Our experience of an aphasia case with a global anomie

Before describing our experience of an aphasia case, we will explain some basic ideas about this shortfall or distortion.
Anomie is defined as: the degree of difficulty a person has in finding words while forming a verbal phrase, equally in a spontaneous discourse as in specific tasks of classifying something. (Peña Casanova 1995).
This is aphasia's most frequent symptom in dementia and in other degenerative disorders. Due to its variations and different levels people show in the act of naming, it is possible to group them in diverse categories. In order to establish the type of anomie, it is necessary to possess knowledge of linguistic processes. This occurs on three levels: semantic level (meaning of the words), lexical meaning (vocabulary) and phonetic level (selection of phoneme in the construction of words). They enable us to place the patient on one or another level, and help to classify the type of anomie.

Anomie can be classified as:
- Semantic anomie: It is characterised by the difficulty in activating conceptual representations (meaning), equally in the creation as in the expression of language. The subject will have difficulties in following conversations and to understand situations of everyday life.
- Pure anomie: It is characteristic of not remembering the words that s/he tries to dominate, despite understanding them. This is a phenomenon similar to having the word "at the tip of the tongue".
- Phonetic anomie: It takes place in the level of selecting phonemes in a verbal formation and in organising sequences of words. In a spontaneous speech the subject uses neologism or jargon and shows a great difficulty in the act of repeating and in reading aloud.

Bearing this in mind, we assess our patient and we design a program of rehabilitation adapted to the tasks of the subject and his environment. By including these factors, the rehabilitation becomes a process that is both open and complex and, at the same time, more complete.
The case study we introduce here is of a 52 years old man. He has equivalent to A-level qualification, is a civil servant and married with three children. He is a good communicator, shows gifts of leadership and football is his favourite hobby. After a heart attack he now suffers left temporoparietal injury (which has both changed the form of understanding and the form of expression).
A treatment starts by employing simple vocabulary on the base of repetition and classifying images, always leaning on the written word for a support. Alongside these exercises are other variants, which we know beforehand that the result is going to be positive. We ask the family to collaborate in different activities. One activity was to take photos of different household tasks and to place cards around with their names. After two months treatment, we realised that there was something that did not work right. The results were not as good as we had hoped.

The change was vital and his attitude became much more positive focusing on his favourite hobby ("football")

We went back to the family and agreed on changing the strategy and to choose the thing that motivated him the most. The change proved to be important and his attitude towards the rehabilitation changed radically when focusing on his favourite hobby ("football").
Hence, we returned to carry out the basic vocabulary, association with images, words, structuring sentences etc. Everything was related to football and, above all, to Real Madrid. Always accompanied with pictograms and drawings.

• My favourite football team is Real Madrid.
• The referee whistled a foul.
• This ball is not according to the regulations.
• The ball entered the goal.


In this way, his self-esteem was reinforced and he started to collaborate and obtaining results. Emotionally, his behaviour was also more participative. He started to accompany his son to the football games where he shouted "Goooool" and hummed the hymn of the Madrid team. He even arranged to meet his friends to see the games.
During the following months, this attitude extended to other interests, desires and necessities such as: to visit other family members, to go alone to a coffee place, go to exhibitions... For all these activities, he had a pocket notebook with laminated pages, which contained strategies to face everyday situations:

With this he reached a level of autonomy that allowed him to come alone to the sessions of rehabilitation and even "miss" them on more than one occasion because he was in the bar.

Conclusions:
A positive relationship between the speech therapist and the patient is fundamental in order to develop activities of rehabilitation for his deficit. The chief aim is to have the person with aphasia to use efficiently all his possible abilities of communication, alternative systems and technical support that are considered appropriate so that the person feels part of his environment. A collaboration of the families from the beginning and the degree of their participation in all the proposed tasks, makes the transition easier from action to linguistic interaction, and thus, to create a link between everyday activities and rehabilitation.
Later, new activities are anticipated in order to increase his degree of self-sufficiency.
Finally, instructive activities could be proposed where the patient would develop a need for new vocabulary. Examples: handicraft classes, clubs for retired people...

Mª Dolores Alonso Riaño is psychologist- speech therapist in Rehabilitation Service Hospital Universitario Virgen de la Arrixaca (Murcia).
Almudena Albacete Perea is educational - speech therapist and Directress of the Department of psycho-pedagogic at "CEMESIP" (Murcia).