Acquired language - Aphasia

Language: is the symbol system for meaning or formulation of thought

Speech: a motor function in oral communication or the respiratory phonatory. (sound), resonant, artic, and prosodic components for communication

Conmunication : an exchange of language betueen 2 people

Four Major Modalities verbal Expression

Expressive OR Output modalities

Written expression

Auditory Comprehension

Receptive OR

Reading Comprehension

Input Modalities

  •   Also Drawing can be a form of communication

  •   Gestural Communication: can be expressive and receptive

Aphasia: (left hemisPhere Multimodality disorder, affecting muttiple forms ot comication lite speaking, Understanding, reading writing, Aphasia is Usually caused by a stroke (CVA), Commonly from

damage to left side of the brain or

from head injury

Memory

Episadic Memory: person's unique memory of a specific event

Semantic Memory: long-term memory that ideas and concepts, not drawn from pers. experiences

- Common knowledge, basic facts.

Procedural Memory: part of long-term memory that is responsible for knowing how to do things.

  •   cooking an egg

  •   tying shoes

  •   Brushing teeth

Lexical Memory: ability to remember words/ vocub of a lang.

Worleing memocy = the brain's temporary wortes pace

tor language

long-term memory= knowledge-base for communication


Aphasia

Disorder of language secondary to a unilateral brain lesion on the left side

- anguage base

  •   attention, memöry is intact

  •   Modalities of receptive e Receptive language are challenged

*- Multimodality linguistic deficit (reading, writing)

- appears suddenly

Boston Classification System: neurological classification of Aphasia types based on speech fluency, comprehension and repetition

Classification System

Non- Fluent

Anterior lesion

Aware of Errors

Туреs:

  1.   Broca's Aphasia

  2.   Transcortical Motor
    Aphasia

  3.   Global Aphasia

  4.   Mixed Aphasia

Fluent

Posterior lesion

Unaware of errors

  1.   Wernickes Aphasia

  2.   Transcortical Sensory
    Aphasia

  3.   Conduction Aphasia

  4.   Anomic Aphasia


Types of Non-fluent Aphasig

Broca's Aphasia

Site of lesion, Anterior to primary motor corter,

3, frontal convolution in the left hemisptere,

- May involve the white matter deep to that region & extend posteriorly to the inferior

Portion of the precentral gyrus

Autory comprehension: relatively good but impaired for more complex grammatical

constructs like "Susan was pushed by bob"

- Non-canonical

Canonical sentence: sentence that follows the most basic, and unmarked structural rules of language

' uses S-V-O (The dog chases the cat)

Non -Canonical sentences: break from the standard Structure to emphasize a specific part of the sentence or to change the tone (The meal was cooked by the chef) -shifts focus to the object (the meal)

conversational Speech: slow rate, labored, sparse output of words/sentences, telegraphic (spaced out sentences) holophrasic sentences (expressing a ideal/thought /action via one word), agrammatic (deficits in formulating and processing syntax & misarticulations/ awkward artic. Have difficulty with more complex syntax

Repetition poor

- Literal paraphasias= substitutions of phonemes/ letter sounds

They are more common than semantic errors (word substitution)

Naming: poor = phonemic & contextual cues facilitate namin in some individuals with BA

- use circumlocutions or other words in an attempt to convey their intended message

Reading Comprenension: Not predictable but frequently mirrors speech

- When they read something, they miss words

Writing: Moderately to severly impaired & mirrors speech.

Agrammatism

Lanquage production deficit where people leave out grammatical structure and function words, creating telegraphic style of speech

Ex. "Booke... table, " please"

- The words that are spoken or written tend to be content word, primarily nouns, verb, adjectives adverb>

Transcortical Motor Aphasia (rare): Twin of Broca

Site of lesion; anterior and superior to Broca's or subcortical lesion deep in Broca’s area

  •   Similar to Broca's excepti they can repeat

  •   Domains of syntax and morphology are challenged

  •   Semantics are less impaired (naming)


Similar to Broca's

  •   auditory comprehension similar

  •   Reading e Writing

  •   Telegraphic speech

  •   Difficulty w/non-canontical sentences
    Global Aphasia

site of Lesion: massive central lesion. Cortical damage in the region supplied by MCA

Conversational Speech: severely impaired. Produce only automatic speech & verbal stereotypes

Comprehension: Poor

  • Difficulty following simple commands

  •   Difficulty responding to simple biographical information

- Difficulty responding to simple explicit info

Reading I Writing: very impaired

Repetition: severely impaired

May/may not respond to simple/ explict questions .

  •   May/not respond well to biographical) or Simple explicit sentences

Ex. Do you have pants on? Do you have kids?

  • may not follow one step commands but if you add gestures they will get it

Naming: Poor

  • still recognize family members

  • Have awareness

  • Cannot repeat

  • May produce grunt like sounds, other voculizution and or verbal stereotypes


Mixed Aphasia (rare)

Glopal Aphasia Twin

Site of Lesion: anterior / posterior damage

  • Similar to global except they CAN repeat

  • Speech is echolalic (repeat the same thing I said

  •   Slightly better than global aphasia

Comprehension: Poor (like twin -Global Aphasia)


Types of Fluent Aphasia

Wernicke's Aphasia

site of Lesion 'posterior portion of the first temporal gyrus of the left hemisphere, posterior left perisylvian region

Conversational speech: jargon (nonsense speech)paraphasias (literal and verbal: word substitutional) well-articulated word substitution, transportation, neologisms, "empty" speech

Auditory Comprehension: Below normal to poor, may be variable: moderate deficits are not uncommon

Repetition: impaired / Poor

Naming: impaired /poor

Resting Comprenension: impaired / poor

Writing: poor, empty

• linguistic domains challenged: phonology, semantics, and morphology


  • Auditory Comprehension is always challenged, often at the one word level

  •   Perform better with functional /context -bound-thematic sitational speech due to redundancy of lang.

  •   Not aware of errors

Slide of Dog biting the man or man biting dog

"The dog bit He postman"

"The dog was bitten by the postman"

Showing how people wlAphasia have non-canontichl sentences (emphasis on a specific part of a sentence) - passive sentences (subject receives the action of the verb

Brocas,& Transcortical Motor Aphasia: Twins

  • difficulty with non-canontical sentences

  •   difficulty with active /passive sentences

"Susan missed her bus at 3:30, But she caught the second bus and made it to her appointment at 6:30"


Trans cortical sensory.

Aphasia

(wernicke's Twin)

site of lesion: extensive lesion in the posterior portion of the middle temporal gyrus that extends into visual and auditory association cortex and occasionally into the angular gyrus

Lesion spares Broca's and werniche's areas, damage in the cortical areas around wernicke's area.

  •   Similar to Wernicke's Aphasia except they can repeat

  •   All language demains are challenged

  •   paraphrasic errors

  •   jargon

  •   logorrhea: talking, going on and on

  • Not aware of what they are saying

* Repetition separates the twins

Conduction Aphasia - Rare

Does Not have a twin)

Site of Lesion: Arcuat Fasciculus (pathway that transfers information from Broca's area to Wemicke's area. Lesions of the supramarginal gyrus.

Dorsal superior temporal gyrus or damage to the gray matter around the tempo-parietal junction rather than exclusively white matter.

Conversational Speech: highlighted by a majority of phonemic paraphrasic errors (sound-"cUp", tup"), occasional paraphasias, and transportations of words (may say spoon- instead of fork)

Comprenension: relatively good

Repetition: is disproportionally impaired compared to the level of fluency (ifficulty)

Naming: impaired

Reading Comprehension: relatively good

Writing: moderately impaired


  •   Speech is generally fluent and is characterized primarily by literal paraphasic errors

  • Oral reading is severely impaired primarily due to literal and some verbal paraphrasic errors, Silent reading is of ten relatively preserved.

  •   Read aloud the way they talke

  • Writing ability is usvally just as involved as speech production

  •   Write the same way they speak
    Anomic Aphasía

Site of lesion: lesions in the posterior language areas, region of the lower temporal lobe-angunar gyrus, and middle temporal gyrus

Conversational Speech; empty, well articulated, mild paraphasic errors, frequent pauses, grammatically, intact syntactic production

Comprehension: good and relatively spared

Repetition: good.

Naming (word retrieval): poor circumlocutions (talke

around the word are common

Reading comprehension; good

Writing: moderately good but mirrors speech production

  •   Semantics is challenged.

  • Word finding difficulty in context of fluent

  •   grammatically intact well formed splech

  •   less nouns

  •   Attempt to describe what happened because they dont have the words to explain
    Ex. "I had an operation on my head"

Becomes: "I had a thing done up to where your hair is"


More Aphasic Errors

•Abnormalities of rhythm

Stereotypy: repetition of the same linguistic segment in automatic speech

Automatisms: some automatic, hign frequency language may be preserved

  • Dysprosody: alters rhythm, stress, pitch, intonation

  •   Monotony: change, variety, or exciternt in a sound

  • Paraphasias

Phonemic! "Can you hand me the rebote?" Semantic: "Can you hand me the TV!" Phonetic: inadequate production of the phonemes of language generally linked to a disorder of the muscles of articulation

Ex. Decemmer for December

Cookie Theft

1. Cookie sar.. fell over... chair. r.water,rempty.. ov.. Ov,, (Examiner "Overflows?") Yeah

- Broca's Aphasia: understand what is happening.

Telegraphic speech (less words)

2. This is a boy and thats a boy an thats a thing!

An this is goint oft pretty soon (points to stool.

This is a.. a place that this is mostly in (Examiner "lould you name the room., a bathroom?") No, a Heitchen...

Kitchen. Anlthis is a girl... an "thats something they're running an' they've got the water going down here

- Anomic Aphasia: lots ot word but not a lot of content words (fluent)


Auditory Comprevension levels

Biographical Questions! "are you a man". “Were you born in Russia? "'Are you wearing a hat? 'Are you married?"

Simple/Explicit: "'Is it day time?", "Are the lights out in this room?"-answer is directly stated

Complex: "Does july come before september?"

- answer is stated,but language structure is harder

Inferential: "Do 2,000 flowers weigh more than one?"

-listener has to figure out the answer using clues

Factual paragraph level ilisten to a longer passage and retrieve explictly stated fuck

Factual Sentence length info:"Hudson river is 315 miles long "- True

Naming = Word retrieval - also called anomia