Jacewicz - Speech and Language

Question 1

What is speech?

Answer 1

• Communication via vocalized sounds (phonation) that form spoken words and sentences

Question 2

What is phonation?

Answer 2

Distinct sounds produced by larynx

Question 3

What is a phoneme?

Answer 3

• A distinct sound that contrasts with others (American English has 25 consonant and 17 vowel phonemes)

Question 4

What is dysphonia?

Answer 4

• Disturbance of phonation causing alteration of volume (hyper- and hypophonia)

Question 5

What is dysarthria?

Answer 5

• Disturbance of articulation caused by impaired motor control, resulting in slurring of speech

Question 6

What is mutism?

Answer 6

Absence of phonation

Question 7

What is the anatomic substrate for speech?

Answer 7

• Neocortex w/sensory (blue) and motor (maroon) strips and overlying homunculi
• Sagittal section through lower face and neck to emphasize mm used in normal phonation
  1. These mm incl the tongue, and mm controlling the lips, pharynx, vocal cords, etc
• Any disruption to these motor pathways or the mm themselves can cause slurring of words denoted as dysarthria

Question 8

How can you examine a pt’s speech?

Answer 8

• Assess spontaneous speech, have subject read, and repeat selected phrases, e.g., “round the rugged rock the ragged rascal ran”
• Listen for:
  1. Speech volume: INC in hearing deficits, DEC in vocal cord and extrapyramidal disorders, e.g., PD
  2. Rate of speech: INC in fluent aphasia, DEC in non-fluent aphasia
  3. Articulation: abnormal in many CNS and PNS disorders, and in end-organ lesions

Question 9

What is language?

Answer 9

• System of arbitrary symbols (sounds, written symbols, gestures) that permit communication of thoughts, ideas, emotions, etc.

Question 10

What is aphasia?

Answer 10

Loss of ability for spoken and written language

Question 11

What is alexia?

Answer 11

Loss of ability to read when no visual impairment exists

Question 12

What is agraphia?

Answer 12

Loss of ability to write when no motor impairment exists

Question 13

What is paraphasia? 2 types?

Answer 13

• Language errors due to word or sound substitution
  1. Semantic paraphasia: substitution of one word for another, e.g., fork for spoon
  2. Phonemic paraphasia: substitution of one sound for another, e.g., moon for spooon

Question 14

What is neologism?

Answer 14

Creation of meaningless words, e.g., woon for spoon

Question 15

What is semantics?

Answer 15

• Meaning or interpretation of a word, sentence, or other language form, i.e., language lexicon

Question 16

What is syntax?

Answer 16

• System of rules (grammar) implicit in a language, viewed as a mechanism for generating all sentences possible in that language

Question 17

What is prosody?

Answer 17

• Tone, inflection, volume of words and sentences that add meaning to language

Question 18

What is the anatomic substrate for language?

Answer 18

• Arcuate fasciculus and other peri-Sylvian fibers connecting Wernicke’s (BA #22) and Broca’s (BA #44-45) areas
• Not shown in this image are the connections bt the main language areas (W and B) and the o/association areas of the frontal, temporal, and parietal lobes
• It also does not demonstrate connections to the non- dominant hemisphere that provide emotional color to language
• Lesions of these connecting fibers will cause aphasia with unique characteristics

Question 19

What are the 3 main language disorders and their characteristics (image)?

Answer 19

Question 20

How does the lateralization of language work?

Answer 20

• >95% of R-handed ppl are left-hemisphere dominant
• About 65% of L-handed ppl are L-hemisphere dominant, 15-20% are R-hemisphere dominant, and the rest have mixed dominance

Question 21

Imagine this is a R-handed split-brain subject. How will his responses vary based on the hand he uses to examine the objects blocked from his vision?

Answer 21

• When this R-handed split brain subject is asked to name small geometric objects w/o seeing them, he provides the correct answer when he handles the object w/his right hand -> sensory info registers in left hemisphere, which then connects w/language area
• However, when he handles the objects with his left hand (sensory info to the right hemisphere, which is disconnected from the language areas in the left hemisphere), he is unable to name the objects
• NOTE: split brain due to sectioning of the corpus callossum

Question 22

What does this image illustrate?

Answer 22

• Another method for testing split brain subjects: visual input restricted to either left or right calcarine (visual) cortex
• Same results are obtained as described in the tactile test, i.e. info transmitted to R visual cortex (seen with L eye) cannot reach language areas in L hemisphere -> although subject can see the objects he cannot name them

Question 23

What does this image illustrate?

Answer 23

• When subject is instructed to passively view a word, calcarine cortex lights up indicating INC metabolic activity and thus neuronal activation
• When subject listens to the word with no visual input, Hershel’s gyrus and Wernicke’s area light up
• NOTE: SPECT scans register changes in regional cerebral metabolism, measured with positron emitting isotopes, in this case radioactive deoxyglucose

Question 24

What does this image illustrate?

Answer 24

• When subject speaks the word, the facial area of the motor strip and Broca’s area light up
• When subject is asked for more complex language-related task, e.g., to generate word associations, the language association areas light up
• NOTE: SPECT scans register changes in regional cerebral metabolism, measured with positron emitting isotopes, in this case radioactive deoxyglucose

Question 25

Describe the left/right hemisphere language functions in a left hemisphere dominant individual (table).

Answer 25

- Orange boxes around specific lang funcs of the 2 hemispheres - L HEMI: _lexical and syntactic language_, writing, and spoken word abilities - R HEMI: some rudimentary spoken language and the emotional coloring of language (_prosody_) - NOTE: stereognosis = mental perception of depth or 3-dimensionality by the senses, usually in reference to the ability to perceive form of solid objects by touch

Question 26

What are the 6 components of language testing?

Answer 26

- _Expression_: normal verbal output 100-150 words/min; assess through spontaneous convo - _Comprehension of spoken language_: test ability to follow simple and complex spoken commands - _Repetition_: ask subject to repeat single words and phrases - _Reading_: ask subject to read aloud and follow a written command - _Writing_: ask subject to write a sample sentence - _Naming_: ask subject to identify common objects

Question 27

What is Broca's aphasia?

Answer 27

- Perisylvian syndrome: _non-fluent, expressive aphasia_ - **Reduced verbal outpu****t**, \<50 words/min; single word or short phrase (\<5 words) - Word use restricted to nouns, verbs, adjectives, with limited use of syntactical words, e.g., adverbs, articles, prepositions - **Comprehension relatively spared**, but some trouble w/understanding complex syntactical language - Repetition poor, agrammatic; _paraphasias common_ - **Lesion to BA #44-45** - Causes multiple; _MCC is a stroke_

Question 28

What is Wernicke's aphasia?

Answer 28

- Perisylvian syndrome: _fluent, receptive aphasia_ - **Verbal output normal or INC**; about 200 words/min - Sentences devoid of meaningful lang, most noticeable is absence of nouns, replaced by pronouns and prepositions - **Comprehension seriously impaired**, repetition poor, and paraphasic errors and _neologism common_ - **Lesion at BA #22**; causes multiple, but _MCC stroke_

Question 29

What is global aphasia?

Answer 29

- Perisylvian syndrome - Both _expressive AND receptive language function seriously impaired_ - Nonfluent, common paraphasic errors - Lesion involves **large area of L hemisphere** - Causes similar to Broca's/Wernicke's aphasia (e.g., _stroke_)

Question 30

What is conduction aphasia?

Answer 30

- Perisylvian syndrome - Comprehension and fluency relatively good - **Repetition poor** and paraphasic errors common - Lesion location in **supramarginal gyrus and arcuate fasciculus** - MCC occlusion of _angular branch of left middle cerebral artery_

Question 31

What is transcortical motor aphasia?

Answer 31

- Extra-sylvian syndrome - Uncommon aphasia similar to Broca's, except _subjects able to repeat_ - Lesion in _left anterior frontal lobe_, superior or inferior to Broca's area; lesions of left basal ganglia may be a rare lesion site - Causes similar to Broca's (e.g., stroke)

Question 32

What is transcortical sensory aphasia?

Answer 32

- Extra-sylvian syndrome - Uncommon aphasia similar to Wernicke's, except _subjects able to repeat_ - Lesion in border zone _bt left middle cerebral and posterior cerebral aa_ - Causes similar to Wernicke's, but also **severe hypotension**

Question 33

What is mixed transcortical aphasia?

Answer 33

- Extra-sylvian aphasia - Uncommon aphasia similar to global aphasia, except subjects are _able to repeat_ - Lesion in border zone _bt left middle cerebral and ant cerebral aa_ - Causes are stroke and _severe hypotension_

Question 34

What is anomic aphasia?

Answer 34

- Extra-sylvian syndrome - Poorly defined since all aphasias have naming difficulty - Lesion location can be _anywhere in language area_ - **Gerstmann** **syndrome**: anomia, alexia, agraphia, right-left disorientation, acalculia, finger agnosia, lesion localized to left angular gyrus (BA #**39**)

Question 35

What is sub-cortical aphasia?

Answer 35

- Extra-sylvian aphasia - Subjects with lesions of _left basal ganglia or left thalamus_ - May be associated with variable forms of aphasia

Question 36

What is alexia without agraphia?

Answer 36

- Extra-sylvian syndrome - Inability to read with preserved ability to write - Lesion in _left medial occipital and medial temporal lobe_, involving splenium of corpus callossum - Cause is branch occlusion of _left posterior cerebral artery_

Question 37

What will this lesion cause?

Answer 37

- **Alexia without agraphia**: unusual bc reading and writing typically are linked language functions - Lesion that produces this syndrome shown in purple, and involved the _left visual cortex and splenium of the corpus callosum_ - Language areas of L hemisphere are intact, so pt able to speak normally and write normally, but they cannot read - Pt has a R visual field deficit (_R homonymous hemianopsia_) -\> they have no registration of R visual field and left visual field info (which registers normally in R visual cortex) _cannot reach language areas bc of splenium lesion_, so the pt is unable to read

Question 38

What is the language syndrome algorithm?

Answer 38

- Testing the patient for fluency, comprehension, and the ability to repeat simple phrases permits the categorization of all aphasic syndromes - Color-coded circle under each type of aphasia helps to identify the anatomical lesion responsible for that aphasia

Question 39

What are the 9 language aphasias, and their differentiating features (table)?

Answer 39

- NOTE: only the first 4 columns are useful in separating one aphasic syndrome from all the others