1
Q
Aphasia
A
acquired disorder of language caused by brain damage
Can affect comprehension (reception), expression of language or both aspects
All modalities can be affected (spoke, written, gestural- if someone is deaf they may lose the ability to sign
2
Q
5 domains of speech sound production
A
Respiration (tier 1) Resonation (1) Phonation (2) Articulation (3) Prosody (3)
3
Q
5 domains of language
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Pragmatics Phonology Syntax Semantics Morphology
4
Q
5 domains of cognition
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Executive function Memory Attention Problem solving Sequencing
5
Q
Considerations for Aphasia:
Clinical importance
A
Clinically important: can be a confusing disorder (historically) and it is often thought of demographically as a disorder of aging, but we know that it can occur in all ages. We also know that since this is an acquired disorder of language, language must be in place
6
Q
Considerations for Aphasia:
Scientically important
A
- Scientifically important: there is a relationship between the brain and language, area affected and how language is impacted. Allows us to understand how the brain controls and modulates language functions
7
Q
Early Perspectives on Aphasia
A
- Misunderstood intially (ventricles controlled cognition or caused by tongue paralysis)
- Gesner (1770) called it speech amnesia (language amnesia would be more accurate)
- Gesner claimed that lang. was controlled by the brain
8
Q
Phrenology
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associates mental and intellectual functions topographically on the skull
9
Q
Aphasia and Dysarthria
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Aphasia- Language aspect Dysarthria- Speech aspect Pt. can have both Cortical stroke= spastic dysarthria Brainstem stroke= flaccid dysarthria
10
Q
Phrenological organs
A
does not hold up
11
Q
Paul Broca
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- French neurosurgeon that linked frontal lobe and left brain to lang. production
- Broca’s research focused on lower portion of frontal lobe, Broca’s area.
- Broca’s aphasia is caused by injury to that frontal area (area 44)
12
Q
Communication
A
By itself, it is a total brain function
13
Q
Broca’s Research
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- Termed Aphasia as Aphemia
- Caused: Reduced speech fluency, agrammatic or telegraphic speech, many language production errors, and/or limited impairment to comprehension of spoken language (normal or almost normal)
14
Q
Carl Wernicke
A
- German scientist who described Wernicke’s Aphasia, the form opposite of Broca’s
- Lesions or injury to the posterior portion of the left superior temporal gyrus cause Wernicke’s aphasia
15
Q
Broca’s Aphasia
A
Affects anterior (pre-motor area), nonfluent aphasia Speech is very choppy, telegraphic, doesn't flow easily Cry a lot because they know they are wrong pseudobulbar affect- find it with broca's aphasia and spastic dysarthria
16
Q
Wernicke’s Aphasia
A
Affects posterior portion of the brain (sensory motor strip)
Speech is fluent but not coherent
Wernicke patients are fluent but they do not make any sense- called cocktail party speech
comprehension is affected so they have no idea if their responses make sense
17
Q
Wernicke’s Work
A
- Wernicke called his aphasia sensory aphasia
- Causes: fluent, but meaningless speech, grammatically correct speech, problems understanding language, difficulty comprehending spoken or read material
- Wernicke stated that other aphasias existed, TCM, conduction Aphasia, and TCS
18
Q
- TCM
2. TCS
A
- Transcortical Motor Aphasia- anterior damage
- Transcortical Sensory Aphasia- posterior damage
both go through wernicke’s area
19
Q
Handedness Theory
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Joannes Nielson suggested that language was in the hemisphere opposite of the preferred hand.
Most people are left hemisphere dominate for language (very seldomly right)
Hypothesis has been discounted and handedness is not a reliable indicator of hemispheric language dominance
85% of the population is right handed and 15% of the population is left handed
~15% of the (15% left-handed persons) are right hemisphere dominate for language
20
Q
Cerebrum (The Brain)
A
AKA- cerebral cortices or cortex
computer of your body
The cerebrum is the final integrative and executive structure of the nervous system
The cerebrum is responsible for all higher brain functions (most in the frontal lobe):
everyday thinking, speaking, judgment, logical reasoning, lang. production, emotional experience, abstract reasoning, artistry, attention, mathematical reasoning, scientific achievement, problem solving, memory, lang. comprehension, and executive functioning
21
Q
Brain Facts
A
- brain contains billions of neurons w/ trillions of synapses
- Brain weighs 3-3.5lbs (1-2% of body mass)
- 6 layers (outside is gray matter)
- 2 hemispheres connected by corpus callosum (thick myelinated axons)
- Regions within the hemispheres are connected by shorter association fibers
- Surface of the brain is comprised of gyri and sulci
22
Q
Landmarks on the brain
- Gyri
- Sulci
- LCF
- Meniniges
A
- hills, folds, and convolutions
- grooves, valleys, and fissures
- longitudinal cerebral fissure- separates the left/right hemispheres
- Covers the brain (dura keeps the brain together in its structure)
23
Q
- Fissure of Rolando
- Lateral Cerebral Fissure
- Perisylvian Area
A
- Central Sulcus- divides anterior and posterior aphasias. It runs laterally downward, and forward dividing the anterior half of the brain from the posterior half.
- AKA- Sylvian Fissure which moves laterally and upward (along the superior temporal gyrus)
- Regions surrounding this area are especially involved in speech, language, and hearing. Area around the sylvian fissure (includes broca’s area)
24
Q
- Fluent Aphasia
2. Non-Fluent Aphasia
A
- 4 types of fluent aphasia. They are the aphasias that affect receptive language (posterior aphasias)
- 4 Non-fluent aphasias (expressive aphasias) more anterior injury
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Injury to Broca's Area
Can cause aphasia or AOS.
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4 Cerebral Lobes
```
Frontal Lobe
Occipital Lobe
Parietal Lobe
Temporal Lobe
-Each lobe has predominant functions
```
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Frontal Lobe
- Most important lobe for speech/language
- largest lobe (1/3 of the cortical surface)
- Precentral gyrus- major portion of the primary motor cortex via the pyramidal system
- Movements are modified by the EPS
- Controls voluntary movements on the opp. side of the body (motor strip/homonculus)
- Anterior to the motor strip is the premotor area and the supplementary areas
- Prefrontal Cortex- controls intellectual tasks (thinking, reasoning, and decision making)
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Gyri of the frontal lobe
Frontal Lobe has the superior, middle, and inferior gyri
Inferior frontal gyrus- left inferior frontal gyrus is significant for speech
-contains Broca's area
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1. Arcuate Fasciculus
| 2. Conduction Aphasia
Connection between Wernickes and Broca's area
2. Breakdown at the arcuate fasciculus
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Frontal Lobe Impairments
1. Loss of simple movement
2. Poor spontaneity
3. Loss of flexible thinking
4. Loss of ability to problem solve
5. Perseveration
6. Inability to focus on a task
7. Mood changes
8. Personality changes
9. Changes in social behavior
10. Inability to speak
11. Difficulty Sequencing
12. Motor Control Issues
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Temporal Lobe
- lowest 1/3 of the brain; lies just under the temporal bone
- no marked area between the temporal and occipital lobes
- Contains 3 important gyri
- superior, middle, and temporal gyri
- contains the primary auditory cortex and wernicke's area.
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Primary Auditory Cortex
-Heschl's Gyrus (makes sense of auditory information, allows us to focus on impt. sounds)
Present in both left and right hemisphere's but it is larger in left (receptive dominance in left hemisphere also)
Area adjacent to heschl's is the secondary auditory cortex
Right temp. lobe is responsible for nonverbal memory, appreciation of music and rhythm (less active lobe)
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Wernicke's Area (location)
- posterior 2/3 of the superior temporal gyrus in the left hemisphere
- May be7x larger than it is in the right hemisphere
- vital for comprehension of written and spoken lang.
- Connected to the frontal (motor speech area) via the arcuate fasciculus
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Hippocampus
-Medial part of the temporal lobe that forms the medial wall of the lateral ventricle
• Mediates memory and learning
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Temporal lobe + processing
Site of auditory reception, interpretation, and AV association; comprehension of
spoken and written material as well as processing of semantic/syntactic sounds; music
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Temporal Lobe Impairments
Prosopagnosia- inability to recognize familiar faces
- Cannot comprehend spoken words
- Poor selective attention
- STM loss (short term memory)
- Interference with LTM (long term memory)
- increase or decrease in sexual behaviors
- Inability to categorize
- Logorrhea (verbal dirrehea)
- Increase in aggressive behaviors
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Occipital Lobe
-Smalles of the lobes
| 2 major structures: Primary and Secondary Visual Cortex
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Occipital Lobe Impairments
- visual field cuts
- poor color recognition
- inability to recognize words
- cannot locate objects
- visual illusions
- difficulty with reading
- cannot recognize drawn objects
- decrease seeing objects
- difficulty with writing
- poor recognition of movement
- word blindness
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Parietal Lobe
- Posterior to frontal lobe
- Post Central Gyrus (sensory cortex or sensory strip) Primary sensory area that controls and integrates somesthetic sensory impulses
This lobe controls perception, sensation of touch, pressure, position, position sense, and body awareness
- Controls spatial relations and selective attention (damage to right side may cause left neglect)
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Supramarginal Gyrus
Gyri in the parietal lobe that significantly affects lang.
-Damage to the supramarginal gyrus may result in agraphia (writing problems) and/or
conduction aphasia
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Angular Gyrus
- Gyri in the parietal lobe that significantly affects lang.
- Damage to the angular gyrus may result in deficits of reading, writing, and/or naming.
- Damage to the angular gyrus may also cause TSA or transcortical sensory aphasia
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Parietal Lobe Impairments
- inability to attend to 1+ (object/person)
- Alexia- loss of ability to read
- Agraphia - loss of ability to write
- Inability to recognize words
- Difficulty w/ goal directed mvt.
- Dyscalculia- inability to do math
- Difficulty drawing objects
- Difficulty knowing L/R
- Decrease awareness of body parts
- Poor manipulation of objects
- Unilateral neglect
- unable to focus visual attention
- Loss of hand eye coordination
- Impaired perception of touch
43
Major communication areas
- premotor cortex
- primary motor cortex
- primary somatosensory cortex
- wernicke's area
- broca's
- primary auditory cortex
- primary visual cortex
44
cerebral ventricles
-System of cavities deep within the brain that are filled with CSF (produced by chroid plexus)
Σ 4: 2 lateral along with the 3rd and 4th ventricles
Contain the choroid plexus that produces CSF of which totals 130ml (30ml in the
ventricles, 75ml in the spinal system, and 25ml in the cranium)
The turn over of CSF is around 500ml daily from the choroid plexus to the 4th
ventricle to subarachnoid space and the arachnoid villi
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Hydrocephalus
When CSF is blocked or its absorption is impaired (brain increases in size)
-Ventricles expand because there is too much csf in the brain
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Brain Protection (layers)
Protective Mechanism:
• Layer of skin, bones of the skull, and layers of tissue called the meninges
• CSF serves in part to cushion the brain and spinal cord
• Spinal Cord: protected by the vertebral column
-these layers provide the brain with shape
47
Brain Protection (Layers)
-SCALP provides the outermost protection and includes five layers
-The scalp is the first line of defense in the protection of the bony skull and the brain
S- skin
C- connective tissue
A- aponeurosis (tissue)
L- loose areolar (tissue)
P- Periosteum pericranium
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Meninges
-The meninges are protective layers that cover the brain and the spinal cord
• Outermost Membrane: Dura Mater
• Middle Membrane: Arachnoid (contains blood vessels) spider like webs
• Subarachnoid Space (CSF)
• Innermost Membrane: Pia Mater (covers the brain)
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Cerebrovascular System
-neurological problems arise from disrupted blood supply to the brain
-neurogenic language disorders especially aphasia are vascular pathologies and/or hemorrhage
-Brain is: (a) roughly 2% of the body’s weight, (b) receives 17-20% of the body’s blood,
and (c) 25% of the body’s oxygen
• Brain depends on the blood for nourishment and ability to function
-LOC results after 10s of blood interruption; permanent brain damage after 4-6m
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1. internal carotid
2. vetebral
3. Stroke
1. supplies anterior brain
2. supplies posterior brain
3. brain tissue death
- brain is electrical chemical- need oxygen and glucose
- blood should never come in contact with the brain
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Carotid Arteries
1.External-Muscles of the face and neck; oral/nasal cavities; sides of the head; skull and dura mater
2.Internal-Major blood supplier to the brain
• Has two main branches: anterior cerebral and middle cerebral arteries
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Anterior Cerebral Artery
Supplies the middle portion of the frontal and parietal lobes, basal ganglia, and corpus
callosum
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Damage to Anterior Cerebral Artery
* Causes disruption of blood to the midsagittal portions of the motor cortex
* Motor symptoms include paralysis of the legs and feet
* Associated cognitive deficits include impaired reasoning, judgment, and concentration
paralysis- loss of movement
paresis-weakness
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Middle Cerebral Artery
- Artery of stroke
- Largest branch of the internal carotid; supplies blood to the entire lateral surface of the cortex including major portions of the frontal lobe
- supplies post central gyrus (somatosensory cortex), motor cortex in the precentral gyrus, Broca's area, Heshl's gyrus (primary auditory cortex), Wernicke's area, angular gyrus, supramarginal, putamen, caudate nucleus, globus pallidus, and portions of the thalamus
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Damage to MCA
* Frequent result of stroke and aphasia; will cause contralateral hemiplegia
* Impaired sense of touch, position sense, pain, and temperature; reading/writing deficits
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Vetebral Artery
The left/right vertebral arteries are branches of the two subclavian arteries that emerge
from the aortic arch
• They join together to form the basilar artery
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Basilar Artery
• The basilar artery divides to form the two posterior cerebral arteries
• Supplies the lower/lateral temporal lobes and the middle/lateral portions of the
occipital lobes
• The other branches of the basilar artery supply the pons, cerebellum, and inner ear
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Watershed Areas of the Brain
-Smaller vessels that run off major arteries that go to the brain and cause TCM or TCS aphasia
-The anterior, middle, and posterior cerebral arteries supply the majority of the blood to
the brain
• However, each one ends their individual distribution and supply in small branches of
arteries called the watershed
• Somewhat inefficient supply of blood
• If blood supply to the watershed areas is interrupted, specific kinds of aphasia can
result in addition to other vascular diseases
• TCM and TCS
-Watershed strokes or laconer strokes
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ethnocultral prevalence of stroke
- african americans 2x the risk of stroke
- males more likely than females
- mortality rates are lowest for native americans and latinos
- more women w/ aphasia then men
- whites have a higher prevalence of ischemic strokes--
Aphasia
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