Chapter 4: The Aphasias

aphasia

is a deficit in language abilities or in the ability to produce/comprehend written/spoken language resulting from damage to the brain

strictly a deficit in language production, language comprehension, or both

acquired

not born with it, develops after birth and can be caused by many different things

the loss of something you had

ex: aphasia

after language developed

when does aphasia develop?

strokes to the left cerebral hemisphere

what is aphasia MOST often caused by?

expressive language deficits and receptive language deficits

what are the two categories of language deficits?

expressive language deficits

is a difficulty in formulation and production of language to communicate an intended meaning

usually arise from lesions in the anterior portion of the left cerebral hemisphere at or near broca’’s area

receptive language deficit

is a deficit in the ability to derive meaning from language, print or spoken signals not understood, and include problems with verbal or written language

usually arise from lesions in the posterior portion of the left hemisphere at or near wernicke’s area

anomia

is a deficit in word finding ability/can’t get a thought out

overuse of nonspecific pronouns/nouns like it, thing, those, etc

circumlocution

person knows the meaning they want to communicate but cannot find the words to do so

circumlocution

to go around a target word by saying words related

like the target word is table but the person says the thing with legs, you put a plate on it, sit down and eat

anomia

is always present in aphasia whether its mild, moderate, or severe

verbal comprehension deficit

inability to comprehend the spoken language others produce

appearance of comprehension

most language used in social interactions is formulaic and predictable and discernable

severe deficits may yield inability to understand a single word of the speech

paraphasias

are errors in expressive language (phonemes, words, or phrases) unrelated to motor deficits but linked to higher language-level deficits

have 4 types

phonemic paraphasia

aka literal paraphasia

when the word produced is discernable, mostly correct, and yet there are phoneme-level mistakes

phoneme substitutions, omissions, or transpositions

taple for staple

neologism

aka neologistic paraphasia

when an individual produces a word that is entirely different from the intended word and is mostly unintelligible

when 50% or more of the word is unintelligible

dowfler for pencil

semantic paraphasia

when one word is substituted for another word that is similar in meaning

like glass for cup or airplane for helicopter

unrelated verbal paraphasia

a substitution of a word that is unrelated in meaning to the intended word

like lunch for bicycle

perseverate

to do something repeatedly, redundantly, and inappropriately

perseveration

is a word that is said repeatedly and inappropriately

perseveration aphasia

occurs when a word produced earlier is repeated and inadvertently produced by an individual instead of the intended word

like correctly naming a hammer but then using hammer for every other answer

very frustrating

agrammatism

is a lack of grammar by omitting function/functor words

function/functor words

are the in between words used to frame the major content words in a sentence

like: that, is, to, be, and

content words

are the words that carry the majority of meaning

like: happiness, dissolved

telegraphic speech

few words are used, but words still carry a great deal of meaning

arcuate fasciulus

the white matter pathway (association fiber tract) that stretches between the broca’s area and wernicke’s area that allows for repetition of words

repetition deficits

inability to repeat words due to lesion at arcuate fasciculus

word is transmitted from left temporal lobe where it was comprehended, to the left frontal lobe for verbal output

understand the word

the inability to repeat does not mean someone is unable to…

alexia

is an acquired impairment of reading

caused by a lesion at the angular gyrus

is NOT dyslexia (never used on adults)

agraphia

is an acquired impairment in the ability to form letters or form words using letters (not about handwriting)

“a” means total loss of and “dys” means impaired or dysfunctional

at the beginning of a letter, what is the difference between “a” and “dys”

self-repair

occurs when a speaker restates or revises a word or phrase in attempt to produce it in an error-free fashion or refine it to better reflect the intended meaning

decreases fluency of speech

speech disfluencies

can inhibit the fluency of individuals with nonfluent aphasia. these behaviors consist of sound, word, part-word, or phrase repetitions, prolongations, and interjections

struggle in nonfluent aphasia

verbal expression is lost to some degree with individuals with expressive language deficits

individuals become frustrated at having to expend incredible amounts of effort to produce and use language that was formally effortless

preserved and automatic language

even in severe cases of aphasia, it is common for some production of rote and overlearned language to be preserved

can take the form of an intact ability to sing songs that the individuals often heard or sang premorbidly

also take the form of intact abilities to recite rote language such as the days of the week, the months of the year, and the count from 1 to 10

might still be able to produce swear words

prognosis of recovery

the more preserved and automatic language an individual with aphasia has, the better that person’s what will be?

comprehension deficits

matching single word pictures

saying a word/phrases ± picture prompt

sentences to ± picture prompt

following directions ± picture prompt

discourse ± picture prompt

phonological, comprehension, and fluency/naming speed

what are the 3 skill sets of reading that you develop as a kid?

decoding

spoken language is the foundation of written language

self-repair

when a speaker restates or revises a word or phrase in order to produce it error-free or refine what they mean

those with aphasia are less successful at this

perseverative self-repairing

may decrease speech fluency, slow down rate of speech, and make speaker frustrated

pathognomonic

names the pathology, the degree and frequency

speech disfluencies

pathological production of phoneme repetitions, word repetitions, part-word repetitions, phrase repetitions, prolongations, and/or interjections that may affect speech fluency

neurogenic stuttering

neurogenic stuttering

sudden, functor words, no secondary symptoms, no avoidance/anxiety, no change with repeated readings, no change when singing, and no change apart from change in underlying disease

struggle in nonfluent aphasia

frustration and anger may occur with expressive deficits due to loss of automaticity of language

may visibly struggle to find words

preserved language

rote or overlearned language (like days of week or months, happy birthday song, address, alphabet, greetings)

if person cannot initiate, they may need to be given the first few words in order to complete it

automatic language

a form of preserved speech where language is produced automatically or closely associated with a stimulus

producing swear words in response to anger, can’t say “hey” when asked but can say it when someone enters a room

associated deficits

is both cognitive and motor

associated cognitive deficits

may not occur with aphasia, though it is unlikely that none will co-occur (may be mild to severe and determined by location and severity of damage)

deficits include arousal, attention, short-term memory, problem solving, inference, executive functioning skills

associated motor deficits

commonly co-occur with aphasia

arise when frontal lobe is damaged (bc responsible for initiating and gross planning of movement)

deficits include dysarthria, apraxia of speech, dysphagia (feeding/swallowing)

work of an SLP

job is to evaluate, teach, treat, and diagnose (to name)

cortical aphasia

damage to the cortex

fluent vs nonfluent

nonfluent cortical aphasias

broca’s, transcortical motor, global, and mixed transcortical

fluent cortical aphasia

wernicke’s, transcortical sensory, conduction, and anomic

mixed aphasia

a nonspecific form of fluent or nonfluent aphasia

lesion localization

is the practice of identifying the location of the brain of focal lesions based on the profile of deficits displayed by the patient

subcortical aphasia

arise a a result of damage to subcortical structures

like thalamic and striatocapsular

striatocapsular aphasia

no distinct pattern of language deficits

ischemic stroke damaging part of basal ganglia known as the striatum, occlusion that brings damage to striatum may also disrupt blood flow to primary language cortices to create aphasia

loss of fluency, rare phonemic paraphasia’s, reserved repetition, and mild anomia

thalamic aphasia

damage to thalamus (sensory relay except olfaction)

word finding difficulties, reduced spontaneous speech, perserverations dominate

grossly intact grammar and often preserved reading and writing capabilities, repetition

is characterized by almost fluent speech and significant anomia in spontaneous speech

nonfluent aphasia

damage to the anterior of the language-dominant hemisphere near motor areas of control

display agrammatic, halting, and effortful speech that consists mainly of content words

speak in short phrases/single word utterances and are aware of their language deficits

broca’s aphasia

nonfluent and cortical and paradox

occlusion to left middle cerebral artery of inferior posterior frontal lobe of left hemisphere

broca’s aphasia

experience agrammatic and telegraphic speech, shortened utterance length and self-repairs (affects prosody and fluency), anomia, intact receptive language, aware of errors, impaired ability to repeat, motor deficits in dominant hand, writing being affected, and written language mirrors spoken language

paradox

good communicators; poor speakers

transcortical motor aphasia

nonfluent aphasia

damage to the supplementary motor cortex and the area just anterior to broca’s area

occlusion of branches of anterior cerebral artery or most anterior brances of middle cerebral artery providing blood supply to supplementary motor cortex and area anterior to broca’s

transcortical motor aphasia

display intact receptive language abilities paired with very disfluent speech patterns, anomia, preserved repetition abilities, articulation preserved, written language mirrors spoken language, and unlikely to have preserved writing

because the lesion spares the arcuate fasciculus

how are there preserved repetition abilities in transcortical motor aphasia?

lesion reaches motor cortex

articulation is preserved in transcortical motor unless…

global aphasia

cortical and nonfluent

occlusion to primary branch of middle cerebral artery in left hemisphere supplying zone of language

zone of language

comprises all of broca’s area, wernicke’s area, and arcuate fasciculus

global aphasia

little to no receptive language or expressive language, unable to comprehend short utterances, often unable to verbally produce a single word, able to produce one or two words/neologisms, unable to repeat, cognitive deficits (arousal, attention, short-term memory), motor deficits (apraxia of speech, oral apraxia, dysphagia, hemiparalysis), and usually never recover because of most severe damage to the brain

fluent aphasia

individuals display fluent but nonsensical speech

arise from damage to the midposterior of the language-dominant hemisphere

no gross motor deficits

wernicke’s aphasia

fluent

occlusion of inferior/posterior branches of MCA to posterior one-third of superior gyrus of temporal lobe of LH

wernicke’s aphasia

significant receptive language deficits, impaired repetition, posterior lesion may cause reading/visual deficits

experience anosognosia, neologisms and paraphasias, loss of pragmatic skills, logorrhea, and the result is empty speech

anosognosia

having a deficit and not knowing it exists or denying that it exists

unable to recognize deficits and confabulate

neologisms

more than 50% of the word is unrelated to the target

semantic paraphasias

whole word substitutions that are related by meaning

phonemic paraphasias

incorrect phonemes are substituted, more than 50% of the word is there

pragmatic skills

language words used to mediate social experience, body language, eye contact, etc

logorrhea

nonstop output of speech, too many words/constant flow, no recognition

empty speech

language carries no meaning

transcortical sensory aphasia

fluent

occlusion to anterior area between MCA and posterior cerebral artery (PCA) posterior to wernicke’s area at the temporo-occipital-parietal area

transcortical sensory aphasia

poor auditory comprehension, relatively intact repetition, fluent speech with semantic paraphasias

visual deficits often present because of lesion location within the visual/occipital association area

conduction aphasia

fluent

CVA on supramarginal gyrus of parietal lobe, posterior to sensory cortex, and above wernicke’s area damaging arcuate fasciculus though leaving broca’s and wernicke’s intact

conduction aphasia

fluent speech and relatively intact auditory comprehension

repetition inordinately impaired relative to other deficits (those with severe version often cannot repeat even single words)

can paraphrase the meaning of language

anomia

are aware of errors and self-repair (which affects fluency)

conduit d’approche

conduit d’approche

a zeroing-in behavior in which a person with aphasia correctly produces a target word after several repeated and unsuccessful attempts of which each failed attempt is closer to the correct production of the target word than the last

anomic aphasia

is characterized by fluent speech, intact receptive language, and a significant deficit in naming

can be produced by damage anywhere within the language areas

characteristic is in every aphasia but is named when in disproportionate severity relative to other deficits present

atypical aphasias

includes progressive nonfluent aphasia and semantic aphasia, which are both primary progressive aphasias, which is frontotemporal dementia

includes crossed aphasia

frontotemporal dementia

is a condition in which the frontal and temporal lobes of the brain atrophy while the parietal and occipital lobes remain intact

progressive nonfluent aphasia and semantic dementia

what are the two subcategories of frontotemporal dementia known as the primary progressive aphasias (PPA)?

primary progressive aphasia

nonfluent

degeneration in frontal lobes especially the left

primary progressive aphasia

nonfluent PPA

phonemic paraphasias, anomia, grammatical errors, slow rates of speech, simplified syntax/deficits in complete syntax, reduced phrase length, mostly intact receptive language, continuing deterioration, progressive

semantic dementia

fluent PPA

initial greater degradation in the temporal lobes rather than the frontal lobes

semantic dementia

excessive and disinhibited verbal output (pouring out words), difficulty turn taking, will not stop speaking to listen to others, significant anomia, semantic jargon (meaningful words that don’t have meaning when they are combined), pragmatic deficits, question meaning of words, continuing deterioration, progressive

contralateral in the right hand

normally, since people are right handed, if there is damage to the left hemisphere, where will there be hemiplegia or hemiparesis?

this damages the writing ability

ipsilateral in the left hand

if someone is left handed and they have damage to the left hemisphere, where will there be hemiplegia or hemiparesis?

this does not affect the writing ability in dominant hand

crossed aphasia

individuals with a right hemisphere lesion that affects right-handed individuals

left

most left handed individuals are mainly ____ hemisphere dominant

assessment of aphasia

gather case history and observe client, administer standardized test(s), assess speech production, assess cognition, and integrate observations

case history

chart review and patient/family interview

gather demographic information (name, age, race, gender, social, and medical history) read entire chart not just the latest note

interview the patient and his or her family

administer standardized tests

assess multiple modalities of language, including verbal reception of language, verbal expression, reading (visual reception of language), and writing (written expression of language)

these vary in different strengths and weaknesses that make them more or less appropriate in various practice settings

commonly used aphasia tests

aphasia diagnostic profile (ADP), boston dianostic aphasia examination (BDAE), communication activities of daily living (CADL), western aphasia battery: revised (WAB-R), quick assessment for aphasia, comprehensive aphasia test (CAT)

cookie theft picture

is a long and complex task that makes you produce single words and sentences

tests expressive and connective oral language