aphasia

People with agrammatic aphasia often concomitantly demonstrate effortful, groping articulation.

true

People with fluent aphasia exhibit hemiparesis with much greater frequency than people with nonfluent aphasia.

false

The term *literal paraphasia* is synonymous with the term *semantic paraphasia*.

false

The substitution of "tegetable" for "vegetable" is an example of a literal paraphasia.

true

The substitution of "harp" for "violin" is an example of a semantic paraphasia.

true

Symptoms of aphasia have been associated only with cortical, not subcortical, lesions.

false

Broca's aphasia is a motor speech disorder.

false

Wernicke's aphasia is characterized by telegraphic speech.

false

People with Wernicke's aphasia generally produce more neologisms than persons with Broca's aphasia, conduction aphasia, and transcortical motor aphasia.

true

Compared to a person with Wernicke's aphasia, a person with Broca's aphasia is more likely to use neologisms in conversation.

false

People with Broca's aphasia typically have no deficits in linguistic comprehension.

false

Most people with aphasia have some form of both dyslexia and dysgraphia.

true

Telegraphic speech is generally associated with more anterior as opposed to posterior aphasia types.

true

Imagine two people engaging in conversation with you, one with Broca's aphasia and the other with Wernicke's aphasia. Which one is most likely to have concomitant hemiplegia?

broca’s

Imagine two people engaging in conversation with you, one with Broca's aphasia and the other with Wernicke's aphasia. Which one is most likely to be depressed?

broca’s

Imagine two people engaging in conversation with you, one with Broca's aphasia and the other with Wernicke's aphasia. Which one is most likely to have press of speech or logorrhea?

wernicke’s

Imagine two people engaging in conversation with you, one with Broca's aphasia and the other with Wernicke's aphasia. Which one is most likely to use fewer function (closed-class) words than content (open-class) words?

broca’s

Imagine two people engaging in conversation with you, one with Broca's aphasia and the other with Wernicke's aphasia. Which one is most likely to have poor self-monitoring of their linguistic errors?

wernicke’s

**Broca’s aphasia (NONFLUENT)**

* Lesion in inferior frontal lobe; Brodmann area 44 and 45 (pars opercularis and pars triangularis)


* In the frontal cortex
* Blood supply = middle cerebral artery
* Mild to moderate difficulty with passives and complex grammar
* Mild to severe agrammatism, telegraphic speech (Spoken language production characterized by the use of primarily open-class words and omission of function words)
* Anomia (word finding difficulties), literal paraphasias (substitution of words) (more common than semantic), circumlocutions 
* Typically aware of deficits
* Often concomitant with apraxia and dysarthria 
* Contralateral hemiparesis

**Wernicke’s aphasia  (FLUENT)**

* Lesion in Wenickes area in superior temporal lobe that corresponds to brodmanns area 22
* Blood supply = middle cerebral artery
* Speech that is fluent but has no content; nickname “jargon aphasia”. Prosody is intact but unintelligible. 
* Non words or neologisms (i.e. bring me a trunket instead of bring me a drink)
* Paraphasias (words substituted for target words); semantic paraphasias, phonemic (literal) paraphasia
* Circumlocutions (use of many words) 
* Logorrhea (spoken language that is overly abundant in light of a given communicative context) aka excessive talkativeness 
* Poor self-monitoring and lack of awareness of deficits
* Moderate to severe auditory and reading comprehension impairment
* Cant repeat 

**Conduction aphasia (FLUENT)**

* Lesion in arcuate fasciculus, supramarginal gyrus (brodmann area 40)
* Blood supply = middle cerebral artery
* Mild to moderate auditory and reading comprehension impairment 
* Repetition impairment
* Phonemic paraphasias (substitution of one or more sounds in an intended word)
* Conduit d’approche (where the person makes a series of incorrect approximations of the target word, sometimes, but not always, ending up with the right pronunciation of the word)

**Anomic aphasia FLUENT**

* variable , often angular gyrus
* Blood supply = middle cerebral artery
* Mild auditory and reading comprehension impairment 
* Mild to severe word finding difficulties, paraphasias, circumlocutions, fillers, use of generic terms 

**Global aphasia NONFLUENT**

* Large perisylvian lesion, including frontal temporal lobe and often parietal lobes 
* Blood supply = middle cerebral artery and posterior cerebral artery
* Severe auditory and reading comprehension impairment
* Severe may be nonverbal may have jargon and stereotypy (language output characterized by production of the same word or set of words or nonwords regardless of the meaning intended)

**Transcortical sensory aphasia**

* Temporal lobe watershed regions; angular gyrus (brodmanns area 39) posterior middle temporal gyrus (brodmanns area 37)
* Blood supply = middle cerebral artery and posterior cerebral artery
* Moderate to severe auditory and reading comprehension
* Moderate to severe paraphasias, neologisms (non-words), logorrhea, poor seilf-monitoring, intact repetition

**Transcortical motor aphasia**

* Lesion in frontal lobe watershed regions; brodmanns areas 6, 8, 9, 10, and 46
* Blood supply = Anterior cerebral artery and middle cerebral artery
* Mild to moderate auditory and reading comprehension; difficulty with passives and complex grammar 
* Mild to moderate speech deficits, telegraphic, intact repetition, literal and semantic paraphasias

Fluent aphasias:

 are those in which people can speak or write “fluently” and have few struggles when generating language (even though words may not be real words or there is no content). People with fluent aphasia have more trouble understanding language (hence why it is called receptive aphasia). Fluent is based on intact abilities, __receptive is primary area of deficit.__ Fluent aphasias are sometimes caused by temporal lobe legion hence the posterior aphasia term.

Nonfluent aphasias

are the opposite of fluent aphasias. People __generate few words but understand language__ (expressive) Nonfluent aphasia tend to be caused by frontal lobe lesions hence anterior type aphasia

**Why is it problematic to classify aphasia dichotomously as “fluent” versus “nonfluent”?**

“Catchall terms that gloss over important differences among people who fit into both categories.” 

* Think about cause of disfluency 
* Example - Two people with conduct aphasia with similar lesions. One may not be able to repeat, so during a repetition task, she is technically nonfluent. But in spontaneous speech, she may produce better speech output and may seem fluent. Other person can have milder repetition problems, but more severe anomia, thus making her disfluent despite having tghe same lesion.
* No “one size fits all”
* Range of how fluent of disfluent someone is (person with wernickes may be fluent in words per minute, but disfluent in content)
* Lesion sights have overlapping components as well

Agrammatism

deficit in formulating and processing syntax. 

Circumlocutions

words other than the intended words, to get around the words they are striving to say and yet still communicate their intended meaning.

Conduit d’approche

language output characterized by repeated attempts to articulate a verbal stimulus.

Logorrhea

spoken language that is overly abundant in light of communicative context (also called press of speech)

Neologism

a new word

Phonemic paraphasia (also called literal paraphasias) 

the substitution of a word with a nonword that preserves at least half of the segments and/or number of syllables of the intended word

\[e.g., “Give an example of reversible passives \[e.g., give an example of a reversible passive and a non-reversible passive\]

One example of a grammatical construct that people with Broca’s aphasia tend to have trouble with is reversible passives. For example, it may be hard to tell who did the kissing and who got kissed when trying to process the sentence, “Yangfan was kissed by Jacques”; this is because it would make logical sense for either the subject (Jacques in this case) or the object (Yangfan in this case) to do the kissing. In contrast, a passive sentence such as, “The ball was kicked by Wanda,” is not reversible (in that a ball cannot kick a person) and would be relatively easy for a person with Broca’s aphasia to understand. 

Semantic paraphasias (also called verbal or global paraphasias)

entail the substitution of a real word for the target word. Examples are saying the word ear instead of nose (in this instance sharing the same semantic category) and saying the word car instead of ladder (where the paraphasia has less of a clear semantic relationship with the target word)

Stereotypy

the production of the same few words or nonwords regardless of the meaning intended. For example, a person may say only “hello,” “wonderful,” or “kippish” in any verbal context and no other words. Communication is carried out largely through gesture, tone of voice, and facial expression.

Closed-class words

words that are missing usually occurring in broca’s aphasia (such as prepositions, pronouns, determiners, conjunctions, and auxiliary verbs). These are also referred to as closed-class words because there is a relatively small set of these in a language compared to open-class words, and there are rarely new words in this category added to a language

Content words

primarily nouns, verbs, adjectives, and adverbs

Continuous perseveration

form of recurrent perseverations in which a behavior is continued when it is no longer appropriate

Dysnomia

 problems with word finding

Emotional lability

tendency to cry, swear, and otherwise openly emote, in a way that is not typical for the person prior to brain  injury or stroke

Fluent aphasias

any type of aphasia in which spoken language production in terms of morphemes or words per unit of time (regardless of meaningful content expressed) is normal or excessive;  often used interchangeably with the term receptive aphasia

Function words

 words that exist to explain or create grammatical or structural relationships into which the content words may fit. Words like **"of," "the," "to,"** have little meaning on their own. They are much fewer in number and generally do not change as English adds and omits content words. (such as prepositions, pronouns, determiners, conjunctions, and auxiliary verbs).

Grammaticality judgments

 decisions about whether sentence constructions are correct or incorrect

Jargon aphasia

a type of aphasia characterized by the tendency to produce non-words, sometimes used to describe Wernicke's aphasia

Neologistic paraphasia

substitution of a neologism (newly coined word) for a real word

Nonfluent aphasias

types of aphasia in which language is restricted, characterized by fewer units of verbal production (e.g., phonemes, words, content information units)  conveyed per unit of time compared to a standard of "normal" fluent speech.  (Often used interchangeably with the term expressive aphasia)

Open-class words

 (content words) in this class, words continue to be added to languages and the way words are used in these languages evolve. People with brocas aphasia tend to say “ i go” or “britany study”

Press of speech

Spoken language that is overly abundant in light of communicative context (also called logorrhea)

Stuck-in-set perseveration

Persistence in carrying out a task recently performed or saying a word previously spoken when the task or word is no longer appropriate.

Telegraphic Speech

Spoken language production characterized by the use of primarily open-class words and omission of function words

Verbal perseveration

Persistence in saying a word spoken previously, often not the word intended at the moment; a type of stuck-in-set perseveration.