Abstract
Health professionals, researchers, and policy makers often consider the two terms aphasia and dysphasia to be synonymous. The aim of this article is to argue the merits of the exclusive use of the term aphasia and present a strategy for creating change through institutions such as the WHO-ICD. Our contention is that one term avoids confusion, speech-language pathologists prefer aphasia, scholarly publications indicate a preference for the term aphasia, stroke clinical guidelines indicate a preference for the term aphasia, consumer organizations use the title aphasia in their name and on their websites, and languages other than English use a term similar to aphasia. The use of the term dysphasia in the broader medical community may stem from the two terms being used interchangeably in the ICD10. Aphasia United http://www.shrs.uq.edu.au/aphasiaunited, an international movement for uniting the voice of all stakeholders in aphasia within an international context, will seek to eliminate the use of the term dysphasia.
The term aphasia comes from the Greek “a” (without) “phásis” (speech) or, interpreted more loosely, “speechless.” 1 In terms of its derivation, aphasia may be interpreted literally as a total loss of language, whereas dysphasia denotes a partial impairment of language impacting the ability to communicate. Nevertheless, terminology continues to evolve. Even early pioneers of aphasia research, such as Trousseau, Wernicke, Jackson, and Luria, all used the term aphasia to describe the symptomology of aphasia at varied levels of severity. While the labeling distinction between the prefixes -a and -dys is etymologically correct, the current preference across academics, researchers, clinical practitioners, and consumers worldwide is to use one label, aphasia, to refer to complete and/or partial loss of language, in which language is defined as how meanings are conveyed symbolically, such as through speech, writing, or sign. Therefore, aphasia is described as impairments of comprehension and expression in the verbal, written, and signed modalities.
One term avoids confusion
The use of one term to refer to aphasia avoids confusion regarding diagnosis. Furthermore, use of a single term across all researchers, care providers, policy makers, and consumers allows consistent access to empirical and clinical information and promotes clearer and more efficient advocacy efforts. Since it is extremely rare to find anyone with a total loss of language affecting all modalities, particularly in the chronic phases of recovery, 2 the choice of one term might lean toward dysphasia. However, selecting the term aphasia avoids the frequent and unfortunate confusion with the widely used term dysphagia (a disorder of swallowing), which is pronounced and spelt similarly. Since both dysphasia and dysphagia are frequent complications of acquired brain injury, confusion of the words is a potential problem for health care providers as well as consumers. For example, speech-language pathologists frequently report erroneous referrals for “expressive dysphagia” in clinical practice.
Speech-language pathologists prefer aphasia
In a recent survey of Australian speech-language pathologists, 3 the vast majority of respondents (83%, n = 120) demonstrated a preference for the term aphasia. Most international speech-language pathology professional organizations and relevant national organizations also exclusively use the term aphasia on their websites.
Scholarly publications prefer the term aphasia
Unfiltered English language searches with the academic search engine EBSCO for the past 20 years from 1995 to 2015 revealed 20,271 hits for aphasia versus only 4650 hits (19%) for dysphasia. Many of the articles using the term dysphasia were in journals that were not easily accessed or well cited, with low impact ratings. A search in the topic-specific, international scholarly journal Aphasiology resulted in 11,101 hits for aphasia and only 108 hits (1%) for dysphasia. Figure 1 shows the Google Ngram View of aphasia and dysphasia. The Google Ngram Viewer charts frequencies of these words in a range of languages across Google. This figure shows the dominant use of the term aphasia on the internet. In striking contrast to this ascendant academic preference for using the term aphasia, ICD10 and ICD9 use both aphasia and dysphasia interchangeably: The code R47.0 is headed as both dysphasia and aphasia.
Google Ngram of the terms aphasia and dysphasia.
Stroke clinical guidelines indicate a preference for the term aphasia
Clinical Practice Guidelines are developed and published by stroke organizations to inform health professionals and consumers about best practices for the management of stroke. A search of clinical guidelines for stroke across the world 4 found that aphasia was the term adopted in all guidelines. The Australian, New Zealand, and Scottish guidelines acknowledged that both terms exist but used the preferred term aphasia. There was no mention of dysphasia in the American guidelines and the term dysphasia only appeared in other guidelines (e.g. Canadian, Malaysian, Catalan) to refer to older assessments or studies from the UK. The UK NICE Full Clinical Guideline 16212 contained both terms with seven instances of dysphasia and 168 instances of the term aphasia, often reflecting the use of the former term in publications cited, and additionally suggesting this term is still used by a minority in the UK. The World Stroke Organization guidelines and action plan 5 used solely the term aphasia. In summary, our search through current guideline documents indicates that the world’s stroke organizations promote the term aphasia as best practice.
Consumer organizations use the title aphasia in their name and on their websites
Organizations using the term aphasia
Many more support organizations and educational resources are found for the search term aphasia. For example, if consumers in Australia carry out an online search using the term dysphasia, they are directed to a UK or USA based organization. If they search using the term aphasia, then the most relevant local Australian Aphasia Association appears on the first page.
Languages other than English use a term similar to aphasia
Terms for aphasia in languages other than English that use the Latin alphabet
Conclusion and recommendations
Aphasia is the more frequently used term in specialized aphasia research and practice internationally. Current scholarly publications, as well as consumer materials, reflect the preference for the term aphasia. There is a need to reflect the current preference for the term aphasia in the ICD10 and anywhere else the term still might be used interchangeably with dysphasia. Using both terms is a source of confusion, especially for consumers and for health professionals outside the specialist field.
The term dysphasia should be eliminated from the vocabulary of health professionals, researchers, and consumer organizations. Aphasia United will promote the consistent and worldwide use of the term aphasia. The educational programs of disciplines involved with the care of people with aphasia (e.g. medicine, nursing) will be particularly targeted. Through its networks, Aphasia United will challenge the use of the term dysphasia. Aphasia United will approach the World Health Organization ICD Committee to advocate for the use of one term only. Stroke clinical guidelines will continue to be monitored for consistent use of the terms. Ongoing internet searches will also determine whether there is confusion over the terms for people wishing to gain access to information and support. This is the first step in achieving an internationally united voice for people with aphasia and those who support them.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.