1. Aphasia: Symptoms and Syndromes
Ling 411 – 04
Aphasia: Symptoms and Syndromes

2. Simple Functions / Complex Functions
What about "understanding speech“? Is it a simple process,
localized in Wernicke's area?
Actually it seems to be a pretty complex process...how is
simplicity/complexity determined?
Similarly, “speaking” – pretty complex, not just Broca's area
As we have seen, speaking is pretty complex and uses not
just Broca’s area but also Wernicke’s area. Without a
properly functioning Wernicke’s area, speech is erratic

3. Simple Functions / Complex Functions
Speaking vs. Phonological Production
Phonological production is one part of speaking – located in Broca’s area
Speaking is a complex process
Phonological production plus planning what is about to be produced – involves Wernicke’s area
Understanding speech vs. phonological recognition
Phonological recognition is one part of speech understanding – located in Wernicke’s area
Speech understanding is a complex process
Includes grammatical and semantic activity
Motor activity (Broca’s area) also contributes

4. Simple Functions / Complex Functions

5. Motor contributions to perception
Reading: It helps if you know how to write
Especially with Chinese characters
Listening to guitar playing
You appreciate it more if you play guitar
Watching a sports event
You get more out of it if you have played yourself
Understanding 2nd language speech
It helps a lot if you can speak

6. Basic functions and complex functions – speaking
Phonological recognition is a basic function
Located in Wernicke’s area
along with, perhaps, the area intermediate between primary auditory area and W’s area
Speaking is a complex function
It is a cooperative effort of several areas, including Broca’s area and Wernicke’s area
Phonological recognition is a necessary component of speaking

7. Aphasic Symptoms Varieties of language deficits
Inferences from language deficits
Problems of interpretation

8. Some speech of a Broca aphasic
Examiner: What brought you to the hospital?
Patient: Yes ... Monday ... Dad, and Dad ... hospital, and ... Wednesday, Wednesday, nine o'clock and ... Thursday, ten o'clock ... doctors, two, two ... doctors and ... teeth, yah. And a doctor ... girl, and gums, and I
(Patient was trying to explain that his father had brought him into the hospital on Wednesday to have some work done on his teeth.)

9. Complexity within the process of speech production
The motor realization of speech involves the smooth coordination of a number of separate neuromuscular systems
Sensory feedback and monitoring enter this process at many points
Coordination
Activity of different systems must be coordinated
Planning of neural activity has to precede low-level activation by varying amounts of time
Lead time from neural activity to muscle activity differs from system to system
(Goodglass, 62)

10. More, from a (different) Broca’s apasic
"Me ... build-ing ... chairs, no, no cab-in-ets. One, saw ... then, cutting wood ... working ..."

11. Attempt to describe “cookie theft” picture (Broca’s aphasic)
Cookie … Okay … the cookie jar … and the kid is a … uh … stool … bump … the skool … skool … uh … hurt … and girl … I don’t know …
Goodglass 139

12. Agrammatism in Broca’s aphasia
Examiner: Can you tell me about why you came back to the hospital?
Patient: Yes … eh … Monday … eh … dad … Peter Hogan and dad .. hospital. Er … two … er … doctors … and … er … thirty minutes … and … er … yes … hospital. And .. Er … Wednesday … Wednesday. Nine o’clock. And … er … Thursday, ten o’clock … doctors … two … two … doctors… and … er… teeth … fine.
E: Not exactly your teeth … your g-
P: Gum … gum …
E: What did they do to them?
P: And er … doctor and girl … and er .. And er gum …
(Goodglass 105)

13. Some speech of a Wernicke aphasic
Examiner’s question: Who lives at home with you?
Patient: My wife, she goes her work to work on it but her heffle is all about it.
On testing for comprehension of single words, patient can point to only one of six objects that are named for him. His attempts to write result in a jargon similar to his speech.
Goodglass 2

14. Another Wernicke aphasic
Attempt to describe a picture showing a young woman standing with books in her arms, portrayed in a farm scene with family members engaged in farm labor:
“Well, all I know is, somebody is clipping the kreples and some wha, someone here on the kureping arm … why I don’t know.”

15. Examples of anomia
I gave him a … Oh God! I know it! Why can’t I say it?
I lost my … I keep my money in it.

16. Some speech of a conduction aphasic
Patient: I came into the hospital for some tecs ... Some secs … tesk … T E S … tests.
Goodglass 73

17. Paraphasia Verbal paraphasia
Use of one word instead of the intended one
Usually, same part of speech
Phonemic paraphasia
Unintended phonemes or sequences of phonemes
“paker” for “paper”, “sisperos” for “rhinoceros”
Neologistic paraphasia
“tilto” for “table”
See, my refkid is … are bad. Oh, my cathopes noe too good. Well, my gupa wasn’t too good. (85)

18. Examples from a picture-naming test
Patient Target Word Response
Mr. W. stethoscope telescope – not right
(Broca) asparagus carrot – no
pinwheel kite
nozzle hose – no
Father L. seahorse mandarin
(Wernicke) globe atlas
stethoscope octopus – no*
hourglass it’s a weather
*A picture of an octopus had been presented earlier in the test
(Goodglass 78)

19. Phonemic paraphasia in a conduction aphasic
Target Word (picture) Response__________
Dart cart … part … chart
Broom broo … croo … broom
Scroll scrip… screl … scrit … roll it up … sholl … scroll
Bench fence … park bence … bench
Pinwheel pan .. P E A … peanwheel … pinwill … penwhale … pinfin … no pinwheel
(Goodglass 88)

20. Perisylvian Aphasic Syndromes

21. The most common perisylvian aphasias in order of frequency of occurrence
Broca Aphasia
Wernicke Aphasia
Conduction Aphasia

22. Characteristics of Broca Aphasia
Non-fluent speech
Sparse verbal output
Poorly articulated
Consists of short phrases
Produced with effort
Mostly nouns and other content words
Deficiency or absence of inflectional affixes
Absent or deficient syntactic structure

23. Word classes in Broca aphasia
Mostly nouns
Some adjectives
A few verbs
Generally uninflected or in ‘-ing’ form
Function words few or non-existent

24. Comprehension in Broca aphasia
Generally good
More or less impaired for syntactically complex sentences
Difficulty in comprehending the same words that are omitted in speech production
Also, difficulty with repetition of these words
Difficulty understanding relational words
E.g. bigger/smaller, up/down, within/without

25. Verbal short-term memory deficit (in Broca aphasia)
Patients can readily point to individual objects or body parts named by the examiner
But when asked to point to the same items in a specific sequence they often fail at the level of only two or three items
Benson & Ardila 124
How to explain?

26. Subtypes of Broca aphasia
Type I
A.k.a. little Broca aphasia
Milder defects
Less extensive damage
Better prognosis
Type II
Symptoms worse
More extensive damage
These are not distinct, but variations
Two spans along a scale

27. Conduction Aphasia Originally postulated by Wernicke
Good comprehension
Poor repetition
Many phonemic paraphasias
Defective production
Different subtypes
Different areas of damage
5 to 10 percent of all aphasias

28. Pronunciation deficits – Phonetic vs. Phonemic
Correct phonemes but faulty articulation
Can occur with Broca’s aphasia
The problem is more phonetic than phonemic
Correct articulation but wrong phoneme(s)
i.e., phonemic paraphasia
B&A call it ‘literal paraphasia’
Common in conduction aphasia
The problem is phonemic, not phonetic
How to explain?

29. Areas of damage in conduction aphasia
Different areas for different subtypes
Arcuate fasciculus
Left parietal lobe
Goldstein: ‘central aphasia’
Probably the supramarginal gyrus (?)
Lower postcentral gyrus
Luria: ‘afferent motor aphasia’
Insula
More than one of these areas can be damaged in individual cases

30. Coronal section, showing Sylvian fissure, insula, etc.

31. Example of Broca’s Aphasia
2:25

32. end