Higher Cortical Function: Language

Question 1

What is the difference between language and speech?

Answer 1

Speech is verbal language, the major component of language
Written language and gesture are included in language
Therefore speech loss does not necessarily mean language loss

Question 2

What are the major components of speech?

Answer 2

• understanding

- expressing

Question 3

What are the three major anatomical speech areas?

Answer 3

• inferior frontal gyrus (Broca’s Area)
• superior temporal gyrus (Wernicke’s Area)
• arcuate fasciculus (perisylivian region), which connect the superior temporal surfs with the inferior frontal gyrus

Question 4

How is handidness related to speech?

Answer 4

• the cortical are of speech is in the dominant hemisphere
• left hemisphere in right-handed people
• left hemisphere in 60-70% of left-handed people

Question 5

What are the inputs into the speech areas?

Answer 5

• motor input from corticobulbar pathway, cerebellum and basal ganglia
• cranial nerve input such as CN X (supplies larynx), CN XII (supplied tongue)

Question 6

List the apparatus of speech, both mechanical and cognitive

Answer 6

Mechanical 
- muscles as bellows 
- larynx as voice generator 
- oropharynx and sinuses as modulators 
- phrenic nerve and intercostals 
Cognitive
- auditory recognition areas of brain 
- speech generating cortex 
- lower cranial nerve 
- cerebellum, basal ganglia and brainstem as modulator

Question 7

List the speech components and the conditions that they result in

Answer 7

• phonation (sound and volume) –> aphonia or dysphonia
• articulation of speech –> dysarthria
• compression or production of language –> aphasia/dysphasia

Question 8

Describe the characteristics of aphonia/dysphonia

Answer 8

• low volume of speech
• absence of spoken language in extreme cases
• muscle weakness
• vocal cord paralysis
• can still wet or gesture accurately

Question 9

Describe the characteristics of dysarthria/anarthria

Answer 9

• failure of articulation
• slurring but content is normal (can sound drunk)
• weakness of the muscle required for speech production
• partial vocal cord paralysis
• oropharyngeal e.g. Motor Neurone Disease
• badly fitting dentures
• cerebrally or brainstem pathology - cerebellar ataxia and Parkinson’s
• can still write or gesture accurately

Question 10

List all the names for expressive aphasia?

What are the characteristics of expressive dysphasia?

Answer 10

Expressive = motor aphasia, nonfluent aphasia, Broca’s aphasia, anterior aphasia)

• patients comprehension is preserved
• speech is not fluent
• lesion in the inferior formal gyrus in the dominant (left) hemisphere

Question 11

List all the names for receptive aphasia?

What are the characteristics of expressive dysphasia?

Answer 11

Receptive = sensory, fluent, Wernicke’s, posterior

• patients comprehension in impaired
• speech is very fluent but does not make any sense (unitelligable)
• patient could be mislabelled as confused
• lesion in the super temporal gyrus in the dominant (left) hemisphere

Question 12

What is the problem if only repetition is impaired? What is this called?

Answer 12

• isolated impairment in repetition is called conductive aphasia
• usually due to a lesion in the arcuate fasciculus

Question 13

What are the components of clinical examination?

Answer 13

The two most important aspects in examination of speech are comprehension and fluency. These should be examined together by:

• -> Asking questions
• What is your address?
• What do you do for a living?
• What did you have for breakfast today?
• Ask to describe your job
• -> Giving commands
• simple and then increase complexity as appropriate
• close your eyes
• show me your right hand
• close you right eye and touch your left ear with your right right
• -> Assessing repetition
• ask the patient to repeat a simple word such as pen or watch
• try a full sentence - ‘it is very cold today’
• try a complicated phrase - ‘no ifs, ands or buts’