Transcript Ling 411 – 04 Aphasia: Symptoms and Syndromes Simple Functions / Complex Functions • What about "understanding speech“? Is it a simple process, localized.

Ling 411 – 04
Aphasia:
Symptoms and Syndromes
Simple Functions / Complex Functions
• What about "understanding speech“? Is it a simple process,
localized in Wernicke's area?
• Actually it seems to be a pretty complex process...how is
simplicity/complexity determined?
• Similarly, “speaking” – pretty complex, not just Broca's area
• As we have seen, speaking is pretty complex and uses not
just Broca’s area but also Wernicke’s area. Without a
properly functioning Wernicke’s area, speech is erratic
Simple Functions / Complex Functions
 Speaking vs. Phonological Production
• Phonological production is one part of speaking
– located in Broca’s area
• Speaking is a complex process
 Phonological production plus planning what is about
to be produced – involves Wernicke’s area
 Understanding speech vs. phonological recognition
• Phonological recognition is one part of speech
understanding – located in Wernicke’s area
• Speech understanding is a complex process
 Includes grammatical and semantic activity
 Motor activity (Broca’s area) also contributes
Simple Functions / Complex Functions
Complex
function
Simple
function
Motor contributions to perception
 Reading: It helps if you know how to write
• Especially with Chinese characters
 Listening to guitar playing
• You appreciate it more if you play guitar
 Watching a sports event
• You get more out of it if you have played
yourself
 Understanding 2nd language speech
• It helps a lot if you can speak
Basic functions and complex functions – speaking
 Phonological recognition is a basic function
 Located in Wernicke’s area
• along with, perhaps, the area intermediate
between primary auditory area and W’s area
 Speaking is a complex function
• It is a cooperative effort of several areas,
including Broca’s area and Wernicke’s area
• Phonological recognition is a necessary
component of speaking
Aphasic Symptoms
Varieties of language deficits
Inferences from language deficits
Problems of interpretation
Some speech of a Broca aphasic
Examiner: What brought you to the hospital?
Patient: Yes ... Monday ... Dad, and Dad ... hospital, and
... Wednesday, Wednesday, nine o'clock and ...
Thursday, ten o'clock ... doctors, two, two ... doctors and
... teeth, yah. And a doctor ... girl, and gums, and I
(Patient was trying to explain that his father had brought
him into the hospital on Wednesday to have some work
done on his teeth.)
Complexity within the process of speech production
 The motor realization of speech involves the smooth
coordination of a number of separate neuromuscular
systems
 Sensory feedback and monitoring enter this process
at many points
 Coordination
• Activity of different systems must be coordinated
• Planning of neural activity has to precede lowlevel activation by varying amounts of time
• Lead time from neural activity to muscle activity
differs from system to system
(Goodglass, 62)
More, from a (different) Broca’s apasic
"Me ... build-ing ... chairs, no, no cab-in-ets.
One, saw ... then, cutting wood ... working ..."
Attempt to describe “cookie theft” picture
(Broca’s aphasic)
Cookie … Okay … the cookie jar … and the
kid is a … uh … stool … bump … the skool …
skool … uh … hurt … and girl … I don’t know
…
Goodglass 139
Agrammatism in Broca’s aphasia
Examiner: Can you tell me about why you came back to the
hospital?
Patient: Yes … eh … Monday … eh … dad … Peter Hogan and
dad .. hospital. Er … two … er … doctors … and … er … thirty
minutes … and … er … yes … hospital. And .. Er … Wednesday …
Wednesday. Nine o’clock. And … er … Thursday, ten o’clock …
doctors … two … two … doctors… and … er… teeth … fine.
E: Not exactly your teeth … your gP: Gum … gum …
E: What did they do to them?
P: And er … doctor and girl … and er .. And er gum …
(Goodglass 105)
Some speech of a Wernicke aphasic
Examiner’s question: Who lives at home with you?
Patient: My wife, she goes her work to work on it but
her heffle is all about it.
On testing for comprehension of single words, patient
can point to only one of six objects that are named for
him. His attempts to write result in a jargon similar to his
speech.
Goodglass 2
Another Wernicke aphasic
Attempt to describe a picture showing a young woman
standing with books in her arms, portrayed in a farm scene
with family members engaged in farm labor:
“Well, all I know is, somebody is clipping the kreples
and some wha, someone here on the kureping arm …
why I don’t know.”
Examples of anomia
I gave him a … Oh God! I know it!
Why can’t I say it?
I lost my … I keep my money in it.
Some speech of a conduction aphasic
Patient: I came into the hospital for some
tecs ... Some secs … tesk … T E S … tests.
Goodglass 73
Paraphasia
 Verbal paraphasia
• Use of one word instead of the intended one
• Usually, same part of speech
 Phonemic paraphasia
• Unintended phonemes or sequences of phonemes
• “paker” for “paper”, “sisperos” for “rhinoceros”
 Neologistic paraphasia
• “tilto” for “table”
• See, my refkid is … are bad. Oh, my cathopes noe
too good. Well, my gupa wasn’t too good. (85)
Examples from a picture-naming test
Patient
Target Word
Response
Mr. W.
(Broca)
stethoscope
asparagus
pinwheel
nozzle
telescope – not right
carrot – no
kite
hose – no
Father L.
(Wernicke)
seahorse
globe
stethoscope
hourglass
mandarin
atlas
octopus – no*
it’s a weather
*A picture of an octopus had
been presented earlier in the test
(Goodglass 78)
Phonemic paraphasia in
a conduction aphasic
Target Word (picture)
Response__________
Dart
cart … part … chart
Broom
broo … croo … broom
Scroll
scrip… screl … scrit …
roll it up … sholl … scroll
Bench
fence … park bence … bench
Pinwheel
pan .. P E A … peanwheel …
pinwill … penwhale … pinfin …
no pinwheel
(Goodglass 88)
Perisylvian Aphasic Syndromes
The most common perisylvian aphasias
in order of frequency of occurrence
1.
2.
3.
Broca Aphasia
Wernicke Aphasia
Conduction Aphasia
Characteristics of Broca Aphasia
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Non-fluent speech
Sparse verbal output
Poorly articulated
Consists of short phrases
Produced with effort
Mostly nouns and other content words
Deficiency or absence of inflectional affixes
Absent or deficient syntactic structure
Word classes in Broca aphasia
 Mostly nouns
 Some adjectives
 A few verbs
• Generally uninflected or in ‘-ing’ form
 Function words few or non-existent
Comprehension in Broca aphasia
 Generally good
 More or less impaired for syntactically complex sentences
 Difficulty in comprehending the same words that are
omitted in speech production
• Also, difficulty with repetition of these words
 Difficulty understanding relational words
• E.g. bigger/smaller, up/down, within/without
Verbal short-term memory deficit
(in Broca aphasia)
 Patients can readily point to individual objects
or body parts named by the examiner
 But when asked to point to the same items in
a specific sequence they often fail at the level
of only two or three items
Benson & Ardila 124
How to explain?
Subtypes of Broca aphasia
 Type I
• A.k.a. little Broca aphasia
• Milder defects
• Less extensive damage
• Better prognosis
 Type II
• Symptoms worse
• More extensive damage
 These are not distinct, but variations
• Two spans along a scale
Conduction Aphasia
 Originally postulated by Wernicke
 Good comprehension
 Poor repetition
• Many phonemic paraphasias
 Defective production
• Many phonemic paraphasias
 Different subtypes
• Different areas of damage
 5 to 10 percent of all aphasias
Pronunciation deficits – Phonetic vs. Phonemic
 Correct phonemes but faulty articulation
• Can occur with Broca’s aphasia
• The problem is more phonetic than phonemic
 Correct articulation but wrong phoneme(s)
• i.e., phonemic paraphasia
 B&A call it ‘literal paraphasia’
• Common in conduction aphasia
• The problem is phonemic, not phonetic
How to explain?
Areas of damage in conduction aphasia
 Different areas for different subtypes
 Arcuate fasciculus
 Left parietal lobe
•
•
Goldstein: ‘central aphasia’
 Probably the supramarginal gyrus (?)
Lower postcentral gyrus
 Luria: ‘afferent motor aphasia’
 Insula
 More than one of these areas can be
damaged in individual cases
Coronal section,
showing Sylvian
fissure, insula, etc.
Example of Broca’s Aphasia
http://www.youtube.com/watch?v=f2IiMEbMnPM&feature=related
2:25
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