Expressive Aphasia
Named after Paul Broca, whose descriptions of patients with damage to a specific frontal lobe region linked that area to the production of speech.
Expressive aphasia is a difficulty putting thoughts into words, ranging from mild word-finding trouble and mispronunciation to, in severe cases, speech restricted to a handful of expletives or fixed phrases. The person typically understands what is said to them and knows what they want to say, but struggles, sometimes severely, to produce it.
This has traditionally been attributed to lesions of Broca's area, in the posterior part of the frontal lobe, or to the association fibres running forward from the speech centre in the temporal lobe, and is distinguished from the language disorders of severe illness by the person's usual awareness of, and frustration with, their own errors.
Also known as
- Broca's aphasia
- The most widely used eponymous name for this condition.
- Verbal aphasia
- An older alternative name for the same condition.
- Cortical motor aphasia
- A further alternative name emphasising the motor speech difficulty at its core.
Recognition features
- Difficulty producing spoken language despite generally intact understanding of what is said
- In severe cases, speech may be reduced to a few words, expletives, or fixed 'recurring utterances' delivered with different intonation to convey different meanings
- Words are often mispronounced, and longer words tend to be abbreviated
- Omission of small words such as articles gives a characteristic clipped, 'telegram style' quality to speech, while grammar in longer utterances is comparatively less affected than word selection
Eliciting it at interview
- Assess comprehension separately from production, since understanding is typically much better preserved than the ability to speak
- Note whether the person appears aware of their errors and attempts to self-correct, which is a common and clinically useful feature
- Test preserved automatic speech, such as counting or reciting the days of the week, since these 'serial' abilities are often relatively spared even when spontaneous speech is severely affected
Distinguishing features
- Differs from receptive aphasia in that comprehension is relatively preserved while production is chiefly affected
- Differs from mutism in that some speech output, however limited, is typically still present, including expletives or fixed utterances under emotional stress
- Preserved comprehension alongside severely limited output, together with the person's own evident frustration and awareness of the difficulty, distinguishes this from most psychiatric causes of reduced speech
Common misconceptions
- That a person who can barely speak has lost the ability to understand; comprehension is typically much better preserved than production in this condition
- That the telegram-style, clipped quality of speech reflects confusion; it specifically reflects the systematic omission of small grammatical words rather than disordered thinking
Related phenomena
Aphasia · Pure Word-Dumbness · Paraphasia
Practice this
A patient understands everything said to him and clearly knows what he wants to say, but can only produce a handful of expletives and fixed phrases, delivered with different intonation each time to try to convey different meanings, visibly frustrated by his inability to say more. What is this? · A patient sits through an entire interview producing no spoken words whatsoever, not even a single sound, despite appearing to understand and attend closely to everything said to him, though he does eventually communicate a brief message by writing on paper. Before revealing the answer: is this expressive aphasia? · A patient's spoken output is severely reduced. Before revealing the answer, decide what distinguishes expressive aphasia from mutism. · A patient produces no spoken output at all. Before revealing the answer, decide what distinguishes pure word-dumbness from expressive aphasia. · A patient shows an aphasic language disturbance. Before revealing the answer, decide what distinguishes receptive aphasia from expressive aphasia. · You suspect a patient has expressive aphasia. Before revealing the answer, decide how you would assess for this. · Explain why the "telegram style" quality of speech in expressive aphasia is a clinically useful feature to recognise.
Illustration
Following a left frontal lobe stroke, a 64-year-old woman understands every instruction given to her and clearly knows what she wants to say, but can only produce a handful of effortful, mispronounced words at a time, such as "want... cup... no... tea," visibly frustrated each time the right words fail to come, while she can still recite the days of the week from memory almost fluently.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 4, 'Disorders of Thought and Speech'.