TMoA is generally characterized by reduced speech output, which is a result of dysfunction of the affected region of the brain.
Patients with this form of aphasia may present with a contiguity disorder in which they have difficulty combining linguistic elements.
[4] TMoA is classified as a non-fluent aphasia that is characterized by a significantly reduced output of speech, but good auditory comprehension.
[1] Individuals with TMoA also exhibit good repetition skills and can repeat long, complex phrases effortlessly and without error.
[1] Due to damage in the anterior superior frontal lobe, people with TMoA have deficits in initiation and maintenance of conversations, which results in reduced speech output.
[1] Neurological imaging has shown that TMoA is typically caused by an infarct of the anterior superior frontal lobe in the perisylvian area[6] of the left, or language-dominant, hemisphere.
[1] The anterior superior frontal lobe is known as the prefrontal cortex which is responsible for the initiation and ideation of verbal speech.
[7] The damage leaves the major language networks, Broca's and Wernicke’s areas and the arcuate fasiculus, unaffected.
The overall sign of TMoA is nonfluent, reduced, fragmentary echoic, and perseverative speech with frequent hesitations and pauses.
A screening typically includes evaluation of oral motor functions, speech production skills, comprehension, use of written and verbal language, cognitive communication, swallowing, and hearing.
Under the American Speech-Language-Hearing Association (ASHA) and World Health Organization (WHO) guidelines and the International Classification of Functioning, Disability and Health (ICF) framework, the comprehensive assessment encompasses not only speech and language, but also impairments in body structure and function, co-morbid deficits, limitations in activity and participation, and contextual (environmental and personal) factors.
[8] From this assessment, the SLP will determine type of aphasia and the patient's communicative strengths and weaknesses and how their diagnosis may impact their overall quality of life.
The SLP chooses specific therapy tasks and goals based on the speech and language abilities and needs of the individual.
[1] New research in aphasia treatment is showing the benefit of the Life Participation Approach to Aphasia (LPAA) in which goals are written based on the skills needed by the individual patient to participate in specific real-life situations (i.e. communicating effectively with nurses or gaining employment).
To work on more connected speech, the clinician may ask the patient to describe procedures such as making a sandwich or doing laundry.
[1] Research supports the use of reduced syntax therapy to help patients overcome the non-fluent speech and agrammatism that often occurs with TMoA.
Because agrammatism inhibits the patient's ability to form grammatically correct sentences, this type of treatment involves reducing these agrammatic deficits and teaching the patient to simplify linguistic structures while still conveying the message in order for language used to be more productive in conversation.
Strategies include saying “I know you know” when appropriate, using gestures to supplement messages, limiting background noise, and given sufficient time for response.
With a hemorrhagic stroke, the patient often shows little improvement in the first few weeks and then has relatively rapid recovery until they stabilize.
[1] Other factors that determine a patient's prognosis include age, education prior to the stroke, gender, motivation, and support.