Lecture 4.2

Question 1

What are the spoken language characteristics of Wernicke’s aphasia?

Answer 1

fluent except for periods of anomia

normal to excessive verbal output
- logorrhea

semantically empty, primarily functors

morphosyntax and grammar near normal

articulation and prosody normal

all types of paraphasias

• unintended syllables/words during effort to speak
• paragrammatism

Question 2

What is paragrammatism?

Answer 2

morphological substitution errors (ex. she for he)

well-constructed syntax of sentences with errors in grammatical morphemes, substitutions of and blending among lexical items

may occur in writing as well as speech

Question 3

What is theorized to account for the difference in error types in aphasias?

Answer 3

neurological deficits affecting different stages of sentence processing

paragrammatic errors occurring later in sentence formulation process

Question 4

What is literal/phonemic paraphasia?

Answer 4

phonemes or syllables of a word are produced early but in incorrect order OR word is distorted by production of unintended sounds

usually some phonemic features of the word are preserved

cat for mat, light for live

Question 5

What is a neologism?

Answer 5

extreme literal paraphasic error such that the word is grossly distorted to such a degree that it is unintelligible

slammazer, carporta

Question 6

What is a verbal paraphasia?

Answer 6

intelligible word used in place of intended/target word

tall for sail

run for sing

Question 7

What is a semantic paraphasia?

Answer 7

substituted word has some lexical relationship to the intended word

can be random/irrelevant or perseverative

bowl for dish, girl for boy

Question 8

What is extended jargon?

Answer 8

running/connected utterances (phrases or sentences) which include senseless words or neologisms

Question 9

What are some other characteristics of Wernicke’s aphasia?

Answer 9

paraphasias pervasive

word finding difficulties severe

doesn’t respond to phonemic cues

resists interruption

unaware of communication difficulties

Question 10

How is repetition affected in Wernicke’s aphasia?

Answer 10

disturbed

may be related to severe auditory comprehension difficulties

contains paraphasias

Question 11

How is auditory comprehension affected in Wernicke’s aphasia?

Answer 11

severely impaired

some understand very little while others can comprehend simple words/phrases

system overloads easily

may have phoneme discrimination problems

Question 12

How is reading comprehension affected in Wernicke’s aphasia?

Answer 12

often reading deficit parallels auditory comprehension deficit

comprehension and reading aloud

reading learned through auditory system so if it is impaired then reading is too

Question 13

How is writing affected in Wernicke’s aphasia?

Answer 13

mechanical writing ability is good

well-formed letters

but content reflects paraphasic output at verbal levels, lacks meaning and semantically empty

Question 14

Where is the site of lesion in Wernicke’s aphasia?

Answer 14

Wernicke’s area

posterior 1/3 of superior temporal gyrus plus inferior parietal lobe

Question 15

What are some emotional and physical effects of Wernicke’s aphasia?

Answer 15

usually no hard neurological signs

may exhibit initial paresis but brief
- visual and ambulatory losses rare

tactile losses may be present

may become paranoid as others focus on deficits that clients can’t see

Question 16

What are the spoken language effects of conduction aphasia?

Answer 16

generally fluent aphasia but verbal output limited to brief bursts of utterances
- words/min approaches normal

conversational output impaired but fluency maintained

• literal/phonemic errors
• impaired phoneme selection

disjointed spoken output
- facilitated by singing/rhythmic pattern

normal intonation, syntax

aware of errors

Question 17

How is repetition affected in conduction aphasia?

Answer 17

serious problems

understand what they hear but can’t transfer to Broca’s to be repeated

classic sign of conduction aphasia

Question 18

How is auditory and reading comprehension in conduction aphasia?

Answer 18

good!

contrasts with Wernicke’s

Question 19

How is reading aloud impacted in conduction aphasia?

Answer 19

impaired because information cannot be transmitted to Broca’s area for verbal output

Question 20

How is writing impacted in conduction aphasia?

Answer 20

impaired on linguistic level but not motoric

spelling errors because of storage disturbances to angular gyrus

words omitted and interchanged in sentences

Question 21

Where is the lesion site in conduction aphasia?

Answer 21

along arcuate fasciculus

- white matter pathways under supramarginal gyrus

Question 22

What are the physical and emotional effects of conduction aphasia?

Answer 22

often no neurological deficits

motor hemiparesis varies based on site and size of lesion
- same with sensory disturbances (but usually only fingers or right side of face)

visual field impairments usually apparent, important implications for treatment to move items into field

Question 23

What are the spoken language effects on anomic aphasia?

Answer 23

anomia - inability to retreive known words

semantically empty speech

circumlocutions that are vague and bizarre

Question 24

How is repetition impacted in anomic aphasia?

Answer 24

evoking names spontaneously poor but repetition is good

Question 25

How is auditory comprehension impacted in anomic aphasia?

Answer 25

inconsistent can be relatively good for connected language but poorer for isolated words

Question 26

How is writing and reading impacted in anomic aphasia?

Answer 26

reading and writing varies along a broad spectrum spelling skills vary considerably

Question 27

Where is the lesion site in anomic aphasia?

Answer 27

least reliably localized usually in L temperoparietal area may extend into angular gyrus resulting in severe alexia and agraphia

Question 28

What are the physical and emotional effects of anomic aphasia?

Answer 28

do not usually see hard or soft neurological signs

Question 29

What is transcortical sensory aphasia?

Answer 29

damage to temporal lobe that cuts off Wernicke's and Broca's area from the rest of the brain

Question 30

What are the spoken language effects of transcortical sensory aphasia?

Answer 30

fluent output devoid of meaning - irrelevant, semantically empty - literal paraphagias and neologisms naming severely impaired because of angular gyrus involvement does not initiate utterance but those that are evoked are fluent yet empty

Question 31

How is repetition affected in TCSA?

Answer 31

excellent may be considered echolalic - involuntary repetition of everything heard

Question 32

How is auditory and reading comprehension affected in TCSA?

Answer 32

impaired/poor moderate to severe levels

Question 33

How is reading aloud and writing impacted in TCSA?

Answer 33

wide range of performance from preserved to defective writing skills similar to Wernicke's aphasia (poor)

Question 34

What is the site of lesion in TCS aphasia?

Answer 34

watershed lesion posterior parieto-temporal - sparing Wernicke's area - parietal and temporal border zones disruption in blood supply from PCA affecting inferior temporal lobe and anterior occipital lobe

Question 35

What are the physcial and emotional effects of TCSA?

Answer 35

sensory impairments Gerstman's syndrome - R/L disorientation - finger agnosia (can't tell what finger is touched when eyes closed) - agraphia - acalculia

Question 36

How can subcortical lesions cause aphasia?

Answer 36

thalamus and basal ganglia play direct regulatory or indirect gating roles in cortical language functions subcortical vascular lesions may have widespread effects, creating hypofusion in L hemisphere Perisylvian regions combination of 1 and 2

Question 37

What are the types of subcortical aphasias?

Answer 37

anterior capsule/putamen posterior capsule/putamen thalamic

Question 38

Describe anterior/putamen subcortical aphasias.

Answer 38

combination of TCM and Broca's characteristics short phrase length, impaired articulation, poor nonverbal skills relatively good repetition and auditory comprehension

Question 39

Describe posterior/putamen subcortical aphasias.

Answer 39

combination of Broca's and Wernicke's symptoms good articulation and verbal skills, poor nonverbal skills poor repetition and auditory comprehension

Question 40

Describe thalamic subcortical aphasias.

Answer 40

TCM and TCS like linguistic characteristics fluent aphasia with semantic paraphasias and neologisms spared repetition, variable comprehension

Question 41

Describe pure alexia/pure word blindness.

Answer 41

alexia without agraphia most common single language modality syndrome can't read or recognize written whole words - can perceive letter by letter can name objects presented visually, recognize numbers, and comprehend oral spelling

Question 42

What is the site of lesion in pure alexia?

Answer 42

complex lesion or series of lesions L visual cortex and connections between R visual cortex and L hemisphere destroyed absence of visual input to intact language areas of L hemisphere

Question 43

What is pure word deafness/subcortical sensory aphasia?

Answer 43

rare can't repeat or understand spoken utterances - but hearing still present - can interpret environmental sounds can still speak, read, and write normally - paraphasias usually present acutely vowel contrasts appreciated but less so for consonant contrasts

Question 44

What is the site of lesion in subcortical sensory aphasia?

Answer 44

pathology in 2 locations lesions isolate Wernicke's area from primary auditory cortex in BOTH temporal lobes - fibres that bring info from auditory association areas in R hemisphere destroyed subcortical lesions in language-dominant superior temporal gyrus with destruction of primary auditory cortex (Heschl's gyrus)

Question 45

What is pure agraphia/subcortical aphasia?

Answer 45

writing problems in absence of other significant language disturbances may be due to focal lesion or acute confusional state motor and spelling errors present but spelling errors dependent on lesion location 5 types

Question 46

What is anterior disconnection syndrome?

Answer 46

unilaterail tactile agnosia, agraphia, apraxia unilateral L hand apraxia, can't follow verbal directions with left hand can't name or talk about objects in L hand though can usually draw item or demonstrate its function lesion in anterior corpus callosum - interruption of connection between verbal areas in L language dominant hemisphere and sensory areas of L hand in right hemisphere

Question 47

What is posterior disconnection syndrome?

Answer 47

objects seen in L visual field can not be named non-specific visual disturbances lesion in posterior portion corpus callosum