NeuroTeach 51 - Aphasia

House of Words: Aphasias!

Armand Trousseau (1801 – 1867) French internist

2) History
Late 18th, Gall - speech function localized frontal lobes Dax, 1986 - aphasia & L hemisphere Broca, 1861 - lesion L inferior frontal convolution Trousseau, 1862 - coined aphasia term Wernicke, 1864 - speech comprehension Lichtheim, 1885 - subcortical aphasia


3) Definition
“disorder of language, including impairment in ability to produce, understand, and repeat speech, as well as defects in the ability to read and write.” *deficit affecting only speech is usually dysarthria

4) Three levels of comprehension and function
Language comprehension - arrival, knowing, recognition Motor speech function - emotional, automatic, symbolic (propositional) *elementary levels are the least to be affected

5) Hand preference matters
90% is R-handed - 99% has L hemisphere dominance L-hand - 60% has L hemisphere dominance > 20% R hemisphere dominance > 20% L&R dominance

6) Multilingual aphasia
Most patients have a parallel recovery in languages. - Pitre’s law: recovery first the most used language - Ribot’s rule: recovery first the native language

7) Language evaluation
(6 components) - spontaneous (conversational) - auditory comprehension - naming - repeating - reading - writing

8) Spontaneous speech
Motor speech fx: emotional, automatic, symbolic -emotional: ouch -automatic: Y/N; Happy Birthday; monophasia (Tan) *paraphasia: substitution wrong word/sound for the intended word or sound. *aphasic are laconic, do not speak more than needed

9) Comprehension
Verbal commands, multistep command *dx: apraxia Not following simple commands - ask simple, are you riding a taxi cab? - complex, is a mother older than her daughter? - Marie’s paper test - imitation (lower level) *dx: R-L confusion, do not ask sides

10) Naming
Name simple objects - pencil, watch, body parts (knuckles) FAS test - 12 words within 1 minute, starting with F Animal naming test - 15 within 1 minute

11) Repeating
Avoid automatic language Repeat - no ifs, ands, or buts - they heard him speak on the radio last night

12) Reading
Aloud versus comprehension
- read this for me
- what does this phrase mean?
*alexia, dyslexia

13) Writing - Write this phrase “Today is a sunny day in Philadelphia” - write a phrase for me - FAS test *preserved in dysarthria and verbal apraxia

14) Aphasia House You have a family living in a house 1- draw the bedrooms 2- do a Ramp to Repetition 3- Celling to Comprehension 4- Side Speech fluency

15) The people that live in the house
The MAN is Broca Woman is Wernick Child is Conduction aunTs are Transcortical (motor, sensory, and mixed)

16) Others do not live in the house Nephew is Nominal Grandmother is Global Brother is Basal ganglia and the rest are WaTershed people, Watershed areas and Thalamic

17) Broca versus Wernicke aphasia

18) Motor aphasia (Broca aphasia)
- expressive aphasia

19) Sensory aphasia (Wernicke aphasia)
- receptive aphasia
TSA can be associated with echolalia (pts will often incorporate words & phrases uttered by the examiner into their speech) while apparently failing to understand the meaning of the words

20) Conduction aphasia

21) Transcortical motor

22) Anomic aphasia

23) Subcortical aphasias Anterior vs posterior syndrome

24) Broca-Wernicke model of language
- possible anatomical localization