9/23 Language and Aphasia - Woodbury Flashcards Preview

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Flashcards in 9/23 Language and Aphasia - Woodbury Deck (13):
1

three basic steps of using language

 

slightly more complex steps of using language

1. receive input

2. process it

3. respond

 

1. distinguish speech from noise

2. identify words

3. attach meaning

4. interpret overarchin message

a. formulate response

b. choose approp words

c. structure correctly

d. plan motor movements

e. deliver response

2

language localization

98% of people, language lateralized to left hemisphere

all people, language localized to perisylvian fissure area

 

however, language system extends throughout cortex ("language octopus") → can get aphasia if you damage outside of the lang core

  • see diff clinical presentation

3

language

 

aphasia

  • definition
  • primary cause

ability to understand spoken and written language

ability to produce spoken and written language

 

aphasia is partial/total loss of ability to articular ideas and comprehend spoken/written language resulting from damage to the brain (acquired deficit!!!)

  • by definition, if you have aphasia, ALL ATTRIBUTES MUST BE COMPROMISED TO SOME EXTENT (not necessarily equally)

most aphasias are due to vascular accidents (often involving MCA)

 

4

aphasia decision tree

naming tests

  • difficulty naming objects is an indicator of aphasia
  • ability to name obj is the last attribute to recover

fluent vs nonfluent?

  • fluent: fluid speech (not asuming content)
  • nonfluent: relatively more difficulty with output

5

fluent vs nonfluent aphasia

 

locations

cause of aphasias/specific aphasia types

most aphasias occur due to vascular accidents often involving MCA

 

1. non-fluent aphasia (Broca's)

  • frontal lobe/insula
  • blockage of MCA superior division (insula/frontal)

2. fluent aphasia (Wernicke's)

  • temporal/parietal lobe
  • blocage of MCA inferior division (temporal)

 

global aphasia with blockage of MCA (M1)

 

 

6

types of aphasia : what's affected → localization

global : input and output → temporal/frontal/insula

Broca : output → frontal/insula

  • Big Broca's: present like global - can't understand, cant express! but input fx regained after a couple of days
  • Little Broca's: less severely affected - just can't express

Wernicke : input → temporal

conduction : relatively intact input and output BUT connection between two sets is compromised

 

transcortical motor : output

  • similar to Broca's

transcortical sensory : input

  • similar to Wernicke's

7

how do you distinguish between Broca's/Wernicke's and transcortical_motor/transcortical_sensory?

Broca's and transcortical motor : input OK, output not

Wernicke's and transcortical sensory : input not, output OK

 

Broca's/Wernicke's → core is destroyed → repetition is lost

transcortical_motor/sensory → core intact → repetition intact

8

Broca's area

 

Broca's contributions

inferior frontal gyrus

  • Brodmann's area 44 (pars opercularis)
  • Brodmann's area 45 (pars triangularis)

 

Broca's contributions

1. localization of function: frontal lobes (Broca's area)

2. lateralization of function: L hemi is usually dominant

3. Broca's aphasia: expressive (non-fluent) aphasia

  • Broca's myth is that Broca's aphasia is always due to lesion in Broca's area
  • NOT TRUE!

9

Broca's aphasia

 

little vs big

labored, halting speech

telegraphic

naming difficulty

paraphasic errors

comprehension relatively well preserved

 

Little Broca's

  • presents like Broca's
  • recover usually within a year

Big Broca's

  • presents like global → transitions into Broca's
  • life-long aphasia problems

10

Wernicke's area

 

Wernicke's aphasia

posterior region of secondary auditory cortex

 

  • fluent and "highly talkative"
  • comprehension very poor
  • difficulty following commands
  • speech unintellible
    • word subs
    • jargon
  • unaware of deficits

11

conduction aphasia

 

whats intact?

whats not? why?

 

characteristic presentation

disrupts communication between Wernicke's area, Broca's area

  • repetition ability compromised BUT W and B areas are undamaged
    • comprehension mostly intact
    • patient mostly fluent

so what IS affected?

  • lang skills that rely on speed
  • ability to self-correct sentences before speaking

^ both require bidrectional comm between Broca's and Wernicke's areas

 

"paraphasic loop"

  • paraphasic error (sub of a repeated word) followed by multiple iterations until error corrected
  • fluency for several words, then get stuck again

12

transcortical aphasias

due to damage in watershed areas outside of Perisylvian Language Area 

  • anterior cerebral artery (transcort motor?)
  • posterior cerebral artery (transcort sens?)

 

transcortical motor : presents like Broca's

transcortical sensory : presents like Wernicke's

in both, perisylvian core spared → repetition spared!

13

what does the R hemisphere do?

involved in recognizing emotional content of speech

 

damage to Wernicke's equivalent results in inability to recognize emotional content

ex. difficulty determining when being lied to

 

damage to Broca's equivalent results in "prosody deficits" - no alteration of tone/speed/emotion of speech

ex. difficulty putting emotional content into speech

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