Wernicke’s & Broca's aphasia

Wernicke’s & Broca's aphasia Brain & Language LING 411/412/489 NSCI 411/611/489/689 Harry Howard Tulane University

Wernicke’s aphasia aka posterior aphasia aka receptive aphasia

Introduction • Imagine your favorite doctor joke. • They usually begin with “a guy walks into a doctor’s office …” • Now imagine that the guy, or woman, is a patient with Wernicke’s aphasia … Brain & Language, Harry Howard, Tulane University

Short samples of Wernicke’s aphasia • Clinician: “Tell me where you live.” • Patient: “Well, it’s a meender place and it has two … two of them. For dreaming and pinding after supper. And up and down. Four of down and three of up …” (Brookshire 2003:155) • Clinician: “What’s the weather like today?” • Patient: “Fully under the jimjam and on the altigrabber.” (Brookshire 2003:155) • What is broken? What is preserved? Brain & Language, Harry Howard, Tulane University

A long sample of Wernicke’s aphasia • Patient is asked what brought him to the hospital. • “Is this some of the work that we work as we did before? … All right … From when wine [why] I’m here. What’s wrong with me because I … was myself until the taenz took something about the time between me and my regular time in that time and they took the time in that time here and that’s when the the time took around here and saw me around in it’s started with me no time and I bekan [began] work of nothing else that’s the way the doctor find me that way…” (Obler & Gjerlow 1999:43) Brain & Language, Harry Howard, Tulane University

Phonemic paraphasia & neologism • Errors in the selection of phonemes include addition, omission, or change in position. For instance, Damasio (1992:535) cites • trable for table • pymarid for pyramid. • Clearly, the more such phonemic paraphasias accumulate in a word, the harder it is to understand it, to the extent that the intended word may become unidentifiable. • This is the point of neologism, illustrated in another of Damasio’s examples: • hipidomateous for hippopotamus. • Patients with severe Wernicke’s aphasia may produce strings of neologisms with a sprinkling of connecting words, known as jargon Brain & Language, Harry Howard, Tulane University

Wernicke's aphasia on YouTube • http://www.youtube.com/watch?v=B-LD5jzXpLE Brain & Language, Harry Howard, Tulane University

Semantic paraphasia • A patient with damage to Wernicke’s region may also fail to select the proper words with which to convey her ideas, though this deficit can be compensated for by the usage of paraphrases. • Such semantic paraphasias (or empty speech) are often quite simple, such as relying on generic terms like thing or stuff to stand in for the more specific words that do not spring to mind. • Other times, they become quite elaborate. • Kandel (1995:640) cites the example of a Wernicke’s patient who was asked where he lived and answered: • “I came there before here and returned there.” • “A patient with moderate Wernicke’s aphasia was attempting to explain what he had done on a shopping trip the previous day. He concluded with, • ‘I went down to the thing to do the other one and she was only the last one that ever did it, so I never did.’” (Brookshire 2003:155) Brain & Language, Harry Howard, Tulane University

Circumlocution • Some Wernicke’s patients talk around missing words, a behavior called circumlocution. • A patient with moderate Wernicke’s aphasia was attempting to tell the examiner what she had had for breakfast that morning: • Patient: “This morning for – that meal – the first thing this morning – what I ate – I dined on – chickens, but little – and pig – pork – hen fruit and some bacon, I guess.” (Brookshire 2003:156) Brain & Language, Harry Howard, Tulane University

Wernicke's aphasia on YouTube • http://www.youtube.com/watch?v=aVhYN7NTIKU Brain & Language, Harry Howard, Tulane University

Logorrhea, press of speech • The ease with which Wernicke’s patients produce speech, their circumlocution, and their deficient self-monitoring may contribute to their inclination to run on when they talk. • Such an overabundance of speech is referred to as logorrhea or press of speech. • Clinician: “Tell me what you do with a comb.” Brain & Language, Harry Howard, Tulane University

Logorrhea, press of speech Patient: “What do I do with a comb … what I do with a comb. Well a comb is a utensil or some such thing that can be used for arranging and rearranging the hair on the head both by men and by women. One could also make music with it by putting a piece of paper behind and blowing through it. Sometimes it could be used in art – in sculpture, for example, to make a series of lines in soft clay. It’s usually made of plastic and usually black, although it comes in other colors. It is carried in the pocket or until it’s needed, when it is taken out and used, then put back in the pocket. Is that what you had in mind?” (Brookshire 2003:155) Brain & Language, Harry Howard, Tulane University

Reading • Reading can also be disrupted? • Why? • Because reading connects to speech for the pronunciation of letters and the storage of words Brain & Language, Harry Howard, Tulane University

comprehension of spoken material comprehension of written material segmental phonology word selection word semantics fluency (production of speech) production of writing use function words grammaticality repetition of what others say conversational proficiency, e.g. turn taking concern about impairment concern about errors short-term retention & recall of verbal materials impaired, mild to severe impaired impaired: phonemic paraphasia, neologism, jargon impaired: circumlocution impaired: semantic paraphasia, empty speech (overly) fluent: logorrhea normal normal normal or mildly impaired: paragrammatism impaired: (no evidence) normal little to none little to none impaired: (no evidence) Aphasia checklist: Wernicke’s Brain & Language, Harry Howard, Tulane University

The effect of WA on cerebral function Brain & Language, Harry Howard, Tulane University

Broca's aphasia • aka expressive aphasia • aka anterior aphasia • aka agramamtic aphasia Brain & Language, Harry Howard, Tulane University

Describe this picture (silently!) Brain & Language, Harry Howard, Tulane University

Broca's aphasia sample #1 • Examiner: Describe this picture. • Patient: kid … kk … can … cookie … caandy …well I don’t know but it’s writ … easy does it … slam … early … fall … men … many … no … girl. Dishes … soap … water … … water … falling pah that’s all … dish … that’s all. Cookies … can … candy … cookies cookies … he … down … That’s all. Girl … slipping water … water … and it hurts … much to do. Her … clean up. Dishes … up there … I think that’s doing it • Examiner: What is she doing with the dishes? • Patient: discharge no … I forgot … dirtying clothes [?] dish {?} water … • Examiner: What about it? • Patient: slippery water … [?] scolded … slipped Brain & Language, Harry Howard, Tulane University

Broca's aphasia sample #2 • Examiner: Describe this picture. • Patient: uh … mother and dad … no … mother … dishes … uh … runnin[g] over … water … and floor … and they … uh … wipin[g] dis[h]es … and … uh … two kids … uh … stool … and cookie … cookie jar … uh … cabinet and stool … uh … tippin[g] over … and … uh … bad … and somebody … gonna get hurt. Brain & Language, Harry Howard, Tulane University

Broca's aphasia on YouTube • Broca's aphasia (1) • Broca's aphasia (2) Brain & Language, Harry Howard, Tulane University

Content words noun verb adjective adverb Function words article demonstrative conjunction coordinating subordinating pronoun preposition Background: word classes Brain & Language, Harry Howard, Tulane University

Background: morphology • Inflectional • noun • plural • verb • present and past tenses • present and past participles • adjective • comparative, superlative • Derivational • un-, -ify, etc., etc Brain & Language, Harry Howard, Tulane University

Breakdowns in grammar • Breakdown in morphology • Patients express nouns in the singular and verbs in the infinitive or participle • Breakdown in modifying parts of speech • Patients often eliminate articles, adjectives, and adverbs altogether. • Instead of saying “I saw some large gray cats”, a patient with Broca’s aphasia might say “see gray cat”. Brain & Language, Harry Howard, Tulane University

The overall result • All this leads to a breakdown in syntax • For the sentence, “Ladies and gentlemen, you are now invited into the dining room”, a patient with Broca’s aphasia may only be able to say “Ladies, men, room.” • When asked his occupation, a mailman with Broca’s aphasia said “Mail … mail … m ….” • The examples are remarkable in that they appear to be constructed almost entirely by juxtaposition of isolated words. • They are practically devoid of the markers of grammatical relationships that bind together normal English – with the exception of and. • They also involve distortion of word order. • Damasio, 1992, p. 533, cites the attempt of a Broca’s aphasiac to express I will go home tomorrow coming out as Go I home tomorrow. • Altogether, this is called agrammatism or telegraphic speech Brain & Language, Harry Howard, Tulane University

Reversible sentences • The (b) sentences of each pair are difficult for Broca's patients to understand compared to the (a) sentences: • 1a) The boy ate the apple. • 1b) The clown chased the violinist. • 2a) The cop shot the robber. • 2b) The robber was shot by the cop. • 3a) It was the cop who __ shot the robber. • 3b) It was the robber who the cop shot __. Brain & Language, Harry Howard, Tulane University

Repetition of one's own speech • The most famous case is that of Broca’s first patient, who could only say the (French) word "tan", which he repeated often, and so was known as "Tan". • Uncontrollable repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, usually caused by brain injury or other organic disorder. • This is know as perseveration. Brain & Language, Harry Howard, Tulane University

Summary of main symptoms • Impaired production of speech • mild: non-fluent • severe: Broca’s Tan (perseveration) • Non-fluent speech: • effortful: slow, deliberate, halting, with pauses between words and even syllables, false starts • misarticulated: distorted consonants and vowels, called phonetic dissolution • Laconic speech: • short utterances with few function words (agrammatism or telegraphic speech) • Good short-term retention & recall of verbal materials • may generalize treatment skills & strategies to daily life • Great concern about their impairment and the errors they make Brain & Language, Harry Howard, Tulane University

comprehension of spoken material comprehension of written material segmental phonology word selection word semantics fluency (production of speech) production of writing use function words grammaticality repetition of what others say conversational proficiency, e.g. turn taking concern about impairment concern about errors short-term retention & recall of verbal materials other normal normal impaired: phonetic dissolution normal normal impaired: mild to severe (perseveration) impaired impaired: agrammatism or telegraphic speech impaired impaired (no evidence) normal yes yes normal -- Broca's aphasia checklist Brain & Language, Harry Howard, Tulane University

Wernicke’s & Broca's aphasia