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Chapter 10

Aphasia in Adults

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Landmarks

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Landmarks

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Motor Cortex

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Motor/Sensory Homunculushttp://www.cs.uta.fi/~jh/homunculus.html

http://mywebpages.comcast.net/epollak/PSY255_pix/homunculus.jpg

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Deficit Areas

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Blood Supply

Uses about 20% of blood at any one timeUses 25% of oxygen1. Internal Carotid Arteries and branches2. Vertebral artery and branches divides into:

Internal Carotid Arteries1. Anterior cerebral arteries

Supplies medial surface of cortex, leg area of motor strip, and portions ofcaudate nucleus, lentiform nucleus, and internal capsule

2. Middle cerebral arteriesSupplies most of lateral surface of hemisphere

3. Ophthalmic arteriessupplies eye, frontal scalp, dorsum of the nose, ethmoid, and frontal sinuses

4 & 5. Posterior & Anterior communicating arteriesForms circle of Willis

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Circle of Willis

Joining of the two internalcarotid arteries with thetwo vertebral arteries

Allows distribution of bloodto any part of bothhemispheres

Safety valve function forthe brain

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Cranial Nerves

I. Olfactory (S) II. Optic (S) III. Oculomotor (M) IV. Trochlear (M) V. Trigeminal* (B) VI. Abducens (M) VII. Facial* (B) VIII. Vestibulocochlear (S) IX. Glossopharyngeal* (B) X. Vagus* (B) XI. Accessory (M) XII. Hypoglossal* (M)

* Oral Musculature Nerves

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Aphasia

Impairment in the ability to understandand produce language as a result ofacquired neurological damage

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Etiology

Stroke CVA

1. Thrombotic stroke2. Embolic stroke3. Hemorrhagic stroke

Catagories1. TIA - transient ischemic attack2. RIND - reversible ischemic neurological deficit3. Stroke in evolution4. Completed stroke

CVA - cerebral vascular accident usually sudden onset involving blockage ofblood flow to brainThrombotic stroke - build-up of plaque on inner vessel walls blocking flow ofblood (ischemic - deficiency of blood)Embolic stroke - traveling clot (ischemic)Hemorrhagic stroke - bursting of arterial walls due to aging of high bloodpressure (hematoma - accumulation of blood in brain)TIA - less than 24 hoursRIND - days or weeks but with minimal or no damageEvolution - longer than 24 hours with associated progressive deteriorationCompleted - deterioration stops and patient stabilizes

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Cranial Nerve Assessment

Table 10-3 (p. 233)

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Brain Imaging Techniques

Angiography Radioisotope Scanning Computerized Tomography Magnetic Resonance Imaging Positron Emission Tomography (PET)

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Angiography

http://www.med.harvard.edu/JPNM/TF03_04/Feb3/CTA.gif

X-ray technique checking flow of blooddye inserted in artery and trackednot noted beyond blockage

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Radioisotope Scanning

www.smithsonianmag.si.edu/.../brain_jpg.html

Tracking of isotopes through the brain

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Computerized Tomography

www.med.harvard.edu/AANLIB/hms1.html

CT Scan - narrow x-ray beams focus on a single planeAccurate computerized reconstruction of cerebral structuresAreas of altered density indicate pathology

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Magnetic Resonance Imaging

www.med.harvard.edu/AANLIB/hms1.html

Large electromagnets manipulate spin of hydrogen molecules to differentiatebetween white and gray matterSuperior to CT Scan

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Positron Emission Tomography

www.med.harvard.edu/AANLIB/hms1.html

Radioactive chemicals injectedPatterns of brain activity examined

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Hemispheric Differentiation

EEG Dichotic listening tasks Wada test

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EEG

www.mrc-cbu.cam.ac.uk/EEG/doc/mmnlang.shtml

“The EEG, or electroencephalograph, deserves mention as one of the first --and still very useful -- ways of non-invasively observing human brain activity.An EEG is a recording of electrical signals from the brain made by hooking upelectrodes to the subject's scalp. These electrodes pick up electric signalsnaturally produced by the brain and send them to galvanometers (instrumentsthat detect and measure small electric currents) that are in turn hooked up topens, under which graph paper moves continuously. The pens trace thesignals onto the graph paper.”(http://www.pbs.org/wnet/brain/scanning/eeg.html)

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Dichotic Listening

UCLA LinguisticsDepartment dichoticlistening experimentof dominance

Ole Miss dichoticlistening experiment

dart.fine-art.com/aqd-asp-im_87237-buy-m.htm

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WadaTest

http://cnri.edu/Clinical_Studies/Independent_Studies/CNRI_Research_&_Development/Iridological_Evaluation_2003.htm

The Wada test (named for a neurologist, Juhn A. Wada) consists of behavioraltesting after the injection of an anesthetic (such as sodium amobarbital orsodium methohexital*) into the right or left internal carotid artery. Dependingon how the injection is made (and the quantity), we have a certain amount oftime during which the activities of one of the cerebral hemispheres aresuspended, so the abilities subserved by the other hemisphere can be tested inisolation. (http://www-personal.umich.edu/~gusb/wadadesc.html)

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Language Testing

Differential Diagnosis1. Naming2. Speech fluency3. Auditory comprehension (figure 10-1, p. 239)4. Repetition skills (figure 10-2, p. 240)

Standardized Assessment Tools Western Aphasia Battery Boston Diagnostic Aphasia Examination Porch Index of Communicative Ability

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Syndromes of Aphasia

For additional information seeChapter 13

Shames, Wiig, & Secord

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Speech and Language Areas

AA P

Anterior speech centerPosterior language area

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Fluent Aphasias

Wernicke’s Aphasia Conduction Aphasia Transcortical Sensory Aphasia

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Wernicke’s Aphasia

Ofter lacks contentJargonNormal intonational structureReading and writing similarRepetition impaired

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Anomic Aphasia

Otherwise normal language marred by word-retrieval difficultiesAuditory and reading comprehension near normalWord problems present in writingRepetition usually better than spontaneously produced speech

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Conduction Aphasia

Comprehension of language highSpeech often marred by inappropriate words (usually result of incorrectsounds in words)May include table for chairFrequent self correctionsDifficulty making use of cues and repeating information supplied by others

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Transcortical Sensory Aphasia

Rare syndromeIsolated language centers from other cortical centersDramatic preservation in ability to repeat

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Nonfluent Aphasias

Broca’s Aphasia Transcortical Motor Aphasia Mixed Transcortical Aphasia Global Aphasia

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Broca’s Aphasia

Paucity of speechDifficulties in word retrievalLabored and slow rate of speechBetter comprehension of spoken and written language

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Transcortical Motor Aphasia

Intact repetition with Broca’s like symptomsTrouble initiating speech and writing

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Mixed Transcortical Aphasia

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Global Aphasia