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Speech/Language Function
BCS 242 NeuropsychologyFall 2004
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Brief Anatomy
In >96% of right-handers and 70% of left-handers, 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
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Brain areas involved in Language
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Basic Language Components Auditory Comprehension Visual Comprehension Articulation Word Finding Grammar/Syntax Repetition Verbal Fluency Writing Prosody
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Language Deficits Aphasia – spoken language Alexia – reading Agraphia - writing Anomia - naming Dysarthria - articulation
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Types of Language Errors
Paraphasia: Substitution of a word by a sound, an incorrect word,
or an unintended word Neologism:
Paraphasia with a completely novel word Nonfluent speech:
Talking with considerable effort Agraphia:
Impairment in writing Alexia:
Disturbances in reading
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19th Century Neuropsychology
Broca (1865) described patients who displayed halting, agrammatic speech Content words were well preserved Function words (i.e., adjectives, articles)
impaired
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Broca’s Aphasia
Patient “Tan” Brain tumor in Left frontal brain region Broca: Lesion disrupted speech
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Broca’s Aphasia
“Yes… ah… Monday… er… Dad and Peter H… (patient’s name), and Dad… er… hospital… and ah… Wednesday… Wednesday, nine o’clock… and oh… Thursday… ten o’clock, ah doctors… two… an’ doctors… and er… teeth…yah
Goodglass & Geschwind, 1976
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Broca’s Aphasia
Broca’s Aphasia – Damage to “motor images”
Language comprehension skills relatively preserved
Typically observed in patients with damage to left inferior prefrontal cortex
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Wernicke’s 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
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Wernicke’s Aphasia
“Well this is… mother is away here working her work out o’here to get her better, but when she’s looking in the other part. One their small tile into her time here. She’s working another time…”
Goodglass & Geschwind, 1976
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Broca’s, Wernicke’s Area, and Connections
Lichtheim’s (1885) and Geschwind’s (1965) model
Auditory input mediated by Wernicke’s area Motor output mediated byBroca’s area Regions connected by arcuate fasciculus
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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
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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
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Aphasia Syndromes III “Pure” Aphasias – selective
impairments with NORMAL speech production Alexia without Agraphia: poor reading Agraphia: poor writing Word Deafness: poor comprehension,
poor repetition
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Major Aphasia SyndromesType Production Comp. Repetition Naming
Global impaired impaired impaired impaired
Broca’s not fluent intact limited limited
Wernicke’s fluent/ impaired impaired impaired impaired
Anomic fluent/ intact intact impaired circumlocutory
Mixed/ impaired limited limited limitednonfluent
Conduction fluent/ intact impaired limitedcircumlocutory
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Right Hemisphere Contribution to Language Functions Good comprehension for gestural
language Prosody (inflection, timbre,
melody) Semantic language (word
recognition, verbal meaning, concepts, and especially visual meaning)
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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)