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APHASIA

Pendahuluan
Bahasa adalah :
Kumpulan simbol yang luas
punya makna untuk komunikasi
Tidak hanya digunakan untuk
berbicara
Alat pokok dalam berhubungan
Dasar untuk kemampuan kognitif

all animals can communicate. They can


exchange information with one another.
Although these animals can communicate,
do they have LANGUAGE?

Certainly other animals


communicate...bees have the ability to
communicate with other bees using their
special "dance." However, human language
is more than just communication.

Arti

Anatomi dan
Fisiologi Pusat Bahasa

sempit (area Wernicke dan area


Broca)
Arti luas (pemahaman, mengingat,
membaca, berhitung, menulis, dlsb)

Anatomi dan
Fisiologi Pusat Bahasa

Korteks serebri Neokorteks


Campbell, 1905-20 area
Brodmann, 1909-47 area
Von Economo, 1929-109 area
Vogts, 1919-200 area
Area reseptive area Wernicke (area
41 & 42)
Area ekspresive area Broca (area 44
& 45)

Daerah Bahasa

Jalannya suara, reseptor

radiatio auditive kolikulus inf


CGM mencapai area 41

Informasi

diteruskan ke area
asosiasi integrasi di daerah
supramarginal girus angularis
serabut asosiasi area
motorik Broca

History
The

ancient Greeks noticed that


brain damage could cause aphasia.
Centuries later, in 1836, Marc Dax
described a group of patients who
could not speak properly. Dax
reported that all of these patients
had damage to the left side of their
brain.

History
A

quarter century later in 1861, Paul


Broca described a patient who could
say only one word..."tan." For this
reason, Broca called this patient
"Tan." When Tan died, Broca
examined his brain and found that
there was damage to part of the left
frontal cortex. This part of the brain
has come to be known as "Broca's
Area."

History
In

1876, Karl Wernicke found that


damage to a different part of the
brain also caused language
problems. This area of the brain
("Wernicke's Area"), was further
back and lower in the brain
compared to Broca's area. In fact,
Wernicke's area is in the posterior
part of the temporal lobe.

Broca's

area and Wernicke's area are


connected by a bundle of nerve
fibers called the arcuate fasciculus.
Damage to the arcuate fasciculus
causes a disorder called conduction
aphasia. People with conduction
aphasia can understand language,
but their speech does not make
sense and they cannot repeat words.

What is Aphasia

Aphasia is an impairment of language. An


acquired communication disorder that
impairs a persons ability to process
language, but does not affect intelligence.

Impairs ability to speak and understand


others and most people with aphasia
experience difficulty reading and writing.

Definitions
loss

or impairment of language
secondary to brain damage. Aphasia
is somewhat fuzzily distinguished
from dysarthria, which designates a
motor speech disturbance (e.g.
weakness of the tongue or lips,
cerebellar disorder).

Gangguan

berbahasa yang didapat


dengan penyebab cedera di otak,
ditandai dengan gangguan
pemahaman & gangguan
pengutaraan bahasa lisan maupun
bahasa tulisan

What causes Aphasia


Most

common cause of aphasia is


stroke about 23 40% of stroke
survivors acquire aphasia.

It

is estimated that about one million


people in the United States have
acquired aphasia, or 1 in 250
people.

What causes Aphasia


More

common than Parkinsons


Disease, cerebral palsy or muscular
dystrophy.

About

1/3rd of severely head-injured


persons have aphasia.

Akibat

cedera otak berarti


kerusakannya di otak akibat stroke,
tumor otak, cedera kepala & infeksi
otak.
Berbahasa adalah kemampuan untuk
berkomunikasi melalui penggunaan
simbol tidak hanya wicara tetapi juga
pengungkapan & pengertian dari
bahasa tulis, isyarat, gestural & musik

Untuk

menilai gangguan berbahasa


dapat dilihat dari beberapa modalitas
bahasa antara lain : bicara spontan,
pengertian auditif, pengulangan,
penamaan, membaca & menulis

Klasifikasi
Ada

beberapa klasifikasi yang dibuat


oleh para ahli. Klasifikasi yang dibuat
oleh Goodglass & Kaplan tahun 1972
cukup mudah & praktis dalam klinik
karena berdasarkan observasi klinik
& atas dasar ciri-ciri penamaan kata
kefasihan, meniru ucapan &
pemahaman audit

1.
2.
3.
4.
5.
6.

Aphasia
Aphasia
Aphasia
Aphasia
Aphasia
Aphasia

global
Broca
Wernicke
Transkortikalis motorik
transkortikalis sensorik
anomik

Patofisiologi
Pusat wicara & berbahasa di sekitar sulcus
lateralis (Sylvius) di hemispher kiri untuk
orang bukan kidal
Terdiri dari seluruh operculum (frontalis,
frontoparietalis & temporalis), insula,
bagian bawah gyrus centralis posterior,
gyrus supramarginalis, gyrus angularis,
gyrus parietalis inferior, bagian atas lobus
temporalis superior
Pusat bahasa disebut area bahasa, area di
dekat & sekitar area bahasa disebut area
peralihan atau borderzone

Patofisiologi
Kerusakan

di pusat bahasa inilah


yang menimbulkan aphasia &
tergantung letak & luasnya
kerusakan inilah yang menimbulkan
bermacam-macam aphasia

Clinical Features of Aphasias


and Related Conditions
Comprehension

Repetition of
Spoken Language

Naming

Fluency

Wernicke's

Impaired

Impaired

Impaired

Preserved or increased

Broca's

Preserved (except
grammar)

Impaired

Impaired

Decreased

Global

Impaired

Impaired

Impaired

Decreased

Conduction

Preserved

Impaired

Impaired

Preserved

Nonfluent (motor)
transcortical

Preserved

Preserved

Impaired

Impaired

Fluent (sensory)
transcortical

Impaired

Preserved

Impaired

Preserved

Isolation

Impaired

Echolalia

Impaired

No purposeful speech

Anomic

Preserved

Preserved

Impaired

Preserved except for wordfinding pauses

Pure word deafness

Impaired only for


spoken language

Impaired

Preserved

Preserved

Pure alexia

Impaired only for


reading

Preserved

Preserved

Preserved

Aphasia global
is

characterized by comprehension
deficits and non-fluent speech.
Combination of Broca's and
Wernickes. Mild forms are called
"mixed"
Usually results from strokes that
involve the entire middle cerebral
artery distribution in the left
hemisphere.

Aphasia Broca
is

characterized by an almost
telegraphic speech pattern in which
the words that are uttered are short
and often agrammatic, while
comprehension remains
comparatively intact.

Afasia Broca
Bicara tidak lancar, terdapat disartria
dan sulit menemukan kata, disertai
parafasia atau disprosodia. Tapi
pengetahuan dan pendengaran baik.

Aphasia Wernicke
is

characterized by fluent speech, but


poor comprehension.

Afasia Wernicke
Gangguan serius pd proses
pendengaran, dan pemahaman,
pengulangan kata terganggu
karena adanya blok informasi
Dijumpai adanya parafasia,
gangguan penamaan, membaca
dan menulis

Aphasia Transkortikalis motorik


is

similar to Broca's aphasia except


the ability to repeat is intact.
Normal repetition.
Decreased fluency and specch
output.

Afasia Transkortikal Motorik


Bila terganggu jaras motorik, ia
mampu mengulang kata, dapat
membaca dan mengerti dengan
baik.

Aphasia transkortikalis sensorik


is

similar to Wernicke's aphasia but


the ability to repeat spoken language
is spared.
Normal repetition.
Poor comprehension of spoken
language and paraphasic errors.

Afasia Transkortikal Sensorik


Bila terganggu jaras sensorik,
ia dapat mengulang dengan
baik, menyebutkan nama cukup
lancar, tapi pemahaman tidak
baik dan dijumpai parafasia

Afasia anomik
Kemampuan menemukan dan
menyebutkan kata terganggu,
membaca dan menulis juga
terganggu, tapi bicara spontan
lancar, dan struktur bahasa baik.

Conduction aphasia
is

also known as disconnection


syndrome because it is a lesion that
disconnects Broca's area from
Wernicke's area via the arcuate
fasciculus and is characterized by a
comparatively reduced ability to
repeat spoken language.
Unable to repeat.

Afasia Konduktif
Ketidaktepatan dalam pengulangan
kata. Ketidak lancaran berbahasa,
bicara lambat dan terputus-putus.
Pemahaman baik, penamaan dan
pengulangan kata terganggu berat.

Penanganan
Penanganan

aphasia selama ini


diberikan terapi wicara oleh para ahli
terapi wicara secara sistematis &
terarah berdasarkan pemikiran
sebagai berikut : aphasia adalah
gangguan bahasa, bahasa adalah
alat komunikasi, maka tujuan utama
adalah optimalisasi komunikasi
pasien dengan lingkungannya

Pemeriksaan:
Lakukan allo-anamnesa dengan orang /
keluarga terdekat.
Pastikan apakah ia right handed atau
left handed.
Kenali bahasa ibunya. (first language).
Evaluasi pengertiannya dengan
menanyakan hal-hal yang sederhana
seperti:
- nama dan alamat.
- pekerjaan dan apa yang
dikerjakannya.
- dari mana asalnya.

Pemeriksaan:
Test Pengertiannya.
Ajukan pertanyaan sederhana.
Berikan perintah sederhana.
Susul dengan perintah yang lebih
kompleks.
Nilai bahasa spontannya.
Nilai temuan kata dan kemampuan
menemukan kata.
Nilai pengulangan kata.

Pemeriksaan:
Lakukan Test:

Membaca.
Menulis.
Berhitung.
Menggambar.
Menceritakan kembali paragraf yg
sudah dibaca

Penanganan
The

broad range of the types and


severity of aphasia, as well as the
diverse strategies used in its
treatment, complicates the design of
clinical trials.

Penanganan

A meta-analysis of the diverse approaches


used to treat all patients with aphasia
after stroke showed a positive, moderate
effect for treatment begun within the first
3 months after stroke, as compared with
no treatment, as well as a smaller but
positive effect when treatment was
initiated between 3 to 12 months after
stroke and even after more than 1 year.

Penanganan
Patients treated by speech therapists
perform better than those treated by
trained volunteers.
Greater intensity of treatment, ranging
from 40 to 100 hours (5 hours or more
weekly) of treatment targeted to specific
impairments, correlates directly with the
magnitude of improvement, primarily
among patients whose stroke occurred
less than six months previously.

Penanganan
Pemberian

piracetam

Prognosis
Jenis

aphasia mempengaruhi
prognosisnya, di mana aphasia global
& Wernicke paling buruk
prognosisnya

Penutup
Untuk

mengetahui adanya gangguan


pada hemisferium, maka
pemeriksaan fungsi bahasa harus di
kuasai dan evaluasi yang seksama
adalah penting

Speaking the Written Word

Speaking the Heard Word

Speaking the Written Word


To

speak a word that is read,


information must first get to the
primary visual cortex. From the
primary visual cortex, information is
transmitted to the posterior speech
area, including Wernicke's area.
From Wernicke's area, information
travels to Broca's area, then to the
Primary Motor Cortex.

Speaking the Heard Word


To

speak a word that is heard,


information must first get to the
primary auditory cortex. From the
primary auditory cortex, information
is transmitted to the posterior speech
area, including Wernicke's area.
From Wernicke's area, information
travels to Broca's area, then to the
Primary Motor Cortex.