1. Wernicke’s & Broca's aphasia Brain & Language LING 411/412/489 NSCI 411/611/489/689 Harry Howard Tulane University

2. Wernicke’s aphasia aka posterior aphasia aka receptive aphasia

3. 5/11/2015Brain & Language, Harry Howard, Tulane University3 Introduction Imagine your favorite doctor joke. They usually begin with “a guy walks into a doctor’s office …” Now imagine that the guy, or woman, is a patient with Wernicke’s aphasia …

4. 5/11/2015Brain & Language, Harry Howard, Tulane University4 Short samples of Wernicke’s aphasia Clinician: “Tell me where you live.” Patient: “Well, it’s a meender place and it has two … two of them. For dreaming and pinding after supper. And up and down. Four of down and three of up …” (Brookshire 2003:155) Clinician: “What’s the weather like today?” Patient: “Fully under the jimjam and on the altigrabber.” (Brookshire 2003:155) What is broken? What is preserved?

5. 5/11/2015Brain & Language, Harry Howard, Tulane University5 A long sample of Wernicke’s aphasia Patient is asked what brought him to the hospital. “Is this some of the work that we work as we did before? … All right … From when wine [why] I’m here. What’s wrong with me because I … was myself until the taenz took something about the time between me and my regular time in that time and they took the time in that time here and that’s when the the time took around here and saw me around in it’s started with me no time and I bekan [began] work of nothing else that’s the way the doctor find me that way…” (Obler & Gjerlow 1999:43)

6. 5/11/2015Brain & Language, Harry Howard, Tulane University6 Phonemic paraphasia & neologism Errors in the selection of phonemes include addition, omission, or change in position. For instance, Damasio (1992:535) cites  trable for table  pymarid for pyramid. Clearly, the more such phonemic paraphasias accumulate in a word, the harder it is to understand it, to the extent that the intended word may become unidentifiable. This is the point of neologism, illustrated in another of Damasio’s examples:  hipidomateous for hippopotamus. Patients with severe Wernicke’s aphasia may produce strings of neologisms with a sprinkling of connecting words, known as jargon

7. 5/11/2015Brain & Language, Harry Howard, Tulane University7 Wernicke's aphasia on YouTube http://www.youtube.com/watch?v=B- LD5jzXpLE http://www.youtube.com/watch?v=B- LD5jzXpLE

8. 5/11/2015Brain & Language, Harry Howard, Tulane University8 Semantic paraphasia A patient with damage to Wernicke’s region may also fail to select the proper words with which to convey her ideas, though this deficit can be compensated for by the usage of paraphrases. Such semantic paraphasias (or empty speech) are often quite simple, such as relying on generic terms like thing or stuff to stand in for the more specific words that do not spring to mind. Other times, they become quite elaborate.  Kandel (1995:640) cites the example of a Wernicke’s patient who was asked where he lived and answered:  “I came there before here and returned there.”  “A patient with moderate Wernicke’s aphasia was attempting to explain what he had done on a shopping trip the previous day. He concluded with,  ‘I went down to the thing to do the other one and she was only the last one that ever did it, so I never did.’” (Brookshire 2003:155)

9. 5/11/2015Brain & Language, Harry Howard, Tulane University9 Circumlocution Some Wernicke’s patients talk around missing words, a behavior called circumlocution. A patient with moderate Wernicke’s aphasia was attempting to tell the examiner what she had had for breakfast that morning: Patient: “This morning for – that meal – the first thing this morning – what I ate – I dined on – chickens, but little – and pig – pork – hen fruit and some bacon, I guess.” (Brookshire 2003:156)

10. 5/11/2015Brain & Language, Harry Howard, Tulane University10 Wernicke's aphasia on YouTube http://www.youtube.com/watch?v=aVhYN7N TIKU http://www.youtube.com/watch?v=aVhYN7N TIKU

11. 5/11/2015Brain & Language, Harry Howard, Tulane University11 Logorrhea, press of speech The ease with which Wernicke’s patients produce speech, their circumlocution, and their deficient self-monitoring may contribute to their inclination to run on when they talk. Such an overabundance of speech is referred to as logorrhea or press of speech. Clinician: “Tell me what you do with a comb.”

12. 5/11/2015Brain & Language, Harry Howard, Tulane University12 Logorrhea, press of speech Patient: “What do I do with a comb … what I do with a comb. Well a comb is a utensil or some such thing that can be used for arranging and rearranging the hair on the head both by men and by women. One could also make music with it by putting a piece of paper behind and blowing through it. Sometimes it could be used in art – in sculpture, for example, to make a series of lines in soft clay. It’s usually made of plastic and usually black, although it comes in other colors. It is carried in the pocket or until it’s needed, when it is taken out and used, then put back in the pocket. Is that what you had in mind?” (Brookshire 2003:155)

13. 5/11/2015Brain & Language, Harry Howard, Tulane University13 Reading Reading can also be disrupted? Why?  Because reading connects to speech for the pronunciation of letters and the storage of words

14. 5/11/2015Brain & Language, Harry Howard, Tulane University14 Aphasia checklist: Wernicke’s a)comprehension of spoken material b)comprehension of written material c)segmental phonology d)word selection e)word semantics f)fluency (production of speech) g)production of writing h)use function words i)grammaticality j)repetition of what others say k)conversational proficiency, e.g. turn taking l)concern about impairment m)concern about errors n)short-term retention & recall of verbal materials a) impaired, mild to severe b) impaired c) impaired: phonemic paraphasia, neologism, jargon d) impaired: circumlocution e) impaired: semantic paraphasia, empty speech f) (overly) fluent: logorrhea g) normal h) normal i) normal or mildly impaired: paragrammatism j) impaired: (no evidence) k) normal l) little to none m) little to none n) impaired: (no evidence)

15. 5/11/2015Brain & Language, Harry Howard, Tulane University15 The effect of WA on cerebral function LHRH Anterior grammatical rules function words conversational rules? motivation to speak? Posterior convergent word semantics categorical phonology divergent word semantics coordinate phonology

16. 5/11/2015Brain & Language, Harry Howard, Tulane University16 Broca's aphasia aka expressive aphasia aka anterior aphasia aka agramamtic aphasia

17. 5/11/2015Brain & Language, Harry Howard, Tulane University17 Describe this picture (silently!)

18. 5/11/2015Brain & Language, Harry Howard, Tulane University18 Broca's aphasia sample #1 Examiner: Describe this picture. Patient: kid … kk … can … cookie … caandy …well I don’t know but it’s writ … easy does it … slam … early … fall … men … many … no … girl. Dishes … soap … water … … water … falling pah that’s all … dish … that’s all. Cookies … can … candy … cookies cookies … he … down … That’s all. Girl … slipping water … water … and it hurts … much to do. Her … clean up. Dishes … up there … I think that’s doing it Examiner: What is she doing with the dishes? Patient: discharge no … I forgot … dirtying clothes [?] dish {?} water … Examiner: What about it? Patient: slippery water … [?] scolded … slipped

19. 5/11/2015Brain & Language, Harry Howard, Tulane University19 Broca's aphasia sample #2 Examiner: Describe this picture. Patient: uh … mother and dad … no … mother … dishes … uh … runnin[g] over … water … and floor … and they … uh … wipin[g] dis[h]es … and … uh … two kids … uh … stool … and cookie … cookie jar … uh … cabinet and stool … uh … tippin[g] over … and … uh … bad … and somebody … gonna get hurt.

20. 5/11/2015Brain & Language, Harry Howard, Tulane University20 Broca's aphasia on YouTube Broca's aphasia (1) Broca's aphasia Broca's aphasia (2) Broca's aphasia

21. 5/11/2015Brain & Language, Harry Howard, Tulane University21 Background: word classes Content words noun verb adjective adverb Function words article demonstrative conjunction  coordinating  subordinating pronoun preposition

22. 5/11/2015Brain & Language, Harry Howard, Tulane University22 Background: morphology Inflectional  noun plural  verb present and past tenses present and past participles  adjective comparative, superlative Derivational  un-, -ify, etc., etc

23. 5/11/2015Brain & Language, Harry Howard, Tulane University23 Breakdowns in grammar Breakdown in morphology  Patients express nouns in the singular and verbs in the infinitive or participle Breakdown in modifying parts of speech  Patients often eliminate articles, adjectives, and adverbs altogether.  Instead of saying “I saw some large gray cats”, a patient with Broca’s aphasia might say “see gray cat”.

24. 5/11/2015Brain & Language, Harry Howard, Tulane University24 The overall result All this leads to a breakdown in syntax  For the sentence, “Ladies and gentlemen, you are now invited into the dining room”, a patient with Broca’s aphasia may only be able to say “Ladies, men, room.”  When asked his occupation, a mailman with Broca’s aphasia said “Mail … mail … m ….” The examples are remarkable in that they appear to be constructed almost entirely by juxtaposition of isolated words. They are practically devoid of the markers of grammatical relationships that bind together normal English – with the exception of and. They also involve distortion of word order.  Damasio, 1992, p. 533, cites the attempt of a Broca’s aphasiac to express I will go home tomorrow coming out as Go I home tomorrow. Altogether, this is called agrammatism or telegraphic speech

25. 5/11/2015Brain & Language, Harry Howard, Tulane University25 Reversible sentences The (b) sentences of each pair are difficult for Broca's patients to understand compared to the (a) sentences: 1a) The boy ate the apple. 1b) The clown chased the violinist. 2a) The cop shot the robber. 2b) The robber was shot by the cop. 3a) It was the cop who __ shot the robber. 3b) It was the robber who the cop shot __.

26. 5/11/2015Brain & Language, Harry Howard, Tulane University26 Repetition of one's own speech The most famous case is that of Broca’s first patient, who could only say the (French) word "tan", which he repeated often, and so was known as "Tan". Uncontrollable repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, usually caused by brain injury or other organic disorder. This is know as perseveration.

27. 5/11/2015Brain & Language, Harry Howard, Tulane University27 Summary of main symptoms Impaired production of speech  mild: non-fluent  severe: Broca’s Tan (perseveration) Non-fluent speech:  effortful: slow, deliberate, halting, with pauses between words and even syllables, false starts  misarticulated: distorted consonants and vowels, called phonetic dissolution Laconic speech:  short utterances with few function words (agrammatism or telegraphic speech) Good short-term retention & recall of verbal materials  may generalize treatment skills & strategies to daily life Great concern about their impairment and the errors they make

28. 5/11/2015Brain & Language, Harry Howard, Tulane University28 Broca's aphasia checklist a)comprehension of spoken material b)comprehension of written material c)segmental phonology d)word selection e)word semantics f)fluency (production of speech) g)production of writing h)use function words i)grammaticality j)repetition of what others say k)conversational proficiency, e.g. turn taking l)concern about impairment m)concern about errors n)short-term retention & recall of verbal materials o)other a) normal b) normal c) impaired: phonetic dissolution d) normal e) normal f) impaired: mild to severe (perseveration) g) impaired h) impaired: agrammatism or telegraphic speech i) impaired j) impaired (no evidence) k) normal l) yes m) yes n) normal o) --