Assessment of Aphasia

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

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

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

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

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.

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

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

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

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

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

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’

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’

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

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 …’

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

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

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

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”

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

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

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

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

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

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

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

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

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

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

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

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