{"paper_id":"3dda3557-3d5b-403c-b810-0d77d18c6d35","body_text":"Mapping Brain Lesions to Language deficits in Aphasia: Evidence from Kenyan Hospitals | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mapping Brain Lesions to Language deficits in Aphasia: Evidence from Kenyan Hospitals Mercyrose J Jesang, Benard Kodak, Kenneth Odhiambo, Beatrice Owiti, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6922576/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Aphasia, a neurological condition caused by left-hemisphere brain lesions, impairs language functions. Although lesion-linguistic deficit correlations are well documented in high-income countries, they remain understudied in resource-limited settings like Kenya where post-stroke rehabilitation is scarce. This study bridges this gap by analyzing lesion-symptom correlations in adults with aphasia, integrating clinical data with patient experiences. Methods: Using a mixed-methods correlational design, we assessed 36 aphasic adults from Tier four hospitals in Nakuru county, Kenyan healthcare system, selected via purposive and convenience sampling. Quantitative data was collected on lesion location using MRI/CT reports, and language deficits using standardized tests, and analyzed via chi-square tests and descriptive statistics to determine associations. Qualitative using semi-structured interviews with patients and clinicians, was thematically analyzed to identify recurring language impairment themes. Results : Brain lesion location strongly predicted the severity of aphasia symptoms (χ² = 18.24, *p* < 0.05). Specifically, Broca’s area lesions (38.9% of cases) correlated with expressive language impairments ( agrammatism, reduced fluency ), while Wernicke’s area lesions (30.6%) linked to receptive language deficits ( impaired comprehension, paraphasias ). Global lesions (19.4%) caused mixed deficits. Variability in speech production despite similar lesion locations highlighted the `potential influence of cognitive reserve and premorbid language ability. Thematic analysis revealed syntactic disruptions, semantic retrieval struggles, and social isolation due to communication barriers. Clinical observations suggested positive impacts of early intervention and structured rehabilitation on language outcomes. Conclusions : This study confirms Broca’s/Wernicke’s lesion-deficit patterns in aphasia, supporting global psycholinguistic theories while revealing local rehabilitation disparities and offer valuable insights for clinical diagnosis and tailored rehabilitation strategies in Kenya. Findings underscore the need early, lesion-specific individualized speech therapy and assistive communication approaches to address the heterogeneity of aphasia symptoms to optimize recovery. Aphasia Language Production Neuro-Linguistics Speech Deficits Cognitive Science Introduction About 2.5 million people in the United States have aphasia, primarily resulting from stroke, traumatic brain injury (TBI), or brain tumors (National Aphasia Association, 2025). Of these, 2.2 million are stroke survivors, 65,000 of TBI, and about 198,000 of tumor. Moreover, Primary Progressive Aphasia, occurs in approximately 1 in 100,000 people. Aphasia affects all modalities of communication (listening, reading, speaking, and writing). Language production, the process by which individuals convey their thoughts and ideas through spoken or written language, or through gestures, encompasses several stages: retrieving information from memory, planning the articulatory program, and engaging in self-monitoring (Jacob, 2018). Speech, as a mode of communication, involves articulation (the production of speech sounds), voice (the use of vocal folds and respiration), and aspects of fluency and prosody (rhythm, intonation, and stress). The complexity of language production includes message formulation, discourse planning, lexical selection, and syntactic encoding (Cahana-Amitay & Jenkins, 2018). This process is closely linked with language comprehension, which involves the analysis of discourse, syntax, and lexical representation. Accordingly, the current study seeks to analysis all the five Linguistics levels. The key brain regions implicated in aphasia include Broca’s Area, which is essential for language production; Wernicke’s area, involved in language comprehension; and the Angular Gyrus, which supports language processing and the integration of auditory and visual information (Kirshner & Wilson, 2021). The Arcuate Fasciculus, which connects Broca’s and Wernicke’s Areas, facilitates the transfer of information between these regions, and damage to this neural pathway can result in conduction aphasia. The Perisylvian language network, comprising Broca’s and Wernicke’s Areas along with adjacent regions, is integral to effective language processing. Damage to this networks can impair both language production and comprehension (Borrett & Gould, 2021 ). In right-handed individuals, language functions are predominantly localized in the left hemisphere, whereas in left-handed individuals, these functions may be more evenly distributed. Damage to the language-dominant hemisphere typically results in aphasia, while damage to the non-dominant hemisphere may lead to other types of deficits (Code, 2021 ). Understanding the neurology of aphasia is crucial for accurate diagnosis, classification, and the development of effective treatment strategies (Hedge, 2022 ). Aphasia can be broadly categorized into neurogenic, neurodegenerative, and non-neurogenic types, deduced from different underlying mechanisms (Pregla 2021). Thus, the study only investigated the left hemisphere which when impairment is experienced, could lead to aphasia. Aphasics are individuals who experience any language disorder resulting from brain damage, commonly in the left hemisphere (Sehic, 2017). While aphasia is an impairment of language, not cognitive functioning, damage to the brain can also cause some cognitive problems (Theodorou 2021 ). These are problems with reasoning, memory, planning, time, and understanding complicated directions. 30–60% of persons with aphasia will experience these other cognitive problems. In Primary Progressive Aphasia patients, the symptoms worsen as the illness progresses (Thomas & Golding 2020 ). About 30–35% of people with Aphasia also have dysarthria characterized by slurred speech; slow speech; speech that is too loud or too soft; difficulty moving tongue, lips, jaw; or a change in the way the voice sounds. Up to 80% of people with aphasia also have some apraxia -brain pathways (Wilshire & Kearns 2021 ). About 25% of people with Aphasia have difficulty with numbers (acalculia) and it might be as much as 50%. An estimated 30–45% of people with Aphasia are diagnosed with Dysphagia, with up to 80% have some hemiparesis in their arm or leg (Wood & Lamb 2022 ). Mental Health effects are experienced, with at least 60% of people with Aphasia having depression. About 30–60% of people with Aphasia might also have some cognitive issues associated with brain damage (Thomas & Golding 2020 ). Other effects include difficulty with coordination, balance, sensation, and visual problems. Although there is no cure for aphasia at present, recovery can and does occur and is ongoing. The foundation of recovery lies in speech therapy, which takes advantage of the brain's capacity to change and reform itself its neuroplasticity. This enables the brain to create new pathways in the brain that can host better language abilities, even when the affected zones cannot heal, thereby allowing for potential reorganization and recovery of language functions, supported by neuro-rehabilitation practices such as speech and language therapy. To allow for comprehensive analysis of aphasia, a questionnaire was adapted from the validated Western Aphasia Battery (WAB), Boston Diagnostic Aphasia Examination (BDAE), Aphasia Diagnostic Profiles (ADP), Boston Naming Test, (BNT), and Spontaneous Speech Analysis. The data on the specific domains affected by each aphasia category, provides insight into the linguistic deficits associated with different types of aphasia (independent variable) that affects both expressive and receptive language which is language production (dependent variable). The relationship between lesion location and language comprehension deficits in aphasia is well-documented in neurolinguistic and neuropsychological literature. One of the most significant associations is that between damage to Wernicke’s area and deficits in auditory comprehension. Wernicke’s area, located in the posterior superior temporal gyrus of the left hemisphere, is primarily responsible for processing spoken language (Goodglass & Kaplan, 1983, McNeil & Tseng 2021 ). When this region is impaired, individuals typically exhibit fluent but nonsensical speech and marked difficulty understanding spoken and written language - a condition known as Wernicke’s aphasia. Lesion mapping studies using neuroimaging technologies such as functional MRI (fMRI) and positron emission tomography (PET) scans further substantiate the role of Wernicke’s area in language comprehension. Binder et al. (1997) demonstrated that patients with poor auditory comprehension consistently had lesions extending into the superior temporal gyrus and surrounding areas, reinforcing the specificity of these brain regions in processing linguistic input. Moreover, research indicates that comprehension is not solely limited to Wernicke’s area. The broader perisylvian region, including the angular gyrus and supramarginal gyrus, also contributes to language understanding (Mätzig 2018, Dronkers et al., 2004, Amunts et al. 2019 ). Damage to these regions may result in complex comprehension deficits that go beyond simple auditory processing, including difficulty with sentence-level semantics and syntax. The study was based on three theoretical models. The Broca’s Theory describes the relationship between damage to the left posterior inferior frontal gyrus and expressive language deficits. Damage to the Broca’s area, essential for motor planning and the production of articulate speech, often results in Broca’s aphasia, characterized by non-fluent, effortful, and grammatically simplified speech, although comprehension remains relatively preserved (Damasio, 1992, Anderson et al. 2021 ). The Wernicke’s Theory describes a region in the left posterior superior temporal gyrus (now known as Wernicke’s area ) as critical for language comprehension, storage and retrieval of word meanings, and in linking phonological forms to their corresponding semantic representations. Damage to this area leads to Wernicke’s aphasia, marked by fluent but often nonsensical speech and profound difficulty in understanding spoken and written language (Goodglass & Kaplan, 1983, Andreetta et al. 2022 ). Thirdly, is the Communication Accommodation Theory (CAT) which explores how individuals adjust their communicative behaviors in social interactions to either reduce or emphasize social distance. In the context of aphasia, CAT provides a useful lens for understanding how caregivers and interlocutors adapt their speech to improve communication with individuals affected by language impairments (Giles et al., 1991, Bennett et al. 2022 ). It distinguishes between convergence, where the speaker modifies their language to align more closely with the listener’s abilities (e.g., simplifying vocabulary, speaking slowly), and divergence, where such adjustments are not made or are insufficient. Effective convergence strategies promote understanding, reduce communication breakdowns, and support emotional well-being in aphasia patients (Simmons-Mackie & Damico, 1996, Berube et al. 2020 ). This theory highlights the relational and interactive nature of communication, emphasizing that successful language exchange in aphasia is co-constructed between speaker and listener. As such, CAT informs therapeutic practices and caregiver training, promoting strategies that enhance communication effectiveness and preserve the dignity of individuals with aphasia. Statement of Problem This knowledge gap ultimately paves away for the current study tailored for a comprehensive analysis of their linguistic challenges among adults receiving treatment within Kenyan clinical settings. Based on these, the study proposes to analyze language processing in relation to aphasia among adults receiving treatment or are on palliative care for a comprehensive analysis on language processing in Tier Four Hospitals in Nakuru County, Kenya. The purpose of this study was to conduct a comprehensive analysis of language processing in aphasia among adults receiving treatment in selected level Four hospitals in Nakuru County, Kenya. Case Scenario of the Researcher The researcher is a person living with mild aphasia after a traumatic brain injury in teen age due to a fall. She restored speech after several speech therapies clinical visits after one year of the incident, later on in her adulthood the condition recurred after child birth in 2006 which lasted for six months, after several therapies she restored speech though without fully recovery. She has continued with the mild impairment to date, a motivation for aphasia research to create awareness to the world making the invisible visible not only in Africa, East Africa but also in Kenya by creating aphasia awareness through advocacy research work through aphasia ambassador campaigns. METHODOLOGY Research Design This study adopted a mixed-methods correlational design to examine the relationship between brain lesion location and language deficits in aphasia among adults in Tier Four hospitals in Nakuru County, Kenya. The quantitative approach enabled the analysis of lesion-deficit correlations using neuroimaging and standardized linguistic assessment tools, while the qualitative approach provided depth through patient narratives and clinical perspectives. The mixed-methods strategy facilitated triangulation, enhancing the validity and comprehensiveness of findings by integrating statistical trends with real-life linguistic experiences of people living with aphasia in resource-constrained clinical contexts. Study Location and Setting The research was conducted in Tier four hospitals in Nakuru County, Kenya, selected for their capacity to offer neurological diagnosis, speech-language therapy, and post-stroke rehabilitation. These hospitals are part of the Kenyan public healthcare system and serve a broad socio-demographic population. The facilities were chosen based on the availability of MRI/CT scanning equipment, rehabilitation programs, and speech-language specialists. The setting provided a unique opportunity to study aphasia within under-resourced yet functional clinical environments where stroke and brain injuries are commonly treated but under-documented in terms of language outcomes. Sampling Procedure A purposive and convenience sampling strategy was employed to recruit participants. Adults aged 18 and above who were diagnosed with aphasia following a confirmed left-hemisphere lesion via MRI or CT scans were eligible. A total of 36 participants were selected, ensuring representation across age, gender, and aphasia severity. Clinicians and caregivers were also interviewed to supplement observational data. The purposive approach ensured that only patients meeting neuro-linguistic inclusion criteria were enrolled, while convenience sampling allowed for practical access to patients actively receiving care in the selected hospitals. Data Collection Tools Quantitative data was collected using neuroimaging reports (MRI/CT scans) and standardized language assessment tools including the Western Aphasia Battery (WAB), Boston Diagnostic Aphasia Examination (BDAE), Aphasia Diagnostic Profiles (ADP), Boston Naming Test (BNT), and spontaneous speech analysis. Qualitative data was gathered through semi-structured interviews as per Bruns et al. 2019 with patients, clinicians, and caregivers. Interviews explored the emotional, social, and functional impacts of language impairment. The combination of validated tools and thematic interviews as in supplementary-2 (S-2) enabled a comprehensive understanding of both the structural and experiential dimensions of aphasia. Data Analysis Techniques Quantitative data was analyzed using descriptive statistics to summarize lesion types and language deficits, and chi-square tests to assess the statistical relationship between lesion location and severity/type of language impairment (p < 0.05). Qualitative data was subjected to thematic analysis, identifying recurring patterns such as syntactic disruptions, naming deficits, or communication frustrations. This dual analysis provided both measurable associations and nuanced insights into the lived experiences of aphasia patients. Integration of findings allowed for interpretation within the framework of Broca’s and Wernicke’s theories, as well as Communication Accommodation Theory. RESULTS Linguistic relationship between aphasia severities and language production deficits This study investigated the linguistic relationship between aphasia severity and language production deficits among adults diagnosed with aphasia in Tier Four hospitals in Nakuru County, Kenya. A total of 40 patients were identified using hospital records and speech therapist referrals, then categorized by aphasia type: Broca’s aphasia, Wernicke’s aphasia, Primary Progressive Aphasia (PPA), Anomia, and Global aphasia. The goal was to assess how aphasia severity relates to specific language production impairments. Standardized assessments, including the Western Aphasia Battery (WAB) and the Boston Naming Test (BNT), were administered to evaluate deficits in word and noun retrieval, sentence repetition, spontaneous speech, and comprehension. This structured approach enabled reliable comparisons across patients. Findings by Aphasia Type : Broca’s Aphasia: Predominantly mild to moderate severity, mainly observed in hospitals A, B, C, and D. Patients exhibited significant syntactic difficulties such as reduced speech rate, phonological errors, and problems with grammatical judgment and sentence construction (e.g., subject-verb agreement and word order). Semantic processing remained largely intact. Their syntactic complexity was notably lower than that of milder cases. Wernicke’s Aphasia: Found in patients across most hospitals, this type showed fluent but semantically impaired speech. Patients struggled with lexical access and category fluency tasks, indicating moderate to severe semantic deficits despite fluent verbal output. Primary Progressive Aphasia (PPA): Identified mainly in hospitals A and B, patients - two of whom were centenarians - showed progressive, severe impairments in word and noun retrieval, verb generation, and fluency, reflecting a marked decline in semantic processing over time. Global Aphasia: Present across all hospitals, patients exhibited severe impairments spanning syntax, semantics, and phonology. Their verbal output was minimal, with extremely low scores on all language production tasks, reflecting the most severe level of aphasia. Severity and Language Production Deficits : The relationship between aphasia severity and language deficits was clear: Mild Aphasia: Characterized by relatively preserved syntax with subtle word retrieval difficulties and slight reductions in speech rate. Phonological processing was largely intact, with high accuracy in tasks like non-word repetition and phoneme monitoring. Deficits were primarily syntactic, with limited semantic impairment. Moderate Aphasia: Marked by significant disruptions in both syntactic and semantic domains. Patients showed reduced speech rate, frequent phonological errors, and severe semantic retrieval difficulties affecting verbal fluency and category naming. Syntactic complexity and phonological accuracy were notably compromised. Severe Aphasia: Featured profound deficits across all linguistic domains—syntax, phonology, and semantics. Patients had minimal verbal output, highly non-fluent speech, and poor performance on all language tasks, including word repetition and phoneme monitoring. Relationship between Aphasia Types and Severity Broca’s aphasia patients were mainly mild to moderate in severity, with primary syntactic impairments. Wernicke’s aphasia showed fluent but semantically impaired speech, with moderate to severe semantic deficits. PPA patients exhibited progressive semantic deficits with severe impairment in lexical retrieval. Global aphasia reflected the broadest and most severe language impairments affecting all aspects of production. Document analysis revealed that hospitals with more traumatic brain injury cases (e.g., hospitals A and B) had higher rates of Broca’s aphasia, while those with more neurodegenerative disorders (hospitals D and E) reported more PPA cases. Severity ratings from hospital documents aligned closely with assessment results, confirming consistent patterns of aphasia severity linked to distinct language production deficits. Link between locations and specific language Comprehension impairments This study examined the link between patients’ hospital locations and specific language comprehension impairments among adults diagnosed with aphasia in six Tier Four hospitals across Nakuru County, Kenya. The research aimed to determine whether language comprehension deficits varied based on the hospital location and associated neurological damage. Data were collected through one-on-one patient assessments using standardized language comprehension tasks such as following instructions, object identification, and answering comprehension questions, employing both verbal and non-verbal cues. Neuroimaging data, particularly fMRI scans, were used to analyze brain lesion locations and their relationship to comprehension deficits. Patients were grouped according to lesion sites: Broca’s area, Wernicke’s area, arcuate fasciculus, and global lesions. Broca’s area lesions were assessed for impacts on syntactic processing and grammatical comprehension, focusing on sentence structure and coherence. Wernicke’s area lesions were linked to semantic understanding deficits, particularly in word and sentence meaning. The arcuate fasciculus, connecting Broca’s and Wernicke’s areas, was evaluated for its role in comprehension and repetition abilities. Patients with global lesions, reflecting extensive damage to multiple language-related brain areas, showed widespread comprehension impairments. Language comprehension performance was measured using the Token Test and the Psycholinguistic Assessments of Language Processing in Aphasia (PALPA), with results categorized as mild, moderate, or severe impairments. Key findings included: Patients from hospitals with more neurodegenerative cases, particularly those with Primary Progressive Aphasia (PPA), showed pronounced semantic processing deficits, including difficulties with verbal retrieval and category fluency that progressively worsened over time. In contrast, patients from hospitals with a higher incidence of traumatic brain injuries (TBI), often diagnosed with Broca’s aphasia, exhibited more severe syntactic processing difficulties, such as problems with sentence construction and grammatical judgment. Location-specific patterns emerged: urban hospitals reported more cases of Wernicke’s aphasia, characterized by fluent but semantically incoherent speech, while rural hospitals had a higher prevalence of non-fluent aphasia types like Broca’s aphasia. These trends suggest a strong connection between hospital location, aphasia type, and specific language comprehension impairments. Role of Medics : Medics were instrumental throughout the study, providing clinical histories, diagnosing aphasia types, and identifying underlying causes such as TBI, strokes, and neurodegenerative diseases. Their expertise ensured accurate categorization of aphasia syndromes (Broca’s, Wernicke’s, Global aphasia, PPA) based on established clinical criteria. They also interpreted neuroimaging results, confirming lesion locations and aphasia severity. This collaboration helped contextualize language deficits in relation to patients’ overall health profiles, co-morbidities, and prior neurological events. Medics’ insights allowed for a nuanced understanding of how different brain lesions impact comprehension deficits and aphasia severity. Their involvement strengthened the link between neurological damage, aphasia type, severity of language comprehension impairments, and geographical patterns observed in Nakuru’s hospitals. Individual variability in speech production impairments observed among the affected adults individuals. The third objective of the study explored the extent of individual variability in speech production impairments among adults affected by aphasia in Tier Four hospitals in Nakuru, Kenya. The goal was to understand how factors such as age, gender, and aphasia type influenced differences in speech production deficits. Patients were categorized into five aphasia types: Broca’s aphasia, Wernicke’s aphasia, Global aphasia, Primary Progressive Aphasia (PPA), and Anomia. Detailed speech production tasks were conducted, including sentence formation, word retrieval, and spontaneous speech generation. Observations focused on articulation, fluency, grammatical structure, and naming abilities, highlighting the unique speech patterns and difficulties of each individual. Caregivers played a crucial role in the data collection process, helping to communicate with patients, especially those with severe impairments. They provided important context about patients’ conditions, histories, and baseline language abilities before aphasia onset, offering insights that enriched the understanding of patients’ speech behaviors beyond clinical observations. Medical professionals, including neurologists and speech therapists, contributed clinical records and expert assessments, ensuring the study’s findings aligned with established clinical knowledge of different aphasia types and their linguistic profiles. To facilitate communication, a supportive environment was created where patients were fully informed about the study’s purpose and their voluntary participation. For those with severe language deficits, visual aids and gestures were used to enhance understanding. Patient responses were carefully noted and recorded, with errors in naming tasks categorized by type (such as paraphasia or anomia). Sentence formation exercises were analyzed for fluency and grammatical accuracy, with adjustments made to task complexity based on individual capabilities. Speech production variability was examined through key metrics like articulation rate, fluency, and word accuracy, measured using tools such as Praat speech analysis software. These metrics were collected repeatedly over time, allowing for longitudinal tracking of speech performance and variability. Patients were grouped by aphasia severity - mild, moderate, and severe - to identify patterns within each category and understand how individual differences influenced speech abilities. Results revealed marked individual variability. Among those with mild aphasia, some maintained near-normal conversational skills, while others struggled significantly with semantic retrieval and phonological accuracy which correspond to a study done by Chen et al. 2024 . The moderate aphasia group showed even wider differences, with some participants displaying moderate syntactic and phonological difficulties and others closer to mild impairment levels. In the severe group, although all showed profound speech production deficits, variability persisted- some could produce isolated words or short phrases, while others had near-complete loss of verbal expression as supported by study done by Crosson et al. 2020 . Neuroimaging data helped explain this variability, revealing that differences in brain activation, especially in left hemisphere areas linked to syntax and semantics, played a role (Federico et al. 2021 ). Patients with stronger activation in regions such as the left superior temporal gyrus and Broca’s area generally exhibited milder aphasia symptoms (Garcia et al. 2023 ). Conversely, those with more diffuse or reduced brain activation had more severe speech production impairments (Henry et al. 2021 ). This comprehensive analysis underscores the complex interplay between individual factors and neurological differences in shaping speech production impairments among aphasic adults, highlighting the need for personalized assessment and intervention approaches. Specific linguistic features affected among the affected adults To analyze the specific linguistic features affected in aphasic adults at Tier four hospitals in Nakuru, Kenya, the study presented data on sentence structure, grammatical errors, and word retrieval issues. The tools used for this analysis include Frequency Distribution Graphs and Syntactic Tree Diagrams, with the Quantitative Production Analysis (QPA) and the Northwestern Assessment of Verbs and Sentences (NAVS) being key assessment methods. The study revealed that different linguistic features were disproportionately affected depending on the type and severity of aphasia. In Broca’s aphasia, syntactic complexity and phonological accuracy were significantly impaired, with patients frequently making errors in word order and subject-verb agreement. These patients also exhibited slowed speech rates and difficulty with word repetition tasks. Wernicke’s aphasia patients showed substantial deficits in semantic processing, particularly in tasks involving verbal retrieval and category fluency. Their speech was fluent but often nonsensical, with little ability to access meaningful lexical items. Global aphasia patients demonstrated the most extensive linguistic impairments, with significant deficits in all domains, including syntax, phonology, and semantics. These individuals struggled with even basic verbal expression and comprehension. Finally, patients with neurodegenerative aphasia, particularly those diagnosed with Primary Progressive Aphasia, showed progressive declines in their ability to generate verbs and engage in meaningful conversation. EEG data revealed that patients with more severe aphasia exhibited delayed event-related potentials (ERPs) in response to syntactic and phonological violations, further supporting the notion that aphasia severity is closely linked to deficits in specific linguistic features. Case Scenarios Case Scenario 1 A 48-year-old woman, mama Asha, was admitted to Hospital B with severe malnutrition and noticeable speech difficulties. She is currently breastfeeding her 8-month-old infant. Over the past year, her family observed a gradual decline in her ability to communicate effectively. Mama Asha’s speech became increasingly halting and effortful, with frequent word-finding pauses and use of circumlocutions in Swahili, such as “kitu cha kunywa” (thing to drink) instead of “maziwa” (milk). She struggled with naming objects and forming coherent sentences, often producing fragmented utterances like “Nataka... mtoto... chakula...” (I want... child... food...), showing impaired lexical retrieval and syntax. During assessment, Mama Asha displayed prominent anomia, especially with verbs and nouns in Swahili, affecting her ability to construct grammatically correct sentences. For example, she said “mtoto kula...” instead of “mtoto anakula” (the child is eating), reflecting difficulties in verb conjugation and tense marking. Her comprehension of complex instructions remained relatively preserved, but she had trouble understanding subtle semantic nuances, such as differentiating between “kula” (eat) and “kunywa” (drink). Her speech was characterized by reduced fluency and phonological paraphasias, substituting sounds within words, for example, “beba” (carry) pronounced as “peba.” These features are typical of PPA, which progressively impairs language production and semantic processing. Coupled with severe malnutrition, mama Asha’s cognitive and linguistic functions are severely compromised, necessitating multidisciplinary care including nutritional rehabilitation and speech therapy. Feature Observed Impairment Example (Swahili) Linguistic Sub-strand Affected Lexical retrieval Anomia, circumlocution “kitu cha kunywa” (thing to drink) instead of “maziwa” Vocabulary (nouns/verbs) Syntax Simplified, fragmented sentences “mtoto kula” vs. “mtoto anakula” Verb conjugation, tense marking Phonology Sound substitutions (paraphasias) “beba” → “peba” Phonological processing Semantics Difficulty with subtle meaning distinctions Confusing “kula” (eat) and “kunywa” (drink) Semantic comprehension Fluency Halting, effortful speech Frequent pauses, fragmented speech Speech fluency Comprehension Preserved for simple commands, impaired for complex semantic distinctions Difficulty with nuanced meaning Language comprehension Case Scenario 2 Mzee, a 67-year-old retired Kiswahili teacher from Mombasa, suffered a left frontal lobe stroke, resulting in Broca’s Aphasia. Before the stroke, he was fluent in Kiswahili with strong literacy skills. After the stroke, he exhibits non-fluent, effortful speech with relatively preserved comprehension but significant difficulties in syntax and grammar, particularly with past tense constructions. Mzee produces short, telegraphic phrases with omitted function words and grammatical markers. His speech is slow and effortful, with frequent pauses. For example, he might say, “Nenda... sokoni... leo” instead of “Nilienda sokoni leo” (I went to the market today). His word retrieval is impaired, especially verbs, and he struggles to form past tense verbs such as “nilikwenda” (I went), often defaulting to present tense or root verbs. He shows difficulty in sentence construction and uses mostly content words with few connecting words. Mzee's comprehension remained relatively intact, especially for simple sentences and commands. He understands instructions like “leta chai” (bring tea) or “kaa hapa” (sit here). However, he finds complex syntactic structures challenging, particularly passive sentences or those involving embedded clauses, such as “Mtu aliyemwita jana hayuko hapa” (The person who called him yesterday is not here). His ability to interpret nuances and grammatical cues is limited but basic semantic understanding is preserved. He can read familiar words and short sentences but struggles with sentences requiring syntactic analysis. For example, he reads “kitabu kipo mezani” (the book is on the table) fluently but has difficulty understanding complex passages with subordinate clauses or nuanced meaning. Reading aloud is slow and halting, with frequent pauses and mispronunciations. Writing mirrors his speech output - effortful, with short phrases missing grammatical elements. He writes “nenda sokoni leo” instead of “nilienda sokoni leo.” His spelling of common Kiswahili words is generally correct, but sentence structure is impaired. Writing tasks that require verb conjugation in the past tense or more complex syntax reveal significant difficulties. Language Skill Observed Impairments Example (Kiswahili) Linguistic Feature Affected Speaking Non-fluent, telegraphic, omitted grammar “Nenda sokoni leo” vs “Nilienda sokoni leo” Syntax, verb conjugation, fluency Listening Good basic comprehension; difficulty with complex syntax Difficulty with passive/embedded clauses Syntax comprehension Reading Slow, halting reading; difficulty with complex sentences Can read “kitabu kipo mezani” but struggles with complex texts Reading fluency, syntactic parsing Writing Effortful, telegraphic, missing grammar Writes “nenda sokoni leo” instead of “nilienda sokoni leo” Syntax, verb tense, writing fluency Case Scenario 3: Palliative care Gogo was a 107-year-old woman living in a rural community. Despite her advanced age, she has no known lifestyle diseases such as hypertension or diabetes. However, over the past ten years, her family has observed significant memory loss and a steady decline in her cognitive abilities. She has developed aphasia as a result of neurodegenerative changes in her brain, likely linked to a form of Primary Progressive Aphasia (PPA). With this, gogo cannot remember her own children. Her memory takes her back to a time in life when she was breastfeeding hence occasionally she could begin looking around for her breastfeeding child. Her speech has become increasingly impaired. She struggles to find the right words and often substitutes incorrect ones, a phenomenon known as paraphasia. For example, she might say “gari” (car) when meaning “simu” (phone), or confuse similar sounding words. Her sentences are fragmented and lack coherence, showing difficulties with semantic processing - understanding and producing meaningful language. She frequently uses vague words like “kitu” (thing) or repeats the same phrases, reflecting her effort to communicate despite word-finding difficulties. Listening comprehension has declined; Gogo finds it hard to follow conversations, especially when multiple people speak or complex ideas are discussed. She understands simple, everyday commands such as “kaa chini” (sit down) or “lete maji” (bring water), but struggles with abstract or multi-step instructions. Her memory loss affects her ability to recall recent events and names of family members, contributing to confusion and frustration. Cognitive decline extends beyond language, affecting attention and problem-solving skills. Despite these challenges, Gogo’s family provides constant support, helping her with communication and daily activities. They assist her during conversations by gently prompting words or using gestures. Medical evaluation with neuroimaging shows progressive atrophy in the left temporal lobe, a hallmark of semantic dementia subtype of PPA. Feature Observations Examples (Swahili) Linguistic/Cognitive Impact Speech Production Word-finding difficulties, paraphasia, fragmented sentences “gari” instead of “simu”; uses “kitu” (thing) Semantic impairment, word retrieval Comprehension Difficulty understanding complex speech, retains simple commands Understands “kaa chini” but struggles with complex instructions Decline in semantic comprehension Memory Poor recent memory recall Forgetting names of family members Cognitive decline, memory loss Cognitive Function Decline in attention, problem-solving Confusion during multi-step tasks General cognitive impairment Declarations We declare that this is our original work, and no part of this work is under consideration anywhere. We have read and agreed to the published version of the manuscript. Ethical Considerations Ethical approval was obtained from NACOSTI under approval ref. No. NACOSTI/P/25/417895 as in supplementary (S-1). Informed consent was secured from all participants or their legal guardians, with procedures adjusted for individuals with severe language impairment. Privacy and confidentiality were strictly maintained through anonymization of data and secure storage. Participants were informed of their right to withdraw at any stage without prejudice. Special attention was given to communicative accommodations, including the use of visual aids and simplified language to ensure that individuals with aphasia could meaningfully participate in the research process. Participant information was handled in confidence. All the research procedures reported in this paper were done per the Declaration of Helsinki. Consent for publication: All the patient gave written informed consent for their personal or clinical details to be published in this study. Availability of data and material The datasets used in the current study are available upon reasonable request to the author (MJJ & SOA). Competing interests: The authors declare that there are no competing interests Funding: No funding support was received for this work. Author Contributions MJJ, BK, KO, BO, WWJ and SOA were involved in the conception and design of the study. MJJ supervised interviews, MJJ & SOA analyzed the data and prepared the manuscript. BK, KO, WWJ, BO and SOA provided guidance and mentorship during the implementation of the study. All authors reviewed and approved the final manuscript. Acknowledgement We acknowledge all that contributed to the success of this research, especially the staff of Level Four hospitals in Nakuru County and all the participants who concept to be part of this study. References Amunts, K., Kedo, O., & Zilles, K. (2019). Broca’s area: From anatomy to function. Brain, 142 (5), 1195-1212. Anderson, J. A., Henry, M. L., & Kiran, S. (2021). Psychological components of disfluency in aphasia: Addressing anxiety and frustration. Journal of Speech, Language, and Hearing Research, 64 (4), 1173-1186. Andreetta, J., Thoma, K., & Frey, M. (2022). Comprehension of communicative intentions in aphasia: The role of syntactic structure and theory of mind. Aphasiology, 36 (9), 1035-1056. Bennett, S. J., McHugh, L., & Jones, R. (2022). Disfluency patterns in children with ADHD, SLI, and ASD: A comparative analysis. International Journal of Language & Communication Disorders, 57 (4), 671-684. Berube, M., Scherer, N., & Rojas, M. (2020). The role of assistive technology in enhancing written expression among aphasic individuals. Technology and Disability, 32 (1), 29-41. Borrett, J. J., & Gould, R. L. (2021). Disruption of language networks in aphasia: Clinical implications. International Journal of Language & Communication Disorders, 56 (3), 492-509. Bruns, C., Varley, R., Zimmerer, V. C., Carragher, M., Brekelmans, G., & Beeke, S. (2019). “I don’t know”: a usage-based approach to familiar collocations in non-fluent aphasia. Aphasiology , 33 (2), 140-162. Chen, P. Y., Hsu, C. W., & Tsai, Y. C. (2024). Effectiveness of intensive language therapy targeting Wernicke’s area: A longitudinal study. Aphasiology, 38 (1), 68-88. Code, C. (2021). The role of the brain in language processing: Implications for aphasia treatment. Neuropsychology Review , 31(1), 35-49. Crosson, B., McGregor, K. M., & Roger, W. C. (2020). Phonological-based therapy in aphasia: Importance of repetitive practice and auditory feedback. Aphasiology, 34 (10), 1159-1178. Federico, R., Sgandurra, G., & Fiore, M. (2021). A multidimensional approach to the diagnosis and rehabilitation of aphasia following acute encephalitis. Neuropsychological Rehabilitation, 31 (2), 216-230. Garcia, J., Casado, M., & Peralta, L. (2023). Combining speech therapy with cognitive-behavioral techniques in aphasia rehabilitation. Journal of Speech, Language, and Hearing Research, 66 (1), 59-74. Hedge, M. (2022). Language production and comprehension in aphasia: A clinical perspective. Aphasiology , 36(2), 197-213. Henry, M. L., Kiran, S., & Mauldin, L. (2021). Fluency-shaping techniques for aphasia: A review of the evidence. American Journal of Speech-Language Pathology, 30 (2), 647-659. Mätzig, S., et al. (2018). Individual variability in language production impairments in aphasia: A review. Language, Cognition and Neuroscience , 33(3), 345-359. McNeil, M. R., & Tseng, C. (2021). The impact of aphasia on conversational discourse. Topics in Language Disorders, 41 (3), 243-258. Pregla, A., et al. (2021). Variability in language production impairments in aphasia: A review of recent studies. Neuropsychological Rehabilitation , 31(6), 826-848. Theodorou, E. (2021). Narrative discourse and identity in individuals with aphasia: A qualitative approach. Journal of Communication Disorders, 94 , 106027. Thomas, M., & Golding, S. (2020). Pragmatic language therapy in adults with aphasia: Current approaches and future directions. Language, Cognition and Neuroscience, 35 (4), 487-501. Wilshire, C. E., & Kearns, D. (2021). Speech errors and monitoring in aphasia: Implications for assessment and treatment. Journal of Speech, Language, and Hearing Research, 64 (1), 24-34. Wood, D., & Lamb, A. (2022). Language and memory in individuals with aphasia: Exploring the connections. Journal of Communication Disorders, 94 , 106080. Additional Declarations No competing interests reported. Supplementary Files MercysupplementaryS1.pdf ThermticInterviewFormS2.pdf Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Awuor\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3ElEQVRIiWNgGAWjYDACZuYGGOsAkJCQIUILI0wLWwJICw8R1sC18BiASYIa5NsZGz/+qDmc2C995vOrGzUWPAzsh49uwKfF4DBjszTPscOJM/tyt1nnHAM6jCct7QZeLUC/SDOw3U7ccIZ3m3EOG1CLBI8ZXi3yzYzNP3/8A2nheWac848ILQyHGdskeNvAWpgf57YRoQXolzZr3r7/xjN72MyYc/skeNgI+UW+//Dhmz++pcn2Ay35nPOtTo6f/fAx/A5DAmwSYJJY5SDA/IEU1aNgFIyCUTByAACXvUZhqZTaIAAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Jaramogi Oginga Odinga Teaching and Referral Hospital\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Silas\",\"middleName\":\"O.\",\"lastName\":\"Awuor\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-06-18 11:23:41\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-6922576/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6922576/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":93130542,\"identity\":\"e8cafd9b-9d3b-49ff-a595-e87f6dcfc656\",\"added_by\":\"auto\",\"created_at\":\"2025-10-09 11:24:25\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":872820,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6922576/v1/60e4c248-f3f5-4d5b-84fa-158a746b1514.pdf\"},{\"id\":90616533,\"identity\":\"4d3817df-9733-489d-9946-eb077c1d5c8a\",\"added_by\":\"auto\",\"created_at\":\"2025-09-04 18:40:25\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":600015,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"MercysupplementaryS1.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6922576/v1/c27305b195238f9046811a72.pdf\"},{\"id\":90616538,\"identity\":\"c9d2c7e5-89f8-4f39-a7b7-7888f1bd8521\",\"added_by\":\"auto\",\"created_at\":\"2025-09-04 18:40:25\",\"extension\":\"pdf\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":383360,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"ThermticInterviewFormS2.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6922576/v1/d6647de7562e2e7bacb3ef79.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Mapping Brain Lesions to Language deficits in Aphasia: Evidence from Kenyan Hospitals\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eAbout 2.5\\u0026nbsp;million people in the United States have aphasia, primarily resulting from stroke, traumatic brain injury (TBI), or brain tumors (National Aphasia Association, 2025). Of these, 2.2\\u0026nbsp;million are stroke survivors, 65,000 of TBI, and about 198,000 of tumor. Moreover, Primary Progressive Aphasia, occurs in approximately 1 in 100,000 people.\\u003c/p\\u003e\\u003cp\\u003eAphasia affects all modalities of communication (listening, reading, speaking, and writing). Language production, the process by which individuals convey their thoughts and ideas through spoken or written language, or through gestures, encompasses several stages: retrieving information from memory, planning the articulatory program, and engaging in self-monitoring (Jacob, 2018). Speech, as a mode of communication, involves articulation (the production of speech sounds), voice (the use of vocal folds and respiration), and aspects of fluency and prosody (rhythm, intonation, and stress). The complexity of language production includes message formulation, discourse planning, lexical selection, and syntactic encoding (Cahana-Amitay \\u0026amp; Jenkins, 2018). This process is closely linked with language comprehension, which involves the analysis of discourse, syntax, and lexical representation. Accordingly, the current study seeks to analysis all the five Linguistics levels.\\u003c/p\\u003e\\u003cp\\u003eThe key brain regions implicated in aphasia include Broca’s Area, which is essential for language production; Wernicke’s area, involved in language comprehension; and the Angular Gyrus, which supports language processing and the integration of auditory and visual information (Kirshner \\u0026amp; Wilson, 2021). The Arcuate Fasciculus, which connects Broca’s and Wernicke’s Areas, facilitates the transfer of information between these regions, and damage to this neural pathway can result in conduction aphasia. The Perisylvian language network, comprising Broca’s and Wernicke’s Areas along with adjacent regions, is integral to effective language processing. Damage to this networks can impair both language production and comprehension (Borrett \\u0026amp; Gould, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e). In right-handed individuals, language functions are predominantly localized in the left hemisphere, whereas in left-handed individuals, these functions may be more evenly distributed. Damage to the language-dominant hemisphere typically results in aphasia, while damage to the non-dominant hemisphere may lead to other types of deficits (Code, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e). Understanding the neurology of aphasia is crucial for accurate diagnosis, classification, and the development of effective treatment strategies (Hedge, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e). Aphasia can be broadly categorized into neurogenic, neurodegenerative, and non-neurogenic types, deduced from different underlying mechanisms (Pregla 2021). Thus, the study only investigated the left hemisphere which when impairment is experienced, could lead to aphasia.\\u003c/p\\u003e\\u003cp\\u003eAphasics are individuals who experience any language disorder resulting from brain damage, commonly in the left hemisphere (Sehic, 2017). While aphasia is an impairment of language, not cognitive functioning, damage to the brain can also cause some cognitive problems (Theodorou \\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e). These are problems with reasoning, memory, planning, time, and understanding complicated directions. 30–60% of persons with aphasia will experience these other cognitive problems. In Primary Progressive Aphasia patients, the symptoms worsen as the illness progresses (Thomas \\u0026amp; Golding \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e). About 30–35% of people with Aphasia also have dysarthria characterized by slurred speech; slow speech; speech that is too loud or too soft; difficulty moving tongue, lips, jaw; or a change in the way the voice sounds. Up to 80% of people with aphasia also have some apraxia -brain pathways (Wilshire \\u0026amp; Kearns \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e). About 25% of people with Aphasia have difficulty with numbers (acalculia) and it might be as much as 50%. An estimated 30–45% of people with Aphasia are diagnosed with Dysphagia, with up to 80% have some hemiparesis in their arm or leg (Wood \\u0026amp; Lamb \\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e). Mental Health effects are experienced, with at least 60% of people with Aphasia having depression. About 30–60% of people with Aphasia might also have some cognitive issues associated with brain damage (Thomas \\u0026amp; Golding \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e). Other effects include difficulty with coordination, balance, sensation, and visual problems.\\u003c/p\\u003e\\u003cp\\u003eAlthough there is no cure for aphasia at present, recovery can and does occur and is ongoing. The foundation of recovery lies in speech therapy, which takes advantage of the brain's capacity to change and reform itself its neuroplasticity. This enables the brain to create new pathways in the brain that can host better language abilities, even when the affected zones cannot heal, thereby allowing for potential reorganization and recovery of language functions, supported by neuro-rehabilitation practices such as speech and language therapy.\\u003c/p\\u003e\\u003cp\\u003eTo allow for comprehensive analysis of aphasia, a questionnaire was adapted from the validated Western Aphasia Battery (WAB), Boston Diagnostic Aphasia Examination (BDAE), Aphasia Diagnostic Profiles (ADP), Boston Naming Test, (BNT), and Spontaneous Speech Analysis. The data on the specific domains affected by each aphasia category, provides insight into the linguistic deficits associated with different types of aphasia (independent variable) that affects both expressive and receptive language which is language production (dependent variable).\\u003c/p\\u003e\\u003cp\\u003eThe relationship between lesion location and language comprehension deficits in aphasia is well-documented in neurolinguistic and neuropsychological literature. One of the most significant associations is that between damage to Wernicke’s area and deficits in auditory comprehension. Wernicke’s area, located in the posterior superior temporal gyrus of the left hemisphere, is primarily responsible for processing spoken language (Goodglass \\u0026amp; Kaplan, 1983, McNeil \\u0026amp; Tseng \\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e). When this region is impaired, individuals typically exhibit fluent but nonsensical speech and marked difficulty understanding spoken and written language - a condition known as Wernicke’s aphasia.\\u003c/p\\u003e\\u003cp\\u003eLesion mapping studies using neuroimaging technologies such as functional MRI (fMRI) and positron emission tomography (PET) scans further substantiate the role of Wernicke’s area in language comprehension. Binder et al. (1997) demonstrated that patients with poor auditory comprehension consistently had lesions extending into the superior temporal gyrus and surrounding areas, reinforcing the specificity of these brain regions in processing linguistic input. Moreover, research indicates that comprehension is not solely limited to Wernicke’s area. The broader perisylvian region, including the angular gyrus and supramarginal gyrus, also contributes to language understanding (Mätzig 2018, Dronkers et al., 2004, Amunts et al. \\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e). Damage to these regions may result in complex comprehension deficits that go beyond simple auditory processing, including difficulty with sentence-level semantics and syntax.\\u003c/p\\u003e\\u003cp\\u003eThe study was based on three theoretical models. The Broca’s Theory describes the relationship between damage to the left posterior inferior frontal gyrus and expressive language deficits. Damage to the Broca’s area, essential for motor planning and the production of articulate speech, often results in Broca’s aphasia, characterized by non-fluent, effortful, and grammatically simplified speech, although comprehension remains relatively preserved (Damasio, 1992, Anderson et al. \\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e). The Wernicke’s Theory describes a region in the left posterior superior temporal gyrus (now known as \\u003cem\\u003eWernicke’s area\\u003c/em\\u003e) as critical for language comprehension, storage and retrieval of word meanings, and in linking phonological forms to their corresponding semantic representations. Damage to this area leads to Wernicke’s aphasia, marked by fluent but often nonsensical speech and profound difficulty in understanding spoken and written language (Goodglass \\u0026amp; Kaplan, 1983, Andreetta et al. \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e). Thirdly, is the Communication Accommodation Theory (CAT) which explores how individuals adjust their communicative behaviors in social interactions to either reduce or emphasize social distance. In the context of aphasia, CAT provides a useful lens for understanding how caregivers and interlocutors adapt their speech to improve communication with individuals affected by language impairments (Giles et al., 1991, Bennett et al. \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e2022\\u003c/span\\u003e). It distinguishes between convergence, where the speaker modifies their language to align more closely with the listener’s abilities (e.g., simplifying vocabulary, speaking slowly), and divergence, where such adjustments are not made or are insufficient. Effective convergence strategies promote understanding, reduce communication breakdowns, and support emotional well-being in aphasia patients (Simmons-Mackie \\u0026amp; Damico, 1996, Berube et al. \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e). This theory highlights the relational and interactive nature of communication, emphasizing that successful language exchange in aphasia is co-constructed between speaker and listener. As such, CAT informs therapeutic practices and caregiver training, promoting strategies that enhance communication effectiveness and preserve the dignity of individuals with aphasia.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eStatement of Problem\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThis knowledge gap ultimately paves away for the current study tailored for a comprehensive analysis of their linguistic challenges among adults receiving treatment within Kenyan clinical settings. Based on these, the study proposes to analyze language processing in relation to aphasia among adults receiving treatment or are on palliative care for a comprehensive analysis on language processing in Tier Four Hospitals in Nakuru County, Kenya. The purpose of this study was to conduct a comprehensive analysis of language processing in aphasia among adults receiving treatment in selected level Four hospitals in Nakuru County, Kenya.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eCase Scenario of the Researcher\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe researcher is a person living with mild aphasia after a traumatic brain injury in teen age due to a fall. She restored speech after several speech therapies clinical visits after one year of the incident, later on in her adulthood the condition recurred after child birth in 2006 which lasted for six months, after several therapies she restored speech though without fully recovery. She has continued with the mild impairment to date, a motivation for aphasia research to create awareness to the world making the invisible visible not only in Africa, East Africa but also in Kenya by creating aphasia awareness through advocacy research work through aphasia ambassador campaigns.\\u003c/p\\u003e\"},{\"header\":\"METHODOLOGY\",\"content\":\"\\u003cp\\u003e\\u003cb\\u003eResearch Design\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThis study adopted a mixed-methods correlational design to examine the relationship between brain lesion location and language deficits in aphasia among adults in Tier Four hospitals in Nakuru County, Kenya. The quantitative approach enabled the analysis of lesion-deficit correlations using neuroimaging and standardized linguistic assessment tools, while the qualitative approach provided depth through patient narratives and clinical perspectives. The mixed-methods strategy facilitated triangulation, enhancing the validity and comprehensiveness of findings by integrating statistical trends with real-life linguistic experiences of people living with aphasia in resource-constrained clinical contexts.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eStudy Location and Setting\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe research was conducted in Tier four hospitals in Nakuru County, Kenya, selected for their capacity to offer neurological diagnosis, speech-language therapy, and post-stroke rehabilitation. These hospitals are part of the Kenyan public healthcare system and serve a broad socio-demographic population. The facilities were chosen based on the availability of MRI/CT scanning equipment, rehabilitation programs, and speech-language specialists. The setting provided a unique opportunity to study aphasia within under-resourced yet functional clinical environments where stroke and brain injuries are commonly treated but under-documented in terms of language outcomes.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eSampling Procedure\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eA purposive and convenience sampling strategy was employed to recruit participants. Adults aged 18 and above who were diagnosed with aphasia following a confirmed left-hemisphere lesion via MRI or CT scans were eligible. A total of 36 participants were selected, ensuring representation across age, gender, and aphasia severity. Clinicians and caregivers were also interviewed to supplement observational data. The purposive approach ensured that only patients meeting neuro-linguistic inclusion criteria were enrolled, while convenience sampling allowed for practical access to patients actively receiving care in the selected hospitals.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eData Collection Tools\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eQuantitative data was collected using neuroimaging reports (MRI/CT scans) and standardized language assessment tools including the Western Aphasia Battery (WAB), Boston Diagnostic Aphasia Examination (BDAE), Aphasia Diagnostic Profiles (ADP), Boston Naming Test (BNT), and spontaneous speech analysis. Qualitative data was gathered through semi-structured interviews as per Bruns et al. \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e2019\\u003c/span\\u003e with patients, clinicians, and caregivers. Interviews explored the emotional, social, and functional impacts of language impairment. The combination of validated tools and thematic interviews as in supplementary-2 (S-2) enabled a comprehensive understanding of both the structural and experiential dimensions of aphasia.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eData Analysis Techniques\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eQuantitative data was analyzed using descriptive statistics to summarize lesion types and language deficits, and chi-square tests to assess the statistical relationship between lesion location and severity/type of language impairment (p \\u0026lt; 0.05). Qualitative data was subjected to thematic analysis, identifying recurring patterns such as syntactic disruptions, naming deficits, or communication frustrations. This dual analysis provided both measurable associations and nuanced insights into the lived experiences of aphasia patients. Integration of findings allowed for interpretation within the framework of Broca’s and Wernicke’s theories, as well as Communication Accommodation Theory.\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003e\\u003cb\\u003eLinguistic relationship between aphasia severities and language production deficits\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThis study investigated the linguistic relationship between aphasia severity and language production deficits among adults diagnosed with aphasia in Tier Four hospitals in Nakuru County, Kenya. A total of 40 patients were identified using hospital records and speech therapist referrals, then categorized by aphasia type: Broca’s aphasia, Wernicke’s aphasia, Primary Progressive Aphasia (PPA), Anomia, and Global aphasia. The goal was to assess how aphasia severity relates to specific language production impairments.\\u003c/p\\u003e\\u003cp\\u003eStandardized assessments, including the Western Aphasia Battery (WAB) and the Boston Naming Test (BNT), were administered to evaluate deficits in word and noun retrieval, sentence repetition, spontaneous speech, and comprehension. This structured approach enabled reliable comparisons across patients.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eFindings by Aphasia Type\\u003c/b\\u003e:\\u003c/p\\u003e\\u003cp\\u003e Broca’s Aphasia: Predominantly mild to moderate severity, mainly observed in hospitals A, B, C, and D. Patients exhibited significant syntactic difficulties such as reduced speech rate, phonological errors, and problems with grammatical judgment and sentence construction (e.g., subject-verb agreement and word order). Semantic processing remained largely intact. Their syntactic complexity was notably lower than that of milder cases.\\u003c/p\\u003e\\u003cp\\u003eWernicke’s Aphasia: Found in patients across most hospitals, this type showed fluent but semantically impaired speech. Patients struggled with lexical access and category fluency tasks, indicating moderate to severe semantic deficits despite fluent verbal output.\\u003c/p\\u003e\\u003cp\\u003ePrimary Progressive Aphasia (PPA): Identified mainly in hospitals A and B, patients - two of whom were centenarians - showed progressive, severe impairments in word and noun retrieval, verb generation, and fluency, reflecting a marked decline in semantic processing over time.\\u003c/p\\u003e\\u003cp\\u003eGlobal Aphasia: Present across all hospitals, patients exhibited severe impairments spanning syntax, semantics, and phonology. Their verbal output was minimal, with extremely low scores on all language production tasks, reflecting the most severe level of aphasia.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eSeverity and Language Production Deficits\\u003c/b\\u003e:\\u003c/p\\u003e\\u003cp\\u003eThe relationship between aphasia severity and language deficits was clear:\\u003c/p\\u003e\\u003cp\\u003e Mild Aphasia: Characterized by relatively preserved syntax with subtle word retrieval difficulties and slight reductions in speech rate. Phonological processing was largely intact, with high accuracy in tasks like non-word repetition and phoneme monitoring. Deficits were primarily syntactic, with limited semantic impairment.\\u003c/p\\u003e\\u003cp\\u003eModerate Aphasia: Marked by significant disruptions in both syntactic and semantic domains. Patients showed reduced speech rate, frequent phonological errors, and severe semantic retrieval difficulties affecting verbal fluency and category naming. Syntactic complexity and phonological accuracy were notably compromised.\\u003c/p\\u003e\\u003cp\\u003eSevere Aphasia: Featured profound deficits across all linguistic domains—syntax, phonology, and semantics. Patients had minimal verbal output, highly non-fluent speech, and poor performance on all language tasks, including word repetition and phoneme monitoring.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eRelationship between Aphasia Types and Severity\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eBroca’s aphasia patients were mainly mild to moderate in severity, with primary syntactic impairments. Wernicke’s aphasia showed fluent but semantically impaired speech, with moderate to severe semantic deficits. PPA patients exhibited progressive semantic deficits with severe impairment in lexical retrieval. Global aphasia reflected the broadest and most severe language impairments affecting all aspects of production.\\u003c/p\\u003e\\u003cp\\u003eDocument analysis revealed that hospitals with more traumatic brain injury cases (e.g., hospitals A and B) had higher rates of Broca’s aphasia, while those with more neurodegenerative disorders (hospitals D and E) reported more PPA cases. Severity ratings from hospital documents aligned closely with assessment results, confirming consistent patterns of aphasia severity linked to distinct language production deficits.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eLink between locations and specific language Comprehension impairments\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThis study examined the link between patients’ hospital locations and specific language comprehension impairments among adults diagnosed with aphasia in six Tier Four hospitals across Nakuru County, Kenya. The research aimed to determine whether language comprehension deficits varied based on the hospital location and associated neurological damage. Data were collected through one-on-one patient assessments using standardized language comprehension tasks such as following instructions, object identification, and answering comprehension questions, employing both verbal and non-verbal cues. Neuroimaging data, particularly fMRI scans, were used to analyze brain lesion locations and their relationship to comprehension deficits. Patients were grouped according to lesion sites: Broca’s area, Wernicke’s area, arcuate fasciculus, and global lesions.\\u003c/p\\u003e\\u003cp\\u003eBroca’s area lesions were assessed for impacts on syntactic processing and grammatical comprehension, focusing on sentence structure and coherence. Wernicke’s area lesions were linked to semantic understanding deficits, particularly in word and sentence meaning. The arcuate fasciculus, connecting Broca’s and Wernicke’s areas, was evaluated for its role in comprehension and repetition abilities. Patients with global lesions, reflecting extensive damage to multiple language-related brain areas, showed widespread comprehension impairments.\\u003c/p\\u003e\\u003cp\\u003eLanguage comprehension performance was measured using the Token Test and the Psycholinguistic Assessments of Language Processing in Aphasia (PALPA), with results categorized as mild, moderate, or severe impairments.\\u003c/p\\u003e\\u003cp\\u003eKey findings included: Patients from hospitals with more neurodegenerative cases, particularly those with Primary Progressive Aphasia (PPA), showed pronounced semantic processing deficits, including difficulties with verbal retrieval and category fluency that progressively worsened over time. In contrast, patients from hospitals with a higher incidence of traumatic brain injuries (TBI), often diagnosed with Broca’s aphasia, exhibited more severe syntactic processing difficulties, such as problems with sentence construction and grammatical judgment. Location-specific patterns emerged: urban hospitals reported more cases of Wernicke’s aphasia, characterized by fluent but semantically incoherent speech, while rural hospitals had a higher prevalence of non-fluent aphasia types like Broca’s aphasia. These trends suggest a strong connection between hospital location, aphasia type, and specific language comprehension impairments.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eRole of Medics\\u003c/b\\u003e:\\u003c/p\\u003e\\u003cp\\u003eMedics were instrumental throughout the study, providing clinical histories, diagnosing aphasia types, and identifying underlying causes such as TBI, strokes, and neurodegenerative diseases. Their expertise ensured accurate categorization of aphasia syndromes (Broca’s, Wernicke’s, Global aphasia, PPA) based on established clinical criteria.\\u003c/p\\u003e\\u003cp\\u003eThey also interpreted neuroimaging results, confirming lesion locations and aphasia severity. This collaboration helped contextualize language deficits in relation to patients’ overall health profiles, co-morbidities, and prior neurological events.\\u003c/p\\u003e\\u003cp\\u003eMedics’ insights allowed for a nuanced understanding of how different brain lesions impact comprehension deficits and aphasia severity. Their involvement strengthened the link between neurological damage, aphasia type, severity of language comprehension impairments, and geographical patterns observed in Nakuru’s hospitals.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eIndividual variability in speech production impairments observed among the affected adults individuals.\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eThe third objective of the study explored the extent of individual variability in speech production impairments among adults affected by aphasia in Tier Four hospitals in Nakuru, Kenya. The goal was to understand how factors such as age, gender, and aphasia type influenced differences in speech production deficits. Patients were categorized into five aphasia types: Broca’s aphasia, Wernicke’s aphasia, Global aphasia, Primary Progressive Aphasia (PPA), and Anomia. Detailed speech production tasks were conducted, including sentence formation, word retrieval, and spontaneous speech generation. Observations focused on articulation, fluency, grammatical structure, and naming abilities, highlighting the unique speech patterns and difficulties of each individual.\\u003c/p\\u003e\\u003cp\\u003eCaregivers played a crucial role in the data collection process, helping to communicate with patients, especially those with severe impairments. They provided important context about patients’ conditions, histories, and baseline language abilities before aphasia onset, offering insights that enriched the understanding of patients’ speech behaviors beyond clinical observations. Medical professionals, including neurologists and speech therapists, contributed clinical records and expert assessments, ensuring the study’s findings aligned with established clinical knowledge of different aphasia types and their linguistic profiles.\\u003c/p\\u003e\\u003cp\\u003eTo facilitate communication, a supportive environment was created where patients were fully informed about the study’s purpose and their voluntary participation. For those with severe language deficits, visual aids and gestures were used to enhance understanding. Patient responses were carefully noted and recorded, with errors in naming tasks categorized by type (such as paraphasia or anomia). Sentence formation exercises were analyzed for fluency and grammatical accuracy, with adjustments made to task complexity based on individual capabilities.\\u003c/p\\u003e\\u003cp\\u003eSpeech production variability was examined through key metrics like articulation rate, fluency, and word accuracy, measured using tools such as Praat speech analysis software. These metrics were collected repeatedly over time, allowing for longitudinal tracking of speech performance and variability. Patients were grouped by aphasia severity - mild, moderate, and severe - to identify patterns within each category and understand how individual differences influenced speech abilities.\\u003c/p\\u003e\\u003cp\\u003eResults revealed marked individual variability. Among those with mild aphasia, some maintained near-normal conversational skills, while others struggled significantly with semantic retrieval and phonological accuracy which correspond to a study done by Chen et al. \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e2024\\u003c/span\\u003e. The moderate aphasia group showed even wider differences, with some participants displaying moderate syntactic and phonological difficulties and others closer to mild impairment levels. In the severe group, although all showed profound speech production deficits, variability persisted- some could produce isolated words or short phrases, while others had near-complete loss of verbal expression as supported by study done by Crosson et al. \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e2020\\u003c/span\\u003e.\\u003c/p\\u003e\\u003cp\\u003eNeuroimaging data helped explain this variability, revealing that differences in brain activation, especially in left hemisphere areas linked to syntax and semantics, played a role (Federico et al. \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e). Patients with stronger activation in regions such as the left superior temporal gyrus and Broca’s area generally exhibited milder aphasia symptoms (Garcia et al. \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e2023\\u003c/span\\u003e). Conversely, those with more diffuse or reduced brain activation had more severe speech production impairments (Henry et al. \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e2021\\u003c/span\\u003e). This comprehensive analysis underscores the complex interplay between individual factors and neurological differences in shaping speech production impairments among aphasic adults, highlighting the need for personalized assessment and intervention approaches.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eSpecific linguistic features affected among the affected adults\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eTo analyze the specific linguistic features affected in aphasic adults at Tier four hospitals in Nakuru, Kenya, the study presented data on sentence structure, grammatical errors, and word retrieval issues. The tools used for this analysis include Frequency Distribution Graphs and Syntactic Tree Diagrams, with the Quantitative Production Analysis (QPA) and the Northwestern Assessment of Verbs and Sentences (NAVS) being key assessment methods.\\u003c/p\\u003e\\u003cp\\u003eThe study revealed that different linguistic features were disproportionately affected depending on the type and severity of aphasia. In Broca’s aphasia, syntactic complexity and phonological accuracy were significantly impaired, with patients frequently making errors in word order and subject-verb agreement. These patients also exhibited slowed speech rates and difficulty with word repetition tasks. Wernicke’s aphasia patients showed substantial deficits in semantic processing, particularly in tasks involving verbal retrieval and category fluency. Their speech was fluent but often nonsensical, with little ability to access meaningful lexical items. Global aphasia patients demonstrated the most extensive linguistic impairments, with significant deficits in all domains, including syntax, phonology, and semantics. These individuals struggled with even basic verbal expression and comprehension. Finally, patients with neurodegenerative aphasia, particularly those diagnosed with Primary Progressive Aphasia, showed progressive declines in their ability to generate verbs and engage in meaningful conversation. EEG data revealed that patients with more severe aphasia exhibited delayed event-related potentials (ERPs) in response to syntactic and phonological violations, further supporting the notion that aphasia severity is closely linked to deficits in specific linguistic features.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\"},{\"header\":\"Case Scenarios\",\"content\":\"\\u003cp\\u003e\\u003cb\\u003eCase Scenario 1\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eA 48-year-old woman, mama Asha, was admitted to Hospital B with severe malnutrition and noticeable speech difficulties. She is currently breastfeeding her 8-month-old infant. Over the past year, her family observed a gradual decline in her ability to communicate effectively. Mama Asha’s speech became increasingly halting and effortful, with frequent word-finding pauses and use of circumlocutions in Swahili, such as “kitu cha kunywa” (thing to drink) instead of “maziwa” (milk). She struggled with naming objects and forming coherent sentences, often producing fragmented utterances like “Nataka... mtoto... chakula...” (I want... child... food...), showing impaired lexical retrieval and syntax.\\u003c/p\\u003e\\u003cp\\u003eDuring assessment, Mama Asha displayed prominent anomia, especially with verbs and nouns in Swahili, affecting her ability to construct grammatically correct sentences. For example, she said “mtoto kula...” instead of “mtoto anakula” (the child is eating), reflecting difficulties in verb conjugation and tense marking. Her comprehension of complex instructions remained relatively preserved, but she had trouble understanding subtle semantic nuances, such as differentiating between “kula” (eat) and “kunywa” (drink). Her speech was characterized by reduced fluency and phonological paraphasias, substituting sounds within words, for example, “beba” (carry) pronounced as “peba.” These features are typical of PPA, which progressively impairs language production and semantic processing. Coupled with severe malnutrition, mama Asha’s cognitive and linguistic functions are severely compromised, necessitating multidisciplinary care including nutritional rehabilitation and speech therapy.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003ctable float=\\\"No\\\" id=\\\"Taba\\\" border=\\\"1\\\"\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003c/colgroup\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFeature\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eObserved Impairment\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eExample (Swahili)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eLinguistic Sub-strand Affected\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLexical retrieval\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eAnomia, circumlocution\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e“kitu cha kunywa” (thing to drink) instead of “maziwa”\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eVocabulary (nouns/verbs)\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSyntax\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSimplified, fragmented sentences\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e“mtoto kula” vs. “mtoto anakula”\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eVerb conjugation, tense marking\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003ePhonology\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSound substitutions (paraphasias)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e“beba” → “peba”\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003ePhonological processing\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSemantics\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDifficulty with subtle meaning distinctions\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eConfusing “kula” (eat) and “kunywa” (drink)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSemantic comprehension\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFluency\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eHalting, effortful speech\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eFrequent pauses, fragmented speech\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSpeech fluency\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eComprehension\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePreserved for simple commands, impaired for complex semantic distinctions\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eDifficulty with nuanced meaning\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eLanguage comprehension\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eCase Scenario 2\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eMzee, a 67-year-old retired Kiswahili teacher from Mombasa, suffered a left frontal lobe stroke, resulting in Broca’s Aphasia. Before the stroke, he was fluent in Kiswahili with strong literacy skills. After the stroke, he exhibits non-fluent, effortful speech with relatively preserved comprehension but significant difficulties in syntax and grammar, particularly with past tense constructions.\\u003c/p\\u003e\\u003cp\\u003eMzee produces short, telegraphic phrases with omitted function words and grammatical markers. His speech is slow and effortful, with frequent pauses. For example, he might say, “Nenda... sokoni... leo” instead of “Nilienda sokoni leo” (I went to the market today). His word retrieval is impaired, especially verbs, and he struggles to form past tense verbs such as “nilikwenda” (I went), often defaulting to present tense or root verbs. He shows difficulty in sentence construction and uses mostly content words with few connecting words.\\u003c/p\\u003e\\u003cp\\u003eMzee's comprehension remained relatively intact, especially for simple sentences and commands. He understands instructions like “leta chai” (bring tea) or “kaa hapa” (sit here). However, he finds complex syntactic structures challenging, particularly passive sentences or those involving embedded clauses, such as “Mtu aliyemwita jana hayuko hapa” (The person who called him yesterday is not here). His ability to interpret nuances and grammatical cues is limited but basic semantic understanding is preserved.\\u003c/p\\u003e\\u003cp\\u003eHe can read familiar words and short sentences but struggles with sentences requiring syntactic analysis. For example, he reads “kitabu kipo mezani” (the book is on the table) fluently but has difficulty understanding complex passages with subordinate clauses or nuanced meaning. Reading aloud is slow and halting, with frequent pauses and mispronunciations.\\u003c/p\\u003e\\u003cp\\u003eWriting mirrors his speech output - effortful, with short phrases missing grammatical elements. He writes “nenda sokoni leo” instead of “nilienda sokoni leo.” His spelling of common Kiswahili words is generally correct, but sentence structure is impaired. Writing tasks that require verb conjugation in the past tense or more complex syntax reveal significant difficulties.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003ctable float=\\\"No\\\" id=\\\"Tabb\\\" border=\\\"1\\\"\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003c/colgroup\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eLanguage Skill\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eObserved Impairments\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eExample (Kiswahili)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eLinguistic Feature Affected\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSpeaking\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eNon-fluent, telegraphic, omitted grammar\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e“Nenda sokoni leo” vs “Nilienda sokoni leo”\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSyntax, verb conjugation, fluency\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eListening\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eGood basic comprehension; difficulty with complex syntax\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eDifficulty with passive/embedded clauses\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSyntax comprehension\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eReading\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eSlow, halting reading; difficulty with complex sentences\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eCan read “kitabu kipo mezani” but struggles with complex texts\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eReading fluency, syntactic parsing\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eWriting\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eEffortful, telegraphic, missing grammar\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eWrites “nenda sokoni leo” instead of “nilienda sokoni leo”\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSyntax, verb tense, writing fluency\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eCase Scenario 3: Palliative care\\u003c/b\\u003e\\u003c/p\\u003e\\u003cp\\u003eGogo was a 107-year-old woman living in a rural community. Despite her advanced age, she has no known lifestyle diseases such as hypertension or diabetes. However, over the past ten years, her family has observed significant memory loss and a steady decline in her cognitive abilities. She has developed aphasia as a result of neurodegenerative changes in her brain, likely linked to a form of Primary Progressive Aphasia (PPA). With this, gogo cannot remember her own children. Her memory takes her back to a time in life when she was breastfeeding hence occasionally she could begin looking around for her breastfeeding child.\\u003c/p\\u003e\\u003cp\\u003eHer speech has become increasingly impaired. She struggles to find the right words and often substitutes incorrect ones, a phenomenon known as paraphasia. For example, she might say “gari” (car) when meaning “simu” (phone), or confuse similar sounding words. Her sentences are fragmented and lack coherence, showing difficulties with semantic processing - understanding and producing meaningful language. She frequently uses vague words like “kitu” (thing) or repeats the same phrases, reflecting her effort to communicate despite word-finding difficulties.\\u003c/p\\u003e\\u003cp\\u003eListening comprehension has declined; Gogo finds it hard to follow conversations, especially when multiple people speak or complex ideas are discussed. She understands simple, everyday commands such as “kaa chini” (sit down) or “lete maji” (bring water), but struggles with abstract or multi-step instructions.\\u003c/p\\u003e\\u003cp\\u003eHer memory loss affects her ability to recall recent events and names of family members, contributing to confusion and frustration. Cognitive decline extends beyond language, affecting attention and problem-solving skills.\\u003c/p\\u003e\\u003cp\\u003eDespite these challenges, Gogo’s family provides constant support, helping her with communication and daily activities. They assist her during conversations by gently prompting words or using gestures. Medical evaluation with neuroimaging shows progressive atrophy in the left temporal lobe, a hallmark of semantic dementia subtype of PPA.\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e\\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e\\u003ctable float=\\\"No\\\" id=\\\"Tabc\\\" border=\\\"1\\\"\\u003e\\u003ccolgroup cols=\\\"4\\\"\\u003e\\u003c/colgroup\\u003e\\u003cthead\\u003e\\u003ctr\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eFeature\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eObservations\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eExamples (Swahili)\\u003c/p\\u003e\\u003c/th\\u003e\\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eLinguistic/Cognitive Impact\\u003c/p\\u003e\\u003c/th\\u003e\\u003c/tr\\u003e\\u003c/thead\\u003e\\u003ctbody\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eSpeech Production\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eWord-finding difficulties, paraphasia, fragmented sentences\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003e“gari” instead of “simu”; uses “kitu” (thing)\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eSemantic impairment, word retrieval\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eComprehension\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDifficulty understanding complex speech, retains simple commands\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eUnderstands “kaa chini” but struggles with complex instructions\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eDecline in semantic comprehension\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eMemory\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003ePoor recent memory recall\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eForgetting names of family members\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eCognitive decline, memory loss\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003ctr\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u003cp\\u003eCognitive Function\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u003cp\\u003eDecline in attention, problem-solving\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u003cp\\u003eConfusion during multi-step tasks\\u003c/p\\u003e\\u003c/td\\u003e\\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u003cp\\u003eGeneral cognitive impairment\\u003c/p\\u003e\\u003c/td\\u003e\\u003c/tr\\u003e\\u003c/tbody\\u003e\\u003c/table\\u003e\\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003eWe declare that this is our original work, and no part of this work is under consideration anywhere. We have read and agreed to the published version of the manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthical Considerations\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eEthical approval was obtained from NACOSTI under approval ref. No. NACOSTI/P/25/417895 as in supplementary (S-1). Informed consent was secured from all participants or their legal guardians, with procedures adjusted for individuals with severe language impairment. Privacy and confidentiality were strictly maintained through anonymization of data and secure storage. Participants were informed of their right to withdraw at any stage without prejudice. Special attention was given to communicative accommodations, including the use of visual aids and simplified language to ensure that individuals with aphasia could meaningfully participate in the research process. Participant information was handled in confidence. All the research procedures reported in this paper were done per the Declaration of Helsinki.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003eAll the\\u003cstrong\\u003e\\u0026nbsp;\\u003c/strong\\u003epatient gave written informed consent for their personal or clinical details to be published in this study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and material\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe datasets used in the current study are available upon reasonable request to the author (MJJ \\u0026amp; SOA).\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests:\\u0026nbsp;\\u003c/strong\\u003eThe authors declare that there are no competing interests\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u0026nbsp;\\u003c/strong\\u003eNo funding support was received for this work.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor Contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMJJ, BK, KO, BO, WWJ and SOA were involved in the conception and design of the study. MJJ supervised interviews, MJJ \\u0026amp; SOA analyzed the data and prepared the manuscript. BK, KO, WWJ, BO\\u0026nbsp;and SOA provided guidance and mentorship during the implementation of the study. All authors reviewed and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgement\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eWe acknowledge all that contributed to the success of this research, especially the staff of Level Four hospitals in Nakuru County and all the participants who concept to be part of this study.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eAmunts, K., Kedo, O., \\u0026amp; Zilles, K. (2019). \\u003cem\\u003eBroca\\u0026rsquo;s area: From anatomy to function.\\u003c/em\\u003e \\u003cem\\u003eBrain, 142\\u003c/em\\u003e(5), 1195-1212.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eAnderson, J. A., Henry, M. L., \\u0026amp; Kiran, S. (2021). Psychological components of disfluency in aphasia: Addressing anxiety and frustration. \\u003cem\\u003eJournal of Speech, Language, and Hearing Research, 64\\u003c/em\\u003e(4), 1173-1186.\\u003c/li\\u003e\\n \\u003cli\\u003eAndreetta, J., Thoma, K., \\u0026amp; Frey, M. (2022). Comprehension of communicative intentions in aphasia: The role of syntactic structure and theory of mind. \\u003cem\\u003eAphasiology, 36\\u003c/em\\u003e(9), 1035-1056.\\u003c/li\\u003e\\n \\u003cli\\u003eBennett, S. J., McHugh, L., \\u0026amp; Jones, R. (2022). Disfluency patterns in children with ADHD, SLI, and ASD: A comparative analysis. \\u003cem\\u003eInternational Journal of Language \\u0026amp; Communication Disorders, 57\\u003c/em\\u003e(4), 671-684.\\u003c/li\\u003e\\n \\u003cli\\u003eBerube, M., Scherer, N., \\u0026amp; Rojas, M. (2020). \\u003cem\\u003eThe role of assistive technology in enhancing written expression among aphasic individuals.\\u003c/em\\u003e \\u003cem\\u003eTechnology and Disability, 32\\u003c/em\\u003e(1), 29-41.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eBorrett, J. J., \\u0026amp; Gould, R. L. (2021). \\u003cem\\u003eDisruption of language networks in aphasia: Clinical implications.\\u003c/em\\u003e\\u003cem\\u003e\\u0026nbsp;International Journal of Language \\u0026amp; Communication Disorders, 56\\u003c/em\\u003e(3), 492-509.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eBruns, C., Varley, R., Zimmerer, V. C., Carragher, M., Brekelmans, G., \\u0026amp; Beeke, S. (2019). \\u0026ldquo;I don\\u0026rsquo;t know\\u0026rdquo;: a usage-based approach to familiar collocations in non-fluent aphasia. \\u003cem\\u003eAphasiology\\u003c/em\\u003e, \\u003cem\\u003e33\\u003c/em\\u003e(2), 140-162.\\u003c/li\\u003e\\n \\u003cli\\u003eChen, P. Y., Hsu, C. W., \\u0026amp; Tsai, Y. C. (2024). \\u003cem\\u003eEffectiveness of intensive language therapy targeting Wernicke\\u0026rsquo;s area: A longitudinal study.\\u003c/em\\u003e \\u003cem\\u003eAphasiology, 38\\u003c/em\\u003e(1), 68-88.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eCode, C. (2021). The role of the brain in language processing: Implications for aphasia treatment. \\u003cem\\u003eNeuropsychology Review\\u003c/em\\u003e, 31(1), 35-49.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eCrosson, B., McGregor, K. M., \\u0026amp; Roger, W. C. (2020). Phonological-based therapy in aphasia: Importance of repetitive practice and auditory feedback. \\u003cem\\u003eAphasiology, 34\\u003c/em\\u003e(10), 1159-1178.\\u003c/li\\u003e\\n \\u003cli\\u003eFederico, R., Sgandurra, G., \\u0026amp; Fiore, M. (2021). A multidimensional approach to the diagnosis and rehabilitation of aphasia following acute encephalitis. \\u003cem\\u003eNeuropsychological Rehabilitation, 31\\u003c/em\\u003e(2), 216-230.\\u003c/li\\u003e\\n \\u003cli\\u003eGarcia, J., Casado, M., \\u0026amp; Peralta, L. (2023). \\u003cem\\u003eCombining speech therapy with cognitive-behavioral techniques in aphasia rehabilitation.\\u003c/em\\u003e \\u003cem\\u003eJournal of Speech, Language, and Hearing Research, 66\\u003c/em\\u003e(1), 59-74.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eHedge, M. (2022). Language production and comprehension in aphasia: A clinical perspective. \\u003cem\\u003eAphasiology\\u003c/em\\u003e, 36(2), 197-213.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eHenry, M. L., Kiran, S., \\u0026amp; Mauldin, L. (2021). Fluency-shaping techniques for aphasia: A review of the evidence. \\u003cem\\u003eAmerican Journal of Speech-Language Pathology, 30\\u003c/em\\u003e(2), 647-659.\\u003c/li\\u003e\\n \\u003cli\\u003eM\\u0026auml;tzig, S., et al. (2018). Individual variability in language production impairments in aphasia: A review. \\u003cem\\u003eLanguage, Cognition and Neuroscience\\u003c/em\\u003e, 33(3), 345-359.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eMcNeil, M. R., \\u0026amp; Tseng, C. (2021). \\u003cem\\u003eThe impact of aphasia on conversational discourse.\\u003c/em\\u003e \\u003cem\\u003eTopics in Language Disorders, 41\\u003c/em\\u003e(3), 243-258.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003ePregla, A., et al. (2021). Variability in language production impairments in aphasia: A review of recent studies. \\u003cem\\u003eNeuropsychological Rehabilitation\\u003c/em\\u003e, 31(6), 826-848.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eTheodorou, E. (2021). \\u003cem\\u003eNarrative discourse and identity in individuals with aphasia: A qualitative approach.\\u003c/em\\u003e \\u003cem\\u003eJournal of Communication Disorders, 94\\u003c/em\\u003e, 106027.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eThomas, M., \\u0026amp; Golding, S. (2020). \\u003cem\\u003ePragmatic language therapy in adults with aphasia: Current approaches and future directions.\\u003c/em\\u003e \\u003cem\\u003eLanguage, Cognition and Neuroscience, 35\\u003c/em\\u003e(4), 487-501.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eWilshire, C. E., \\u0026amp; Kearns, D. (2021). \\u003cem\\u003eSpeech errors and monitoring in aphasia: Implications for assessment and treatment.\\u003c/em\\u003e \\u003cem\\u003eJournal of Speech, Language, and Hearing Research, 64\\u003c/em\\u003e(1), 24-34.\\u0026nbsp;\\u003c/li\\u003e\\n \\u003cli\\u003eWood, D., \\u0026amp; Lamb, A. (2022). \\u003cem\\u003eLanguage and memory in individuals with aphasia: Exploring the connections.\\u003c/em\\u003e \\u003cem\\u003eJournal of Communication Disorders, 94\\u003c/em\\u003e, 106080. \\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Aphasia, Language Production, Neuro-Linguistics, Speech Deficits, Cognitive Science\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6922576/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6922576/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground: \\u003c/strong\\u003eAphasia, a neurological condition caused by left-hemisphere brain lesions, impairs language functions. Although lesion-linguistic deficit correlations are well documented in high-income countries, they remain understudied in resource-limited settings like Kenya where post-stroke rehabilitation is scarce. This study bridges this gap by analyzing lesion-symptom correlations in adults with aphasia, integrating clinical data with patient experiences.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods: \\u003c/strong\\u003eUsing a mixed-methods correlational design, we assessed 36 aphasic adults from Tier four hospitals in Nakuru county, Kenyan healthcare system, selected via purposive and convenience sampling. Quantitative data was collected on lesion location using MRI/CT reports, and language deficits using standardized tests, and analyzed via chi-square tests and descriptive statistics to determine associations. Qualitative using semi-structured interviews with patients and clinicians, was thematically analyzed to identify recurring language impairment themes.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e: Brain lesion location strongly predicted the severity of aphasia symptoms (χ² = 18.24, *p* \\u0026lt; 0.05). Specifically, Broca’s area lesions (38.9% of cases) correlated with expressive language impairments (\\u003cem\\u003eagrammatism, reduced fluency\\u003c/em\\u003e), while Wernicke’s area lesions (30.6%) linked to receptive language deficits (\\u003cem\\u003eimpaired comprehension, paraphasias\\u003c/em\\u003e). Global lesions (19.4%) caused mixed deficits. Variability in speech production despite similar lesion locations highlighted the `potential influence of cognitive reserve and premorbid language ability. Thematic analysis revealed syntactic disruptions, semantic retrieval struggles, and social isolation due to communication barriers. Clinical observations suggested positive impacts of early intervention and structured rehabilitation on language outcomes.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusions\\u003c/strong\\u003e: This study confirms Broca’s/Wernicke’s lesion-deficit patterns in aphasia, supporting global psycholinguistic theories while revealing local rehabilitation disparities and offer valuable insights for clinical diagnosis and tailored rehabilitation strategies in Kenya. Findings underscore the need early, lesion-specific individualized speech therapy and assistive communication approaches to address the heterogeneity of aphasia symptoms to optimize recovery.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Mapping Brain Lesions to Language deficits in Aphasia: Evidence from Kenyan Hospitals\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-09-04 18:40:20\",\"doi\":\"10.21203/rs.3.rs-6922576/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":4}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"64782540-8238-4e0e-af65-361e9aacd380\",\"owner\":[],\"postedDate\":\"September 4th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-10-09T11:24:17+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-09-04 18:40:20\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6922576\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6922576\",\"identity\":\"rs-6922576\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}