Language

GSP505 NEUROPSYCHOLOGY OF LANGUAGE

SPEECH, LANGUAGE & COMMUNICATION DIFFICULTIES

  • Communication Disorders include the following:

    • Language Disorder

    • Speech Sound Disorder (previously Phonological Disorder)

    • Childhood-Onset Fluency Disorder (Stuttering)

    • Social (Pragmatic) Communication Disorder

    • Unspecified Communication Disorder

Speech

  • Definition: The articulation of sound.

  • Involves coordination of:

    • Tongue

    • Teeth

    • Soft and hard palates

    • Abdominal muscles

    • Breath to produce sound.

  • Relationship with language:

    • Speech involves underlying thoughts that must be articulated and expressed in words.

Language

  • Definition: A rule-governed process.

  • Key components include:

    • Grammar (Syntax): Structure and rules that govern sentence formation.

    • Meaning (Semantics): The interpretation and significance of words.

    • Use (Pragmatics): The context and purpose behind uttering particular phrases.

    • Vocabulary: The set of words known and utilized by an individual.

  • Cognitive functions associated with language:

    • Thinking

    • Remembering: Tracking working memory and long-term memory.

    • Reasoning: The ability to make logical deductions.

    • Predicting: Anticipating outcomes based on language use.

  • Forms of language beyond speech:

    • Writing

    • Sign language

Communication

  • Definition: The use of language and/or speech to convey messages to others.

  • Statistics: 93% of information in conversation is transmitted non-verbally (Mehrabian, 1972).

  • Elements that affect communication:

    • Intonation (Prosody): Modifications in pitch or tone that can alter meaning.

    • Nonverbal communication challenges are significant in Autism Spectrum Disorder (ASD) and Social Emotional Behavioral Difficulties (SEBD).

  • Components of communication:

    • Sender:

    • Must have the opportunity to communicate, formulate thoughts, and convey messages appropriately.

    • Receiver:

    • Needs the capability to hear, listen, comprehend, and demonstrate understanding through responses.

The Communication Chain

  • Steps involved in effective communication include:

    • Understanding meaning

    • Comprehending sentence structure

    • Grasping word semantics

    • Auditory memory (Remembering)

    • Listening/hearing

    • Looking/attending

    • Speaking appropriately (Pragmatics)

    • Speaking fluently

    • Articulating sounds

    • Coordinating speech muscles

    • Selecting sounds (Phonology)

    • Choosing sentence structure (Syntax)

    • Generating ideas and decisions

    • Choosing words (Semantics)

    • Interpreting non-verbal communication

Delay versus Disorder

  • Delay: Language development follows normal developmental stages but occurs at a slower pace.

  • Disorder: Development deviates in form or function relative to peers.

  • Recommendations: Children displaying speech and language disorders should be referred to Speech and Language Therapy (SALD).

Impact of SALD on Literacy

  • Areas affected by Speech and Language Disorders (SALD):

    • Reading comprehension and reading aloud

    • Expressive writing; focusing on syntax and vocabulary

    • Spelling: Relying on phonological awareness and segmentation abilities:

    • Segmentation of sentences into words.

    • Words into syllables.

    • Syllables into phonemes.

    • Awareness of rhyme.

Social Use of Language (Pragmatics)

  • Significance of pragmatics:

    • Vital for establishing and managing personal and professional relationships.

    • Abilities essential to successful interactions:

    • Using language for various purposes

    • Adjusting language based on the listener

    • Adhering to conversational and narrative rules (e.g., topic maintenance, initiating repairs, maintaining eye contact)

    • Understanding non-verbal guidelines.

Story Frameworks

  • Elements for constructing narratives:

    • Title

    • Characters (Who?)

    • Setting (Where?)

    • Introduction to the story

    • The exciting conflict

    • Resolution of the conflict

    • Conclusion (The end)

Visual Timelines

  • Utilization for organizing information and activities in contexts like:

    • Registration processes

    • Daily schedules (e.g., Maths, Writing, Lunchtime)

Language Components of the Brain

  • Wernicke’s Area:

    • Location: Left temporal lobe.

    • Function: Mediates language comprehension.

  • Broca’s Area:

    • Location: Left frontal lobe.

    • Function: Responsible for speech production.

  • Less Specialized Areas:

    • Involvement of: primary sensory, auditory, visual, and motor cortices in language processing.

Language as a Collective Process

  • Overall participation of various brain regions when engaging in language tasks:

    • Frontal Lobe: Assists in planning sentences.

    • Temporal Lobe: Aids hearing and understanding sounds.

    • Parietal Lobe: Connects words to their meanings.

    • Motor Cortex: Moves mouth and facilitates articulation.

    • Auditory Cortex: Processes speech sounds.

  • Conceptualization: "The brain treats language like music. Language is primarily a form of pattern recognition."

Language Pathways

  • Ventral Stream (The What Pathway):

    • Function: Aids in understanding meaning, vocabulary, and word associations.

  • Dorsal Stream (The How Pathway):

    • Function: Connects sounds to movements; assists in pronunciation and word repetition.

Damage and Functions

  • Different types of language deficits based on specific brain region damage:

    • Broca's Damage: Results in slow, effortful speech (expressive problems).

    • Wernicke's Damage: Produces fluent but nonsensical speech.

    • Angular Gyrus Damage: Difficulty in reading and writing.

    • Arcuate Fasciculus Damage: Ability to speak and understand but inability to repeat.

Visual and Auditory Building Blocks

  • Language processing includes:

    • Words and Sounds (Phonology, Orthography)

    • Speech Perception (Semantic associations)

    • Speech Production (Articulatory planning and execution)

    • Word retrieval

Types and Levels of Language Processing Difficulties

  • Prelinguistic: Issues in analyzing acoustic properties, stress, and pitch.

  • Phonological: Difficulties with consonant sequencing, segmenting, and blending.

  • Lexical: Vocabulary access challenges.

  • Semantic: Issues with word meanings and concepts.

  • Syntactic: Grammar difficulties related to phrases, clauses, and sentence structure.

  • Discourse: Context and functional difficulties in language usage.

Auditory Processing

  • Cognition in relation to auditory processing entails:

    • Recoding, associating, hypothesizing, and selecting response strategies.

  • Speech perception significantly influenced by the speaker's visual cues and proximity.

Physiological Parameters in Auditory Processing

  • Sensation and perception factors:

    • Auditory acuity: Enhanced via sustained experiences with modulated sounds.

    • Auditory processing: Improved through controlled input of gestures, sounds, words, and phrases.

  • Cognition: Relates to auditory comprehension and understanding cues to facilitate word/phrase recognition.

Lateralization of Language

  • Insight: Language is both lateralized and localized.

  • Emotional response: Looking forward to events can create a positive communicative desire.

Spatial Abilities and Language

  • Communication necessitates interpersonal interactions:

    • Engage in activities that encourage engagement.

  • Examples:

    • Melodic intonation therapy (singing words to promote speech).

    • Tai Chi for enhancing communication through movement and breathing.

    • Singing as a tool for boosting self-expression linked with vocal behaviors.

Motor Activities & Language

  • Relationship between motor skills and language:

    • Fine motor activities: Actions like touching, tapping, drinking, writing, drawing, and singing.

    • Gross motor activities: Actions involving movement, such as standing, walking, swimming, and gardening.

    • Essential practices that support communication: reinforcement, turn-taking, confidence, humor, and structure.

Reading Brain

  • Anatomy and functions involved in reading:

    • Frontal Lobe: Controls articulation (PrG - precentral gyrus).

    • Parietal Lobe: Links letters with sounds (SMG - supramarginal gyrus).

    • Temporal Lobe: Processes speech (STG - superior temporal gyrus) and sight words (MTG - middle temporal gyrus), with meaning processed by the angular gyrus (ANG).

    • Occipital Lobe: Responsible for letter/word recognition (OT - occipital-temporal region).

    • Cerebellum and Brain Stem: Involved in decoding and recognition pathways.

Language Disorders

  • Definition: Language disorders or impairments involve difficulties in processing linguistic information.

    • Types of issues can include:

    • Grammar issues (syntax and/or morphology)

    • Meaning problems (semantics)

    • Receptive, expressive, or both types of issues.

  • Examples of language disorders include specific language impairment and aphasia. Language disorders can impact spoken, written, and signed communication.

Spoken Language Components

  • Phonology: Sounds and speech structures.

  • Form: Pertaining to morphology and syntax.

  • Content: Pertaining to semantics (meaning).

  • Use: Related to pragmatics (appropriate context and usage).

Expressive vs. Receptive Language

  • Receptive Language: Ability to understand what is said (listening competency).

  • Expressive Language: Ability to create coherent utterances with proper semantics and grammar (speaking competency).

Receptive Language Disorder

  • Described as impairments in understanding language inputs via spoken, written, or gestural systems.

  • Symptoms may include:

    • Lack of attentiveness to verbal discussions.

    • Difficulty grasping complex sentences.

    • Problems with following instructions and lack of engagement with storybooks.

    • Echolalia: Repeating phrases instead of comprehension.

    • Delayed language skills compared to age-mates.

Expressive Language Disorder

  • Defined as communication issues with producing language adequately both verbally and in writing.

  • Symptoms include:

    • Difficulty forming sentences, short or simple sentences, incorrect word order.

    • Challenges finding suitable vocabulary, often characterized by word omissions.

    • Limited vocabulary compared to peers, repetitive language use, frustration in communication.

Receptive Language Difficulty

  • Description: Issues understanding spoken language at expected developmental levels.

  • Identification challenges arise due to reliance on visual cues.

  • Issues may become pronounced as curriculum complexity increases.

  • Warning signs: Difficulty with instructions, persistent expressive difficulties, attention issues, and behaviors demonstrating confusion with language.

Support Strategies for Receptive Language

  • Simplify instructions and language support.

  • Assess understanding and incorporate appropriate input levels.

  • Allow responses and verification of vocabulary comprehension through visual aids and real-life objects.

Expressive Language Difficulty

  • Definition: Challenges utilizing language effectively, requiring proficiency in grammar, vocabulary, and expression.

  • Signs to monitor: Withdrawal, poor relationship building, frustration, reliance on vague expressions, and difficulties with sequencing.

Support Strategies for Expressive Language

  • Facilitate adequate response time, avoiding interruptions from others

  • Model language suitable to the child’s level.

  • Match children with effective communicators for tasks.

  • Prompt to encourage elaboration and expansion of their speech.

  • Create opportunities for communication.

Types of Aphasias

  • Motor/Production (Broca's) Aphasia: Difficulty in fluent speech, comprehension may be better than production.

  • Sensory/Receptive (Wernicke's) Aphasia: Fluent but meaningless speech.

  • Conduction Aphasia: Challenges producing responses to comprehended speech (pathway damage).

  • Anomia: Problems with naming and word association.

Speech Disorders

  • Articulation Disorders: Involves problems positioning speech articulators.

  • Phonological Disorder: Represents issues with organizing phonemes within linguistic systems; involves knowing rules.

  • Developmental Phonological Disorder: Issues with learning placement rules for speech sounds.

Communication Disorder

  • Definition: Encompasses difficulties impacting the ability to communicate effectively.

  • Range: May include simple sound substitutions to severe language usage impairments.

Support for Social Communication

  • Use visual schedules to provide structure and routine.

  • Clearly denote task beginnings and endings.

  • Encourage communication with gentle prompts; facilitate choices for expressing needs.

  • Employ visual cues and activities like turn-taking games and role play to foster interaction.

  • Consider implementing structured programs such as "First Steps to Emotional Literacy" for early years and Key Stage 1.

Types of Language Disorders

  • Include but are not limited to:

    • Sensory impairments

    • Apraxia

    • Dyslexia

    • Dysgraphia

    • Stuttering

    • Down Syndrome

    • Autism

    • Attention Deficit Hyperactivity Disorder (ADHD)

Language Difficulties and Compensating Interventions

  • Suggestions for various impairments:

    • Communication processing difficulties: Support through visual gestures.

    • Difficulty in articulating meaning: Use modeling and cues.

    • Problems with initiating communication: Employ explicit planning and reminder strategies.

    • Speech planning challenges: Implement therapeutic activities that reduce stress-related speech inhibition.

Brain Areas Related to Language

  • Broca’s Area: Left frontal lobe, responsible for producing speech ("Broca = Broken speech when damaged").

  • Wernicke’s Area: Left temporal lobe, crucial for understanding language ("Wernicke = What? (difficulty understanding)").

  • Arcuate Fasciculus: Pathway linking Broca’s and Wernicke’s areas, facilitating communication ("The language highway").

  • Primary Auditory Cortex: Located in the temporal lobe, processes sounds and speech input.

  • Angular Gyrus: The parietal lobe's role in reading/writing conversion of written words to meaning ("Turns letters into language").

  • Primary Motor Cortex: Controls speech muscles in the frontal lobe ("Motor = movement of speech muscles").

  • Basal Ganglia: Regulates speech fluency and timing ("Smooth talking system").

  • Cerebellum: Modulates speech rhythm and accuracy ("Keeps speech steady and smooth").

  • Right Hemisphere: Manages emotion-related language comprehension.

Summary of Language and Brain Relations

  • Understanding Speech: Role of Wernicke’s Area.

  • Producing Speech: Function of Broca’s Area and associated motor cortex activities.

  • Reading Words: Impact of visual areas on literacy.

  • Connecting Sounds and Meanings: Temporal lobe functions.

  • Pronunciation and Fluency: Coordination by motor cortices.

  • Combining Words: Frontal lobe's involvement in grammatical construction.

  • Store of Word Meanings: Angular gyrus and temporal lobes' contributions.

Types of Aphasia

  • Definitions and characteristics of specific aphasic disorders, detailing fluency, comprehension, and repetition capabilities:

    • Transcortical Motor Aphasia: Fluent speech difficulties, comprehension intact.

    • Broca's Aphasia: Non-fluent speech with primary expressive difficulty.

    • Mixed Transcortical Aphasia: Pairing of expressive and understanding challenges with intact repetition.

    • Global Aphasia: Severe communication deficits across dimensions.

    • Anomic Aphasia: Mild with challenges in word retrieval, intact comprehension.

    • Conduction Aphasia: Challenges in comprehension with fluent yet meaningless speech, intact repetition.

    • Transcortical Sensory Aphasia: Difficulty with understanding spoken language and repeating.

    • Wernicke's Aphasia: Receptive difficulties alongside fluent inappropriate language expression.

Common Norm-referenced Tests for Language Assessment

  • Clinical Evaluation of Language Fundamentals (CELF)

  • Peabody Picture Vocabulary Test (PPVT)

  • Expressive Vocabulary Test (EVT)

  • Goldman-Fristoe Test of Articulation (G-F)

  • Preschool Language Scale (PLS)

  • Comprehensive Test of Phonological Processing (CTOPP)