Apraxias and Aphasias Flashcards
Which two parts of the brain are used in motor processing
Primary motor cortex and secondary motor cortex
Where is the primary motor cortex
In the pre central gyrus, anterior to the central sulcus
Relationship between primary motor and somatosensory cortex
Reciprocity in info sharing
Structural build up of the primary motor cortex
Homunculus, contralateral
Damage to primary motor cortex
Hemiplegia - loss of voluntary movement in half the body
What is hemiparesis?
Loss of sensation over half of the body
Three sections of the secondary motor cortex
- Supplementary motor area
- Promotor area
- Cingulate motor area
Location of the three components of the secondary motor cortex
Supplementary motor - anterior to the primary motor cortex
Premotor area - lateral to that
Cingulate motor - beneath the supplementary area
Function of supplementary motor area
- Plans motor sequences
- Stimulation elicits an urge or anticipation to make a movement or an internally cued readiness for action
Function of premotor area
- Externally cued readiness for action
- Sequencing, timing and initiation of voluntary movement
Function of cingulate motor area
- Emotional and motivational momentum for movement
- Has a role in the initiation of speech
- Damage can lead to a lack of spontaneous motor activity
Two mor regions used in movement and their functions
- Posterior parietal lobe: coordinating spatial mapping with motor programming
- Dorsolateral prefrontal cortex: executive programming for movement
Three sections of the secondary motor cortex
- Supplementary motor area
- Promotor area
- Cingulate motor area
Location of the three components of the secondary motor cortex
Supplementary motor - anterior to the primary motor cortex
Premotor area - lateral to that
Cingulate motor - beneath the supplementary area
Steps for planned movement
Prefrontal cortex plans –> premotor cortex sequences –> motor cortex the executes
Three definitions of apraxia
- Disorder of skilled and symbolic movement
- Mental movement disorder (it’s not physical)
- Loss of voluntary movement
How are apraxias usually acquired?
Generally not developmental, generally from damage to the left hemisphere but symptoms are bilateral
What does Limb Kinetic Apraxia look like?
Problems executing precise, independent and coordinated finger movements, usually only affecting finer movements on one upper extremity
How do limb kinetic apraxia patients present?
No kinetic melody, poor motor control and large grasping movements
Testing for limb kinetic apraxia
Doing up a button, opening a safety pin, putting a letter in an envelope, a key in a lock
Lesion site for limb kinetic apraxia
Precentral gyrus, contralateral to the side effected. Commonly found with Broca’s aphasia, with right upper limb hemiparesis
Presentation of ideomotor apraxia
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
Three kinds of impairment seen in ideomotor apraxia
- Buccofacial (oral, orofacial)
- Upper or lower limb (generally, but not always, bilateral)
- Truncal
Tests for ideomotor apraxia
Perform an imaginary movement (blow a kiss, drink through a straw, kick a ball etc.)
Lesion site for ideomotor apraxia
Left angular and supra marginal gyri
Presentation of ideation apraxia
Disturbance of complex motor planning of a higher order than ideomotor apraxia with an inability to manipulate the environment successfully
Testing for ideation apraxia
“Show me how you would make a cup of tea”
- actions may be performed out of order
- sometimes only individual actions can be performed
Lesion site for ideation apraxia
Dorsolateral prefrontal cortex, bilateral brain disease in the parietal lobe - is often seen with Alzheimer’s
Presentation of conceptual apraxia
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
Lesion site for conceptual apraxias
Posterior regions of the left hemisphere
Six areas in the brain important for language
- Broca’s
- Inferior frontal gyrus
- Wernicke’s
- Arcuate fasciculus
- Supramarginal gyrus
- Angular gyrus
Role of Broca’s area in language and its location
Language production, lies adjacent to facial area of the motor cortex
Role and location of the inferior frontal gyrus
Prepares speech into grammatically correct, semantically sound output (before the motor strip makes it out loud) - in the premotor area
Wernicke’s area’s role
Language comprehension
Role and location of the arcuate fasciculus
White matter fiber band that connects Wernickes to Broca’s and allows for collaboration for coherent speech
Function of the supramarginal gyrus
Assists in reading comprehension
Function of the angular gyrus
Comprehension, reading and writing, as well as being partially responsible for understanding metaphors
What is language?
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
What is an aphasia?
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
Things that aren’t aphasia
- 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
Six components of language
Reading, writing, repetition, production, naming and comprehension
Fluent vs non fluent aphasias
Anatomically correlate dichotomy, anterior vs posterior lesions
Markers of fluent speech
Abundant output, flowing, normal intonation, articulated, normal length phrases, few substantive words
Markers of non fluent speech
Scarce output, poor articulation, short sentences, only meaningful words, no articles or prepositions
Presentation of Broca’s aphasia
Non-fluent, aggrammatic, telegrammatic.
Symptoms of Broca’s aphasia
Relatively intact comprehension, anomia (has difficulty finding words), impaired repetition, can read and understand but not aloud
Add ons found with Broca’s
Right hemiplegia in the face and arm, limb kinetic apraxia on the left and tend to be painfully aware of the deficit.
Paraphasias in Wernicke’s
- 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)
Presentation of Wernicke’s
Inappropriate intonation, comprehension impaired, anomia, poor repetition, often impaired reading, usually anosognosic
Presentation of conduction aphasia
Fluent, frequent paraphasias, preserved comprehension, bad anomia, bad repetition
Presentation of transcortical motor aphasia
Non fluent, repetition is fine, comprehension spared, anomia
Lesion is superior/anterior to Broca’s
Presentation and lesion site of transcortical sensory aphasia
Fluent, repetition in tact, impaired comprehension, reading and writing
Lesion site is the angular gyrus, left parietal
Presentation and lesion site of mixed transcortical aphasia
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
Presentation of anomic aphasia
Everything is pretty much fine, the only issue is producing nouns
Lesion site for anomic aphasia
Focal damage to the left temporal and parietal areas; temporal is nouns, parietal is verbs
Presentation of global aphasia
Everything is impaired, often seen with hemiplegia.
