Chapter 29: Communication, Directing Attention, and Spatial Cognition

Question 1

Temporoparietal Area

Answer 1

• Cognitive intelligence (“convergent” thinking)
• Communication (written but especially oral communication)
• Directing attention
• Comprehending space (spatial relations)

Question 2

Communication

Answer 2

In 95% of adults the cortical areas responsible for understanding language and producing speech are in the LEFT hemisphere.

In 95% of adults the cortical areas responsible for understanding and producing the paraverbal and nonverbal aspects of speech are in the RIGHT hemisphere.

Question 3

Communication

Answer 3

1) Discrimination- temporal lobe- auditory sensation- start to discriminate or describe sounds (pitch, volume) *Primary auditory cortex
2) Classification- Takes langue and ships it off to another place, takes everything else and gives meaning out of it (differentiate footsteps from a doorbell) *Secondary auditory cortex
3) Wernicke’s area- Little piece of temporoparietal junction- Part of the brain that understands speech and language
4) Link- Between stimulus and response. In head there are bundles of white matter, back to front. Association fibers- associate one lobe with another
5) Broca’s area- Motor- creates motor plan for saying the words I am thinking. Hands off to area number 6.
6) Primary motor cortex- Pre-central gyrus (primary motor cortex)- sent to the brainstem and the CNs (CN VII to move mouth and say ohh and ahh, XII move tongue, V- move jaw, X- resonating cavity, uses corticobrainstem fibers to get there.

Projection fibers- up and down fibers
Commisural fibers- side to side fibers- connect language to meaning.

Question 4

Communication- Paraverbal aspects

Answer 4

Right hemisphere-

Area analogous to Wernicke’s- decodes praraverbal aspects of speech- what you hear- helps to interpret the inflection that goes with the words.

Are analogous with Broca’s- help create the inflection that goes with the words- Commissural fibers- side to side
- Helps put inflections with speech.

Question 5

Language Disorders

Answer 5

Aphasia- Impaired spoken language

• Comprehending
• Speaking

Alexia- impaired comprehension of written language

Agraphia- Impaired ability to write

Question 6

Language Disorders- Wernicke’s

Answer 6

• Impaired langue comprehension
• Impairs speaking in addition to hearing
• “Receptive_- Troubles receives receiving language
• “sensory”
• “fluent”
• Also alexia and paraphrasia

Damage to the temporoparietal junction in the left hemisphere.

Paraphrasia- to talk around something-instead of saying marker, may say “that fat pen that you write on the board with” (talk around and describe it).

PT role is to mostly understand this and work around it.

Question 7

Language Disorders- Broca’s

Answer 7

• Impaired language expression
• May still say simple or habitual phrases- “No” or “Mama” same word used for everything.
• “Expressive”
• “Motor”
• “Nonfluent”
• Writing also impaired- may be agraphia

-Impaired language expression
Treatment- gestures, using symbolism and pointing.

Question 8

Language Disorders- Global aphasia

Answer 8

-Inability to use language in any form

Impaired

• Comprehension of spoken language
• Speaking
• Reading
• Writing

Large lesion

Much more rare- involved the entire area- especially 3, 4, and 5

Middle cerebral artery most likely to affect these areas.

Question 9

Area analogous to Wernicke’s

Answer 9

• Difficulty interpreting paraverbal and nonverbal

- This will be a person who can’t tell the difference between two types of phrases (yea, sure).

Question 10

Area analogous to Broca’s

Answer 10

• Difficulty creating paraverbal and nonverbal

- Flat affect- Same pitch and inflection. No melody to speech production.

Question 11

Spatial Perception

Answer 11

Right temporoparietal

Spatial relations Schemas

• The body (in relation to the body)
• The body (in relation to surroundings)- levi is to my life
• The world (in relation to itself)- Aurpe is to the north of massman.

Question 12

Neglect

Answer 12

• Usually following damage of right temporoparietal
• This leads to “left neglect”- left person, left extra personal space, how world organizes around that person.
• Neglect often confused with confusion or lack of cooperation- is not (no left side to refer to)

Question 13

Neglect

Answer 13

Personal neglect
-Lack of attention to one side of body

Anosognosia-

• Deny deficits on impaired side
• May believe impaired limb belongs to someone else.

Teach to scan with eyes- start in right space and draw body and vision to the left.

Left homonymous hemianopsia- more likely to scan to the left.

Treatment- Bring to sides of hand together and bring the whole body to the left, weight bear on left, bring the head to the left with the body.

Anosognosia- complete denial of any deficit.

Question 14

Neglect

Answer 14

Spatial neglect-

• The body (in relation to the body)
• The body (in relation to surroundings)
• The world (in relation to itself)

Difficulty with dressing- may only dress one side, and some patients may try to put elbow through arm hole first.

Construction- often just a spatial relations deficit.
-indicates it is right parietotemporal area

Navigation- patient doesn’t understand how world exists in relation to itself. Trying to copy a map.

Can easily wonder somewhere and not understand how to get back.

Left hemiparesis