Aphasia: Symptoms and Syndromes

1. Ling 411 – 04 Aphasia:Symptoms and Syndromes

2. 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

3. 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

4. Simple Functions / Complex Functions Complex function Simple function

5. 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

6. 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

7. Aphasic Symptoms Varieties of language deficits Inferences from language deficits Problems of interpretation

8. 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.)

9. 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)

10. More, from a (different) Broca’s apasic • "Me ... build-ing ... chairs, no, no cab-in-ets. One, saw ... then, cutting wood ... working ..."

11. 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

12. 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)

13. 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

14. 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.”

15. 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.

16. Some speech of a conduction aphasic Patient: I came into the hospital for some tecs ... Some secs … tesk … T E S … tests. Goodglass 73

17. 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)

18. Examples from a picture-naming test Patient Target Word Response Mr. W. stethoscope telescope – not right (Broca) asparagus carrot – no pinwheel kite nozzle 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)

19. 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)

20. Perisylvian Aphasic Syndromes

21. The most common perisylvian aphasiasin order of frequency of occurrence • Broca Aphasia • Wernicke Aphasia • Conduction Aphasia

22. 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

23. Word classes in Broca aphasia • Mostly nouns • Some adjectives • A few verbs • Generally uninflected or in ‘-ing’ form • Function words few or non-existent

24. 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

25. 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?

26. 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

27. 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

28. 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?

29. 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

30. Coronal section, showing Sylvian fissure, insula, etc.

31. Example of Broca’s Aphasia http://www.youtube.com/watch?v=f2IiMEbMnPM&feature=related 2:25

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