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What is speech?

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



What is phonation?

Distinct sounds produced by larynx


What is a phoneme?

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


What is dysphonia?

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


What is dysarthria?

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


What is mutism?

Absence of phonation


What is the anatomic substrate for speech?

- 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


How can you examine a pt's speech?

- 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 


What is language?

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


What is aphasia?

Loss of ability for spoken and written language


What is alexia?

Loss of ability to read when no visual impairment exists


What is agraphia?

Loss of ability to write when no motor impairment exists


What is paraphasia? 2 types?

- 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 


What is neologism?

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


What is semantics?

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


What is syntax?

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


What is prosody?

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


What is the anatomic substrate for language?

- 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


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


How does the lateralization of language work?

- >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 


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?

- 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 


What does this image illustrate?

- 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 


What does this image illustrate?

- 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


What does this image illustrate?

- 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


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

- 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


What are the 6 components of language testing?

- 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 


What is Broca's aphasia?

- Perisylvian syndrome: non-fluent, expressive aphasia 

Reduced verbal output, <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 


What is Wernicke's aphasia?

- 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 


What is global aphasia?

- 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


What is conduction aphasia?

- 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