by mtoom


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What is aphasia?
An impairment of language produced by brain dysfunction
What are dysprosody and aprosody?
Impairment (dys) or lack (a) of vocal intonation
Describe the hemispheric specialization of language
Language processed primarily in dominant hemisphere
  • Left hemisphere in 95% of right-handed persons
  • Left hemisphere in 70% of left-handed persons 
Describe the important function(s) of Broca's area?
Production of language
  • Interacts with many surrounding areas in frontal cortex 
Describe the important function(s) of Wernicke's area?
Comprehension of language
  • Interacts with many surrounding areas in parietal cortex
Where is Broca's area?
Frontal cortex
  • Anterior to the premotor association area 
Where is Wernicke's area?
Temporal lobe
  • Parietal and temporal lobes around the lateral fissure
What is the arcuate fasciculus?
  • What does it do with regard to speech? 
Bundle of axons that forms part of the superior longitudinal fasciculus
  • Connects Broca's and Wernicke's areas

Important role in repetition
What is dysarthria?
  • What type of disorder is it?
  • What does it result from? 
Poor articulation of phonemes
  • Motor speech disorder
  • Results from damage to motor component of the motor-speech system 
What can cause of dysarthria? (5)
  • UMN lesions
  • LMN lesions
  • NMJ lesions
  • Cerebellar lesions
  • Extrapyramidal lesions
What are the ways that speech is evaluated? (6)
  • Articulation
  • Fluency
  • Effort
  • Word-finding
  • Paraphasias
  • Prosody
Define fluency
Smoothness or flow with which sounds, syllables, words and phrases are joined together when speaking
Define effort
How difficult it is to formulate speech
  • Often related to fluency 
Define word-finding
Trouble finding words
  • Ranges from "tip-of-the-tongue" feeling to profound difficult finding words 
Define the following:
  • Phonemic (literal) paraphasias
  • Semantic paraphasis 
  • Phonemic (literal) paraphasias: Sound substitution
     
  • Semantic paraphasias: Word substitution
Define neologism
Made-up word
Define prosody
Intonation of speech, especially as used to convey emotion
What can cause dysprosody or aprosody? (1)
Can be caused by non-dominant hemisphere lesions
What are the examinable components of speech? (6)
  • Speech
  • Auditory comprehension
  • Repetition
  • Naming
  • Writing
  • Reading
How might auditory comprehension be examined? (4)
  • Yes/no questions
  • Multiple choice questions
  • Point to objects/parts
  • Commands ranging from simple to complex
How can repetition be examined? (3)
  • Single words
  • Phrases
  • Complex sentences
Define anomia
Impaired ability to name things in the absence of any other language problem
How does one examine the ability to name things?
Ask patient to name objects
  • Begin with high frequency objects then move to lower frequency objects 
What components of writing/reading are examined:
Writing:
  • Writing words
  • Writing sentences
Reading:
  • Oral
  • Comprehension 
How are aphasia symptoms classified? (4)
According to language examination:
  • Output (Speech/Writing)
  • Comprehension (Auditory/Reading)
  • Repetition
  • Naming 
Describe a non-fluent aphasia (3)
  • What are the non-fluent aphasias? (4) 

Features of non-fluent aphasias:
  • Decreased output
  • Effortful
  • Decreased phrase length

Non-fluent aphasias:
  • Global
  • Mixed transcortical
  • Broca's
  • Transcortical
What is global aphasia?
All components of language are affected
  • Nonfluent/absent speech production
  • Impaired comprehension
  • Impaired repetition 
What is the usual cause of global aphasia?
Damage to both Broca's and Wernicke's area
What is mixed transcortical aphasia?
Damage to areas that communicate with Broca's and Wernicke's areas

Non-fluent, non-comprehending:
  • Non-fluent or absent speech production
  • Impaired comprehension
  • Repetition is preserved
Broca's and Wernicke's and the arcuate fasciculus are functional
What structures are required for intact repetition? (3)
  • Broca's
  • Wernicke's
  • Arcuate fasciculus
Therefore, the following aphasias have impaired repetition:
  • Broca's aphasia
  • Wernicke's aphasia
  • Conduction aphasia (relates to arcuate fasciculus)
  • Global aphasia
What is Broca's aphasia?
  • Describe key features
Damage to Broca's area

Non-fluent, non-repeating

Because Broca's aphasia is a type of motor aphasia:
  • Content words > function words (agrammatic speech)
  • Paraphasias rare
  • Comprehension is good
What is transcortical motor aphasia?
  • Describe key features
Damage to to other areas of the frontal lobes that communication with Broca's area

Non-fluent only (repetition and comprehension intact)

Because transcortical motor aphasia is a type of motor aphasia:
  • Content words > function words (agrammatic speech) 
  • Paraphasis rare
  • Comprehension good
What are the fluent aphasias? (4)
  • Wernicke's aphasia
  • Transcortical sensory aphasia
  • Conduction aphasia
  • Anomic aphasia
What causes Wernicke's aphasia?
  • Describe key features 
Damage to Wernicke's area

Fluent, non-repetitive, non-comprehension

Because it is a sensory aphasia, it also has the following:
  • Function words > content words (empty speech)
  • Paraphasias common 
What causes transcortical sensory aphasia?
  • Describe key features 
Damage to other areas of the temporal/parietal lobe that communicate with Wernicke's area

Fluent, non-comprehension

Because it is a sensory aphasia, it also has the following:
  • Paraphasias common
  • Function words > content words (empty speech)
What causes conduction aphasia?
  • Describe key features 
Damage to peri-Sylvian areas affecting arcuate fasciculus

Fluent, non-repetitive
  • Repitition severely impaired
  • Frequent paraphasias
What is anomic aphasia?
  • What causes it?
  • What are the key features? 
Impaired naming and occasional paraphasias
  • Anatomically non-specific, usually caused by smaller lesions 
  • Fluent, comprehension intact, repetition intact
  • Only impaired naming and occasional paraphasias
What feature is impaired in all aphasias?
Naming
Which aphasias have paraphasias?
All four fluent aphasias that we need to know have paraphasias, these include:
  • Sensory aphasias:
    -Wernicke's
    -Transcortical sensory aphasia
  • Conduction aphasia (frequent paraphasias)
  • Anomic aphasia (occasional paraphasias)
What are the sensory aphasias? (2)
  • Wernicke's aphasia
  • Transcortical sensory aphasia
What are the symptoms of sensory aphasias? (3)
  • Fluent
  • Function words > content words (empty speech)
  • Paraphasias common
  • Comprehension impaired
What are the motor aphasias? (2)
  • Broca's aphasia
  • Transcortical motor aphasia
What are the symptoms of motor aphasias? (4)
  • Non-fluent
  • Content words > function words (agrammatic speech)
  • Paraphasias rare
  • Comprehension is good
Knowing only about the anatomy of the lesion, how do you predict if the patient's speech is fluent?
If the lesion damages Broca's area or cortical areas that communicate with Broca's area, then speech is non-fluent.
What is telegraphic speech?
Speech containing mostly content words
  • Sort of like baby talk: "candy" or "no bath"
Which aphasias have telegraphic speech?
Motor aphasias
  • Broca's aphasia
  • Transcortical motor aphasia 
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