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Sweden, Stockholm, Stockholm University, Department of Special Education Background. An acquired trauma to the body always bring about a loss, be it permanent or momentarily. This means that our self-perception will be affected to a large or small extent. This paper will dwell upon the effects to identity and self perception as a sum of different factors, mainly bodily from the very special trauma that is a stroke. It often brings about Aphasia which in general means a loss to some extent of the language communicative ability of an individual.

The paper will be based upon the experiences of studies on therapeutical and rehabilitational technology usage by persons with Aphasia. Different types of case studies have been used based upon more hermeneutically or even phenomenologically oriented methods. Technologically based therapy for persons with Aphasia has been and still is a problematic area even though there has been awareness of research need ever since the early years of research into Alternative and Augmentative methodology (Magnusson, 2001). In this paper I focus on experiences from work within the Swedish user organization for people with Aphasia.

What is Aphasia. Aphasia is a complex problem to tackle. When making a diagnosis of Aphasia, the clinician is facing a problem since there are different classifications or diagnostic systems available. There are no definite systems of classification, rather different schools mainly based upon assumptions about the structure of the brain and the central nervous system in relation to the different theories about the nature of language and the observed language and speech behavior.

Although Aphasia can then be considered as having many dimensions such as biological, social, psychological dimensions, the only area where a definite classification system has been developed is the biological one, that is, Aphasia can be classified in detail neurobiologically since the trauma is connected with the brain and the central neurological system.

A few words should be mentioned on different sub-categories of Aphasia. The syndrome is not homogenous. All schools of Aphasia researchers and clinicians recognize the existence of different neurological ways of categorizing aphasia. Since the syndrome contains elements of understanding as well as production, two main categories of Aphasia representing those problems were considered (Paradis, 1993) to be the main categories constituting Aphasia during at least the 19 th century. Today the diagnostic systems are more complex and varied. However, there are disagreements between different schools on many of the categories and there are really only three main categories that are accepted as more or less general, and then from a functional point of view. They are Brocas, Wernickes and Global Aphasia. Broca and Wernicke refer to the site of the trauma as well as the symptoms and the behavior of the person. Global Aphasia is less connected to any special site, rather it says something about a sense of total loss. In recent years, several aphasiologists and neurologists have begun to study the special language problems connected with traumas of the right hemisphere of the brain, which seems to open up a new field entirely (Kertesz, 1993). In general, the plasticity of the brain has become very much of interest to aphasiologists during the last years.

Brocas aphasia. When the French clinician Paul Broca presented his findings based on two case studies, he stated that the centre for human speech must be found in the lower part of the 3rd frontal sulci of the left side of the brain, since he found deviations in the form of scar tissue in that area. This area is called Brocas area since that time and the aphasia which seems to be the result of damage of that area is called Brocas aphasia (Broca, 1888; Penfield & Roberts, 1959; Sies, 1974). Brocas aphasia traditionally encompasses a behavior where a person cannot find words, uses fragments of sentences, often experiences a roadblock on the highway to verbal fluency, to use a metaphor. Brocas aphasia is sometimes called non-fluent aphasia.

Wernickes aphasia. In the same way, Wernickes aphasia can be defined in anatomical/neurological terms, a trauma physically situated to the back of Brocas area. It can also be defined as a special deviant language behavior which is almost the opposite of Brocas aphasia. In Wernicke the productivity is very intensive and it can be described as a certain fluency in the sense that the person talks a lot, often incessantly, but the words are incorrect and the listener gets the impression that the person talking has lost control and just uses any words. In certain theories about aphasia, there are hypotheses on the possibility that the incorrect words might be semantically or phonologically related to each other, that there is a structure at the bottom of the deviations (Blumstein, 1990). Carl Wernicke was a German neurologist who made his discoveries in a similar way to Paul Broca, only somewhat later.

Global aphasia. Finally, global aphasia is a less specific concept which covers a situation where a person cannot talk at all and also has difficulty in understanding what other people are saying. Global also means a large area damaged by stroke or trauma. In this report, global will mostly mean does not talk at all.

Biological perspective. From a biological point of view, Aphasia is considered to be a neurological trauma or a medical syndrome. The trauma or syndrome has its physical place or site in the brain and the main problem according to the biological perspective is to know where in the brain the damage has taken place to be able to define the sort of problem that will follow. Biological perspectives necessarily become more or less localizationist.

The origin of Aphasia theory as such was based upon a clear theory which was based on the medical findings of neuro-clinicians Broca and Wernicke. According to their theories, there are a few special physical areas on the left side of the brain where language and speech as functions can be found. If those areas are damaged, then we would have some form of Aphasia or even of Dysarthria, the technical word for motor speech dysfunctions, since the brain also is considered as the motor control center of the human body. The debate was very intense in the late 19 th century and the French physician Charcot (as presented by Goetz, 2000) was a very devout follower of especially Broca.

The theories on special sites gradually developed into theories of structures or networks since it could be seen that Aphasia occurence did not correlate exactly with the sites of Wernicke and Broca. Theories of structuralization build upon the idea that there could be a relation between aphasia and the place of the physical damage (Morin & al, 1991; Meth & al, 1993; Luria, 1960/1980). However, the different areas and layers of the brain cooperate in a large number of different patterns and structures, which means that a certain part of the brain can play a different role according to the activated structure. A theory of this sort in other words accepts the possibility of physical neurological structures but also includes the possibility of cognitive and functional structures which do not necessarily correspond to a clear static physical structure. It could very well be seen as a process, an activity, something dynamic. A main researcher belonging to the latter school of thought was the late neuropsychologist Luria (ibid) from the former Soviet Union. An assumption uniting these and any biological school of thought is the assumption that any mental activity has its physiological (= neurological) correlate.

Today, neurologists cooperate with neurolinguists, neuropsychologists and speech pathologists in the honing of fine diagnostics and possible treatment models (Sies, 1974). An important part of the physiological aspect of aphasia is the fact that pharmaceutical treatment can be used quite successfully, especially in the treatment of depressions. Modern aphasiology also follows in the track of Wepman (1951) and reminds us that Aphasia is connected with stroke which is connected with severe effects on the whole body, for instance hemiparesis. In other words, if you get Aphasia you probably also get general and big changes in all of your body.

Linguistic perspective. One of the major theoretical frameworks for aphasiology apart from the biological one is the linguistic one. This is of course very natural since Aphasia after all is defined officially as a language disability. The debate whether Aphasia is caused by semantic, phonologic morphologic or even syntactic deficits or not is still very much active and there seems to be evidence for all explanations from numbers of case studies (Paradis, 1993; Blumstein, 1994). The early systematic theory on Aphasia as a linguistic problem, comparable to the language development in children, was formulated by Roman Jakobson, who described aphasia as a language breakdown in Saussurean terms (Jakobson,1971; Uri, 1993). The linguistic concepts are very frequent among most aphasia schools even if a few research groups in the world today look for strictly linguistic explanations of aphasia, such as the morphologically oriented group of researchers in Joensuu in Finland (Niemi & Laine, 1997), the phonetically oriented research by Sheila Blumstein (Blumstein, 1990, 1994) or the more general linguistic work on aphasia in the United Kingdom (Garman, 1982; Edwards & Knott, 1994) and in the Netherlands (Bastiaanse, 1995).

In the theories of the Russian neurologist Luria, the importance of language is pointed out. Luria based his theories on practical neurological research on braindamaged people and Vygotskys theories of language development, that language develops in interaction with the environment, a basically socio-cultural theory. Then Luria created a model of the relation between language behavior and the structures of the brain (Luria, 1960, 1980). According to him, language could be defined as one of the higher functions in man and higher functions all had their place in the cortex.

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