INTRODUCTION TO APHASIA Flashcards
What we need to understand about patients
who are neurologically impaired
Neurological basis of speech and language
* Function-structure relationship
* Outcomes of brain damage related to language
areas
* Providing evidence-based intervention
Perisylvian Zone / Language Zone
Perisylvian Zone in the dominant hemisphere
includes …..
* Broca’s area
* Wernicke’s area
* Supramarginal gyrus
* Angular gyrus
* Major long association tracts e.g., arcuate fasciculus
* Perisylvian vs. Extrasylvian areas
Aphasia –
Root word
Which hemisphere is affected ?
Aphasia –
* root word (aphatos: not speak)
* In Greek, aphasia is defined as “the state of a man who had run out
of arguments”
* Aphasia is …
* An __acquire__________ disorder of _language___________
* A dysfunction of the hemisphere dominant for language (followed
by brain damage)
* Aphasia vs. dysphagia
* Dysphagia: symptoms of difficulty in swallowing
* Aphasia is a SYNDROME (a cluster of symptoms)
* a lot of severity and patterns of language difference
The definition Aphasia
Factors influencing language symptoms
Aphasia: acquired communication disorder that impairs a
person’s ability to process language
* Encompassed under the term aphasia are selective, acquired
disorders of reading (alexia) and writing (agraphia)
* Factors influencing language symptoms
* Physiological inefficiency
* Impaired cognition
* Sensory loss
* Motor impairments
* apraxia
Competence vs. Performance Question
Questions: If aphasia is a deficit of linguistic competence or
linguistic performance?
If it’s a competence problem
- If competence problem, aphasia is a loss of linguistic
knowledge -> Rehabilitation will focus on re-learning new
words and rules of sentences - However …
Many reasons to argue that aphasia is a competence and/or
performance deficit (McNeil)
Competence vs. Performance
Aphasia is an access (performance) problem if .
- Aphasia is an access (performance) problem if …
- Symptoms are sometimes transient
- Co-existing impairments can exacerbate linguistic
symptoms - If a continuum exists from aphasic to typical
- Stimulability of patients with aphasia
- Variability of aphasic behavior
Aphasia demographics
- Prevalence
- at least 2,000,000 with aphasia in the States
- 225,000 new cases annually in the States
- Among stroke patients, 20~40% have aphasia (many cases
get bypassed) - Mean survival following stroke: ~10 years
- Handedness
Aphasia-related demographics
- Gender
- No difference between genders but men have a tendency
(30% higher than women) to have more strokes - Age
- Average age of onset is 55 years old
- Aphasia Awareness Report
- In a 2020 survey, only 7% of respondents had heard of
aphasia and could identify it as a language disorder
[NATIONAL APHASIA ASSOCIATION]
From practical standpoint,
why understand “What is aphasia?
Treatment of impairment depends on definition
* 2nd C.A.D.: Celsus believed that the tongue, not the brain, was
the source of speech disorders → Treatment: tongue massages
and gargles
* 1657: William Harvey was treated for his speech loss with a cut
in the frenulum of the tongue (to loosen it)
* Cupping, leeching, bleeding were accepted treatments for
aphasia into the 19th century.
* Despite recent advances, continuing to increase our
knowledge about language will enable us to develop
stronger treatment protocols.
Paul Broca
Paul Broca (1865)
* Presented the case “Tan” along
with other patients
* Autopsy presented basis of
localizing language to the LH in the
__inferior frontal__ lobe
* Acknowledged some language
functions on the RH as well
* Patients described as using “halting,
agrammatic speech”
Carl Wernicke
Carl Wernicke (1874)
* Described receptive aphasia
* First to identify
__auditory comprehension ___ problem
* Patient’s speech was fluent, but had no
informational value
* Associated with temporal lobe damage
in LH
Hughlings Jackson
Nonpropositional vs
Propositional
- “To localize the damage which destroys speech and to
locate speech are two different things” – A warning to
localization - Emotional (automatic) vs. intellectual (controlled)
language - _nonpropositional______ (emotional) language e.g.,
idioms, proverbs, lyrics of songs, conversational formulas,
counting numbers - _propositional_______ (intellectual) language: novel
language that conveys messages and concepts
Impairment of Blood flow
Because of …
* Diseases that produce
alteration in blood
pressure
* Diseases of arterial walls
* Diseases that result in
blockage of the arterial
lumen
Stroke: Cerebrovascular accidents
Stroke: Cerebrovascular accidents (CVA)
* Occurs when blood supply to the brain is stopped
* If this happens for enough time, neurons will start to dies
because they will not get enough oxygen
Types of Stroke
Three main types of
stroke
* ___ischemic strokes_____
* ___Hemorrhogic stroke_____________
* Transient ischemic
attack (mini-stroke)
