SPEECH LANGUAGE PATHOLOGY & CLASSIFICATION OF APHASIA
Hello
Dr. S. Aswini Kumar. MD
Professor of Medicine
Medical College Hospital
Thiruvananthapuram
Definitions:
Speech is a highly evolved function of the cerebral cortex
Speech is the human faculty by which thought processes are symbolically expressed
Speech is the vocalization form of human communication
It is based upon the syntactic combination of lexicals and names that are drawn from very large vocabularies (usually >10,000 different words)
Each spoken word is created out of the phonetic combination of a limited set of vowel and consonant speech sound units
Components of Speech
Speech is the mechanical function of one’s ability to communicate in oral language
It includes
Language production
Phonation and
Articulation
Language
Language is the symbolization of ideas
Ist is the ability to convert thought in to comprehensive words
It consists of five parameters
Speaking
Hearing
Repeating
Reading
Writing
Dimensions of Language
Speech and Hemispherical Dominance
Speech is the function of cerebral hemisphere
It is undertaken by the dominant hemisphere
9 out of 10 human have right handedness
90% of human also have left hemispherical dominance
Rest 10% have left handedness
7 out of these 10% have left hemispherical dominance
3 out of the 10% have right hemispherical dominance
Thus 97% of human have left hemispherical dominance
Only 3% have right hemispherical dominance
It also means speech is a function of Left hemisphere in 97 out of 100 and right hemispere in only 3%
Wernickes Area
The auditory comprehension of spoken speech takes place in the posterior end of the superior temporal gyrus
Karl Wernicke
German Neurologist
Identified it
Described the pathway
Connection to Broca’s area
Arcuate fasciculus
This area is neuroanatomically described as the posterior part of Brodmann area 22
Broca’s Area
The motor area for spoken speech which is situated in the posterior part of the left inferior frontal gyrus
Peirre Paul Broca
French Sugeon
Described it in 1865
Two patients who lost speech
Autopsy done showed
Lesion in lateral frontal lobe
This area is neuroanatomically described as the posterior part of Brodmann area 44 and 45
Conduction Area
Adeep, white matter tract, connecting the Wernickes area to the Brocas area
Also called arcuate fasciculus
Latin word
Curved bundle
Neural tract
Important in dominant hemisphere
Lesion Conduction Aphasia
Repetition deficits arise following damage to the arcuate fasciculus of the dominant hemisphere
Exner’s Area
An area of the brain just above Broca's area and anterior to the primary motor control area.
Seigmund Exner
Austrian Physiologist
1846-1926
Area for writing
Close to area for hand movt
Damage results in agraphia
This area is neuroanatomically described as the posterior part of Brodmann area 6
Reading Area
An area of the brain just medial to the left occipital lobe and in the spleniumof the corpus callosum.
Center for reading
Recieves impulses from eye
Transmits to area Assn area
Analyses red matter
Passes to arcutate fasciculus
Lesion – Pure word blindness
This area is neuroanatomically described as the posterior part of Brodmann area 17
Speech Mechanism
Speech is the process by which a person can communicate with others effectively
Information transmitted via arcuate fasiculus
Activation of Brocas area for word formation
To motor cortex that control speech muscles
Areas of Brain
4, 6
39
45, 44
41
22
18, 19
17
Speech in reponse to hearing
Primary Motor cortex
Arcuate fasciculus
Brocas Speech area
Wernickes Speech Area
Primary Auditory Area
Brainstem
Muscles of Larynx
Pathway in the process of reading
Primary Motor cortex
Primary Visual cortex
Brocas Speech area
Wernickes speech Area
Visual
Association cortex
Brainstem
Muscles of Larynx
Aphasia
Part II
Definitions:
Loss of language due to a dysfunction of the central mechanism in the brain is called aphasia
Minor disorders of the same is called dysphasia
Eg: Right Hemiplegia producing dysphasia
Dysfunction of the peripheral mechanism of speech leading to defective articulation is termed dysarthria
Eg: LMN facial palsy, Pseudobulbar palsy
Loss of voice due to dysfunction of the voice producing mechanism is called dysphonia
Eg: Vocal cord palsy , Acute Laryngitis
Loss of ability to read: alexia
Loss of ability to write: agraphia
Examination of Aphasia
Spontaneous speech
Whether patient spontaneously ask for food, urination etc
Comprehension
Whether patient can obey commands
Repetition
Whether patient can repeat phrases or numbers
Naming
Whether patient can name an object
Reading
Whether patient can read, understand and obey
Writing
Whether patient can write down the answers
Testing Spontaneous speech
Fluency
Whether speech is fluent without hesitations
Uninterrupted by searching for a forgotten word
Effort taken for speech
See whether the patient has effortless/effortful speech
Vocabulary
See whether there is any word-finding difficulty
Whether patient stammers and stumbles
Ability to speak in full sentences
Or patient is able to talk only in phrases
Grammer
Whether the grammer is correct or not
Testing Comprehension
Whether patient can hear and understand speech?
Tested by asking the patient to obey a command
Ask the patient to show the tongue, close eyes, lift a limb
Fluency is preserved or not
Speech whetherfluent without hesitations?
Is it incessant, rapid and uninterrupted?
Use of paraphasias
Use of a descriptive phrase instead of a forgotten word
Use of neologisms
Invented word and nonsense words
Jargon aphasia
Extreme example of the above speech devoid of meanings
Testing Repetition
Patient is asked to repeat a simple sentence
It has to be clearly stated by the examiner
Eg: Today is Wednesday, the August 17th, 2009
See whether the patient is able to repeat what you say
Remember never to shout at a aphasic patient
Hearing is usually normal in these patients
In a patient with left frontal lesion
They can repeat simple words and phrases
In a patient with posterior lesions in the angular gyrus
They cannot repeat what the examiner says
This is the characteristic feature of conduction aphasia
This function is preserved in Trans-cortical aphasia
Testing for Naming
Patient is shown an object and asked to name it
A commonly used object should be shown
Eg: Pen or match box
See whether the patient is able to name the object
Patient may be handed over the object
Or asked to demonstrate the use of the object
In Anomic aphasia or nominal aphasia
Patient is unable to name it, but use it even
Auditory comprehension, repetition, reading and writing
Thse are usually preserved in such a patient
Memory testing other wise will be normal
This function is preserved in Trans-cortical aphasia
Other test done
Ask the patient to read from a command
See whether he answers a question written
See whether he obeys commands, written down
Now ask to read aloud
Ask the patient to write down
The name and address
Draw a picture of a clock face
Answer to a question put forward
Ask the patient to calculate
Subtract 7 from hundred
Ask for 4+4, then more complicated
Aphasia syndromes
Broca’s Aphasia
Non-fluent
Telegraphic speech
Reduced verbal content
Phrase length – generally less then four words
Agrammatical sentences (or frequent errors)
Mostly content words (nouns and verbs)
Absence of functional words ( prepositions & conjunctions)
The matter is conveyed any way
Functional comprehension is present
But trouble following complex grammatical statements
Reading loud is not possible; but can read and obey
MCA territory stroke – Left frontal lobe
Wernicke’s Aphasia
Fluent
Increased verbal content
Para-grammatism – speech running
Phrase length – generally greater than five words
Grammatical sentences (or close to normal)
Paraphasic errors (literal or verbal)
Literal – sound substitution with errors (winging ringing)
Symantic – word substitution ( sister for mother)
Neologisms (made up words)
Logorrhea – Inability to stop speaking
Severely impared auditory comprehension
MCA territory stroke – Left superior temporal lobe
Conduction Aphasia
Relatively uncommon
Spontaneous speech is fluent
Considerable word finding difficulty
Preserved auditory comprehension
Significan difficulty with repetition
Literal paraphasia
Self correction
Numerous pauses
Filled pauses – Aaaaa Aaaaa
Reading deficit - variable
Writing deficit – variable
Lesion: Left superior temporal area, supramarginal gyrus
Nominal Aphasia
Primary deficit – word finding and naming
Speech output is fluent with numerous pauses
Pauses may be filled with circumlocutions
Describing the function of an object
But the name cannot be retrieved
Auditory comprehension is intact
Reading and writing are also intact
Last localized of all aphasias
Focal damage to left temoral and parietal
Usually residual of good recovery from other aphasias
Also indicates good prognosis if seen in acute stage
Global Aphasia
Severe impairment in all modalities
Speaking, listening, reading and writing
Severely impaired auditory comprehension
Very limited speech output
Only few understandable utterances
Some areas of spared speech function
Utilized in communication
Brain damage resulting is massive
Fronto-tempero-parietal lesion
Complete occlusion of MCA
Rarely without hemiplegia
Trans-cortical Motor Aphasia
Similarities to motor aphasia
But with intact repetition
Lesion in the border zone
Superior or anterior to Broca’s area
Non-fluent
Limited speech output
Auditory comprehension – good
Reading comprehension – good
Syntax not as bad as in Broca’s Aphasia
Occlusion of Anterior Cerebral Artery
Trans-cortical Sensory Aphasia
Similarities to snsory aphasia
But with intact repetition
Deficits in all language modalities
Fluent aphasia
Echolalia
They can repeat; but cant understand it
Much difficulty in communicating
Syntax not as bad as in Broca’s Aphasia
Lesion in the border zone
Posterior and inferior to Wrnickes area
Occlusion of Anterior Cerebral Artery
Aphasias - Comparison
Related disorders
Part III
Apraxia
Acquired disorder of learned skill affecting sequential motor movements which cannot be accounted by elementary disturbances of strength, co-ordination, sensation or comprehension
Inability to perform a learned motor activity in the absence of any motor, sensory or coordination defect
It is not a lower level motor disturbance but a deficit in the motor planning
Ideamotor apraxia is the most common type, fails to perform previously learned motor activity
Ideational apraxia is adisturbance of complex motor planning than ideamotor apraxia
Agnosia
An acquired disorder of recognition in some sensory modality ie visual, auditory or tactile
Agnosia can be specific for a particular class within the modality of sensation –
Objects
Pictures
Faces
Colors
It is to important distinguish agnosia from agnosia, just as in case of apraxia
Patietns with auditory agnosia hear adoor bell ring; but does not recognise it meaning
Thank You
Calcification Inhibitors in CKD and Dialysis Patients
Aphasia is the name given to a collection of language disorders caused by damage to the brain. A requirement for a diagnosis of aphasia is that, prior to ...
Read more
Consumer-oriented primer by the American Speech-Language-Hearing Association. Includes descriptions of aphasia varieties and related disorders ...
Read more
What is aphasia? Aphasia is a disorder that results from damage to portions of the brain that are responsible for language. For most people ...
Read more
Expressive aphasia (non-fluent aphasia) is characterized by the loss of the ability to produce language (spoken or written). It is one subset of a larger ...
Read more
Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is always due to injury to
Read more
Lingraphica's blog covers topics relating to speec, language, cognition, and aphasia. Written by clinicians for clinicians, caregivers, and individuals.
Read more
Aphasia is an acquired neurogenic language disorder resulting from an injury to the brain, most typically the left hemisphere, that affects all language ...
Read more
Researchers, physicians, and speech-language pathologists have categorized aphasia into six different types. Anomic Aphasia. ... Wernicke’s Aphasia.
Read more
Sometimes aphasia will improve on its own without treatment, but a type of treatment called speech and language therapy is usually recommended.
Read more
Add a comment