aphasia: symptoms and syndromes
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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 deficitsInferences 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 Aphasia2. Wernicke Aphasia3. 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
end
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