Chapter 8 Aphasias Flashcards
Argument for classifying aphasias
Different areas of the brain control different functions so,
different types of aphasias have different lesion sites and,
different lesion sites produce distinctively different types of symptoms
Different types of aphasias require different forms of Tx
Arguments against classifying aphasias
Brain is thought to function as integrated unit in controlling language
Factors used in classifying aphasias
Speech fluency Paraphasias Repetitions Language comprehension Site of lesion
Classification by fluency
Non-Fluent and Fluent aphasias
Non Fluent aphasias
Speaking is slow, halting, and with effort: Broca's Transcortical Motor Aphasia (TMA) Mixed Transcortical Aphasia (MTA) Global Aphasia
Fluent Aphasia
Speaking is smooth and effortless: Wernicke's Transcortical Sensory Aphasia (TSA) Conduction Aphasia Anomic Aphasia
Classification by comprehension
Receptive Aphasia & Expressive Aphasia
Receptive Aphasia
Primary difficulties are in area of comprehension
Expressive Aphasia
Primary difficulties are in the area of expression
Classification by site of lesion
Damage to the cortical centers for language (served by the middle cerebral artery)
Damage to the association fiber tracts important for language
Damage to the subcortical area
Anomic aphasia does not have a clear localization
Aphasia caused by damage to the cortical area
Broca’s, Wernicke’s, and Global
Aphasia caused by damage to the association fiber tract
Conduction & Transcortical sensory, motor, and mixed aphasias
Broca’s (motor) Aphasia
Damage to lower part of the premotor cortex important for planning and performing expressive language
Damage to the anterior portion of the middle cerebral artery
Often accompanied by right sided hemiplegia or hemiparesis
Broca’s aphasia language characteristics
Nonfluent Agrammatic Monotonous speech May have misarticulations Lacking function words Impaired repetition Written language similar to spoken Comprehension better than their expressive spoken and written language Good self-monitoring
Wernicke’s (sensory) aphasia
Damage to posterior superior temporal lobe of language dominant hemisphere
Damage to posterior branch of the cerebral middle artery
Wernicke’s aphasia language characteristics
Fluent Impaired auditory comprehension is dominant characteristic Paraphasias, neologisms, jargon Empty speech May have circumlocution Press of speech (logorrhea) Handwriting resembles speech If aphasia is mild, may be aware of errors Less concern with speech than Broca’s
Global aphasia
Damage to trunk of middle cerebral artery which causes massive damage to the entire perisylvian area
Broca’s or Wernicke’s sometimes spared
Severe deficits are demonstrated in all areas of language function
Global aphasia language characteristics
Language limited to few words, exclamations
stereotypical utterances
overlearned phrases (How are you?). May perseverate on these words,
Severely impaired comprehension
Reading and writing also terrible
Usually attentive, alert socially appropriate – different than dementia
May be able to perform nonverbal tasks OK – picture matching, etc.
Performance is better when dealing with personal information
Conduction aphasia
Rare (5-10%), Probable sites of lesions: lesions in insula,
upper temporal or lower parietal lobe Damage arcuate fasiculus and /or supramarginal gyrus.
Conduction aphasia language characteristics
Wernicke’s thought by most to be spared Comprehension somewhat spared
Most dominant feature - great difficulty with repetition
Multisyllabic words more difficult than monosyllabic words
Repetition impairment is disproportionate to other impairments.
Rate, intonation and stress are usually normal
May produce paraphasias.
Difficulties reading out loud because oral reading depends on communication between Wernicke’s and Broca’s.
Word retrieval problems are usually quite evident – resulting in inappropriate pauses and/or empty speech.
Writing is usually legible but may contain spelling errors & letter omissions.
Alert and attentive and aware of errors.
self-correction aren’t typically successful
Transcortical aphasias
Spares Broca’s, Wernicke’s, and arcuate fasciculus
Defining characteristic is that repetition is preservered
Transcortical Motor Aphasia (TMA)
Damage to anterior superior frontal lobe and association pathways
Areas affected are supplied by anterior cerebral artery and anterior branch of middle cerebral artery
TMA language characteristics
Markedly reduced speech output
Good repetition (this differentiates it from Broca’s)
Good auditory comprehension
Disturbed writing
Difficulty initiating speech- inertia
May have right sided hemiparesis or hemiplegia
Attentive and alert
Transcortical Sensory Aphasia (TSA)
Damage to posterior temporoparietal region sparing Wernicke’s
TSA language characteristics
Preserved repetition – unlike Wernicke’s
No problem with inertia in initiating speech (unlike TMA)
May often have echolalia
Lesion isolates Wernickes area from rest of brain, so major deficits in comprehension of spoken & written language occur.
Visual cortex is isolated from Wernicke’s causing difficulty in reading.
Fluent but empty speech (like Wernicke’s)
Don’t have press of speech (not like Wernicke’s)
Difficulty following commands
Mixed Transcortical Aphasia (MTA)
Rare, Damage that spares the major language areas but separates them from rest of brain
Damage often occurs in watershed area
Often occurs following conditions that reduce blood flow through cerebral arteries such as: carbon monoxide poisoning, cerebral hypoxia, etc.
(MTA) language characteristics
Similar to global aphasia except with better repetition
Parrot like repetition of what others say - like an echolalia
Nonfluent - very limited spontaneous output
NO functional auditory comprehension
Severely impaired writing and reading skills
Anomic aphasia
Naming difficult, no clear localization, damage may occur to angular gyrus or inferior temporal gyrus
Anomic aphasia language characteristics
Sever word retrieval
May have mild auditory comprehension impairment
Circumlocution and substitutions
Reading and writing is good
Subcortical aphasias
Anterior syndrome
Posterior syndrome
Anterior-posterior syndrome
Thalamic aphasia
Anterior syndrome
Caused by damage to internal capsule & lenticular process extending into anterior white matter
Anterior syndrome language characteristics
Hemiplegic Slow dysarthric speech Good comprehension Good repetition Poor oral reading and writing
Posterior syndrome
Damage to putamen and internal capsule extending into posterior white matter
Posterior syndrome language characteristics
Hemiplegic Fluent speech without dysarthria Poor comprehension Good single word repetition Impaired reading and writing Poor confrontational naming
Anterior-posterior syndrome
Damage to internal capsule and putamen with both anterior and posterior extensions of white matter
Anterior-posterior language characteristics
Mixture of symptoms consistent with both Broca’s and Wernicke’s aphasia.
Thalamic aphasia
Damage to the thalamus
Thalamic aphasia language characteristics
Hemiplegic Difficulty initiating speech Speech is echolalic and neologistic Auditory comprehension and reading is good Writing is impaired Word-finding problems are common
Aphasia a with fair to good comprehension
Broca’s, conduction, anomic, and transcortical motor
Aphasia with poor comprehension
Wernicke’s, transcortical sensory, global
Aphasias with poor repetition
Broca’s (labored), global
