Speech and Language
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Speech/Language Function BCS 242 Neuropsychology Fall 2004
Brief Anatomy
In >96% of right-handers and 70% of lefthanders, left hemisphere is “dominant” for speech and language Different areas implicated in different functions
For example, anterior location for speech production (left frontal lobe); posterior for speech comprehension (left temporal-parietal region) Roles played by subcortical structures (basal ganglia, posterior thalamus) and right hemisphere less well understood
Brain areas involved in Language
Basic Language Components
Auditory Comprehension Visual Comprehension Articulation Word Finding Grammar/Syntax Repetition Verbal Fluency Writing Prosody
Language Deficits
Aphasia – spoken language Alexia – reading Agraphia - writing Anomia - naming Dysarthria - articulation
Types of Language Errors
Paraphasia:
Neologism:
Talking with considerable effort
Agraphia:
Paraphasia with a completely novel word
Nonfluent speech:
Substitution of a word by a sound, an incorrect word, or an unintended word
Impairment in writing
Alexia:
Disturbances in reading
19th Century Neuropsychology
Broca (1865) described patients who displayed halting, agrammatic speech
Content words were well preserved Function words (i.e., adjectives, articles) impaired
Broca’s Aphasia
Patient “Tan” Brain tumor in Left frontal brain region Broca: Lesion disrupted speech
Broca’s Aphasia
“Yes… ah… Monday… er… Dad and Peter H… (patient’s name), and Dad… er… hospital… and ah… Wednesday… Wednesday, nine o’clock… and oh… Thursday… ten o’clock, ah doctors… two… an’ doctors… and er… teeth…yah Goodglass & Geschwind, 1976
Broca’s Aphasia
Broca’s Aphasia – Damage to “motor images” Language comprehension skills relatively preserved Typically observed in patients with damage to left inferior prefrontal cortex
Wernicke’s Aphasia
Neologisms Speech appears to have no information content “fluent nonsense” Preserved function words, impaired content words Comprehension impaired Even simple sentences not well understood Associated with left temporal lobe damage
Wernicke’s Aphasia
“Well this is… mother is away here working her work out o’here to get her better, but when she’s looking in the other part. One their small tile into her time here. She’s working another time…” Goodglass & Geschwind, 1976
Broca’s, Wernicke’s Area, and Connections
Lichtheim’s (1885) and Geschwind’s (1965) model Auditory input mediated by Wernicke’s area Motor output mediated byBroca’s area Regions connected by arcuate fasciculus
Aphasia Syndromes I
Fluent (receptive) Aphasias: All have FLUENT speech and no articulatory disorder; problems with comprehension and/or repetition
Wernicke (aka sensory): neologisms/anomia/ paraphasias, poor comprehension and repetition Transcortical Sensory(aka isolation syndrome): intact repetition; paraphasias/anomia, poor comprehension Conduction: phonemic paraphasias/neologisms, poor repetition, fairly good comprehension Anomic (aka amnesic):anomia and some paraphasias; all else intact
Aphasia Syndromes II
Nonfluent (expressive) Aphasias: All have articulatory disorder but relatively preserved comprehension
Broca (aka motor, expressive, nonfluent): speechlessness with recurring utterances or phonetic disintegration, or phonemic paraphasias with anomia, agrammatism, and dysprosody; poor repetition Transcortical Motor: uncompleted sentences and anomia; naming better than spontaneous speech; repetition fairly intact Global: speechlessness with recurring utterances, poor comprehension, poor repetition
Aphasia Syndromes III
“Pure” Aphasias – selective impairments with NORMAL speech production
Alexia without Agraphia: poor reading Agraphia: poor writing Word Deafness: poor comprehension, poor repetition
Major Aphasia Syndromes Type
Production
Comp.
Repetition
Naming
Global
impaired
impaired
impaired
impaired
Broca’s
not fluent
intact
limited
limited
Wernicke’s
fluent/ impaired
impaired
impaired
impaired
Anomic
fluent/ intact circumlocutory
intact
impaired
Mixed/ nonfluent
impaired
limited
limited
Conduction
fluent/ intact circumlocutory
impaired
limited
limited
Right Hemisphere Contribution to Language Functions
Good comprehension for gestural language Prosody (inflection, timbre, melody) Semantic language (word recognition, verbal meaning, concepts, and especially visual meaning)
Assessment of Language
Standard Aphasia Batteries (e.g., Western Aphasia Battery, Boston Diagnostic Aphasia Exam, Halstead Aphasia Screening Test) Boston Naming Test Token Test Verbal Fluency Written Expression (e.g., Cookie Theft)
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