Aphasia Aphasia Presented by: Eitan Gordon. A Definition Aphasia is a disruption of language associated with brain damage. A comprehensive explanation

• AphasiaAphasia

Presented by: Eitan GordonPresented by: Eitan Gordon

A DefinitionA Definition

Aphasia is a disruption of language associated Aphasia is a disruption of language associated with brain damage. A comprehensive with brain damage. A comprehensive explanation of aphasia is given in a book by M.N. explanation of aphasia is given in a book by M.N. Hedge, he says, “an impairment in Hedge, he says, “an impairment in understanding and formulating complex, understanding and formulating complex, meaningful, and ordered or sequenced elements meaningful, and ordered or sequenced elements of language including words, phrases and of language including words, phrases and sentences; a difficultly in remembering words, sentences; a difficultly in remembering words, saying the correct words, or saying words in saying the correct words, or saying words in correct satanic order; a difficulty in talking correct satanic order; a difficulty in talking grammatically; difficultly in reading and writing grammatically; difficultly in reading and writing in conjunction with the described oral language in conjunction with the described oral language problems; and difficulty understanding or problems; and difficulty understanding or expressing through gestures” (Hedge, 1995).expressing through gestures” (Hedge, 1995).

CausesCauses Aphasia is caused by brain damage Aphasia is caused by brain damage

usually related to an injury; many times usually related to an injury; many times aphasia is caused by Traumatic Brain aphasia is caused by Traumatic Brain Injury (TBI). The most common type of Injury (TBI). The most common type of injury for people with aphasia is stroke injury for people with aphasia is stroke “[i]n the distribution of the left middle “[i]n the distribution of the left middle cerebral artery, which is the main blood cerebral artery, which is the main blood supplier of the perisylvian cortical supplier of the perisylvian cortical areas” (Snyder et al., 1998). areas” (Snyder et al., 1998).

Though many leading neurologists, Though many leading neurologists, “attempting to explain the pathology of “attempting to explain the pathology of speech from these standpoints speech from these standpoints regarded aphasia purely as a regarded aphasia purely as a disturbance of ‘intellectual schemes’ or disturbance of ‘intellectual schemes’ or of abstract sets. Abandoning all of abstract sets. Abandoning all attempts to localizing these attempts to localizing these disturbances in particular brain zones, disturbances in particular brain zones, they limited themselves to the highly they limited themselves to the highly controversial correlation of these controversial correlation of these disturbances with the brain ‘as a disturbances with the brain ‘as a whole’, at best correlating a whole’, at best correlating a disturbance of these higher forms of disturbance of these higher forms of speech activity with the speech activity with the mass mass of brain of brain substance damaged” (Luria, 1973). substance damaged” (Luria, 1973).

Causes, Continued…Causes, Continued…

The main area of the brain that is The main area of the brain that is the cause of aphasia is damage to the cause of aphasia is damage to the perisylvian language areas. the perisylvian language areas. These areas include, “Broca’s area, These areas include, “Broca’s area, which is involved in the motor which is involved in the motor programming of speech; Wernicke’s programming of speech; Wernicke’s area, which is critical for the area, which is critical for the auditory comprehension of spoken auditory comprehension of spoken words; and the arcuate fasciclus, words; and the arcuate fasciclus, which links these two areas and is which links these two areas and is thought to play an important role in thought to play an important role in repetition. Aphasia may also be repetition. Aphasia may also be caused by lesions that do not caused by lesions that do not directly damage the perisylvian directly damage the perisylvian language areas but isolate them language areas but isolate them from brain regions involved in from brain regions involved in semantic processing and the semantic processing and the production of volitional speech. The production of volitional speech. The extraperisylvian aphasias are extraperisylvian aphasias are referred to as transcortical referred to as transcortical aphasias” (Snyder et al., 1998). aphasias” (Snyder et al., 1998).

Types of AphasiaTypes of Aphasia

Because of the damage to these different areas Because of the damage to these different areas there are any different types of aphasia that are there are any different types of aphasia that are classified into to two categories, both having to do classified into to two categories, both having to do with speech, which are fluent aphasias and non-with speech, which are fluent aphasias and non-fluent aphasias:fluent aphasias: Fluent aphasia are determined by patients who display Fluent aphasia are determined by patients who display

normal length phrases and sentences which are well normal length phrases and sentences which are well articulated and easily understandable, these are connected articulated and easily understandable, these are connected with posterior lesions that spare anterior cortical regions with posterior lesions that spare anterior cortical regions critical for motor control for speech; critical for motor control for speech;

Non-fluent aphasias are the opposite and are characterized Non-fluent aphasias are the opposite and are characterized by sparse, hard to understand utterances or sentence by sparse, hard to understand utterances or sentence usually short in length, these are determined by anterior or usually short in length, these are determined by anterior or pre-rolandic lesions that comprise motor and pre-motor pre-rolandic lesions that comprise motor and pre-motor cortical regions involved in speech production.cortical regions involved in speech production.

Types of Aphasia, Types of Aphasia, continued…continued…

In addition to the effect to the fluency part In addition to the effect to the fluency part of aphasia there is also damage to the of aphasia there is also damage to the auditory possessing. Damage to the anterior auditory possessing. Damage to the anterior region causes mild impairment in the region causes mild impairment in the auditory comprehension, whereas posterior auditory comprehension, whereas posterior lesions result in severe impairment to the lesions result in severe impairment to the comprehension. When there is damage to comprehension. When there is damage to any of the areas mentioned above then also any of the areas mentioned above then also there is likely to be distortion to repetition. there is likely to be distortion to repetition. Also, people who have aphasia also Also, people who have aphasia also experience a naming impairment.experience a naming impairment.


Within each type of category of aphasia Within each type of category of aphasia there are a few different types or there are a few different types or subcategories: Fluent and Non-Fluent. subcategories: Fluent and Non-Fluent. There are four types in the fluent aphasia There are four types in the fluent aphasia category, which include Anomic aphasia, category, which include Anomic aphasia, Conduction aphasia, Transcortical sensory Conduction aphasia, Transcortical sensory aphasia, Wernicke’s Aphasia. aphasia, Wernicke’s Aphasia.

Four types of non-fluent aphasias, which Four types of non-fluent aphasias, which include Transcortical Motor aphasia, include Transcortical Motor aphasia, Broca’s aphasia, Mixed Transcortical Broca’s aphasia, Mixed Transcortical aphasia and Global aphasia.aphasia and Global aphasia.


Fluent AphasiaFluent Aphasia Anomic aphasia has good auditory comprehension and Anomic aphasia has good auditory comprehension and

repetition, but is caused “by lesions of the angular gyrus, it repetition, but is caused “by lesions of the angular gyrus, it may be associated with the Gerstmann syndrome and limb may be associated with the Gerstmann syndrome and limb apraxia” (Snyder et al., 1998). apraxia” (Snyder et al., 1998).

Conduction aphasia has good auditory comprehension but poor Conduction aphasia has good auditory comprehension but poor repetition. This results from “posterior perisylvian lesions repetition. This results from “posterior perisylvian lesions affecting primarily the supramarginal gyrus in the parietal lobe affecting primarily the supramarginal gyrus in the parietal lobe and the underlying white matter (arcuate fascuculus)” (Snyder and the underlying white matter (arcuate fascuculus)” (Snyder et al., 1998). et al., 1998).

Transcortical sensory aphasia has impaired comprehension Transcortical sensory aphasia has impaired comprehension and preserved repetition. This type of aphasia results form and preserved repetition. This type of aphasia results form lesions in the temporoparieto-occipital region, usually located lesions in the temporoparieto-occipital region, usually located posterior and deep to Wernicke’s area. posterior and deep to Wernicke’s area.

Wernicke’s aphasia has both poor auditory and repetition. This Wernicke’s aphasia has both poor auditory and repetition. This results from “large posterior perisylvian lesions encompassing results from “large posterior perisylvian lesions encompassing the posterior superior temporal gyrus (Wernicke’s) and often the posterior superior temporal gyrus (Wernicke’s) and often extending superiorly into the inferior parietal lobe” (Snyder et extending superiorly into the inferior parietal lobe” (Snyder et al., 1998). al., 1998).


Non-Fluent AphasiaNon-Fluent Aphasia Transcortical Motor aphasia (TcMA) has relatively good Transcortical Motor aphasia (TcMA) has relatively good

auditory comprehension and reserved repetition. TcMA is auditory comprehension and reserved repetition. TcMA is caused by lesion in the frontal lobe. caused by lesion in the frontal lobe.

Broca’s aphasia had good auditory comprehension and poor Broca’s aphasia had good auditory comprehension and poor repetition. This results from “large lesions encompassing repetition. This results from “large lesions encompassing the entire territory of the superior division of the middle the entire territory of the superior division of the middle cerebral artery” (Snyder et al., 1998). cerebral artery” (Snyder et al., 1998).

Mixed Transcortical aphasia (MTcA) is also known as Mixed Transcortical aphasia (MTcA) is also known as ‘isolation syndrome,’ has poor auditory comprehension and ‘isolation syndrome,’ has poor auditory comprehension and preserved repetition. “MTcA is seen in association with preserved repetition. “MTcA is seen in association with diffuse or multifocal lesions that result in anatomic isolation diffuse or multifocal lesions that result in anatomic isolation of the perisylvian language zone from surrounding cortical of the perisylvian language zone from surrounding cortical areas” (Snyder et al.) areas” (Snyder et al.)

Lastly, Global aphasia has both poor repetition and auditory Lastly, Global aphasia has both poor repetition and auditory comprehension. This type results form lesions typically comprehension. This type results form lesions typically involve the entire perisylvian language zone and are usually involve the entire perisylvian language zone and are usually extensive. extensive.

ResearchResearch

A Yale study- Does Intensive A Yale study- Does Intensive Therapy help?Therapy help?

Does President Bush have brain Does President Bush have brain damage?damage?

What can we do?What can we do?

Children of all ages engage in play Children of all ages engage in play that might cause a fall, riding a bike that might cause a fall, riding a bike or climbing a tree when children are or climbing a tree when children are younger; if they are older, car younger; if they are older, car accident or rough play (sports injury accident or rough play (sports injury of some sort). of some sort). When injury report right away.When injury report right away. If speech problem, look at history on If speech problem, look at history on

injury, from school and parents.injury, from school and parents.

What can we do?, What can we do?, continued…continued…

Also for school psychologist using the Also for school psychologist using the right type of assessment to analyze any right type of assessment to analyze any possible brain damage or impairment to possible brain damage or impairment to an area that results in aphasia:an area that results in aphasia: Boston Diagnostic Aphasia Examination Boston Diagnostic Aphasia Examination

(Goodglass and Kaplan, 1983) (Goodglass and Kaplan, 1983) Western Aphasia Battery (Kertez, 1982)Western Aphasia Battery (Kertez, 1982) Aphasia Diagnostic Profiles (Helm-Aphasia Diagnostic Profiles (Helm-

Estabrooks, 1992).Estabrooks, 1992).


An assessment that will test for impairment in An assessment that will test for impairment in naming is the Boston Naming Test (Kaplan, naming is the Boston Naming Test (Kaplan, Goodglass and Weintraub, 1983). Goodglass and Weintraub, 1983).

Auditory comprehension is something that needs Auditory comprehension is something that needs to be tested for also an impairment, an to be tested for also an impairment, an assessment that tests for this is the Token Test assessment that tests for this is the Token Test of the Multilingual Aphasia Examination (Benton, of the Multilingual Aphasia Examination (Benton, deHamster and Siven, 1994). deHamster and Siven, 1994).

Reading and writing are also affected in aphasia Reading and writing are also affected in aphasia and the Psycholinguistic Assessment of and the Psycholinguistic Assessment of Language Processing in Aphasia (PALPA; Kay, Language Processing in Aphasia (PALPA; Kay, Lesser and Coultheart, 1992). Lesser and Coultheart, 1992).


When someone is diagnosed with aphasia When someone is diagnosed with aphasia there are assessment that help explain there are assessment that help explain the damage or impact of the aphasia the damage or impact of the aphasia diagnosis; these assessment are the diagnosis; these assessment are the American Speech-Language-Hearing American Speech-Language-Hearing Association Functional Assessment of Association Functional Assessment of Commutation skills for Adults (Frttalli, Commutation skills for Adults (Frttalli, Thompson, Holland, Wohl and Ferketic, Thompson, Holland, Wohl and Ferketic, 1995) and the Communicative Abilities in 1995) and the Communicative Abilities in Daily Living (Holland, 1980; Daily Living (Holland, 1980; Holland,Fromm and Frattali, in press). Holland,Fromm and Frattali, in press).

Where to go with this…Where to go with this…

The next place aphasiac study The next place aphasiac study should go is to the school. I believe should go is to the school. I believe a nation wide study of children who a nation wide study of children who have aphasia of aphasiac symptoms have aphasia of aphasiac symptoms should be investigated and looked should be investigated and looked at to see how school officials of all at to see how school officials of all kinds could help future children with kinds could help future children with any aphasia or aphasiac symptoms.any aphasia or aphasiac symptoms.

Work CitiedWork Citied

Furman, J. (1992). The Speech Thing. Furman, J. (1992). The Speech Thing. New New Republic, 207 Republic, 207 (8/9).(8/9).

Hedge, M.N. (1995). Hedge, M.N. (1995). Introduction to Introduction to Communicative Disorders, Second Edition. Communicative Disorders, Second Edition. Texas: Texas: Pro-Ed. Pro-Ed.

Luria, A.R. (1973). Luria, A.R. (1973). The Working Brain: An The Working Brain: An Introduction to Neuropsychology. Introduction to Neuropsychology. New York: Basic New York: Basic Book. Book.

Raloff, J. (1982). Aphasia: Therapy Helps, seldom Raloff, J. (1982). Aphasia: Therapy Helps, seldom cures. cures. Science News, 122 Science News, 122 (24). (24).

Snyder, P.J. & Nussbaum, P.D. (1998). Snyder, P.J. & Nussbaum, P.D. (1998). Clinical Clinical Neuropsychology: A Pocket Handbook for Neuropsychology: A Pocket Handbook for Assessment. Assessment. Washington D.C.: American Washington D.C.: American Psychological Association.Psychological Association.

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Aphasia Aphasia Presented by: Eitan Gordon. A Definition Aphasia is a disruption of language associated with brain damage. A comprehensive explanation