1. 一個有趣的個案研究 譚先生今年63歲，平時最大的嗜好就是吃館子，牠對稀奇古怪的菜特別有興趣，好朋友談天也是以食為主題。譚先生的另一個嗜好是打麻將，每個週末均會與好友即親戚們相約打上8圈麻將，抽煙喝酒他也喜歡。 有一天，在打麻將時他突然感覺到不舒服，頭有些昏、耳鳴、手腳有些麻，但是過了一會兒又好了，他想大概是前一天晚上沒睡好覺，休息不夠的緣故，也就沒有太注意。 又過了幾天，他早上起來時，覺得行動緩慢，舌頭也有些不靈活，他搖醒他太太，但是又講不出話來，太太叫他再躺躺。過了一下，似乎又好些了，他想自己可能是真的感冒了，就隨便吃一點藥。 又過幾天，他吃完中飯以後，一陣頭昏，走倒洗手間就倒下，站不起來了。並且嘔吐不止，譚太太一時手足無措，還是鄰居太太過來才叫了救護車送譚先生到醫院，送去急診室時，譚先生已是昏迷不醒，經過醫生初步的診斷，他得了中風。 過了一陣子，譚先生醒過來，他的右手右腳均不能動，也無法與其他人溝通，醫生診斷，譚先生患了失語症。 2. 各類型失語症的介紹 Aphasia
3. 各類型失語症的症狀 3.1 Receptive Disorders (感受型失語症) ☆ an inability to recognize or understand words or spoken language. ☆ Most patients have difficulty in focusing attention on words spoken to them , and some impairment of reading. ☆ 對語言的了解產生了問題。這一種病人往往聽不懂別人問他的問題，也聽不懂別人要告訴他些什麼，雖然當別人問他時，他不能回答，但他們卻可以表達一些自己的需要。 3.2 Expressive Disorders (表達性失語症) ☆ 這腫病症的病人在於不能表達。他聽得懂，但卻說不出。一個人想要說出他的意願而無法表達，其失望與傷心自是不難想像的。 (a) subfluency ☆ Here the flow of speech is severely hampered. The articulation of every word apparently requires an enormous effort and concentration. ☆ Words are produced slowly and with pauses between them. ☆ Patients know what they wish to say, but they cannot guide the motor integration that is specific to speech. (b) superfluency ☆ Utterances consist of an interminable flow of phrases, unfinished or improperly begun sentences, and clichés. ☆ The patient jumps from one thought to thought and topic to topic, and if he asks a question at all, he fails to wait for answers. (c) semantic disturbances ☆ A never-ending variety of different manifestations may be found. ☆ There may be an inability to name colors or to name numbers; or words are substituted that are inappropriate in the context of the sentence but are semantically related to the word that was apparently intended. ☆ If the patient speak more than one language before the disease, he may slip foreign words into his utterances. (d) word find difficulty ☆ A patient may audibly grope round for the appopriate word by first telling the examiner how the object whose name he forgot is used, what it is fr, or with what it is usually associated. ☆ Even if the patient cannot think of a right name, he is usually able to recognize the correct word, he can immediately repeat it and use it in a grammatically correct sentence. ☆ 這一類的病人無法在自己的字庫中找到和命名物配對得上的名字。好比他想喝水，卻拐彎莫角繞了半天，還是找不到回答問題的字眼。 (e) paraphasic disturbances ☆ Nonsense words are produced more frequently and often exclusively. ☆ The system is also called jargon aphasia. 3.3 Dysarthria (吶吃症) ☆ Although aphasia refers essentially to content, dysarthria refers exclusively to manner of production. ☆ It is common to see aphasia without dysarthria and even more common to see dysarthria without apasia. ☆ 這一類的病人由於腦子的某一部分受損，影響到呼吸、發聲和發音的器官，造成發音、發聲和呼吸調節的障礙。他們往往是想說卻說不出來，即使說出來了，也是含糊不清，更由於舌頭的動作變的遲緩，這類病人有時也發生了吞嚥的困難。 3.4 Alexia (失讀症) ☆ Patients may lose the ability to read. ☆ The subjective experience seems to be analogous to word-deafness and it is, indeed, sometimes called word-blindness. 3.5 Agraphia (失寫症) ☆ Letters may be well formed, but they may not spell any recognizable word; or words may be quite legible, but they do not add up to intelligible sentences. 3.6 Apraxia (失用症) ☆ 這一類的病人雖然舌頭的動作無損，但要他利用舌頭、嘴唇與牙齒合作來發音，卻是很難做到。他們經常發生的問題是發音錯誤，雖然他們自己也知道講錯話，卻沒有辦法使舌唇齒三者相互配合，造成溝通的困難。 ☆ 動過口腔手術的病人通常有一段時間是處於這樣的狀態。 4. 動動腦時間 Q1: 為什麼有些失語症的病人能夠唱歌、數數目卻不能說話呢? Q2: 一個失語症的病人使用第一母語是否比第二母語來的好呢? Q3: 有些失語症的病人會滿嘴粗話，這是怎麼回事呢? Q4: 失語症的病人知道自己得了失語症嗎? Q5: 有些人經常會想不起來一個東西或一個人標準的名字這是得了anomia的前兆嗎? 5. 參考書目 劉麗容 (民83) 。如何克服溝通障礙 。台北：遠流。 Lenneberg, E. (1967). Biological Foundation of Language. New York: John, Wiley & Sons.
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