Overcoming Diagnostic Challenges of Aphasia in Morocco

 

 

What is Aphasia?

Aphasia is a communication disorder that affects a person's ability to understand, produce, or use language. It typically occurs due to damage to the brain's language centers, often as a result of a stroke, head injury, or other neurological conditions. Aphasia can impact speaking, listening, reading, and writing skills to varying degrees.

Stroke is the 3rd leading cause of death in the USA and Great Britain, after heart disease and cancer. In Morocco, stroke is a significant public health issue, with an increasing prevalence reflecting global trends. According to the World Stroke Organization's Global Stroke Fact Sheet, stroke remains one of the leading causes of death and disability worldwide, with lower-middle-income countries, including Morocco, experiencing a significant portion of this burden​ (World Stroke Organization)​​ (World Health Organization (WHO))​.

A stroke occurs when the blood supply to part of the brain is interrupted or reduced, preventing brain tissue from getting enough oxygen and nutrients. This can lead to brain cells dying within minutes. The main causes of stroke include:

Ischemic Stroke: This is the most common type of stroke, accounting for about 87% of all cases. It occurs when a blood clot blocks or narrows an artery leading to the brain. Causes include:

  • Thrombosis: A blood clot forms in one of the arteries supplying blood to the brain.
  • Embolism: A blood clot or other debris forms away from the brain (often in the heart) and is swept through the bloodstream to lodge in narrower brain arteries.

    Hemorrhagic Stroke: This type occurs when a blood vessel in the brain bursts, leading to bleeding in or around the brain. Causes include:

  • High Blood Pressure (Hypertension): This is the most common cause of hemorrhagic stroke.
  • Arteriovenous Malformations (AVMs): Abnormal tangles of blood vessels connecting arteries and veins, which can rupture.
  • Trauma: Head injury that leads to bleeding in the brain.

Transient Ischemic Attack (TIA): Often called a mini-stroke, a TIA is a temporary period of symptoms similar to those of a stroke. A TIA doesn't cause permanent damage and is caused by a temporary decrease in blood supply to part of the brain, often due to a clot or debris.

Risk factors that increase the likelihood of a stroke include:

  • High Blood Pressure: The leading risk factor for stroke.
  • Heart Disease: Conditions like atrial fibrillation and heart failure.
  • Diabetes: Increases the risk of stroke.
  • Smoking: Nicotine and carbon monoxide damage the cardiovascular system.
  • High Cholesterol: Can lead to the buildup of plaques in arteries.
  • Obesity: Excess weight contributes to high blood pressure, diabetes, and cardiovascular disease.
  • Age: The risk of stroke increases with age, particularly after 55.
  • Family History: Genetic factors can play a role.
  • Lifestyle Factors: Lack of physical activity, unhealthy diet, excessive alcohol intake, and drug use.

How to react when you think someone is having a stroke?

If you suspect someone is having a stroke, it is crucial to recognize the symptoms quickly using the FAST test:

Cerebrovascular accident [CVA]), an acute interruption of blood flow to a portion of the brain

Face: Ask the person to smile. A crooked smile or drooping on one side of the face may indicate a stroke.
Arms: Ask the person to raise both arms. If one arm drifts downward or cannot be raised, this could be a sign of a stroke.
Speech: Listen to their speech. Slurred speech, difficulty speaking, or trouble understanding may also suggest a stroke.
Time: Note the duration of these symptoms and call for medical assistance immediately to minimize potential damage.

The lack of psycholinguistic tests, in addition to the neurology scans used to diagnose aphasia and other neurodegenerative diseases in Morocco is a significant challenge in the effective management and rehabilitation of individuals with aphasic brain injuries. These tests are essential for identifying and evaluating functional and dysfunctional modules in language processing. The comprehensive assessment should cover areas such as orthography, phonology, word and picture semantics, morphology and syntax.

Importance of Psycholinguistic Tests

Psycholinguistic tests are crucial because they:

  • Provide a Structured Evaluation: These tests help clinicians systematically evaluate different language functions, leading to a more accurate diagnosis.
  • Guide Therapeutic Interventions: By identifying specific deficits, these tests can inform targeted therapy plans.
  • Monitor Progress: Repeated testing can track changes over time, assessing the effectiveness of interventions.

It is recommended to develop localized tests by collaborating with Linguistic, Neurolinguistic, Psycholinguistic and Clinical experts, ensuring consideration for the unique aspects of Moroccan Arabic and Amazigh languages.

Furthermore, providing training programs for speech-language pathologists and increasing investment in resources, such as funding for the development of diagnostic tools and resources in healthcare settings, is essential to improve the quality of care provided to individuals with language disorders and strokes.

By addressing these gaps, Morocco can significantly improve the diagnosis and treatment of aphasia, enhancing the quality of life for affected individuals.