Lecture 4.2 Flashcards
What are the spoken language characteristics of Wernicke’s aphasia?
fluent except for periods of anomia
normal to excessive verbal output
- logorrhea
semantically empty, primarily functors
morphosyntax and grammar near normal
articulation and prosody normal
all types of paraphasias
- unintended syllables/words during effort to speak
- paragrammatism
What is paragrammatism?
morphological substitution errors (ex. she for he)
well-constructed syntax of sentences with errors in grammatical morphemes, substitutions of and blending among lexical items
may occur in writing as well as speech
What is theorized to account for the difference in error types in aphasias?
neurological deficits affecting different stages of sentence processing
paragrammatic errors occurring later in sentence formulation process
What is literal/phonemic paraphasia?
phonemes or syllables of a word are produced early but in incorrect order OR word is distorted by production of unintended sounds
usually some phonemic features of the word are preserved
cat for mat, light for live
What is a neologism?
extreme literal paraphasic error such that the word is grossly distorted to such a degree that it is unintelligible
slammazer, carporta
What is a verbal paraphasia?
intelligible word used in place of intended/target word
tall for sail
run for sing
What is a semantic paraphasia?
substituted word has some lexical relationship to the intended word
can be random/irrelevant or perseverative
bowl for dish, girl for boy
What is extended jargon?
running/connected utterances (phrases or sentences) which include senseless words or neologisms
What are some other characteristics of Wernicke’s aphasia?
paraphasias pervasive
word finding difficulties severe
doesn’t respond to phonemic cues
resists interruption
unaware of communication difficulties
How is repetition affected in Wernicke’s aphasia?
disturbed
may be related to severe auditory comprehension difficulties
contains paraphasias
How is auditory comprehension affected in Wernicke’s aphasia?
severely impaired
some understand very little while others can comprehend simple words/phrases
system overloads easily
may have phoneme discrimination problems
How is reading comprehension affected in Wernicke’s aphasia?
often reading deficit parallels auditory comprehension deficit
comprehension and reading aloud
reading learned through auditory system so if it is impaired then reading is too
How is writing affected in Wernicke’s aphasia?
mechanical writing ability is good
well-formed letters
but content reflects paraphasic output at verbal levels, lacks meaning and semantically empty
Where is the site of lesion in Wernicke’s aphasia?
Wernicke’s area
posterior 1/3 of superior temporal gyrus plus inferior parietal lobe
What are some emotional and physical effects of Wernicke’s aphasia?
usually no hard neurological signs
may exhibit initial paresis but brief
- visual and ambulatory losses rare
tactile losses may be present
may become paranoid as others focus on deficits that clients can’t see
What are the spoken language effects of conduction aphasia?
generally fluent aphasia but verbal output limited to brief bursts of utterances
- words/min approaches normal
conversational output impaired but fluency maintained
- literal/phonemic errors
- impaired phoneme selection
disjointed spoken output
- facilitated by singing/rhythmic pattern
normal intonation, syntax
aware of errors
How is repetition affected in conduction aphasia?
serious problems
understand what they hear but can’t transfer to Broca’s to be repeated
classic sign of conduction aphasia
How is auditory and reading comprehension in conduction aphasia?
good!
contrasts with Wernicke’s
How is reading aloud impacted in conduction aphasia?
impaired because information cannot be transmitted to Broca’s area for verbal output
How is writing impacted in conduction aphasia?
impaired on linguistic level but not motoric
spelling errors because of storage disturbances to angular gyrus
words omitted and interchanged in sentences
Where is the lesion site in conduction aphasia?
along arcuate fasciculus
- white matter pathways under supramarginal gyrus
What are the physical and emotional effects of conduction aphasia?
often no neurological deficits
motor hemiparesis varies based on site and size of lesion
- same with sensory disturbances (but usually only fingers or right side of face)
visual field impairments usually apparent, important implications for treatment to move items into field
What are the spoken language effects on anomic aphasia?
anomia - inability to retreive known words
semantically empty speech
circumlocutions that are vague and bizarre
How is repetition impacted in anomic aphasia?
evoking names spontaneously poor but repetition is good
How is auditory comprehension impacted in anomic aphasia?
inconsistent
can be relatively good for connected language but poorer for isolated words
How is writing and reading impacted in anomic aphasia?
reading and writing varies along a broad spectrum
spelling skills vary considerably
Where is the lesion site in anomic aphasia?
least reliably localized
usually in L temperoparietal area
may extend into angular gyrus resulting in severe alexia and agraphia
What are the physical and emotional effects of anomic aphasia?
do not usually see hard or soft neurological signs
What is transcortical sensory aphasia?
damage to temporal lobe that cuts off Wernicke’s and Broca’s area from the rest of the brain
What are the spoken language effects of transcortical sensory aphasia?
fluent output devoid of meaning
- irrelevant, semantically empty
- literal paraphagias and neologisms
naming severely impaired because of angular gyrus involvement
does not initiate utterance but those that are evoked are fluent yet empty
How is repetition affected in TCSA?
excellent
may be considered echolalic - involuntary repetition of everything heard
How is auditory and reading comprehension affected in TCSA?
impaired/poor
moderate to severe levels
How is reading aloud and writing impacted in TCSA?
wide range of performance from preserved to defective
writing skills similar to Wernicke’s aphasia (poor)
What is the site of lesion in TCS aphasia?
watershed lesion
posterior parieto-temporal
- sparing Wernicke’s area
- parietal and temporal border zones
disruption in blood supply from PCA affecting inferior temporal lobe and anterior occipital lobe
What are the physcial and emotional effects of TCSA?
sensory impairments
Gerstman’s syndrome
- R/L disorientation
- finger agnosia (can’t tell what finger is touched when eyes closed)
- agraphia
- acalculia
How can subcortical lesions cause aphasia?
thalamus and basal ganglia play direct regulatory or indirect gating roles in cortical language functions
subcortical vascular lesions may have widespread effects, creating hypofusion in L hemisphere Perisylvian regions
combination of 1 and 2
What are the types of subcortical aphasias?
anterior capsule/putamen
posterior capsule/putamen
thalamic
Describe anterior/putamen subcortical aphasias.
combination of TCM and Broca’s characteristics
short phrase length, impaired articulation, poor nonverbal skills
relatively good repetition and auditory comprehension
Describe posterior/putamen subcortical aphasias.
combination of Broca’s and Wernicke’s symptoms
good articulation and verbal skills, poor nonverbal skills
poor repetition and auditory comprehension
Describe thalamic subcortical aphasias.
TCM and TCS like linguistic characteristics
fluent aphasia with semantic paraphasias and neologisms
spared repetition, variable comprehension
Describe pure alexia/pure word blindness.
alexia without agraphia
most common single language modality syndrome
can’t read or recognize written whole words
- can perceive letter by letter
can name objects presented visually, recognize numbers, and comprehend oral spelling
What is the site of lesion in pure alexia?
complex lesion or series of lesions
L visual cortex and connections between R visual cortex and L hemisphere destroyed
absence of visual input to intact language areas of L hemisphere
What is pure word deafness/subcortical sensory aphasia?
rare
can’t repeat or understand spoken utterances
- but hearing still present
- can interpret environmental sounds
can still speak, read, and write normally
- paraphasias usually present acutely
vowel contrasts appreciated but less so for consonant contrasts
What is the site of lesion in subcortical sensory aphasia?
pathology in 2 locations
lesions isolate Wernicke’s area from primary auditory cortex in BOTH temporal lobes
- fibres that bring info from auditory association areas in R hemisphere destroyed
subcortical lesions in language-dominant superior temporal gyrus with destruction of primary auditory cortex (Heschl’s gyrus)
What is pure agraphia/subcortical aphasia?
writing problems in absence of other significant language disturbances
may be due to focal lesion or acute confusional state
motor and spelling errors present but spelling errors dependent on lesion location
5 types
What is anterior disconnection syndrome?
unilaterail tactile agnosia, agraphia, apraxia
unilateral L hand apraxia, can’t follow verbal directions with left hand
can’t name or talk about objects in L hand though can usually draw item or demonstrate its function
lesion in anterior corpus callosum
- interruption of connection between verbal areas in L language dominant hemisphere and sensory areas of L hand in right hemisphere
What is posterior disconnection syndrome?
objects seen in L visual field can not be named
non-specific visual disturbances
lesion in posterior portion corpus callosum
