96 Chapter 5
Response to Loss
Aware patients with irreversible neurogenic communication disorders can experience a mul-
tidimensional sense of loss and the reaction to it: the grief response (Tanner, 1980, 1999a, 2003a;
Tanner & Gerstenberger, 1996). According to Code, Hemsley, and Herrmann (1999), the grief
model is power ful due to its ability to explain some of the emotional and psychosocial reactions
seen in patients with neurogenic communication disorders, although more research is necessary.
Many patients with these disorders experience loss in three dimensions: self, person, and object.
Loss of self occurs when the patient perceives that he or she can no longer function normally.
In aphasia, this includes the multimodality inability to communicate and, in many patients,
concomitant physical limitations such as difficulty walking. Loss of person occurs because the
patient is irreversibly separated from loved ones. Although these persons are not physically lost,
such as occurs in death, the patient can no longer interact meaningfully with them because of the
communication disorder. This psychological separation is compounded by physical separation if
the patient is confined to an institution. Loss of object occurs when the patient is involuntarily
separated from a valued object such as a home, recreational vehicle, or pet. In many aware patients
with severe irreversible aphasia, losses of self, person, and object combine to create a great sense
of grief and sorrow. Many patients go through several stages in coming to terms with their loss.
Denial, anger, and bargaining are attempts to overcome the loss. Grieving depression occurs when
the patient becomes aware of being irreversibly separated from valued aspects of self, person, and
objects. Most patients gradually achieve ac cep tance and resolution of their losses. However, they
are not resigned to their fate; rather, they accept it without major negative emotions and activation
of psychological defenses.
Emotional Lability
Emotional lability is the tendency toward exaggerated emotions, often associated with bilateral
brain damage to the motor strips and associated corticobulbar tracts. The emotional threshold is
lowered, and feelings appear to be on the surface. Patients who are emotionally labile often cry too
much and too long over apparently little things. They also may laugh too much, but crying is more
common. Words, thoughts, and situations may set off bouts of emotional lability, and once begun,
they are difficult for the patient to control.
In the past, emotional lability was considered an inappropriate response or one with no true
emotions, just the be hav ior of crying (or laughing) devoid of feeling. We now know that these
emotional responses are not inappropriate; they are exaggerated. The patient’s affect and feelings
associated with the neurogenic communication disorder and related disabilities are appropriate
but excessive.
Treatment of Aphasia
Many patients with aphasia make a spontaneous recovery, regaining their communication
abilities without the benefit of treatment. The rate of improvement is greatest soon after apha-
sia occurs, but it can continue for weeks and even months. According to the National Aphasia
Association (2015), if the symptoms of aphasia last longer than 2 or 3 months, complete recov-
ery is unlikely. Fortunately, most patients recover some communication abilities spontane-
ously, especially their receptive language abilities. There are several reasons for this reaction,
including gradual reduction of brain swelling, improved blood f low to deprived brain areas,
adjacent areas assuming the functions of damaged ones, and a general tendency for the body
to heal itself. Unfortunately, as a group, patients with global aphasia show little spontaneous
improvement and do not benefit significantly from therapies to improve or restore their com-
munication abilities.