Apraxias and Aphasias

Question 1

Which two parts of the brain are used in motor processing

Answer 1

Primary motor cortex and secondary motor cortex

Question 2

Where is the primary motor cortex

Answer 2

In the pre central gyrus, anterior to the central sulcus

Question 3

Relationship between primary motor and somatosensory cortex

Answer 3

Reciprocity in info sharing

Question 4

Structural build up of the primary motor cortex

Answer 4

Homunculus, contralateral

Question 5

Damage to primary motor cortex

Answer 5

Hemiplegia - loss of voluntary movement in half the body

Question 6

What is hemiparesis?

Answer 6

Loss of sensation over half of the body

Question 7

Three sections of the secondary motor cortex

Answer 7

1. Supplementary motor area
2. Promotor area
3. Cingulate motor area

Question 8

Location of the three components of the secondary motor cortex

Answer 8

Supplementary motor - anterior to the primary motor cortex
Premotor area - lateral to that
Cingulate motor - beneath the supplementary area

Question 9

Function of supplementary motor area

Answer 9

• Plans motor sequences

- Stimulation elicits an urge or anticipation to make a movement or an internally cued readiness for action

Question 10

Function of premotor area

Answer 10

• Externally cued readiness for action

- Sequencing, timing and initiation of voluntary movement

Question 11

Function of cingulate motor area

Answer 11

• Emotional and motivational momentum for movement
• Has a role in the initiation of speech
• Damage can lead to a lack of spontaneous motor activity

Question 12

Two mor regions used in movement and their functions

Answer 12

1. Posterior parietal lobe: coordinating spatial mapping with motor programming
2. Dorsolateral prefrontal cortex: executive programming for movement

Question 13

Three sections of the secondary motor cortex

Answer 13

1. Supplementary motor area
2. Promotor area
3. Cingulate motor area

Question 14

Location of the three components of the secondary motor cortex

Answer 14

Supplementary motor - anterior to the primary motor cortex
Premotor area - lateral to that
Cingulate motor - beneath the supplementary area

Question 15

Steps for planned movement

Answer 15

Prefrontal cortex plans –> premotor cortex sequences –> motor cortex the executes

Question 16

Three definitions of apraxia

Answer 16

1. Disorder of skilled and symbolic movement
2. Mental movement disorder (it’s not physical)
3. Loss of voluntary movement

Question 17

How are apraxias usually acquired?

Answer 17

Generally not developmental, generally from damage to the left hemisphere but symptoms are bilateral

Question 18

What does Limb Kinetic Apraxia look like?

Answer 18

Problems executing precise, independent and coordinated finger movements, usually only affecting finer movements on one upper extremity

Question 19

How do limb kinetic apraxia patients present?

Answer 19

No kinetic melody, poor motor control and large grasping movements

Question 20

Testing for limb kinetic apraxia

Answer 20

Doing up a button, opening a safety pin, putting a letter in an envelope, a key in a lock

Question 21

Lesion site for limb kinetic apraxia

Answer 21

Precentral gyrus, contralateral to the side effected. Commonly found with Broca’s aphasia, with right upper limb hemiparesis

Question 22

Presentation of ideomotor apraxia

Answer 22

A loss of meaning of movement and ideas associated with movement, patients can perform previously learnt motor acts accurately. There is a disconnected between intention and motor sequence

Question 23

Three kinds of impairment seen in ideomotor apraxia

Answer 23

1. Buccofacial (oral, orofacial)
2. Upper or lower limb (generally, but not always, bilateral)
3. Truncal

Question 24

Tests for ideomotor apraxia

Answer 24

Perform an imaginary movement (blow a kiss, drink through a straw, kick a ball etc.)

Question 25

Lesion site for ideomotor apraxia

Answer 25

Left angular and supra marginal gyri

Question 26

Presentation of ideation apraxia

Answer 26

Disturbance of complex motor planning of a higher order than ideomotor apraxia with an inability to manipulate the environment successfully

Question 27

Testing for ideation apraxia

Answer 27

"Show me how you would make a cup of tea" - actions may be performed out of order - sometimes only individual actions can be performed

Question 28

Lesion site for ideation apraxia

Answer 28

Dorsolateral prefrontal cortex, bilateral brain disease in the parietal lobe - is often seen with Alzheimer's

Question 29

Presentation of conceptual apraxia

Answer 29

Loss of concept of objects and their uses, so misusing of objects, not knowing which object to use for which task and difficulty matching objects and actions

Question 30

Lesion site for conceptual apraxias

Answer 30

Posterior regions of the left hemisphere

Question 31

Six areas in the brain important for language

Answer 31

1. Broca's 2. Inferior frontal gyrus 3. Wernicke's 4. Arcuate fasciculus 5. Supramarginal gyrus 6. Angular gyrus

Question 32

Role of Broca's area in language and its location

Answer 32

Language production, lies adjacent to facial area of the motor cortex

Question 33

Role and location of the inferior frontal gyrus

Answer 33

Prepares speech into grammatically correct, semantically sound output (before the motor strip makes it out loud) - in the premotor area

Question 34

Wernicke's area's role

Answer 34

Language comprehension

Question 35

Role and location of the arcuate fasciculus

Answer 35

White matter fiber band that connects Wernickes to Broca's and allows for collaboration for coherent speech

Question 36

Function of the supramarginal gyrus

Answer 36

Assists in reading comprehension

Question 37

Function of the angular gyrus

Answer 37

Comprehension, reading and writing, as well as being partially responsible for understanding metaphors

Question 38

What is language?

Answer 38

Process of rapid translation, understanding and expression of symbolic information, be it written or spoken. It's interactive, between external input and an extensive internal store of knowledge

Question 39

What is an aphasia?

Answer 39

A disruption in a level of language that is higher mental functioning, not mechanical. It is acquired, through neurological damage and they come in degrees

Question 40

Things that aren't aphasia

Answer 40

- Developmental disorders of language - Purely motor speech disorders, stemming from issues with the oral motor apparatus - Language disorders that are secondary to primary thought disorders

Question 41

Six components of language

Answer 41

Reading, writing, repetition, production, naming and comprehension

Question 42

Fluent vs non fluent aphasias

Answer 42

Anatomically correlate dichotomy, anterior vs posterior lesions

Question 43

Markers of fluent speech

Answer 43

Abundant output, flowing, normal intonation, articulated, normal length phrases, few substantive words

Question 44

Markers of non fluent speech

Answer 44

Scarce output, poor articulation, short sentences, only meaningful words, no articles or prepositions

Question 45

Presentation of Broca's aphasia

Answer 45

Non-fluent, aggrammatic, telegrammatic.

Question 46

Symptoms of Broca's aphasia

Answer 46

Relatively intact comprehension, anomia (has difficulty finding words), impaired repetition, can read and understand but not aloud

Question 47

Add ons found with Broca's

Answer 47

Right hemiplegia in the face and arm, limb kinetic apraxia on the left and tend to be painfully aware of the deficit.

Question 48

Paraphasias in Wernicke's

Answer 48

- Semantic (there is a semantic relationship between the error and the intended word) - Remote (words are unconnected) - Neologistic (words aren't in the patient's language) - Literal or phonemic (half of the intended word is there, but the other half has been substituted, rearranged or extra added)

Question 49

Presentation of Wernicke's

Answer 49

Inappropriate intonation, comprehension impaired, anomia, poor repetition, often impaired reading, usually anosognosic

Question 50

Presentation of conduction aphasia

Answer 50

Fluent, frequent paraphasias, preserved comprehension, bad anomia, bad repetition

Question 51

Presentation of transcortical motor aphasia

Answer 51

Non fluent, repetition is fine, comprehension spared, anomia Lesion is superior/anterior to Broca's

Question 52

Presentation and lesion site of transcortical sensory aphasia

Answer 52

Fluent, repetition in tact, impaired comprehension, reading and writing Lesion site is the angular gyrus, left parietal

Question 53

Presentation and lesion site of mixed transcortical aphasia

Answer 53

Literally can only repeat, the combo of the transcortical aphasias makes it impossible to comprehend or produce language Lesion site is the mesial surface of the supplementary motor area

Question 54

Presentation of anomic aphasia

Answer 54

Everything is pretty much fine, the only issue is producing nouns

Question 55

Lesion site for anomic aphasia

Answer 55

Focal damage to the left temporal and parietal areas; temporal is nouns, parietal is verbs

Question 56

Presentation of global aphasia

Answer 56

Everything is impaired, often seen with hemiplegia.