Primary progressive aphasia (PPA) is a neurological disorder that affects a person’s ability to speak and communicate. This blog will dive into what causes PPA and how speech therapy can treat it.
What is PPA?
Unlike other forms of aphasia that occur because of a sudden neurological event such as a stroke or traumatic brain injury, PPA is caused by a gradual decline in language. This is because there is a progressive loss of neurons and brain tissue in areas of the brain responsible for speech and language.
There are 3 different subtypes of PPA which are characterized by different patterns of neural changes and decline. They have different features of language difficulty. They are:
- Non-fluent variant: Have trouble with motor speech and speaking with grammatical sentences
- Semantic variant: Have trouble comprehending words and retrieving words
- Logopenic variant: Affects phonological processing which can make it hard to process sounds and hold on to information that is presented verbally
Symptoms of PPA change and progress over time. They will also vary depending on the particular pattern of brain cell degeneration within each subtype.
In early stages, however, many individuals report difficulty finding the right word to say. “I know what it is, but I can’t think of the word.”
Some explain they have trouble getting sounds to come out the right way. For example, they may say “Coggee” for “coffee” or, “cow” for “horse.”
Others struggle to recall concepts. This could look like, “Safety Pin. I know I’ve heard that word before, but I can’t think of what that is.”
There can be speech coordination difficulties. Speech may sound slurred and there may be articulation errors.
It can be challenging to hold on to information pertaining to numbers. This could make it hard to recall the time and date of an appointment long enough to write it down. Some also find they have trouble taking down phone numbers.
Most individuals with PPA also report changes to their ability to read and write as well as difficulty processing visual information or correctly interpreting what they see.
PPA does NOT impact a person’s intelligence, physical skills, spatial orientation (directions), recall of events and memories, or sense of humor.
What happens in the middle and late stages of PPA?
Sadly, language difficulties will increase with time. In middle and late stages of PPA, it may become increasingly hard to talk. Speech may become very effortful and halting. Difficulty coordinating sounds of speech may cause speech to sound slurred. Significant articulation breakdowns or errors will negatively impact the clarity and intelligibility of a person’s message.
Grammatical aspects of speech may also decline, resulting in messages that contain sentence fragments, word omissions, and vague referents. Speech may sound telegram. This will impact a person’s ability to easily express their ideas. Family, friends, and care teams may struggle to interpret messages. Consequently, individuals living with PPA can find it challenging to participate fully in day-to-day activities and those events and activities that matter most to them.
It may become harder to understand what people are saying, especially when a person is speaking quickly. Comprehending words and longer streams of information may be impacted. This will likely make it difficult to follow and participate in a conversation and speaking within a group with multiple communication partners can be even more challenging.
During middle and late stages of PPA, cognitive and behavioral changes can arise. This could look like difficulty with paying attention to important information and filtering out distractions. Background noises like the chatter and bustling activity in a restaurant make it harder for people with PPA to communicate. Difficulty with memory and mood may also appear.
PPA and Speech Therapy
Neuroscientists and speech and language scientists are actively investigating behavioral interventions that may slow the progression of cognitive communication difficulties. Focusing on fortifying communicative functions enhances life participation, connections, and the overall well-being of individuals and families living with PPA. Results are promising!
Speech therapy can help by:
- Strengthening cognitive-communication skills
- Identifying and using compensatory strategies to circumnavigate communication difficulties
- Establishing and making modifications to the environments people communicate within AND
- Educating and training communication partners to reduce communication breakdowns and help people and partners repair breakdowns
Restorative Treatments: These treatments aim to strengthen specific language skills. This can include naming drills and exercises to strengthen word finding skills and the use of more specific vocabulary. It may also include script training and story-telling exercises which focus on improving speech clarity by planning and practicing functional conversations that contain important and personalized topics needed to verbally communicate needs, information, and ideas.
Compensatory Cognitive-Communication Strategies: These treatments focus on developing strategies to help individuals successfully navigate challenging communication situations. This may include integrating the use of a calendar system or graphic organizer to make it easier to record and manage important information about appointments and events. It could also include developing an organizational system to help track and complete daily tasks. When appropriate, treatment also refers to practicing the use of phone apps, such as Siri dictation to increase the ease and efficiency of text messaging friends, family, or colleagues.
Communication Partner Training: This treatment aims to help families and care teams modify aspects of their own communication skills and patterns to enhance interactions with those living with PPA. Communication partner strategies consider the unique cognitive communication challenges and circumstances of the individual living with PPA. Clinicians use this information to identify specific modifications that will help improve everyone’s ability to communicate with each other. This type of intervention helps those with PPA increase their participation in conversations and everyone’s ease and sense of confidence communicating. Strategies focus on preventing and repairing communication breakdown and may include working with gestures, tone of voice, eye contact, writing down key words, introducing topics before starting a conversation, ensuring a quiet environment, slowing rate of speech, simplifying language and shortening sentences, or restating and paraphrasing to ensure understanding.
How can someone successfully live with PPA?
It is important to stay connected if you or a loved one is living with PPA. Meet up with friends and loved ones for regular catchups in person or by videoconference. Connect with peers through a support group. The encouragement and comfort of our nearest and dearest is invaluable. It’s what we need to stay motivated, to help keep us committed to our goals through the inevitable ups and downs this journey, and to help us maintain our connection to our sense of self.
Working with a speech language pathologist can help maximize communicative success. Research repeatedly demonstrates that the support of a licensed speech-language pathologist can promote wellbeing by enhancing communication functions. This makes it possible to stay meaningfully connected to those we love and participate in those life events we enjoy most. Building a care team of compassionate and knowledgeable people, professionals, (and even pets!) can help you stay connected to all those things in life which matter most to you. Remember your care team can consist of many things, even pets and social or religious groups, and many people are more than willing to help and support once they know you have a need. If you don’t yet have the care team you need, don’t worry! Keep looking, and you will find the right combination of help!
Treating PPA at Open Lines®
As PPA progresses, some people with this neurological disorder can lose all written or verbal communication skills. This fact alone emphasizes the importance of seeking speech therapy treatment to help maintain function for as long as possible.
Contact us today by phone for a free phone consultation with one of our specialists at (212) 430-6800, by email at [email protected], or through our contact form. If you are ready to take the next steps in treating primary progressive aphasia, please request an appointment with us.