Aphasia 105removed and the pro cess of closing begins. The three membranes are replaced, and the square
skull bone is sutured into position. Fi nally, Lou’s skin is sewn back into place, and the anesthesiolo-
gist brings him back to consciousness. The operation is deemed a success, and the patient is taken
to the recovery room.
That eve ning, you go to the library to find the answer. You search the lit er a ture for aphasia
and negatives, affirmatives, closed- ended questions, anomia, dysnomia, confrontation naming
errors, word retrieval, and so forth. After analyzing the studies and articles, you fi nally discover
the likely answer.
In the recovery room, Lou awaits the answer to his question. You explain that aphasic word-
finding errors often involve verbal paraphasias— unintended substitution of one word for another
from the same categor y of words. In this condition, the unintended word is associated semantically
with the desired correct one. Yes and no are associated, one- word, closed- ended responses to ques-
tions. You explain to Lou that when he inadvertently and incorrectly says “No” for “Yes” and vice
versa, the mistake is this type of error. Lou accepts the answer and appears relieved that you know
he is not chronically ambivalent. You and Lou continue with exercises to improve the accuracy
of yes and no, but now with the knowledge that this is simply an example of the types of naming
errors that typically occur in aphasia.
Case Study 5-6: A 69- Year- Old Man With Global Aphasia
Your diagnosis in the nursing home chart reads: “Global aphasia and right hemiparalysis
secondary to a cerebrovascular accident.” The radiology reports show that both Broca’s and
Wernicke’s areas have been severely damaged by an obstruction to the left middle ce re bral artery.
You are confined to a wheelchair, but by carefully moving your left foot and arm, you can move
fairly directly. Sometimes you use your left hand to grasp the rail along the corridors to go from
one place to another. Over the past 4 years, you have become a familiar figure in the halls, lounges,
and dining rooms of this large medical care fa cil i ty.
The massive stroke has destroyed most of your speech and language. The only purposeful ver-
bal expressions you are capable of uttering are “Uh” and “Kayla,” and these are used interchange-
ably for a variety of requests. Words spoken by others sound like a strange foreign language. You
can no longer read or write. However, you are still capable of understanding basic gestures such as
a handshake, and you can turn away to show avoidance and refusal. The entire right side of your
body is para lyzed, including your face.
At first, you were devastated by the stroke and aphasia. You have always been fit, strong, and
active. The only other time you were hospitalized was when you were born, and now you live your
final days in this institution, removed from your home and your wife of 45 years. Even when your
family visits, the bridge of communication has collapsed and the aphasia prevents discussions of
the life you once shared. The stroke and global aphasia have separated you psychologically and
physically from your loved ones. It took many months of grieving, but you now accept life’s new
realities. You have adjusted to the unwanted changes.
In this nursing home, life revolves around the three meals. You are awakened at 7:00 a.m. for
breakfast. Because you have a history of depression, the staff prefers that you eat in the dining
room. They want you to dress and socialize with the other patients rather than eat alone in your
room. Because of the paralysis, you need help to dress, but thanks to occupational therapy, you can
comb your hair, brush your teeth, and take care of basic bathroom activities. Although the kind
nurses’ aides always offer to push you in your wheelchair to the dining room, you insist on doing
it yourself. When they offer, you refuse by politely saying, “Kayla” and “Uh, Kayla” and begin the
time- consuming task of in de pen dent movement. After breakfast, some of the residents do activi-
ties or therapies, but most end up in the tele vi sion area next to the nurses’ station.