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Flashcards in Language disorders Deck (38):
1

Aphasia definition

impairment of language produced by brain dysfunction

differentiated from: dysarthria (disorders of articuation), auditory disorders, psychiatric illnesses

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Language anatomy

Hemispheric specialization
Dominant hemisphere: L in >95% of R-handed, 70% of L-handed people
Non-verbal aspects processed in non-dominant hemisphere (tone, prosody)
Broca's area
Wernicke's area

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Broca's area

production of language
interacts with many surrounding areas in frontal cortex

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Wernicke's area

comprehension of language
interacts with many surrounding areas in temporal and parietal cortex
including angular and supramarginal gyri

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Arcuate fasciculus

connects Broca's and Wernicke's areas

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Corpus callosum

Connects to non-dominant hemisphere

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Examinable components of speech

Articulation
Fluency
Effort
Word finding
Paraph

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Dysarthria

dysarthria is not a language disorder, per se
can be due to:
UMN/LMN lesions
NMJ lesions
cerebellar
extrapyramidal
etc

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Phonemic paraphasias

literal
sound substitutions
e.g. cable instead of table

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Semantic paraphasias

word substitution
e.g. hat instead of coat

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Neologisms:

made-up words

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Prosody

intonation of speech
convey emotion
disorder - dysprosody/aprosody, can be caused by lesions in non-dominant hemisphere

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Auditory comprehension

Yes/no, MC questions
Point to objects and parts
Commands (simple/complex)
Complex syntax

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Naming impairments

can be impaired in absence of any other language problem (pure anomia)

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Classification of aphasias

use a 3-step approach:
1) fluency
2) comprehension
3) repetition
do NOT simply say receptive/expressive

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Global aphasia characteristics

non-fluent, poor comprehension
poor repetition/naming

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Mixed transcortical aphasia characteristics

non-fluent, poor cmprehension
poor naming
good repetition

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Global aphasia cause

Usually due to damage of both Broca's/Wernicke's (MCA)

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Mixed transcortical aphasia cause

damage to areas that communicate with Broca's & Wernicke's
but Broca's , Wernicke's, articulate fasciculus are spared individually
MCA/PCA, MCA/ACA watershed territories

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Broca's aphasia

non-fluent with good comprehension
poor repetition and naming

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Transcortical motor aphasia characteristics

non-fluent with good comprehension
good repetition
poor naming

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Transcortical motor aphasia causes

damage to other areas of frontal lobes that communicate with Broca's area

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Wernicke's aphasia

Fluent speech with poor comprehension
poor repetition and naming

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Transcortical sensory aphasia characteristics

fluent speech with poor comprehension
Good repetition
Poor naming

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Transcortical sensory aphasia causes

damage to other areas of temporal/parietal lobes that communicate with Wernicke's area

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Conduction aphasia characteristics

fluent speech with good comprehension
poor repetition
poor naming with frequent paraphasias

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Conduction aphasia cause

damage to peri-Sylvian areas affecting articlate fasciculus

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Anomic aphasia characteristics

fluent speech with good comprehension
good repetition
Poor naming with occasional paraphasias

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Anomic aphasia cause

anatomically non-specific
usually due to smaller lesions

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Naming in aphasia

poor in ALL aphasias
good screening to test naming

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Agraphia without aphasia

impaired writing without other language impairments
due to lesions to angular gyrus
Gerstmann's syndrome

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Gerstmann's syndrome

lesion to inferior parietal lobule, including angular gyrus
4 components:
agraphia
acalculia
R/L disorientation
finger agnosia

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Alexia without agraphia

Lesions in L occipital cortex/posterior corpus callosum = PCA
Information from L visual field --> R occipital lobe, then should cross over to L angular gyrus and Wernicke's to permit reading
Disconnection syndrome

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Apraxia

lack of ability to execute learned purposeful movements
Not due to primary motor/sensory deficit
Comprehension, attention, motivation intact

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Types of apraxia

ideomotor apraxia
ideational apraxia
apraxia of speech
most due to lesions in dominant hemisphere (frontal/parietal association cortices)

36

Ideomotor apraxia

commonest
failure to perform skilled/learned motor sequences on command, or to imitation
brush teeth, comb, salute, hammer nail (limb)
whistle, blow match, suck straw (bucco-facial)
bow, stand like a boxer (trunk)
intent of movement usually still recognizable

37

Ideational apraxia

conceptual deficit
difficulty performing sequence of steps to complete a task
loss of knowledge to select tools/objects
usually bilateral parietal lobes affected

38

Apraxia of speech

difficulty translating motor plans into speech output
general buccofacial praxis intact
speech effortful, but not due to aphasia (writing intact)
trial and error, groping for words
Lesion in dominant prefrontal areas near Broca's