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Speech, Language and Aphasia


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Power point presentation on examination of a patient with Speech disorders and classification of Aphasia

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Speech, Language and Aphasia

  1. 1. SPEECH LANGUAGE PATHOLOGY & CLASSIFICATION OF APHASIA<br />Hello<br />Dr. S. Aswini Kumar. MD<br />Professor of Medicine<br />Medical College Hospital<br />Thiruvananthapuram<br />
  2. 2. Definitions:<br />Speech is a highly evolved function of the cerebral cortex<br />Speech is the human faculty by which thought processes are symbolically expressed<br />Speech is the vocalization form of human communication<br />It is based upon the syntactic combination of lexicals and names that are drawn from very large vocabularies (usually &gt;10,000 different words)<br />Each spoken word is created out of the phonetic combination of a limited set of vowel and consonant speech sound units<br />
  3. 3. Components of Speech<br />Speech is the mechanical function of one’s ability to communicate in oral language<br />It includes<br />Language production<br />Phonation and <br />Articulation<br />
  4. 4. Language<br />Language is the symbolization of ideas<br />Ist is the ability to convert thought in to comprehensive words<br />It consists of five parameters<br />Speaking<br />Hearing<br />Repeating<br />Reading<br />Writing<br />
  5. 5. Dimensions of Language<br />
  6. 6. Speech and Hemispherical Dominance<br />Speech is the function of cerebral hemisphere<br />It is undertaken by the dominant hemisphere<br />9 out of 10 human have right handedness<br />90% of human also have left hemispherical dominance<br />Rest 10% have left handedness<br />7 out of these 10% have left hemispherical dominance<br />3 out of the 10% have right hemispherical dominance<br />Thus 97% of human have left hemispherical dominance<br />Only 3% have right hemispherical dominance<br />It also means speech is a function of Left hemisphere in 97 out of 100 and right hemispere in only 3%<br />
  7. 7. Wernickes Area<br />The auditory comprehension of spoken speech takes place in the posterior end of the superior temporal gyrus<br />Karl Wernicke<br />German Neurologist<br />Identified it <br />Described the pathway<br />Connection to Broca’s area<br />Arcuate fasciculus<br />This area is neuroanatomically described as the posterior part of Brodmann area 22<br />
  8. 8. Broca’s Area<br />The motor area for spoken speech which is situated in the posterior part of the left inferior frontal gyrus<br />Peirre Paul Broca<br />French Sugeon<br />Described it in 1865<br />Two patients who lost speech<br />Autopsy done showed<br />Lesion in lateral frontal lobe<br />This area is neuroanatomically described as the posterior part of Brodmann area 44 and 45<br />
  9. 9. Conduction Area<br />Adeep, white matter tract, connecting the Wernickes area to the Brocas area<br />Also called arcuate fasciculus<br />Latin word<br />Curved bundle<br />Neural tract<br />Important in dominant hemisphere<br />Lesion  Conduction Aphasia<br />Repetition deficits arise following damage to the arcuate fasciculus of the dominant hemisphere <br />
  10. 10. Exner’s Area<br />An area of the brain just above Broca&apos;s area and anterior to the primary motor control area.<br />Seigmund Exner <br />Austrian Physiologist<br />1846-1926<br />Area for writing<br />Close to area for hand movt<br />Damage results in agraphia<br />This area is neuroanatomically described as the posterior part of Brodmann area 6<br />
  11. 11. Reading Area<br />An area of the brain just medial to the left occipital lobe and in the spleniumof the corpus callosum.<br />Center for reading <br />Recieves impulses from eye<br />Transmits to area Assn area<br />Analyses red matter<br />Passes to arcutate fasciculus<br />Lesion – Pure word blindness<br />This area is neuroanatomically described as the posterior part of Brodmann area 17<br />
  12. 12. Speech Mechanism<br />Speech is the process by which a person can communicate with others effectively<br />
  13. 13. Information transmitted via arcuate fasiculus<br />Activation of Brocas area for word formation<br />To motor cortex that control speech muscles<br />
  14. 14. Areas of Brain<br />4, 6<br />39<br />45, 44<br />41<br />22<br />18, 19<br />17<br />
  15. 15. Speech in reponse to hearing<br />Primary Motor cortex<br />Arcuate fasciculus<br />Brocas Speech area<br />Wernickes Speech Area<br />Primary Auditory Area<br />Brainstem<br />Muscles of Larynx<br />
  16. 16. Pathway in the process of reading<br />Primary Motor cortex<br />Primary Visual cortex<br />Brocas Speech area<br />Wernickes speech Area<br />Visual<br />Association cortex<br />Brainstem<br />Muscles of Larynx<br />
  17. 17. Aphasia<br />Part II<br />
  18. 18. Definitions:<br />Loss of language due to a dysfunction of the central mechanism in the brain is called aphasia<br />Minor disorders of the same is called dysphasia<br />Eg: Right Hemiplegia producing dysphasia<br />Dysfunction of the peripheral mechanism of speech leading to defective articulation is termed dysarthria<br />Eg: LMN facial palsy, Pseudobulbar palsy <br />Loss of voice due to dysfunction of the voice producing mechanism is called dysphonia<br />Eg: Vocal cord palsy , Acute Laryngitis<br />Loss of ability to read: alexia<br />Loss of ability to write: agraphia<br />
  19. 19. Examination of Aphasia<br />Spontaneous speech<br />Whether patient spontaneously ask for food, urination etc<br />Comprehension<br />Whether patient can obey commands<br />Repetition<br />Whether patient can repeat phrases or numbers<br />Naming<br />Whether patient can name an object<br />Reading<br />Whether patient can read, understand and obey<br />Writing<br />Whether patient can write down the answers<br />
  20. 20. Testing Spontaneous speech<br />Fluency<br />Whether speech is fluent without hesitations<br />Uninterrupted by searching for a forgotten word<br />Effort taken for speech<br />See whether the patient has effortless/effortful speech<br />Vocabulary <br />See whether there is any word-finding difficulty<br />Whether patient stammers and stumbles<br />Ability to speak in full sentences<br />Or patient is able to talk only in phrases<br />Grammer <br />Whether the grammer is correct or not<br />
  21. 21. Testing Comprehension<br />Whether patient can hear and understand speech?<br />Tested by asking the patient to obey a command<br />Ask the patient to show the tongue, close eyes, lift a limb<br />Fluency is preserved or not<br />Speech whetherfluent without hesitations?<br />Is it incessant, rapid and uninterrupted? <br />Use of paraphasias<br />Use of a descriptive phrase instead of a forgotten word<br />Use of neologisms<br />Invented word and nonsense words<br />Jargon aphasia<br />Extreme example of the above speech devoid of meanings<br />
  22. 22. Testing Repetition<br />Patient is asked to repeat a simple sentence<br />It has to be clearly stated by the examiner<br />Eg: Today is Wednesday, the August 17th, 2009<br />See whether the patient is able to repeat what you say<br />Remember never to shout at a aphasic patient<br />Hearing is usually normal in these patients<br />In a patient with left frontal lesion<br />They can repeat simple words and phrases<br />In a patient with posterior lesions in the angular gyrus<br />They cannot repeat what the examiner says<br />This is the characteristic feature of conduction aphasia<br />This function is preserved in Trans-cortical aphasia<br />
  23. 23. Testing for Naming<br />Patient is shown an object and asked to name it<br />A commonly used object should be shown<br />Eg: Pen or match box<br />See whether the patient is able to name the object<br />Patient may be handed over the object<br />Or asked to demonstrate the use of the object<br />In Anomic aphasia or nominal aphasia<br />Patient is unable to name it, but use it even<br />Auditory comprehension, repetition, reading and writing<br />Thse are usually preserved in such a patient<br />Memory testing other wise will be normal<br />This function is preserved in Trans-cortical aphasia<br />
  24. 24. Other test done<br />Ask the patient to read from a command<br />See whether he answers a question written<br />See whether he obeys commands, written down<br />Now ask to read aloud<br />Ask the patient to write down<br />The name and address<br />Draw a picture of a clock face<br />Answer to a question put forward<br />Ask the patient to calculate<br />Subtract 7 from hundred<br />Ask for 4+4, then more complicated<br />
  25. 25. Aphasia syndromes<br />
  26. 26. Broca’s Aphasia<br />Non-fluent<br />Telegraphic speech<br />Reduced verbal content<br />Phrase length – generally less then four words<br />Agrammatical sentences (or frequent errors)<br />Mostly content words (nouns and verbs)<br />Absence of functional words ( prepositions & conjunctions)<br />The matter is conveyed any way<br />Functional comprehension is present<br />But trouble following complex grammatical statements<br />Reading loud is not possible; but can read and obey<br />MCA territory stroke – Left frontal lobe<br />
  27. 27. Wernicke’s Aphasia<br />Fluent<br />Increased verbal content<br />Para-grammatism – speech running<br />Phrase length – generally greater than five words<br />Grammatical sentences (or close to normal)<br />Paraphasic errors (literal or verbal)<br />Literal – sound substitution with errors (winging ringing)<br />Symantic – word substitution ( sister for mother)<br />Neologisms (made up words) <br />Logorrhea – Inability to stop speaking<br />Severely impared auditory comprehension<br />MCA territory stroke – Left superior temporal lobe<br />
  28. 28. Conduction Aphasia<br />Relatively uncommon<br />Spontaneous speech is fluent<br />Considerable word finding difficulty<br />Preserved auditory comprehension<br />Significan difficulty with repetition<br />Literal paraphasia<br />Self correction<br />Numerous pauses <br />Filled pauses – Aaaaa Aaaaa<br />Reading deficit - variable<br />Writing deficit – variable<br />Lesion: Left superior temporal area, supramarginal gyrus<br />
  29. 29. Nominal Aphasia<br />Primary deficit – word finding and naming<br />Speech output is fluent with numerous pauses<br />Pauses may be filled with circumlocutions<br />Describing the function of an object<br />But the name cannot be retrieved<br />Auditory comprehension is intact<br />Reading and writing are also intact<br />Last localized of all aphasias<br />Focal damage to left temoral and parietal<br />Usually residual of good recovery from other aphasias<br />Also indicates good prognosis if seen in acute stage<br />
  30. 30. Global Aphasia<br />Severe impairment in all modalities<br />Speaking, listening, reading and writing<br />Severely impaired auditory comprehension<br />Very limited speech output<br />Only few understandable utterances<br />Some areas of spared speech function<br />Utilized in communication<br />Brain damage resulting is massive<br />Fronto-tempero-parietal lesion<br />Complete occlusion of MCA<br />Rarely without hemiplegia<br />
  31. 31. Trans-cortical Motor Aphasia<br />Similarities to motor aphasia<br />But with intact repetition<br />Lesion in the border zone<br />Superior or anterior to Broca’s area<br />Non-fluent<br />Limited speech output<br />Auditory comprehension – good<br />Reading comprehension – good<br />Syntax not as bad as in Broca’s Aphasia<br />Occlusion of Anterior Cerebral Artery<br />
  32. 32. Trans-cortical Sensory Aphasia<br />Similarities to snsory aphasia<br />But with intact repetition<br />Deficits in all language modalities<br />Fluent aphasia<br />Echolalia<br />They can repeat; but cant understand it<br />Much difficulty in communicating<br />Syntax not as bad as in Broca’s Aphasia<br />Lesion in the border zone<br />Posterior and inferior to Wrnickes area<br />Occlusion of Anterior Cerebral Artery<br />
  33. 33. Aphasias - Comparison<br />
  34. 34. Related disorders<br />Part III<br />
  35. 35. Apraxia<br />Acquired disorder of learned skill affecting sequential motor movements which cannot be accounted by elementary disturbances of strength, co-ordination, sensation or comprehension<br />Inability to perform a learned motor activity in the absence of any motor, sensory or coordination defect<br />It is not a lower level motor disturbance but a deficit in the motor planning<br />Ideamotor apraxia is the most common type, fails to perform previously learned motor activity<br />Ideational apraxia is adisturbance of complex motor planning than ideamotor apraxia<br />
  36. 36. Agnosia<br />An acquired disorder of recognition in some sensory modality ie visual, auditory or tactile<br />Agnosia can be specific for a particular class within the modality of sensation – <br />Objects<br />Pictures<br />Faces<br />Colors<br />It is to important distinguish agnosia from agnosia, just as in case of apraxia<br />Patietns with auditory agnosia hear adoor bell ring; but does not recognise it meaning<br />
  37. 37. Thank You<br />