Disorders of speech and communication, including Aphasia (mainly post stroke) are a major community health burden in terms of DALY (Disability Adjusted Life Years). Unfortunately they are relatively neglected with huge treatment gap. Traditionally aphasia related lesion sites have been grouped with reference to Rolandic & Sylvian fissures. However the theoretical models of language and speech organization in brain have undergone major conceptual shifts due to advances in cognitive neuropsychology, linguistics and functional neuro-imaging. Much more widely distributed overlapping neural networks are understood to be actively involved in various communication activities. The notion of speech centers or areas is somewhat outdated. Traditional aphasia syndromes may however be somewhat useful as a shorthand summary of the clinical profile, but are being considered now as of limited utility for planning an intensive, long-term speech therapy. Conventional description of aphasic deficits needs to be replaced by more detailed profiling which helps in better planning for speech therapy. The evidence base for efficacy of speech therapy is now robust. Management of aphasia, though time consuming, is worth the effort, in collaboration with speech therapist. Pharmacotherapy and transcortical magnetic stimulation or transcortical direct current stimulation may also have some role.
"A clinical approach to disorders of speech,"
Pakistan Journal of Neurological Sciences (PJNS): Vol. 9
, Article 13.
Available at: http://ecommons.aku.edu/pjns/vol9/iss4/13