1. Assessment of Aphasia

2. Objectives: Introduction Etiology Meaning of phonotactics
Definition
nature of the disorder
Etiology
Meaning of phonotactics
Aphasic characteristics & behaviors

3. Introduction: Definition:
is a communication disorder which occurs when damage (lesion) to the adult brain impedes the use of language understanding & production.
All aspects of language are affected with variable degrees
Phonetic, phonological, syntactic, semantic, and pragmatic processing & performance are affected in a range of ways
i.e. different level, extent & complexity of phonetic, phonological, syntactic, semantic & pragmatic problems contribute to the disorder in a particular individual

4. Introduction (Cont’d)
It is described as a multimodal disorder
The linguistic deficit does not have to be confined to the expression and comprehension of spoken language, but may extend to the use of written, gestural & other symbols
Ex: reading and writing are different modalities of language ( which might be affected as well)
Ideas & Meanings are well preserved
are conveyed by the use of non-verbal behaviors, such as facial expression, gesture, pointing and drawing

5. Introduction (Cont’d)
Non-linguistic brain functions are most likely to be affected as well
such as attention, memory perception, sensory reception, motor perception, motor skills and emotional responses
A complex of linguistic as well as non-linguistic factors that together reduce the effectiveness of communication
A person with aphasia is idiosyncratic in
neurological impairment, linguistic & non-linguistic behaviors, psychological response, his/her needs & ability as a communicator

6. Etiology:
Brain damage resulting in aphasia can be caused by various problems such as:
tumor
blood clot
abscess
trauma (e.g. gunshot wound, road traffic accident, surgical intervention
Infections (meningitis, encephalitis)
Functions impaired & their severity depend on the location & extent of damage.

7. Classification of aphasia:
According to the area affected
According to the function impaired

8. Phonotactics: Explained in Grundy (page 47) term used in phonology
refers to the way in which a language combines phonemes to make words
Phonotactic rules:
describe the permissible combinations in a particular language

9. Phonotactics (Cont’d)
Aspects of phonotactics:
syllable structure such as;
CV, CCV  open syllables
CVC, CCVC, CVCC  closed syllables
particular phonemes that may occur at each position in the syllable structure, e.g.;
In English, nasals do not occur as the 1st phoneme of a cluster in syllable-initial position /mp-/, /nt-/
but occur in a syllable-final position as in stamp, went

10. PHONOLOGY & PHONETICS Problems in language expression:
Articulatory awkwardness
is used to describe the speech sound errors that contribute to non-fluent speech
Person searches, visibly & auditorily, for articulatory positions
produces variable phonetic errors & also phonological errors which generally fail to comply with the phonotactics of the speaker’s native language

11. PHONOLOGY & PHONETICS(Cont’d)
Articulatory awkwardness (Cont’d)
is due to a problem of phonetic planning
Also called verbal apraxia, speech apraxia, apraxia of speech, aphasic articulatory defect
it is the exacerbated by an anticipation of error & attempts to rectify errors as they are made

12. PHONOLOGY & PHONETICS(Cont’d)
Phonemic paraphasia
phonemic substitutions, rearrangements and additions, with consonants being affected rather than vowels, & segment production achieved with ease or fluently
phonemes & phoneme combinations that occur are always consistent with the phonotactic rules of the speaker’s language, e.g. ‘squottle’ for ‘bottle’, or ‘pusting’ for ‘putting’

13. PHONOLOGY & PHONETICS(Cont’d)
Phonemic paraphasia (Cont’d)
Presence of sufficient phonologically accurate aspects of the target word remaining & which would be identified from the speech context
Lack of contextual knowledge to interpret produced word affects how it would be perceived  ‘neologism’

14. PHONOLOGY & PHONETICS(Cont’d)
Neologism
affects content words making them appear bizarre to the extent that no real word is recognized
i.e. seem as if they are new words
Words not found in the speaker’s language
is the result of severe phonemic paraphasia

15. PHONOLOGY & PHONETICS(Cont’d)
Neologism (Cont’d)
In some cases, neologisms might have structural resemblance to words in the language that could be used in the same position in the sentence
E.g. ‘I am wickling the…’ phonological form is known but phonemes were misselected/ misordered
In other cases, neologisms appear to have no relation to an appropriate type of word for the sentence structure
E.g. ‘I am swink that …’

16. PHONOLOGY & PHONETICS(Cont’d)
Problems in language reception:
Phonological or semantic impairment can result in an impaired single word comprehension
A range of linguistic and non-linguistic (context), information are used for interpretation of the units of speech

17. SEMANTICS Problems in language expression: Word retrieval errors
Impairments in the ability to produce lexical items (vocabularies)
Different behaviors will present depending on the
person’s processing skills &
‘degree of awareness’
If aware of difficulty
blocking & search behaviors, such as pauses, hesitations & re-attempts at initial sounds & syllables or at whole words

18. SEMANTICS (Cont’d)
Language features reflecting problems in lexical retrieval:
Circumlocution
Subject talks around the target word
Such as descriptions & definitions
Semantic paraphrasia
A real word which has the same grammatical function as the target & has semantic association with its substitute
E.g. “walking” for “running”
The phonological structure (number of syllables+ some similarity in the phonemes) of the substitute word is generally dissimilar to the target

19. SEMANTICS (Cont’d)
Language features reflecting problems in lexical retrieval (Cont’d)
Verbal paraphasia
A real word which has the same grammatical function but there is no recognizable semantic association with the target
The phonological structure of the substitute word may
show some similarity to the target word
E.g. “walking” for “wishing” ; “chair” for “chalk”
be dissimilar to the target word (i.e. unrelated in structure)
E.g. “quiet” for “careful”

20. SEMANTICS (Cont’d)
Language features reflecting problems in lexical retrieval (Cont’d)
Perseverative paraphasia
A word which has been expressed in a previous context is inappropriately repeated in a later utterance
A result of failure in processing a new response
Anomia
Refers to disorders of naming rather than word retrieval in running speech

21. SEMANTICS (Cont’d) Problems in receptive language:
Failure to access the meaning of a heard word
Word will be either
perceived as a meaningless nonsense word or
interpreted as another concept from a related semantic field  e.g. “turnip” for “potato”
Difficulty in associating a heard word
(i.e. recall) with 1 of 2 closely related pictures/items rather than with 1 of 2 unrelated ones

22. SEMANTICS (Cont’d) Problems in receptive language(Cont’d):
E.g. “knife” more likely to be recalled  knife-boat
Less likely to be recalled knife, fork
Impairment in the ability to interpret thematic relations of a particular verb –reversible verbs
E.g. “chased” in the “the mouse chased the cat”
Thematic role are understood if the lexical entry “chased” is understood

23. SEMANTICS (Cont’d) Factors which affect semantic comprehension:
Memory span
Information load

24. SYNTAX Aggrammatism Paragrammatism
Nonfluent output characterized by speech produced in a disconnected manner
Function words are omitted to a greater extent than content words
Grammatical inflections are generally lacking
Agreement (gender, number and case) is impaired
Paragrammatism
Function words are distorted but not omitted

25. PRAGMATICS Usually the least affected aspect of language
Many clients are able to use non-verbal signals such as
eye-gaze
pause
gesture
prosody
facial expression to indicate meanings

26. PRAGMATICS (Cont’d) May also engage appropriately in discourse
adopt effective repair strategies
demonstrate a range of communicative acts including;
acknowledgement
greeting
request
question
command

27. PRAGMATICS (Cont’d)
Individuals with severe jargon aphasia can often convey
communicative intent
emotion
question forms
topic change
A person with severe verbal comprehension deficits can often make appropriate responses to
yes-no or wh- question
commands etc
because he/she recognizes the meaning implied by
Prosodic features
Visual cues
Contextual information

28. PRAGMATICS (Cont’d)
May make relevant guesses about a message if have enough contextual information
recognition of people & environment
orientation in time & situation

29. PRAGMATICS (Cont’d) Pragmatic problems:
failure to recognize situations
feigning understanding
ignoring turn taking signals
continuing to jargon in spite of a negative feedback from the conversational partner
failure to
initiate conversation
change topic
Employ a full range of communicative acts

30. OTHER SPEECH BEHAVIORS
Jargon
It consists of fluent, generally incomprehensibles utterances which may contain any type of paraphasia and neologism
Automatic speech
Well preserved even in severe cases of aphasia
Serial speech such as;counting and days of the week
Social responses
Familiar overlearned sayings

31. OTHER SPEECH BEHAVIORS (Cont’d)
Repetitive verbal behavior
takes several forms ; ex.
recurrent utterances
Echolalia
perseveration
stereotypy
Echolalia; repetition of all/part of an utterance just spoken by another person
Perseveration; reproduction of a previous response in a new situation