1. + How can Stroke cause impairment if it occurs in the different lobes of the brain? By Sruti Venkatesh 11R2

2. + What is a stroke? A stroke or ‘brain attack’ is the effect of when the blood flow to the brain has been interrupted when an artery has been blocked by a blood clot or is ruptured. The arteries carry blood, which contains oxygen and nutrients to assigned parts of the brain. When the blood does not reach its desired destination that area of the brain slowly starts to die, and abilities controlled in that area are lost.

3. + Common Strokes Ischemic Stroke The most common occurring stroke, the ischemic stroke, occurs in four out of five cases. The Ischemic stroke can be broken down further into two more strokes: 1) the embolic stroke takes place when a blood clot forms (usually in the heart) and travels in the bloodstream towards the brain. Once the clot reaches the blood vessels in the brain it lodges it self in and clogs up the path. 2) the Ischemic stroke is the thrombotic stroke. This happens when a blockage occurs in one or more arteries in the brain.

4. + Common Strokes Hemorrhagic Stroke A Hemorrhagic stroke takes place when there is a break in the wall of a blood vessel. Due to the break it causes blood leaks into the brain and puts a stop to all the oxygen and nutrients that are entering. There are numerous variations to having a Hemorrhagic stroke as a result of many different causes. One of these causes, an aneurysm, is where a weak spot exists in the wall of the arteries, which as it gets weaker, can burst.

5. + Common Strokes Transient Ischemic Attack (TIA) A Transient Ischemic Attack, commonly known as a mini stroke, is caused by temporary blockage in the arteries, which later naturally clears itself. It has the same symptoms of any other stroke, but does not cause permanent damage to the brain. Common symptoms of this stroke include dizziness, swallowing difficulties and nausea.

6. + The Different Lobes and how Strokes effect it The frontal lobe The parietal lobe The temporal lobe The occipital lobe

7. + The Frontal Lobe The largest of all the lobes, the primary role of the frontal lobe is to control many of the body’s functions, including problem solving, planning, judgment, impulse control and emotions. It is the part of the brain that is most prone to injury because of its size and position. The lobe also consists of the primary motor cortex for each hemisphere. Broca’s area, which is also found in the frontal lobe, is responsible for the production and articulation of speech. The left lobe controls language related tasks while the right controls non-verbal tasks. Those with stroke damage to their frontal lobe find it hard to better themselves from experiences, to learn from mistakes. Damages to this lobe can also cause disturbance to our motor skills, causing varied levels of loss of movement in the arms and fingers. Broca’s aphasia, which is the difficulty to speak, is also a potential symptom. Personality and behavioural changes and sexual behaviour can also change significantly after a stroke. Damage can also reduce a persons IQ.

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9. + The Parietal Lobe The Parietal lobe is located directly behind the Frontal lobe. Its primary purpose is to allow a person to be conscious of their body and to be aware of their surroundings. It has a role in writing, reading and arithmetic. The information that permits the Parietal lobe to function comes primarily from the visual system in the Occipital lobe. This part of the brain also includes the primary somatosensory cortex, it processes the body’s temperature and sensations such as touch and pressure. Stroke damage to the Parietal lobe will cause the patient to have spatial neglect and demonstrate abnormalities with their body image. Injury to the left of the Parietal lobe can result in difficulty in reading, maths and difficulty in language (aphasia) and the ability to perceive objects normally. Damage to the right side of the lobe will result in the inability to care for oneself, including the body and the immediate environment. It can also deter a person’s drawing ability. Most patients experiencing stroke damage of this kind will be in denial that they have these symptoms.

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11. + The Temporal Lobe The Temporal lobe is located under the Frontal and Parietal lobe, in the middle of the brain. It includes the primary auditory cortex located in the upper part of the lobe and Wernicke’s area. Its primary function is to process the sensations received through the ear – it enables us to make sense of what we hear (human speech, music and other noises) and put meaning to it. Damage to the Temporal lobe may disrupt the process of understanding what we are hearing. This part of the brain can also have an effect on the languages that we know and understand. In particular, damage to the left lobe can disrupt the recognition of words while injuries to the right lobe can cause the inhibition to talk. Damage in the left lobe may also potentially cause impaired memory for verbal material, and injuries to the right lobe may impaired memory for non-verbal material.

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13. + The Occipital Lobe The Occipital lobe, which has a left and right component, is located at the back of the entirety of the brain. Its primary role is for vision. An image that we receive from the right of each retina is processed in the left side of the Occipital lobe and vice versa. Images from the center of the visual field are processed in both Occipital lobes. The primary visual cortex is located at the very back of the Occipital lobe and assists with processing information that is coming in from the eyes. The lobe is least vulnerable to injury due to its position. Stroke damaging the primary visual cortex would not make a person blind however, it will defer a patient from analyzing visual stimuli. It is important to note that stroke damaging either side of the actual lobe will cause loss of sight. Other symptoms include visual hallucinations and illusions.

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15. + Broca’s Area Broca’s area is named after Pierre Paul Broca who reported on the impairments of two of his patients. This is located near the primary motor cortex in the left frontal lobe and is responsible for the function of speech production and the movement of mouth muscles for pronunciation. If Broca’s area is damaged, speech would be significantly hindered. Broca’s Aphasia is the result of this impairment.

16. + Wernicke’s Area Wernicke’s Area is named after Carl Wernicke and came just 12 years after Broca’s Area was found. It is situated in the left temporal lobe and is responsible for the interpretation of language and the ability to formulate grammatically correct sentences. If Wernicke’s area had been injured, speech would not be hindered but it would be senseless. Wernicke’s aphasia is the result of this impairment.

17. + Aphasia Aphasia is language difficulty caused by damage to the brain, usually stroke. Head injuries, tumors or infections are other causes. It can affect a persons ability to understand others, their writing, reading and talking skills as well. It also has an effect on everyday communication, living and relationships. Aphasia effects each person differently, while some people will have it mildly, others will have more severe cases. There are two different types of aphasia – Broca’s aphasia and Wernicke’s aphasia

18. + Broca’s Aphasia Broca’s aphasia occurs when there has been notable harm to Broca’s area. Patients with Broca’s aphasia have trouble expressing what they want to say into words and sentences. While patients can comprehend what everyone around them are writing or saying, they take their time to formulate words, and when they do speak it is slow and in short sentences. Typically, speech lacks grammar and short words (longer words are used to get straight to the point) and is commonly non-fluent. With Broca’s aphasia the ability to vocally say what you are thinking is not lost but rather the information needed to translate speech into meaning is.

19. + Wernicke’s Aphasia Wernicke’s aphasia occurs when there has been damage done to Wernicke’s area. A patient with Wernicke’s aphasia has trouble understanding spoken and written language. The difference between Broca and Wernicke’s aphasia is that patients with Wernicke’s, talk freely and fluently but don’t make much sense – the words are formulated correctly and are said in a free manner but when put together they are illogical.

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21. + Spatial Neglect Spatial neglect occurs after brain damage that typically happens in the right parietal lobe. This results in the patient ignoring the stimuli presented to the left side of their body.

22. + Case Study – Phil, Wernicke’s Aphasia Phil enrolled in the Aphasia Centre in Florida 8 months after he suffered from a stroke, and stayed there to endure a 6 week program. He has Wernicke’s aphasia. Even though his speech was fluent, only 2% of what he said made sense, the rest were made up words and sounds. Being a very social person, Phil struggled with coming to terms with his syndrome. His relationships with his family and the immediate people around him deterred because of this. Phil had treatment for 5 hours a day and did it 5 days a week. The program provides intensive aphasia therapy for all kinds of patients for however long they need it. Treatment included rigorous language and speech therapy. The centre recognises that there is no complete cure for aphasia, but progress to better a patients condition is doable. After his 6 weeks at the centre, Phil’s speech bettered by a staggering 80%, meaning that what he was saying was understandable. He is now becoming more like his old self, independent and not relying on his wife.

23. + References The Aphasia Centre, (2013), http://www.theaphasiacenter.com/, accessed: 3 Apr 2014http://www.theaphasiacenter.com/ Traumatic Brain Injury Rehabilitation and Resource Guide, (2014), http://www.neuroskills.com/, accessed: 31 Mar 2014 http://www.neuroskills.com/ Headway – The brain injury association, (2014), https://www.headway.org.uk/home.aspx, accessed: 31 Mar 2014 https://www.headway.org.uk/home.aspx National Stroke Association, (2012), http://www.stroke.org/, accessed: 30 Mar 2014http://www.stroke.org/ Heart Disease, Stroke and Healthy Living-Heart and Stroke Foundation, (2014), www.heartandstroke.ca, accessed: 3 Apr 2014 www.heartandstroke National Stroke Foundation, (2011), http://www.strokefoundation.com.au/blog/, accessed: 31 Mar 2014http://www.strokefoundation.com.au/blog/ Roger Edwards (et al), (2013), Oxford Psychology Units 3+4, 253 Normanby Road, South Melbourne, Victoria 3205, Australia: Oxford University Press