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Transcortical Motor Aphasia: Causes, Symptoms, & Rehabilitation Methods

elderly patient in doctor's office discussing transcortical motor aphasia with doctor

Transcortical motor aphasia is a rare category of aphasia that can make it difficult to speak or understand others. The symptoms can very greatly between patients, which makes it critical to work alongside a speech therapist.

To help you better understand transcortical motor aphasia, this post will discuss that causes, symptoms, and treatment methods that your speech therapist will likely recommend.

Use the links below to jump straight to any section:

Causes of Transcortical Motor Aphasia

Multiple areas of the brain contribute to a person’s language ability. But the two most important areas are Broca’s area and Wernicke’s area.

Broca’s area is primarily responsible for producing spoken language, whereas Wernicke’s area helps a person process and understand language.

Most types of aphasia occur after direct damage to either Broca’s or Wernicke’s area.

However, transcortical motor aphasia occurs when a stroke or brain injury damages the nerve fibers that send information back and forth between these two areas. As a result, Broca’s and Wernicke’s area are essentially isolated from each other.

When the two most important language centers of the brain cannot communicate, the person may struggle to speak to or understand others. The symptoms vary greatly among patients, so let’s take a closer look.

Symptoms of Transcortical Motor Aphasia

watercolor of two people talking, with colors bleeding together to represent transcortical motor aphasia

The defining feature of transcortical motor aphasia is halting, laborious speech. The person might make multiple starts and stops. This makes motor aphasia similar to expressive aphasia.

However, unlike expressive aphasia, patients with transcortical motor aphasia usually retain good repetition skills. In fact, while spontaneous speech is often difficult and slow, repetition is often fluent.

For example, if you asked the person to answer the question “what did you have for dinner?” they would struggle to produce the words. If on the other hand, you asked them to repeat a long sentence, they could do so easily.

Other symptoms of transcortical motor aphasia include:

  • Word-finding difficulty
  • Speech consists mostly of content words such as nouns and verbs, no articles or prepositions
  • Difficulty initiating speech
  • Impairments in writing

Transcortical motor aphasia can vary in severity. People with mild forms might merely have problems with word-finding or complex sentences, while someone with a severe form may be unable to speak at all.

Diagnosing Transcortical Aphasia

doctor putting hands on elderly patient's shoulders

Diagnosis for transcortical motor aphasia is typically performed by a speech-language pathologist. While there no specific tests for motor aphasia exist, therapists can use different screening and assessment protocols to identify the type of aphasia you have.

Screening can include evaluation of oral motor functions, speech production skills, comprehension, use of written and verbal language, cognitive-communication, swallowing, and hearing.

One of the key characteristics speech therapists look for is echolalia, which refers to a person’s tendency to echo back words and sentences they hear others say. If a patient cannot speak on their own but consistently repeats what they hear, that is a strong indicator of transcortical motor aphasia.

Once a diagnosis is made, most speech therapists will begin devising a customized treatment plan.

How Aphasia Is Treated

Treatment for transcortical aphasia is similar to other types of aphasia. One of the most effective ways to treat sensory and motor aphasia is through speech therapy. Speech therapy exercises work by activating neuroplasticity, the brain’s natural repair mechanism.

Neuroplasticity refers to the brain’s ability to form new neural pathways in response to repetition. These pathways allow undamaged portions of the brain to take control of functions previously controlled by damaged ones.

Therefore, even if a stroke severely damages the brain regions that normally control language, it’s still possible for other areas to compensate.

To activate neuroplasticity, the patient must engage in repetitious exercise of speech therapy activities. The more you stimulate your brain through exercise, the more neural pathways your brain will create in response. With these new neural pathways in place, you can hopefully begin to regain speech function.

A speech therapist can give you guidance on which exercises will be most beneficial for your specific type of transcortical aphasia. Therefore, we recommend scheduling an appointment with a therapist as soon as possible.

Rehabilitation Methods for Motor Aphasia

There are several specific rehabilitation methods that a speech therapist might use to help their patient overcome motor aphasia. We’ll look at two effective methods below:

Constraint-Induced Language Therapy (CILT)

Constraint-Induced Language Therapy (CILT) can help people with severe transcortical motor aphasia regain their speaking skills.

CILT forces the person to engage their speaking abilities by eliminating compensatory tactics. As they practice this skill, the brain can relearn how to use and understand language and the patient can begin to regain efficient speech production again.

During constraint-induced language training, a patient must:

  • Avoid compensatory tactics such as gestures
  • Communicate only by speaking
  • Practice heavily for at least one hour per day.

With enough practice, patients can activate their brain’s neuroplasticity and should start to see improvements in their speech.

PACE Therapy (Promoting Aphasics’ Communicative Effectiveness)

This therapy is a variation on the basic picture-naming drill, but the adjustments introduce elements of conversation into the interaction.

The goal of PACE therapy is to improve conversation skills. During a PACE session, the person with aphasia and speech-language pathologist (SLP) take turns being either the speaker or listener. The speaker has a picture or message on a card that they need to communicate to the listener, but they cannot show the listener what they have.

They can use any mode of communication that they choose in order to convey the message. If needed, the SLP can provide feedback and prompting to convey the message. Essentially, this exercise is a lot like the popular game charades, except the person is encouraged to speak as much as possible to describe what they see.

Once the message has been received, partners should discuss what worked best. The therapist might also set a time limit to end the attempt if the message is not received. The SLP and the patient can then work together to figure if there were more effective ways that the message could have been communicated.

Because PACE therapy can be adapted to different skill levels, it is appropriate for people with many types and severities of aphasia, including transcortical motor aphasia.

Speech Therapy Apps for Transcortical Motor Aphasia

Of course, sometimes seeing a speech therapist regularly isn’t an option. Fortunately, there are other ways to practice speech therapy at home through speech therapy apps, such as the CT App.

While the CT apps cannot replace the one-on-one care you get from a speech therapist, they are often the next best thing. In fact, the CT was specially designed by speech-language pathologists to help patients regain speech, memory, and cognitive function.

Featuring over 100,000 exercises that you can tailor to your individual needs, it’s by far the most comprehensive brain training app out there. Therefore, if you are looking for ways to boost your recovery, consider signing up for a subscription.

Overcoming Transcortical Aphasia

Transcortical aphasia is a severe type of aphasia that can impair a person’s speech or comprehension skills. However, the patient’s repetition skills remain intact. Therefore, they will mostly repeat what they hear others say, even if they do not understand them.

As with all types of aphasia, the best way to recover language skills is to work closely with a speech therapist, who can assess your symptoms and give you advice on the most effective ways to manage them.

Featured Image: ©iStock/monkeybusinessimages

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