Language

Question 1

What is the distinction between speech and language

Answer 1

• speech/speaking=production of audible sounds which may or mayn’t be used to communicate
  
  • PHONTION AND ARTICULATION
    
    • phonation=sound production by moving vocal cords
      
      • muscles innvervated by brances of vagus nerve (controlled by its UMN)
    • articulation=sound production by actions and varied positions of the lips, tongue, palate, and pharnyx (CN 7,9,10,12 and associated UMN)
  • connections with the cerebellar and xtrapyrmaidal systems provide the motor coordination for precise, clearly understood enunciation
  • also need: nml fxnl respiratory system
• language=communication by means of symbols (not production of audible sounds)
  
  • L. cerebral hemisphere is dominant in almost all right-handed pp (and half of left)
  • major language centers are in vascular territory of MCA
  • Aphasia=abnml language
    
    • causes: ischemic infarctions, hemorrhage, tumor, traua, dementia
    • disorder of previously acquired language ability due to a lesion in a critical language center

Question 2

Clinical Examination of Language

Answer 2

• language function should be tested in several ways-start with engaging the pt in spontaneous convo
• Fluency=ease, facility, and quantity (regardless of meaning)
• Comprehension-should be evident when verbal or written commands are followed
• Repetition-intact only if a phrase is perfectly repeated by the pt (no ifs, ands, or buts)
  
  • imperfect repitition: lesion in perisylvian language ctr (B or W) or the connecting arcuate fasciculus
• Paraphasia-abnml word or syllable substitution
  
  • more common especially with W’s aphasia
  • Ex: “open the boor”
  • most extreme type: neologism-sounds like nonsensical foregin words

Question 3

Types of aphasia

Answer 3

• diff types of aphasia are associated with lesions of specific language centers

Question 4

BROCA’s aphasia

Answer 4

• caused by PIF (posterior inferior frontal lobe) in dominant hemi
• often an accompanying right hemiparesis since lesion may also involve the primary motor cortex
• FLUENCY (very) IMPAIRED
  
  • speaking or reading aloud is laborious and effortful; telegraphic fasion
• COMPREHENSION (relatively) PRESERVED
  
  • overt frustrated pt
• REPITITION IMPERFECT

Question 5

WERNICKE’s aphasia

Answer 5

• caused by PST (posterior superior temporal lobe) in dominant hemi
• diagnosis may be difficult to make
• FLUENCY PRESERVED
  
  • speaks lng phrases which make little sense; paraphasic errors and gibberish
• COMPREHENSION (very) IMPAIRED
  
  • paranoid pt
• REPITITION IMPERFECT

Question 6

CONDUCTION aphasia

Answer 6

• causes: lesion of the arcuate fasciculus (connecting B and W)
• in between B and W CP (more similar to W)
• FLUENCY (relatively) INTACT
• COMPREHENSION (mildy) IMPARIED
• REPETITION IMPERFECT

Question 7

GLOBAL aphasia (alos: Allexia and Agraphia)

Answer 7

• extensive lesion, damages ENTIRE perisylvian language region
• pt may appear awake but cant communicate and has sever hemiplegia
• ALEXIA: impairment of reading when visual cortex is disconnected form language centers critical for reading
• AGRAPHIA: when a lesion disconnects the motor cortex for the dominant hand from language centers critical for writing

Question 8

Language and the nondominant cerebral hemisphere

Answer 8

• mirror image of language centers in the NON-dominant hemisphere
• PROSODY
  
  • semantic and emotional meaning of language as conveyed by changes in vocal pitch, inflection, melody, or tone-convey affect or mood