that they weren’t born with,” Hugo Botha, a neurologist at Mayo Clinic in Minnesota explained.

  The most common cause is stroke or head injury — and experts stress that while it can affect the production and comprehension of both speech and written words, it normally doesn’t impact intelligence.

  

  US Actor Bruce Willis attends the premiere of “Motherless Brooklyn” during the 57th New York Film Festival at Alice Tully Hall in New York City on Oct. 11, 2019. 美國演員布魯斯威利在第五十七屆紐約電影節出席《布魯克林孤兒》首映。二○一九年十月十一日攝於紐約市愛麗絲塔利音樂廳。

  Photo: AFP 照片：法新社

  It affects some two million Americans, according to the National Aphasia Association, making it more common than Parkinson’s Disease, cerebral palsy or muscular dystrophy.

  While it’s normally caused by a specific one-time event such as stroke, “there are other possibilities, such as from a neurodegenerative disease,” or a growing tumor, explained Brenda Rapp, a cognitive scientist at Johns Hopkins University.

  In such cases the damage is progressive and therapy focuses on preventing further loss of function.

  

  Expressive aphasia is a type of aphasia that results from brain damage in frontal cortex of the dominant hemisphere (usually the left hemisphere), the Broca area. This area is responsible for speech. 表達型失語症為失語症的一種，是優勢半球（通常為左半球）之額葉皮層（布洛卡區）的腦損傷造成，此區域負責言語表達。

  Photo: Pereoptic / Wikimedia Commons 照片：Pereoptic∕維基共享資源

  The brain system governing language is a “very complex machine” that involves selecting the right words, moving the mouth appropriately to vocalize them, and on the other end hearing and decoding their meaning, said Rapp.

  Everyone occasionally struggles to find the right word, “but you could imagine in aphasia, this happens a lot,” she added.

  Doctors sometimes split aphasia into broad clinical categories which correlate to where in the brain injury occurred.

  

  Broca’s area and Wernicke’s area are the two regions of the cerebral cortex that are involved in speech. Broca’s area, which has been considered as a neural base for speech production, is found in the inferior part of the 3rd frontal convolution of the brain. Wernicke’s area, which is associated with the understanding of spoken and written language, is located in the posterior part of the superior temporal gyrus in the dominant cerebral hemisphere, which is the left hemisphere in about 95 percent of right-handed individuals and 70 percent of left-handed individuals. 布洛卡區及威尼克區是大腦皮層中跟言語相關的兩個區域。布洛卡區被認為是產生語言的神經基礎，位於大腦第三額葉迴旋的下部。威尼克區與理解口語及書面語言有關，位於優勢大腦半球的顳上回後部，約百分之九十五的右撇子及百分之七十的左撇子的優勢大腦為左半球。

  Photo: Wikimedia Commons 照片：維基共享資源

  In expressive aphasia, people “usually understand fairly well but have trouble getting words out,” said speech pathologist Brooke Hatfield, of the American Speech-Language-Hearing Association (ASHA).

  The brain is extremely plastic, and speech therapy can engage other parts of it to “bypass the roadblocks” of the damaged areas, and forge new connections, said Rapp.

  Such therapy also teaches people to talk around the subject if they get stuck on a specific word.

  Family members can also develop strategies to make themselves better understood: “Things like shorter sentences, and making sure that you’re talking to the person in full view instead of the other room, and minimizing background noise,” said Botha.

  Some people do well with assistive devices because their ability to write isn’t affected in the same way.

  Over the horizon, there are experimental treatments that combine electrical stimulation of the brain with speech therapy that have shown promise in recovering function, said Rapp.

  In the case of progressive aphasia, developing drugs that target the build up of protein plaques and tangles in the brain that cause neurodegenerative disease are thought to be the way forward.

  (AFP)

  影星布魯斯威利因失語症而息影的消息，讓這鮮為人知的溝通障礙成為焦點。

  美國明尼蘇達州梅奧診所的神經學家休果‧波塔解釋說：「失語症的意思不過是指某人有語言上的問題，而這些問題不是天生的」。

  最常見的成因是中風或頭部受傷——專家強調，雖然失語症會影響言語和書面文字之產出與理解，但通常對智力並無影響。

  根據美國國家失語症協會的資料，美國有約兩百萬人患有失語症，因此比帕金森氏症、腦癱或肌肉萎縮症更常見。

  約翰霍普金斯大學的認知科學家布蘭達‧拉普解釋說，雖然失語症通常是由一次特定的事件（例如中風）所引起，但「還有其他可能性，例如來自神經退化性疾病」或生長的腫瘤。

  在這種情況下，損傷是進行性、逐漸惡化的，因此治療的重點是防止進一步喪失功能。

  拉普表示，控制語言的大腦系統是個「非常複雜的機器」，包括選擇正確的詞、適當地動嘴巴來發出聲音，以及在另一端聽見與解讀其含義。

  每個人偶爾都有想不出合適用詞的時候，「但你可以想像對失語症患者來說，這種情況經常發生」，她補充道。

  醫生有時依腦損傷發生之相關部位將失語症大致分為數個臨床類別。

  美國聽語協會的語言病理學家布魯克‧哈特菲爾德表示，在表達型失語症中，人們「通常理解得很好，但很難說出來」。

  拉普表示，大腦的可塑性極強，語言治療可以利用大腦的其他部分來「繞過受損區域的障礙」，並建立新的連結。

  這種治療還教人在腦袋卡住找不某個詞的時候，就圍繞該主題旁敲側擊。

  失語症患者的家人還可用一些方法讓自己說話較容易被理解：「比如用短一點的句子，在能夠完整看到彼此的地方說話，而不是身處不同房間，以及將背景噪音減到最少」，波塔說。

  有些人用輔助設備可以做得很好，因為他們的書寫能力不會受到同樣的影響。

  拉普表示，一些實驗性的療法已露出曙光，以大腦電刺激配合語言治療，對語言功能的恢復大有可為。

  對於漸進性失語症的治療，開發藥物以針對導致神經退化性疾病的大腦中蛋白質斑塊及纏結，被認為前景可期。

  （台北時報林俐凱編譯）
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