Aphasia:

Symptoms and Syndromes

Ling 411 – 04

Simple Functions / Complex Functions

• What about "understanding speech“? Is it a simple process, localized in Wernicke's area?

• Actually it seems to be a pretty complex process...how is simplicity/complexity determined?

• Similarly, “speaking” – pretty complex, not just Broca's area

• As we have seen, speaking is pretty complex and uses not just Broca’s area but also Wernicke’s area. Without a properly functioning Wernicke’s area, speech is erratic

Simple Functions / Complex Functions

Speaking vs. Phonological Production• Phonological production is one part of speaking

– located in Broca’s area• Speaking is a complex process

Phonological production plus planning what is about to be produced – involves Wernicke’s area

Understanding speech vs. phonological recognition• Phonological recognition is one part of speech

understanding – located in Wernicke’s area• Speech understanding is a complex process

Includes grammatical and semantic activity Motor activity (Broca’s area) also contributes

Simple Functions / Complex Functions

Simple function

Complex function

Motor contributions to perception

Reading: It helps if you know how to write• Especially with Chinese characters

Listening to guitar playing• You appreciate it more if you play guitar

Watching a sports event• You get more out of it if you have played

yourself Understanding 2nd language speech

• It helps a lot if you can speak

Basic functions and complex functions – speaking

Phonological recognition is a basic function Located in Wernicke’s area

• along with, perhaps, the area intermediate between primary auditory area and W’s area

Speaking is a complex function• It is a cooperative effort of several areas,

including Broca’s area and Wernicke’s area• Phonological recognition is a necessary

component of speaking

Aphasic Symptoms

Varieties of language deficits

Inferences from language deficits

Problems of interpretation

Some speech of a Broca aphasic

Examiner: What brought you to the hospital?

Patient: Yes ... Monday ... Dad, and Dad ... hospital, and ... Wednesday, Wednesday, nine o'clock and ... Thursday, ten o'clock ... doctors, two, two ... doctors and ... teeth, yah. And a doctor ... girl, and gums, and I

(Patient was trying to explain that his father had brought him into the hospital on Wednesday to have some work done on his teeth.)

Complexity within the process of speech production

The motor realization of speech involves the smooth coordination of a number of separate neuromuscular systems

Sensory feedback and monitoring enter this process at many points

Coordination

• Activity of different systems must be coordinated

• Planning of neural activity has to precede low-level activation by varying amounts of time

• Lead time from neural activity to muscle activity differs from system to system

(Goodglass, 62)

More, from a (different) Broca’s apasic

"Me ... build-ing ... chairs, no, no cab-in-ets. One, saw ... then, cutting wood ... working ..."

Attempt to describe “cookie theft” picture (Broca’s aphasic)

Cookie … Okay … the cookie jar … and the kid is a … uh … stool … bump … the skool … skool … uh … hurt … and girl … I don’t know …

Goodglass 139

Agrammatism in Broca’s aphasia

Examiner: Can you tell me about why you came back to the hospital?Patient: Yes … eh … Monday … eh … dad … Peter Hogan and dad .. hospital. Er … two … er … doctors … and … er … thirty minutes … and … er … yes … hospital. And .. Er … Wednesday … Wednesday. Nine o’clock. And … er … Thursday, ten o’clock … doctors … two … two … doctors… and … er… teeth … fine.E: Not exactly your teeth … your g-P: Gum … gum …E: What did they do to them?P: And er … doctor and girl … and er .. And er gum …

(Goodglass 105)

Some speech of a Wernicke aphasic

Examiner’s question: Who lives at home with you?

Patient: My wife, she goes her work to work on it but her heffle is all about it.

On testing for comprehension of single words, patient can point to only one of six objects that are named for him. His attempts to write result in a jargon similar to his speech.

Goodglass 2

Another Wernicke aphasic

Attempt to describe a picture showing a young woman standing with books in her arms, portrayed in a farm scene with family members engaged in farm labor:

“Well, all I know is, somebody is clipping the kreples and some wha, someone here on the kureping arm … why I don’t know.”

Examples of anomia

I gave him a … Oh God! I know it! Why can’t I say it?

I lost my … I keep my money in it.

Some speech of a conduction aphasic

Patient: I came into the hospital for some tecs ... Some secs … tesk … T E S … tests.

Goodglass 73

Paraphasia

Verbal paraphasia

• Use of one word instead of the intended one

• Usually, same part of speech Phonemic paraphasia

• Unintended phonemes or sequences of phonemes

• “paker” for “paper”, “sisperos” for “rhinoceros” Neologistic paraphasia

• “tilto” for “table”• See, my refkid is … are bad. Oh, my cathopes noe

too good. Well, my gupa wasn’t too good. (85)

Examples from a picture-naming test

Patient Target Word Response

Mr. W. stethoscope telescope – not right (Broca) asparagus carrot – no

pinwheel kitenozzle hose – no

Father L. seahorse mandarin (Wernicke) globe atlas

stethoscope octopus – no*hourglass it’s a weather

*A picture of an octopus had been presented earlier in the test

(Goodglass 78)

Phonemic paraphasia in a conduction aphasic

Target Word (picture) Response__________

Dart cart … part … chart

Broom broo … croo … broom

Scroll scrip… screl … scrit … roll it up … sholl … scroll

Bench fence … park bence … bench

Pinwheel pan .. P E A … peanwheel … pinwill … penwhale … pinfin … no pinwheel

(Goodglass 88)

Perisylvian Aphasic Syndromes

The most common perisylvian aphasiasin order of frequency of occurrence

1. Broca Aphasia

2. Wernicke Aphasia

3. Conduction Aphasia

Characteristics of Broca Aphasia

Non-fluent speech Sparse verbal output Poorly articulated Consists of short phrases Produced with effort Mostly nouns and other content words Deficiency or absence of inflectional affixes Absent or deficient syntactic structure

Word classes in Broca aphasia

Mostly nouns Some adjectives A few verbs

• Generally uninflected or in ‘-ing’ form Function words few or non-existent

Comprehension in Broca aphasia

Generally good More or less impaired for syntactically complex sentences Difficulty in comprehending the same words that are

omitted in speech production• Also, difficulty with repetition of these words

Difficulty understanding relational words• E.g. bigger/smaller, up/down, within/without

Verbal short-term memory deficit(in Broca aphasia)

Patients can readily point to individual objects or body parts named by the examiner

But when asked to point to the same items in a specific sequence they often fail at the level of only two or three items

Benson & Ardila 124

How to explain?

Subtypes of Broca aphasia

Type I• A.k.a. little Broca aphasia• Milder defects• Less extensive damage• Better prognosis

Type II • Symptoms worse• More extensive damage

These are not distinct, but variations• Two spans along a scale

Conduction Aphasia

Originally postulated by Wernicke Good comprehension Poor repetition

• Many phonemic paraphasias Defective production

• Many phonemic paraphasias Different subtypes

• Different areas of damage 5 to 10 percent of all aphasias

Pronunciation deficits – Phonetic vs. Phonemic

Correct phonemes but faulty articulation• Can occur with Broca’s aphasia• The problem is more phonetic than phonemic Correct articulation but wrong phoneme(s)• i.e., phonemic paraphasia

B&A call it ‘literal paraphasia’

• Common in conduction aphasia• The problem is phonemic, not phonetic

How to explain?

Areas of damage in conduction aphasia

Different areas for different subtypes Arcuate fasciculus Left parietal lobe

• Goldstein: ‘central aphasia’ Probably the supramarginal gyrus (?)

• Lower postcentral gyrus Luria: ‘afferent motor aphasia’

Insula More than one of these areas can be

damaged in individual cases

Coronal section, showing Sylvian fissure, insula, etc.

Example of Broca’s Aphasia

http://www.youtube.com/watch?v=f2IiMEbMnPM&feature=related

2:25

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