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Brief Anatomy
In >96% of right-handers and 70% of lefthanders, left hemisphere is dominant for speech and language Different areas implicated in different functions
For example, anterior location for speech production (left frontal lobe); posterior for speech comprehension (left temporal-parietal region) Roles played by subcortical structures (basal ganglia, posterior thalamus) and right hemisphere less well understood
Auditory Comprehension Visual Comprehension Articulation Word Finding Grammar/Syntax Repetition Verbal Fluency Writing Prosody
Language Deficits
Aphasia spoken language Alexia reading Agraphia - writing Anomia - naming Dysarthria - articulation
Paraphasia:
Substitution of a word by a sound, an incorrect word, or an unintended word Paraphasia with a completely novel word Talking with considerable effort Impairment in writing Disturbances in reading
Neologism:
Nonfluent speech:
Agraphia:
Alexia:
Content words were well preserved Function words (i.e., adjectives, articles) impaired
Brocas Aphasia
Patient Tan Brain tumor in Left frontal brain region Broca: Lesion disrupted speech
Brocas Aphasia
Yes ah Monday er Dad and Peter H (patients name), and Dad er hospital and ah Wednesday Wednesday, nine oclock and oh Thursday ten oclock, ah doctors two an doctors and er teethyah
Goodglass & Geschwind, 1976
Brocas Aphasia
Brocas Aphasia Damage to motor images Language comprehension skills relatively preserved Typically observed in patients with damage to left inferior prefrontal cortex
Wernickes Aphasia
Neologisms Speech appears to have no information content fluent nonsense Preserved function words, impaired content words Comprehension impaired Even simple sentences not well understood Associated with left temporal lobe damage
Wernickes Aphasia
Well this is mother is away here working her work out ohere to get her better, but when shes looking in the other part. One their small tile into her time here. Shes working another time
Goodglass & Geschwind, 1976
Lichtheims (1885) and Geschwinds (1965) model Auditory input mediated by Wernickes area Motor output mediated byBrocas area Regions connected by arcuate fasciculus
Aphasia Syndromes I
Fluent (receptive) Aphasias: All have FLUENT speech and no articulatory disorder; problems with comprehension and/or repetition
Wernicke (aka sensory): neologisms/anomia/ paraphasias, poor comprehension and repetition Transcortical Sensory(aka isolation syndrome): intact repetition; paraphasias/anomia, poor comprehension Conduction: phonemic paraphasias/neologisms, poor repetition, fairly good comprehension Anomic (aka amnesic):anomia and some paraphasias; all else intact
Aphasia Syndromes II
Nonfluent (expressive) Aphasias: All have articulatory disorder but relatively preserved comprehension
Broca (aka motor, expressive, nonfluent): speechlessness with recurring utterances or phonetic disintegration, or phonemic paraphasias with anomia, agrammatism, and dysprosody; poor repetition Transcortical Motor: uncompleted sentences and anomia; naming better than spontaneous speech; repetition fairly intact Global: speechlessness with recurring utterances, poor comprehension, poor repetition
Alexia without Agraphia: poor reading Agraphia: poor writing Word Deafness: poor comprehension, poor repetition
Global
Brocas Wernickes Anomic
impaired
not fluent fluent/ impaired
impaired
intact impaired
impaired
limited impaired intact
impaired
limited impaired impaired
Mixed/ nonfluent
Conduction
impaired
limited
limited
impaired
limited
limited
Good comprehension for gestural language Prosody (inflection, timbre, melody) Semantic language (word recognition, verbal meaning, concepts, and especially visual meaning)
Assessment of Language
Standard Aphasia Batteries (e.g., Western Aphasia Battery, Boston Diagnostic Aphasia Exam, Halstead Aphasia Screening Test) Boston Naming Test Token Test Verbal Fluency Written Expression (e.g., Cookie Theft)