Speech And Language Disorders

Question 1

Broca’s area

Answer 1

. Area 44 and 45
. Located in opercular and triangular portions of inf. Frontal gyrus
. Receives input from wernicke’s area via sup. Longitudinal fasiculus
. Motor speech area: projects to areas of primary motor cortex for articulation and phonation of speech
. Language formulation area: general of verbal and written language

Question 2

Wernicke’s area

Answer 2

. Area 22
. Located in sup. And middle temporal gyri post. To primary auditory cortex
. Receives inputs from auditory, visual, and somatosensory cortices
. Projects via sup. Longitudinal fasciculus to broca’s
. Responsible for decoding language input in verbal or written forms
. Comprehension of linguistic forms

Question 3

Perislyvian zone

Answer 3

. Region around Sylvia fissure

. Communication functions here

Question 4

Insular cortex

Answer 4

. Deep w/in lat. sulcus

. Important for communication and homeostasis, emotional regulation, consciousness, ad self-awareness

Question 5

Ant. Commissural

Answer 5

. Small compact bundle that cross midline rostral to columns of fornix
. Connects regions of middle and inf. Temporal gyri and olfactory tracts and bulbs

Question 6

Corpus callosum

Answer 6

. Connect regions of cortex in 2 hemispheres

Question 7

Intrahemispheric connections

Answer 7

. W/in dominant hemisphere only
. Sup. Longitudinal fasiculus connects wernicke’s and Broca’s areas
. Course from frontal lobe to parietal, occipital, and temporal lobes
. Provides link btw cortical areas involved in sensory and motor aspects of communication

Question 8

Cerebral dominance of language

Answer 8

. Almost all left hemisphere dominant (including most lefties)

Question 9

Functions assigned to dominant hemisphere

Answer 9

. Language and speech
. Math ability
. Problem solving in sequential, logical manner
. Processing of visual sign language

Question 10

Functions assigned to non-dominant hemisphere

Answer 10

. Recognition and appreciation of simple, spatial relationships
. Some elements of music and poetry (nonverbal ideation)
. Artistic ability
. Many aspects emotion

Question 11

Wada test

Answer 11

. Localized functions w/in hemisphere
. Anesthetize one cerebral hemisphere w/ Amytal
. Patient is awake lying on back w/ arm raised in air
. patient will stop counting and then continue a few seconds later is non-dominant hemisphere was injected
. Patient won’t count for duration of drug if dominant hemisphere is injected

Question 12

Process involved in producing spoken word

Answer 12

. Respiration
. Phonation
. Resonance
. Articulations

Question 13

Respiration in speech

Answer 13

. Proper breath support needed w/ functional diaphragm and lungs
. Poor breath support results in dec. vocal volume and intelligibility

Question 14

Phonation in speech

Answer 14

. Ability to vocalize during speech production
. Dependent upon laryngeal function, vocal fold condition, muscle strength, and neural innervation of laryngeal mechanism

Question 15

Resonance in speech

Answer 15

. Sound quality of speech
. Determined by shape of person’s resonators
. Mediated during speech by opening/closing of velopahryngeal port
. Normal speech needs open VP for nasal sounds and closed VP for vowels and other consonants

Question 16

Articulation in speech

Answer 16

. Production of speech sounds via highly synchronized movement of lips, tongue, and mandible
. Children develop this by age 5
. Disorders most commonly seen in kids but can be secondary to neural insult

Question 17

Articulation error types

Answer 17

. Substitutions: most common
. Omissions: seen in young kids
. Additions: unusual, ESL speakers
. Distortions: young kids and people w/ neurological abnormalities

Question 18

Prosody

Answer 18

. Inflection

. Carries meaning assoc. w/ social-affective(pragmatic) intent of messages (humor, sarcasm, etc)

Question 19

Initiation

Answer 19

. Onset of speech
. Ability to initiate speech production or voicing of speech sounds at appropriate time
. Important for speech sound production and clarity
. Important for pragmatic language functions of initiating social interactions appropriately
. Controlled primarily by supplementary motor area

Question 20

Dysarthria

Answer 20

. Motor speech disorders caused by neurologic abnormalities of CNS or PNS
. Speech production is characteristically slow, shaky, or slurred
. Patients retain language ability despite speech disturbance

Question 21

Flaccid dysarthria

Answer 21

. Breathy, hypernasal w/ intermittent nasal emission
. Slurred
. Quiet due to flaccidity of mm. Of phonation and respiration
. Fasciculations and atrophy of tongue
. Due to LMN disease, often trauma to CN X

Question 22

Spastic dysarthria

Answer 22

. Slow effortful speech w/ strained quality
. Mm. Are spastic so speech is hard to produce
. Produced by bilateral damage to pyramidal and extrapyramidal CNS pathways
. UMN disease: cortical or coricobulbar lesions
. Occurs secondary to stroke, TBI, or degenerative disease

Question 23

Ataxic dysarthria

Answer 23

. Speech imprecise, jerky, slurred
. Alternating loudness and speed of production
. Speech production uncoordinated as are other motor movements
. Patient sounds drunk
. Secondary to cerebellar disease

Question 24

Hypokinetic dysarthria

Answer 24

. Speech slow w/ bursts of faster speech
. Mm. Movement limited by rigidity making articulation less precise
. Secondary to basal ganglia pathology (Parkinson’s)
. Also seen following subcortical strokes, penetrating brain injuries, and infections

Question 25

Hyperkinetic dysarthria

Answer 25

. Speech intermittently impacted by fluctuating mm. Tone . May sound normal then suddenly jerky and slurred . Assoc. w/ vocal tremor, SOB, difficulty getting words out so patient is exhausted trying to communicate . Caused by basal ganglia lesions in caudate putamen and globus pallidus . Also have generalized movement disorders (chorea, dystonia) . Commonly assoc. w/ Huntington’s

Question 26

Mixed dysarthria

Answer 26

. Common to see dysarthrias occur in combos | . Difficult to diagnose

Question 27

Apraxia of speech (AOS)

Answer 27

. Impaired ability to plan, program, and execute appropriate series of motor movements for speech production . Speech is fragmented and each production of target word is different (not same problem) . Mm. Intact and functional . Can occur w/ aphasia or dysarthria . Secondary to dominant hemisphere impairment in Broca’s area or left fronto-parietal region response for motor speech programming (LH strokes or degenerative diseases) . Seen in adults who developed speech normally and then lost it due to pathology

Question 28

Developmental apraxia of speech

Answer 28

. Occurs in children . Specific neurological etiology difficult to demonstrate . Results in difficulty learning to speak and moderate to severe articulation impairment

Question 29

Dysphonia

Answer 29

. Disturbance in focalization or phonation . Impaired ability to vocalize due to disorder of larynx or its innervation (laryngitis, vocal nodes) . Impaired vocal quality . Can involve alteration of 1+ vocal parameters . Language ability is not impacted

Question 30

Aphonia

Answer 30

. Loss of voice . Commonly from vocal paralysis secondary to recurrent laryngeal n. (CN X branch) that supplies larynx unilaterally or bilaterally . Can be secondary to laryngeal resection following cancer .can be emotionally mediated but that is transient

Question 31

Simplex tics in speech

Answer 31

. Vocal: involuntary, intermittent expression of noises or sounds . Motor: involuntary, intermittent motor movements that can occur alone or w/ vocal tics

Question 32

Complex tics

Answer 32

. Involuntary intermittent expression of words, phrases, or sentences . Said repetitively and sometimes w/ exaggerated inflection

Question 33

Echolalia

Answer 33

. Involuntary repetition of last sound, word, phrase, or sentence of another person . Echoed phrase may be only verbal output patient will offer . Seen in individuals w/ autism and secondary to other neuro issues

Question 34

Coprolalia

Answer 34

. Involuntary utterance of socially unacceptable or obscene words . Seen in psychiatric or neuro conditions . Side effect of some meds

Question 35

Developmental stuttering

Answer 35

. Involuntary repetition of 1st sound or syllable of word . Movements of stuttering not accompanied by frustration or head/neck tension . Child does not know they are doing it . Occurs for short periods of time and resolves w/o intervention . Developmental not a disorder

Question 36

Stuttering

Answer 36

. Sound, syllable, or word repetition, prolongation of sounds, hesitation beginning to speak . Visible head/neck tension . Frustration and stress . Worse when person is under stress . May be hemispheres struggling for dominance . Very in severity

Question 37

Language

Answer 37

. Ability to converse, comprehend, repeat, read, and write . Includes receptive and expressive abilities . Development parallels w/ emergence of cognitive abilities . Mediated directly by CNS

Question 38

Pragmatic

Answer 38

. Rule system that governs how we use language | . Social application of language: attention, initiation, turn taking

Question 39

Semantics

Answer 39

. Use system that governs encoding and decoding meaning w/in language . Includes decoding the meaning of what we hear . Includes selecting vocal words w/ accurate meaning for message we convey

Question 40

Syntax

Answer 40

. Rule system that governs how we combine words into grammatical sentences

Question 41

Morphology

Answer 41

. Rule system that governs how we encode meaning into words through use of prefixes and suffixes

Question 42

Phonology

Answer 42

. Rule system that governs how we combine sounds to form words that have meaning

Question 43

Comprehension deficits

Answer 43

. Following direction issues | . Not understanding spoken language or what is read

Question 44

Expressive deficits

Answer 44

. Issues reading aloud, writing, or speaking

Question 45

Aphasia

Answer 45

. Results from brain damage to LH | . Problems speaking. Listening, reading, and writing

Question 46

Broca’s aphasia

Answer 46

. Reduced verbal output . Sparse, poorly articulated and effortful speech . Verbal output is telegraphic and agrammatic . Naming is poor but prompting helps significantly . Comprehension of spoken language is significantly better than verbal output . Writing is difficult in dictation and copying

Question 47

Wernicke’s aphasia

Answer 47

. Fluent/sensory/receptive aphasia . Verbal output sounds normal but sentences are devoid of meaning . Person does not realize they have it . Cannot comprehend language or writing

Question 48

Conduction aphasia

Answer 48

. Lesion in arcuate fasciculus running btw Wernicke’s and broca’s . Difficulty repeating . Verbal output is fluent and paraphasic . Articulation good . Comprehension of spoken language intact . Reading out loud is poor but reading silently comprehension is good . Writing disturbed . Spontaneous speech may be meanless, but comprehension of spoken and written word is good

Question 49

Transcortical motor aphasia

Answer 49

. Ant. Watershed zone of dominant ACA infraction ant. And sup. To Broca’s area . Lesion encompasses cortical white matter deep to SMA . Resembles broca’s but repetition is good . Develops after a period of muteness . Limited agramamtical and effortful spontaneous speech . Limited ability to name object and compose word lists . Can’t answer open ended things . Ability to repeat spoken word is good . Articulation is normal

Question 50

Trasnscortical sensory aphasia

Answer 50

. Lesions in post. Watershed zone of dominant hemisphere . Lesion encompasses parietal and temporal areas post. And sup. To wernicke’s . Similar to wernicke’s w/ intact repetition . Impaired comprehension w/ normal verbal fluency . Paraphasia . Echolalia . Naming issues . Reading out loud contaminated w/ errors . Comprehension and writing abnormal

Question 51

Transcortical mixed aphasia

Answer 51

. Lesions in ant. And post. Watershed zones in dominant hemisphere . Like global aphasia but repetition is preserved . Patients don’t speak unless spoken to . Exhibit true echolalia . Repetition preserved but is limited to 3-4 words in sentence that can be repeated

Question 52

Anomic aphasia

Answer 52

. Amnestied/nominal aphasia . Output vague w/ no substantive words . Principal deficit in naming . Can hav normal comprehension and ability to speak in spontaneous conversation . When confronted w/ objects or trying to think of a word or name the patient will falter . Involves lesions of angular gyrus in dominant hemisphere

Question 53

Global aphasia

Answer 53

. All language functions are severely limited . Verbal output is very limited . Comprehension is better than verbal output but it is impaired . Communication may be attempted w/ symbol system . Results from widespread damage to dominant hemisphere involving moist of the language areas

Question 54

Alexia

Answer 54

. Loss of ability to read . Visual info has lost access to wernicke’s area . Lesion involves connections around angular gyrus in dominant hemisphere . Dyslexia is incomplete alexia

Question 55

Agraphia

Answer 55

. Loss or impairment of ability to produce written language . Lesion involving inf. Parietal lobule in angular gyrus in dominant hemisphere . Micrographia seen in Parkinson’s but not the same as agraphia

Question 56

Prospagnosia

Answer 56

. Inability to recognize familiar faces | . Due to bilateral lesions of temporal lobes

Question 57

Aprosodia

Answer 57

. Motor: inability to convey emotions by voice or gestures (monotone speech) . Sensory: difficulty comprehending emotional content of speech or gestures of others . Can be due to issue in non-dominant hemisphere

Question 58

Agnosia

Answer 58

. Inability to recognize or be aware of abject when using a given sense even though sense is functionally intact . Sensory (astereognosia): lesions in sup. Parietal lobule, inability to recognize objects by touch alone but identification can be accomplished w/ other senses . Visual: lesions in visual assoc. cortices (18,19) in dominant hemisphere, inability to recognize objects by sight alone but can recognize it tactily

Question 59

Apraxia

Answer 59

. Inability to correctly perform learned movements on command in absence of elementary sensory-motor deficits . Motor/sensory pathways intact . Patient can perform same action in different cortex (reflex)

Question 60

Kinetic apraxia

Answer 60

. PMC lesion . Difficulties in fine motor control . Loss of ability to make finely graded, precise individual finger movements (picking up pin, finger tapping test)

Question 61

Ideomotor apraxia

Answer 61

. Lesion of supramarginal gyrus in dominant hemisphere . Inability to perform many complex tasks on command . Spatial and temporal errors: orientation of body or tool is wrong . Most errors when patient asked to pantomime action . Given actual objects and context patients do better

Question 62

Ideational apraxia

Answer 62

. Seen in degenerative dementia (frontal lobe dysfunction) | . Inability to perform a series of acts to obtain a goal (making a sandwich)

Question 63

Alexia w/o agraphia

Answer 63

. Due to lesion of post. Cerebral a. And destruction of dominant visual cortex and selenium of surplus callosum . Language areas cut off from visual imputes so the patient can write but not read

Question 64

Executive function disorders

Answer 64

. Due to lesions in ant. Portion of frontal lobe . Inappropriate social behavior . Difficulties in adaptation and loss of initiative . Phineas gage syndrome

Question 65

Neglect syndromes

Answer 65

. Lesions of non-dominant sup. parietal lobule . Lack of appreciation of spatial aspects of all sensory input from contralateral side of body and contralateral visual field . Hemineglect: patient ignore half of their body . Lack of awareness of contralat. Half of personal space of side of body . Failure to dress, groom contralat. Side of body . Assoc. w/ anosognosia (denial of deficit)