Speech and language Flashcards by Meghan May

Intracarotid test

used in pts with intractable epilepsy being considered for surgical tx for epilepsy
catheter is routed into internal carotid and barbiturate injected to left or right side resulting in anestesia of greater part of hemisphere
pt has language tests to measure how well the unanaestetized hemi can perform them

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invasive test and only for ind with pre-exsisting brain fnx abnormatilies so this test may not be a good representation of population as a whole

Intracarotid test

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new imaging tech. Based on changes in ratio of oxyHb to deoxyHb in brain from moment to moment

fMRI

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cognitive activity correlated w/ change in this ratio that are involved in performing the activity
used to identify regions activated by cognitive task… is noninvasive and used in healthy

fMRI

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90% of population, Dextrals

right handed

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10% of population, Sinistrals

left handed

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Atypical dominance patterns include

‘bilateral’ and ‘right’ hemisphere dominance

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more common in left handed relative to right handed individuals

Atypical dominance patterns

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most pts w/out early damage regardless of handedness are left-hemi dominant

left-hemi dominant

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incidence of atypical dominance ________in ind w/ early brane damage, ESPECIALLY for those w/ left or mixed handedness

increases dramatically

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fMRI results
1. show the area of language activation include what 4 regions?
( see variability w/in individual pts.)

left frontal, temporal and parietal regions and rt cerebellum

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More pts w/ epilepsy show __________ compared to healthy

symmetrc and rt hemisphere dominance

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More variability in ind with early or late brain damage

EARLY

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Simular dominance patterns found in health leftys and lefy epileptics with______ onset brain damage

LATE

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lefty epileptic pts with evivdence of EARLY damage

see atypical dominance (crossed-dominance or symmetric dominance) which is high and associated with shift in handed: pathological left-handedness

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In left hemisphere, devo of langauge after injury depends on

age at time of injury

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Damage Early in life (before 1 yr)

a. develops language functions but usually has a generalize decline intelligence

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Damage between 1-5

a. language devos typically but occurs at expense of development of non-linguistic skills (viso-spatial)
b. lang devo occurs in regions usually devoted to devo of non-linguistics and ‘crowds’ those areas

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Damage After 5

a. specific abnormalities of lang skills that are apparent—implies the brain plasticity decreases w/ age

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Selective injury to ant or post speech zones causes

shift of function associated w/ that zone only.

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injury to core or central speech zone may cause a

complete shift in languate fnx to the right hemi; called crossed-dominance

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Cerebral dominance and left-handedness

atypical speech representation is more frequent in lefty and ambidextrous then rightys
healthy ind w/ no left-handed 1st degree relatives (negative familial sinistrality) have more typical lang representation

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Which is more predictive of atypical dominance family history of left-handedness

family history

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Negative correlation between LI and age suggests

langauge processing more symettric w/ age

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Damage to far anterior or poster results in

no shift in language

Damage tosomewhat anterior regio or centered around region of speech see

a complete shift in language

Anterior region of language zone is key for

retrival/syntax/exresspive aspect~ damage we see shit of anterior funx

Damage to posterior or middle language zones:

Shift of posterior speech function when more posterior/middle damage we see comprehension affected

Do both hemis involving language look the same?

hemis aren’t mirrior images of each other in either morphology or funx—see minor shape dif in cylvian fissure and occipital lobe

How are hemis organized?

Hemis are organized dif in terms of how the perform secondary and tertiary levels of fnxs (like multi-modal funxs such as hand-eye coordination)

Lateralization of fnx is relative and complementary and______ with age before pubery and______ thereafter

increases | decrease

Disorders of speech all involve

malfunction of muscles of speech articulation!

How are disorders of speech and disorders of language different (aphasias)

they are different from language disorders (aphasia) that you can get w/out the other and has own correlates

can be psychological or neuro | neuro: IG occurs in context of syndrome such as akinetic mutism (thought to be d/t failure to initiate action)

Mutism

Mutism can result from:

Extensive bifrontal brain disease or bilateral lesions in SUPPLEMENTARY motor area responsible

D/t injury to peripheral NS enervating muscles of vocal chords and ≠ sound production

Aphonia

Able to produce vocal sounds (grunts, groans, sound like features) but cant generate speech

Aphemia

Aphemia is considered a

disconnected syndome

d/t white matter lesion beneath Broca’s area that severs the final output path for speech production

Aphemia

impaired capacity to articulate speech~ more about muscles of speech or discordination

Dysarthria

All aphasias can be classified by integrity of speech:

fluency/comprehension and repetition

Most important classification of integrity of speech

fluency is more important to focus on… heslp us localize brain dysnfunction to anterior or posterior regions

Non-fluent aphasias—occur with dysfnx to

ANTERIOR regions

Fluent aphasias—occur with dysfnx to

POSTERIOR brain regions

Fluency; | evaluated on 3 dimensions

Phrase length (maximum number of words per utterance) Degree of apparent effort in production of speech Prosody—preservation of melodic elements of speech

Nonfluent speech characterized by

contains less then 3 words in utterance, labroius in produciton and monotonic

Evaluation of fluency:

a. ask pt open ended questions or to describe complex picture (Boston Asphasia Exam)

Global aphasia fluency: comprehension: repetition:

fluency: none comprehension: none repetition: none when functions of both anterior and posterior aspects of core language zones impaired

Isolation of speech fluency: comprehension: repetition:

fluency: none comprehension: none repetition: intact

Brocas fluency: comprehension: repetition:

fluency: none comprehension: intact repetition: none

Transcortical motor: fluency: comprehension: repetition:

fluency: none comprehension: intact repetition: intact

Wernickes fluency: comprehension: repetition:

fluency: intact, paraphaisias present comprehension: none repetition: none

Transcortical sensory fluency: comprehension: repetition:

fluency: Yes, paraphiasias present comprehension: none repetition: intact

Conduction fluency: comprehension: repetition:

fluency: yes, paraphiasias present comprehension: intact repetition: none

Nominal, anomic amnesic fluency: comprehension: repetition:

fluency: intact comprehension: intact repetition: intact

fluency: none comprehension: none repetition: none when functions of both anterior and posterior aspects of core language zones impaired

Global aphasia

nonfluent aphasia that has profound impairment in speech articulation. Repetition speech impared d/t articulaiton difficulties

Brocas

Transcortical motor aphasis:

lesion to the premotor region or SMA

Transcortical aphasias: repetition is

PRESERVED

Transcortical sensory aphasia:

fluent aphasia associated with langague comprehension deficits at word level

Transcortical sensory aphasia lesion IG is at

- lesions IG at angular gyrus or post and infereior temporal lobe - repetition is preserved

Isolation aphasia:

when lesions of both transcortical motor and sensory aphasia present

Isolation aphasia

effectively isolates core speech zones from remainder of hemisphere

Isolation aphasia

Conduction aphasia: fluent aphasia associated with

profound impairment in repetition speech but preserved comprehension

-repetition deficit d/t impairment in auditory storage buffer needed to repeat speech sounds or perhaps the transmission path (arcuate fasciculus) btwn speech sound recognition and articulation centers

Conduction aphasia

The cortical zones in temporal, parietal and frontal regions that lie outside of the peri-Sylvain zone also makes

significant contributions to linguistic fnxs.