Speech And Language Disorders Flashcards
Broca’s area
. Area 44 and 45
. Located in opercular and triangular portions of inf. Frontal gyrus
. Receives input from wernicke’s area via sup. Longitudinal fasiculus
. Motor speech area: projects to areas of primary motor cortex for articulation and phonation of speech
. Language formulation area: general of verbal and written language
Wernicke’s area
. Area 22
. Located in sup. And middle temporal gyri post. To primary auditory cortex
. Receives inputs from auditory, visual, and somatosensory cortices
. Projects via sup. Longitudinal fasciculus to broca’s
. Responsible for decoding language input in verbal or written forms
. Comprehension of linguistic forms
Perislyvian zone
. Region around Sylvia fissure
. Communication functions here
Insular cortex
. Deep w/in lat. sulcus
. Important for communication and homeostasis, emotional regulation, consciousness, ad self-awareness
Ant. Commissural
. Small compact bundle that cross midline rostral to columns of fornix
. Connects regions of middle and inf. Temporal gyri and olfactory tracts and bulbs
Corpus callosum
. Connect regions of cortex in 2 hemispheres
Intrahemispheric connections
. W/in dominant hemisphere only
. Sup. Longitudinal fasiculus connects wernicke’s and Broca’s areas
. Course from frontal lobe to parietal, occipital, and temporal lobes
. Provides link btw cortical areas involved in sensory and motor aspects of communication
Cerebral dominance of language
. Almost all left hemisphere dominant (including most lefties)
Functions assigned to dominant hemisphere
. Language and speech
. Math ability
. Problem solving in sequential, logical manner
. Processing of visual sign language
Functions assigned to non-dominant hemisphere
. Recognition and appreciation of simple, spatial relationships
. Some elements of music and poetry (nonverbal ideation)
. Artistic ability
. Many aspects emotion
Wada test
. Localized functions w/in hemisphere
. Anesthetize one cerebral hemisphere w/ Amytal
. Patient is awake lying on back w/ arm raised in air
. patient will stop counting and then continue a few seconds later is non-dominant hemisphere was injected
. Patient won’t count for duration of drug if dominant hemisphere is injected
Process involved in producing spoken word
. Respiration
. Phonation
. Resonance
. Articulations
Respiration in speech
. Proper breath support needed w/ functional diaphragm and lungs
. Poor breath support results in dec. vocal volume and intelligibility
Phonation in speech
. Ability to vocalize during speech production
. Dependent upon laryngeal function, vocal fold condition, muscle strength, and neural innervation of laryngeal mechanism
Resonance in speech
. Sound quality of speech
. Determined by shape of person’s resonators
. Mediated during speech by opening/closing of velopahryngeal port
. Normal speech needs open VP for nasal sounds and closed VP for vowels and other consonants
Articulation in speech
. Production of speech sounds via highly synchronized movement of lips, tongue, and mandible
. Children develop this by age 5
. Disorders most commonly seen in kids but can be secondary to neural insult
Articulation error types
. Substitutions: most common
. Omissions: seen in young kids
. Additions: unusual, ESL speakers
. Distortions: young kids and people w/ neurological abnormalities
Prosody
. Inflection
. Carries meaning assoc. w/ social-affective(pragmatic) intent of messages (humor, sarcasm, etc)
Initiation
. Onset of speech
. Ability to initiate speech production or voicing of speech sounds at appropriate time
. Important for speech sound production and clarity
. Important for pragmatic language functions of initiating social interactions appropriately
. Controlled primarily by supplementary motor area
Dysarthria
. Motor speech disorders caused by neurologic abnormalities of CNS or PNS
. Speech production is characteristically slow, shaky, or slurred
. Patients retain language ability despite speech disturbance
Flaccid dysarthria
. Breathy, hypernasal w/ intermittent nasal emission
. Slurred
. Quiet due to flaccidity of mm. Of phonation and respiration
. Fasciculations and atrophy of tongue
. Due to LMN disease, often trauma to CN X
Spastic dysarthria
. Slow effortful speech w/ strained quality
. Mm. Are spastic so speech is hard to produce
. Produced by bilateral damage to pyramidal and extrapyramidal CNS pathways
. UMN disease: cortical or coricobulbar lesions
. Occurs secondary to stroke, TBI, or degenerative disease
Ataxic dysarthria
. Speech imprecise, jerky, slurred
. Alternating loudness and speed of production
. Speech production uncoordinated as are other motor movements
. Patient sounds drunk
. Secondary to cerebellar disease
Hypokinetic dysarthria
. Speech slow w/ bursts of faster speech
. Mm. Movement limited by rigidity making articulation less precise
. Secondary to basal ganglia pathology (Parkinson’s)
. Also seen following subcortical strokes, penetrating brain injuries, and infections
Hyperkinetic dysarthria
. Speech intermittently impacted by fluctuating mm. Tone
. May sound normal then suddenly jerky and slurred
. Assoc. w/ vocal tremor, SOB, difficulty getting words out so patient is exhausted trying to communicate
. Caused by basal ganglia lesions in caudate putamen and globus pallidus
. Also have generalized movement disorders (chorea, dystonia)
. Commonly assoc. w/ Huntington’s
Mixed dysarthria
. Common to see dysarthrias occur in combos
. Difficult to diagnose
Apraxia of speech (AOS)
. Impaired ability to plan, program, and execute appropriate series of motor movements for speech production
. Speech is fragmented and each production of target word is different (not same problem)
. Mm. Intact and functional
. Can occur w/ aphasia or dysarthria
. Secondary to dominant hemisphere impairment in Broca’s area or left fronto-parietal region response for motor speech programming (LH strokes or degenerative diseases)
. Seen in adults who developed speech normally and then lost it due to pathology
Developmental apraxia of speech
. Occurs in children
. Specific neurological etiology difficult to demonstrate
. Results in difficulty learning to speak and moderate to severe articulation impairment
Dysphonia
. Disturbance in focalization or phonation
. Impaired ability to vocalize due to disorder of larynx or its innervation (laryngitis, vocal nodes)
. Impaired vocal quality
. Can involve alteration of 1+ vocal parameters
. Language ability is not impacted
Aphonia
. Loss of voice
. Commonly from vocal paralysis secondary to recurrent laryngeal n. (CN X branch) that supplies larynx unilaterally or bilaterally
. Can be secondary to laryngeal resection following cancer
.can be emotionally mediated but that is transient
Simplex tics in speech
. Vocal: involuntary, intermittent expression of noises or sounds
. Motor: involuntary, intermittent motor movements that can occur alone or w/ vocal tics
Complex tics
. Involuntary intermittent expression of words, phrases, or sentences
. Said repetitively and sometimes w/ exaggerated inflection
Echolalia
. Involuntary repetition of last sound, word, phrase, or sentence of another person
. Echoed phrase may be only verbal output patient will offer
. Seen in individuals w/ autism and secondary to other neuro issues
Coprolalia
. Involuntary utterance of socially unacceptable or obscene words
. Seen in psychiatric or neuro conditions
. Side effect of some meds
Developmental stuttering
. Involuntary repetition of 1st sound or syllable of word
. Movements of stuttering not accompanied by frustration or head/neck tension
. Child does not know they are doing it
. Occurs for short periods of time and resolves w/o intervention
. Developmental not a disorder
Stuttering
. Sound, syllable, or word repetition, prolongation of sounds, hesitation beginning to speak
. Visible head/neck tension
. Frustration and stress
. Worse when person is under stress
. May be hemispheres struggling for dominance
. Very in severity
Language
. Ability to converse, comprehend, repeat, read, and write
. Includes receptive and expressive abilities
. Development parallels w/ emergence of cognitive abilities
. Mediated directly by CNS
Pragmatic
. Rule system that governs how we use language
. Social application of language: attention, initiation, turn taking
Semantics
. Use system that governs encoding and decoding meaning w/in language
. Includes decoding the meaning of what we hear
. Includes selecting vocal words w/ accurate meaning for message we convey
Syntax
. Rule system that governs how we combine words into grammatical sentences
Morphology
. Rule system that governs how we encode meaning into words through use of prefixes and suffixes
Phonology
. Rule system that governs how we combine sounds to form words that have meaning
Comprehension deficits
. Following direction issues
. Not understanding spoken language or what is read
Expressive deficits
. Issues reading aloud, writing, or speaking
Aphasia
. Results from brain damage to LH
. Problems speaking. Listening, reading, and writing
Broca’s aphasia
. Reduced verbal output
. Sparse, poorly articulated and effortful speech
. Verbal output is telegraphic and agrammatic
. Naming is poor but prompting helps significantly
. Comprehension of spoken language is significantly better than verbal output
. Writing is difficult in dictation and copying
Wernicke’s aphasia
. Fluent/sensory/receptive aphasia
. Verbal output sounds normal but sentences are devoid of meaning
. Person does not realize they have it
. Cannot comprehend language or writing
Conduction aphasia
. Lesion in arcuate fasciculus running btw Wernicke’s and broca’s
. Difficulty repeating
. Verbal output is fluent and paraphasic
. Articulation good
. Comprehension of spoken language intact
. Reading out loud is poor but reading silently comprehension is good
. Writing disturbed
. Spontaneous speech may be meanless, but comprehension of spoken and written word is good
Transcortical motor aphasia
. Ant. Watershed zone of dominant ACA infraction ant. And sup. To Broca’s area
. Lesion encompasses cortical white matter deep to SMA
. Resembles broca’s but repetition is good
. Develops after a period of muteness
. Limited agramamtical and effortful spontaneous speech
. Limited ability to name object and compose word lists
. Can’t answer open ended things
. Ability to repeat spoken word is good
. Articulation is normal
Trasnscortical sensory aphasia
. Lesions in post. Watershed zone of dominant hemisphere
. Lesion encompasses parietal and temporal areas post. And sup. To wernicke’s
. Similar to wernicke’s w/ intact repetition
. Impaired comprehension w/ normal verbal fluency
. Paraphasia
. Echolalia
. Naming issues
. Reading out loud contaminated w/ errors
. Comprehension and writing abnormal
Transcortical mixed aphasia
. Lesions in ant. And post. Watershed zones in dominant hemisphere
. Like global aphasia but repetition is preserved
. Patients don’t speak unless spoken to
. Exhibit true echolalia
. Repetition preserved but is limited to 3-4 words in sentence that can be repeated
Anomic aphasia
. Amnestied/nominal aphasia
. Output vague w/ no substantive words
. Principal deficit in naming
. Can hav normal comprehension and ability to speak in spontaneous conversation
. When confronted w/ objects or trying to think of a word or name the patient will falter
. Involves lesions of angular gyrus in dominant hemisphere
Global aphasia
. All language functions are severely limited
. Verbal output is very limited
. Comprehension is better than verbal output but it is impaired
. Communication may be attempted w/ symbol system
. Results from widespread damage to dominant hemisphere involving moist of the language areas
Alexia
. Loss of ability to read
. Visual info has lost access to wernicke’s area
. Lesion involves connections around angular gyrus in dominant hemisphere
. Dyslexia is incomplete alexia
Agraphia
. Loss or impairment of ability to produce written language
. Lesion involving inf. Parietal lobule in angular gyrus in dominant hemisphere
. Micrographia seen in Parkinson’s but not the same as agraphia
Prospagnosia
. Inability to recognize familiar faces
. Due to bilateral lesions of temporal lobes
Aprosodia
. Motor: inability to convey emotions by voice or gestures (monotone speech)
. Sensory: difficulty comprehending emotional content of speech or gestures of others
. Can be due to issue in non-dominant hemisphere
Agnosia
. Inability to recognize or be aware of abject when using a given sense even though sense is functionally intact
. Sensory (astereognosia): lesions in sup. Parietal lobule, inability to recognize objects by touch alone but identification can be accomplished w/ other senses
. Visual: lesions in visual assoc. cortices (18,19) in dominant hemisphere, inability to recognize objects by sight alone but can recognize it tactily
Apraxia
. Inability to correctly perform learned movements on command in absence of elementary sensory-motor deficits
. Motor/sensory pathways intact
. Patient can perform same action in different cortex (reflex)
Kinetic apraxia
. PMC lesion
. Difficulties in fine motor control
. Loss of ability to make finely graded, precise individual finger movements (picking up pin, finger tapping test)
Ideomotor apraxia
. Lesion of supramarginal gyrus in dominant hemisphere
. Inability to perform many complex tasks on command
. Spatial and temporal errors: orientation of body or tool is wrong
. Most errors when patient asked to pantomime action
. Given actual objects and context patients do better
Ideational apraxia
. Seen in degenerative dementia (frontal lobe dysfunction)
. Inability to perform a series of acts to obtain a goal (making a sandwich)
Alexia w/o agraphia
. Due to lesion of post. Cerebral a. And destruction of dominant visual cortex and selenium of surplus callosum
. Language areas cut off from visual imputes so the patient can write but not read
Executive function disorders
. Due to lesions in ant. Portion of frontal lobe
. Inappropriate social behavior
. Difficulties in adaptation and loss of initiative
. Phineas gage syndrome
Neglect syndromes
. Lesions of non-dominant sup. parietal lobule
. Lack of appreciation of spatial aspects of all sensory input from contralateral side of body and contralateral visual field
. Hemineglect: patient ignore half of their body
. Lack of awareness of contralat. Half of personal space of side of body
. Failure to dress, groom contralat. Side of body
. Assoc. w/ anosognosia (denial of deficit)
