Expressive Aphasia - Prognosis

Prognosis

In most individuals with expressive aphasia, the majority of recovery is seen within the first year following a stroke or injury. The majority of this improvement is seen in the first four weeks in therapy following a stroke and slows thereafter. When compared to patients with the most common types of aphasia, patients with expressive aphasia tend to show the most improvement within the first year. This may be due to an expressive aphasiac's awareness and greater insight of their impairment (unlike in receptive aphasia), which motivates him/her to progress in treatment. Studies have also found that prognosis of expressive aphasia correlates strongly with the initial severity of impairment. Those with the greatest initial disability tend to show the greatest improvement among test groups. Within the first year, the diagnosis of patients with expressive aphasia may change to anomic aphasia. Likewise, patients diagnosed with global aphasia may be re-diagnosed with expressive aphasia upon improvement. Typically, little improvement is seen after the first year following a stroke. However, it has been seen that continued recovery is possible years after a stroke with effective treatment using methods such as constraint-induced aphasia therapy. Depression, anxiety, and social withdrawal are all factors which have been proven to negatively affect a patient's chance of recovery. Due to frustration from the inability to express themselves, suffers of expressive aphasia can become clinically depressed. This creates further impairment because the left hemisphere in depressed individuals functions at lower levels of activity than people without depression. This further complicates issues because the decreased functionality of the two conditions can combine to create even lower levels of activity than in either of the two conditions alone. The strategy for aiding individuals in this condition is to deal with the depression first. Once the depression is alleviated, or at least under control, the patient is better able to focus on treatments that target the aphasia than if the order of treatments was reversed.

Location and size of the brain lesion may also play a role in the prognosis of aphasia. It has been seen in receptive aphasia that larger lesions correlate to slower recovery. It has also been seen that patients with aphasia caused by sub cortical lesions have a better chance of recovery than those with aphasia due to cortical stroke.