Key Aphasia Terms
Substitution of one word for another, may be related in meaning (e.g. marker for pencil) or unrelated (cup for pencil)
Semantic Paraphasia
Substitution of general words such as this, that, stuff, and thing in place of more specific words
Empty Speech
Describe the speech and language of nonfluent aphasias.
Name the nonfluent aphasias.
Broca's aphasia, Transcortical Motor Aphasia, Mixed Transcortical Aphasia, Global Aphasia
Describe the Speech and Language of fluent aphasias.
Name the aphasias that fall into this category
Fluent aphasias are characterized by relatively intact fluency but generally less meaningful, or even meaningless, speech. The speech is generally flowing, abundant, easily initiated, and well articulated with good prosody and phrase length. Lesions that produce fluent aphasia are generally farther away from motor control centers, so do not usually co-occur with right hemiparesis or other gross motor impairments.
Wernicke's aphasia, Transcortical Sensory Aphasia, Conduction Aphasia, and Anomic Aphasia
Compare and contrast Transcortical Motor Aphasia, Mixed Transcortical Aphasia and Transcortical Sensory aphasia. including hallmarks, corresponding lesion location, and blood supply
Transcortical Motor aphasia presents like Brocas but with intact repetition without errors and increased difficulty with initiation. Can co occur with motor disorders including rigidity of upper extremities, akinesia, bradykinesia, apraxia, right hemiparesis. Generally has good comprehension. Caused by damage to the supplementary motor cortex or area anterior to Broca's area (left anterior inferior frontal gyrus). Nonfluent aphasia.
Mixed transcortical aphasia - severe expressive and receptive language along with severe echolalia. Caused by damage to the watershed areas or the arterial border zone of the brain (between the areas supplied by the MCA and anterior and posterior arteries). Nonfluent aphasia.
Transcortical sensory aphasia - fluent aphasia caused by lesions in the temporoparietal region in the brain, especially in the posterior portion of the middle temporal gyrus. Broca's, Wernicke's, and arcuate fasciculus may be largely unaffected. Supplied by posterior branch of the left middle cerebral artery. Presents similarly to Wernicke's aphasia but with intact repetition. Compared to TMA, echolalia for TSA is grammatically incorrect forms, and nonsense syllables. Comprehension of repeated words is poor.
Errors at the sound level, phonemes in intended word may be substituted, omitted, or transposed (tup for cup)
Phonemic (or literal) paraphasia
Anomia
This aphasia presents similarly to Broca's aphasia but differs with intact repetition skills, able to repeat long and complex sentences with errors. These individuals also have increased difficulty with initiation.
2. This aphasia results from damage to what areas of the brain?
Transcortical Motor Aphasia. The anterior superior frontal lobe is involved in speech initiation.
2. Supplementary motor cortex and/or anterior to Broca's area.
1. Wernicke's aphasia is caused by damage to what area?
2. What blood supply?
1. Posterior one third of the superior temporal gyrus in the LH, occasionally lesions may extend throughout the temporal region and into the inferior parietal region.
2. Inferior/posterior branch of the left middle cerebral artery.
Damage to the posterior inferior frontal gyrus of the left hemisphere can cause what kind of aphasia?
What supplies blood to this area?
Broca's aphasia, however damage to this area is not always necessary to produce BA. Damage to the anterior segment of the left arcuate fasciculus (white matter tract lying deep in the posterior part of broca's area) and the sensory motor area reliably predict nonfluent aphasia.
Upper division of the Middle Cerebral Artery (MCA)
Nonword a person creates, unintelligible, unrelated to intended word, and 50% or more of words are meaningless(saying skeen instead of pencil)
Neologistic paraphasia (or neologism)
Production of nonspecific words and "beating around the bush" often due to word finding problems
Circumlocution
This type of aphasia is caused by damage to the watershed area or the arterial border zone of the brain (between the areas supplied by the middle cerebral artery and anterior and posterior arteries) with damage that spares but isolates Broca's, Wernicke's, and the arcuate fasciculus.
What are the hallmarks of this aphasia?
Mixed transcortical aphasia
2. Severe communication deficits (expressive and receptive) along with severe echolalia (parrotlike repetition of what is heard)
Automatic speech may be unimpaired if somehow initiated and not interrupted.
What aphasia presents similarly to Wernicke's aphasia but differs by skills in repetition?
How does it differ?
1. Transcortical Sensory Aphasia
2. Fairly intact repetition (vs. impaired w/ WA)
What aphasia presents similarly to Wernicke's aphasia but has good to normal auditory comprehension?
Conduction aphasia
A word that is repeated inappropriately instead of an intended word.
Also can mean when someone is "stuck" on one idea.
Perseveration
Language that is rote or overlearned and thus spared (e.g. reciting the alphabet, counting numbers, singing a familiar song)
Automatic language (preserved language)
This is the most severe form of non-fluent aphasia caused by extensive lesions to the perisylvian region (all langauge areas), usually due to occlusion of the left middle cerebral artery.
How will it present in regards to expressive and receptive skills, fluency, repetition, naming, reading, writing? What else might you see?
Global aphasia
Severely/Profoundly impaired in all areas listed. Perseveration, verbal and nonverbal apraxia. May occur with right sided paresis or paralysis, neglect to left side of body.
Describe anomic aphasia and what lesions can cause it.
Fluent aphasia, distinguishing feature is impaired naming with otherwise relatively unimpaired language.
Controversial because it can be caused by lesions in different regions of the brain including the angular gyrus, the second temporal gyrus, and juncture of the tempoparietal lobes.
Can aphasia be caused by damage to subcortical structures in the brain?
Yes, subcortical aphasia can be caused by damage to the basal ganglia (anomic, global, Broca's, Wernicke's, or transcortical motor aphasia), thalamus (fluent aphasia), and cerebellum (subtle aphasia symptoms such as limited fluency, mild anomia, agrammatism, mild comprehension difficulties).
Excessive and inappropriate production of speech, often tangential and meaningless.
With what kind of brain damage might you expect to see this?
Logorrhea (verbal diarrhea)
Wernicke's aphasia, traumatic brain injuries in the frontal lobe, lesions on the thalamus, and the ascending reticular inhibitory system (inhibitory system is also associated with spastic dysarthria)
Right hemisphere disorder (more defined as confabulation and excessive speech described with excessive inference, too much attention to details, saying too much, and pragmatic deficits defined as rambling, excessive speech with little communicative value)
Semantic variant PPA (svPPA)
Are communication disorders associated with progressive diseases such as Alzheimer's or Parkinson's disease considered aphasia?
If someone had confused or abnormal language with generally intact grammar often describing unreal events, is that considered aphasia?
NO
NO - hallucinations and delusions are associated with psychiatric disorders such as schizophrenia
Describe how Broca's aphasia can affect the following areas:
Naming,
fluency,
sentence length,
articulation,
grammar,
repetition,
auditory comprehension compared to verbally produced speech,
oral reading,
reading comprehension,
writing,
awareness of deficits,
other neurological symptoms on the body,
emotion,
coexisting motor speech disorders
-Impaired naming
-Nonfluent, effortful, slow, halting, uneven speech
-Limited output, shortened phrases/sentences
-Misarticulated or distorted speech sounds
-Agrammatic or telegraphic speech (limited to content words, omission of function words)
-Impaired repetition, especially grammatical elements
-Deficits in auditory comprehension but usually is better than verbal productions -Difficulty understanding syntactic structures
-Poor oral reading & reading comprehension
-Writing problems (slow, effortful, grammatical errors, right hand paralysis)
-Awareness of deficits, emotional reactions (frustration), depression
-Right sided paralysis/weakness (hemiplegia/hemiparesis)
-Coexisting motor speech disorders (AOS/Dysarthria)
Describe the presentation of Wernicke's aphasia in speech and language features, grammar, word finding, auditory comprehension, repetition, pragmatics, prosody, insight into deficits, and other associated neurologic symptoms in the body.
2. What makes Wernicke's difficult to treat?
-incessant, effortlessly produced flowing speech with even or excessive fluency (logorrhea) with normal phrase length
-Rapid rate of speech with normal prosodic features and good articulation
-intact grammatical structures
-Severe anomia
-paraphasias speech with semantic, literal, or neologostic paraphasias
-empty speech
-Poor auditory comprehension
-Impaired repetition and turn taking
-Reading and writing problems
-Generally poor communication despite fluent speech
-Anosognosia - lack of insight into own difficulties
-Generally free from other obvious neurologic symptoms, hemiparesis or paralysis are uncommon.
2. Lack of insight into own deficits and severe difficulty with auditory comprehension
For bilingual patients that have aphasia, with both languages have the same pattern and level of impairment?
How should a SLP assess a bilingual patient with aphaisa?
No! In some individuals, L1 may be more impaired than L2, and in others, the reverse is true. No particular variable predicts pattern of deficits or recovery.
Assessment should be on individual patterns in both languages.