1. ADULT LANGUAGE DISORDERS
The inability to speak. A condition that is a result of trauma, stroke, an nero disorder.
Week 2
Jan 20, 2011

2. Objectives Aphasia: definition and its symptomatology
Differences between Aphasia and other neurogenic communication disorders such as Dysarthria and Apraxia of Speech
Explanations for Aphasic behaviors

3. An Example..
Not long ago, Prof. Martin was home practicing an important lecture when he suddenly stopped, stared at his wife Jackie, and dropped to the floor. An ambulance rushed him to the hospital. He did not recognize Jackie at first, was not quite sure where he was, and could not talk. She tried to get him to write, but he had to hold the pen with his left hand and just threw it at his feet. “I can’t ….talk” was all he could say. He looked frightened, and she was scared to death. The doctor told her that her husband probably had suffered a stroke. A couple days later she remembered the doctor also mentioned something called “aphasia”. She thought she knew what a stroke was, but she had never heard of aphasia before. (P.1; Davis, 2007)

4. What is Aphasia?

5. What is Aphasia?
Frederic Darley (1982) –fundamental diagnostic features of aphasia
Impairment, as a results of brain damage, of the capacity for interpretation and formulation of language symbols; multimodality loss or reduction in efficiency of the ability to decode and encode conventional meaningful linguistic elements (morphemes and larger syntactic units); disproportionate to impairment of other intellective functions; not attributable to dementia, confusion, sensory loss, or motor dysfunction; and manifested in reduced availability of vocabulary, reduced efficiency in application of syntactic rules, reduced auditory attention span, and impaired efficiency in input and output channel selection. (P. 42, Darley, 1982).
Reading, writing, sign langauge-apahasia mainly affects the language function, words and meaning.
Encoding – talking
Decoding - listening

6. Language Disorder 1. Multimodality deficit
Modalities of speaking, listening, reading and writing are all impaired, although not equally.
Aphasic people comprehend better than they talk or write, and reading-writing skills usually more impaired than auditory-speech skills (e.g., Duffy and Ulrich, 1976).
Listening is least impared….writing is most impaired.

7. Modality Specific Disorders
Agnosia- you can hear the sound but cannot recognize what the sound is.
Davis, A. (2007). Aphasiology, 2nd Edition. Pearson

8. Modality Specific Disorders
Agnosia: impairment in the ability to interpret incoming stimuli (aware of it but can’t assign meaning)
Dysarthrias: impairments of the ability to execute movement with the muscle used for speaking.
Muscle weakness, rigidity or uncontrollable movement
Speech may be slurred or slowed; patient may also have difficulty chewing and swallowing food.
Apraxia of speech (AOS), an impaired programming of movement for the purpose of speaking without neuromuscular deficit
Aphasia (words)(aphasia) -> AOS((phonelogcial encoding(sequencing of phonemes; that way your target word is the same as the intended word) -> Phonetic encoding(identifying different phonetic features for the sounds) -> Motor planning) (apraxia of speech) -> Execution(dysartria)

9. Language disorder
When Jackie first met SLP, she remarked that “Marty doesn’t talk but his mind is OK”.
Darley description- “disproportionate to impairment of other intellective functions”.
With aphasia many of the non-verbal skills may be preserved.
Low marks- linguistic tasks, high marks- nonverbal tasks such as drawing a flower or putting a puzzle together.

10. Propositional Use of Language
Jackie was amazed when the SLP got Martin to count to ten.
Counting came out much easier than any talking
Aphasic people tend to retain so-called subpropositional forms, which “come ‘readymade’ or preformulated for the speaker” (Eisenson, 1984).
E.g., counting to ten, singing a song, or producing routine greetings like “how are you?” or I’ am fine.
Aphasic errors are observed in the propositional use of language
A creative formulation of words with specific and appropriate regard to the situation (Eisenson, 1984).
Important distinction from Dysarthria
Automatic tasks are usually not impaired.

11. Other disorders
Brain damage can cause other patterns of difficulty and success.
Darley – language problems of aphasia are “not attributable to dementia, confusion…”
Robert Wertz (1985) wrote about the “language of confusion” in which discourse can be twisted by disorientation, inability to sustain attention, failures of recollection, and extreme impatience and irritation.
A patient may be said to be incoherent.
Distinguishing amnesia from aphasia may be help in diagnostic distinction
Dementia – Irreversible dementias are associated progressive deterioration over months or years.
Confusion - which discourse can be twisted by disorientation, inability to sustain attention, failures of recollection, and extreme impatience and irritation.

12. Other disorders
Dementias are somewhat similar to confusion because of their involvement of varied intellectual skills, but are associated with different causes
Confusion is associated with TBI
Irreversible dementias are associated progressive deterioration over months or years.
Patients with confusion or dementia tend to have substantially reduced performance on clinical tests beyond the tests for language.
Primary progress aphasia – degeneration of the language portions of the brain (frontal, temporal)

13. Other disorders
Besides language skills, visuospatial or musical skills can be uniquely impaired by stroke.
These functions contribute to artistic expression as well as orientation to everyday sights and sounds.
The general pattern of performance is the opposite of the pattern with aphasia, namely, deficits of nonverbal functions with verbal functions relatively spared.
E.g., they do not get the punch line of jokes, or they randomly stray from the point of conversation.

14. Aphasia Demographic information
1. caused by damage to areas of brain primarily responsible for language
2. important to note that it is an acquired disorder
3. etiology primarily being a CVA (stroke) of the LH
4. average age of clinical population with aphasia around years of age
5. onset of aphasia is usually sudden
Cerebrall vascular acident (CVA)

15. Aphasia Symptomatology
General descriptions
Acquired impairment of language processes
1. general language disorder underlying receptive and expressive modalities
2. reduces person’s ability to derive meaning from language that is read or heard
3. reduces ability to express ideas with language, especially in speaking, writing and gesture

16. Aphasia Symptomatology
General descriptions
Acquired impairment of language processes
4. reduces person’s ability to receive and send messages in conversations
5. disorder affects all communication modalities
6. disorder of symbolization
7. disturbance to central processor of verbal information
8. Multimodality disorder
a. comprehension deficits in listening and reading
b. expressive deficits in speaking and writing

17. Aphasia Symptomatology
General descriptions
Acquired impairment of language processes
9. degree of impairment often differs among modalities
a. expressive modalities are usually more impaired than receptive modalities
b. reading is usually more impaired than auditory comprehension
c. writing is usually more impaired than verbal output
10. Propositional and volitional use of language is impaired with nonpropositional and nonvolitional use of language preserved to a greater degree.

18. Aphasia Symptomatology
Spoken Language
A. Word finding (Anomia)
Problem of finding words
Linguistic units cannot be retrieved or are partially omitted
circumlocution: upon failure to retrieve a word, patient gives definition and/or descriptions
“I wear it right here, and I tell time with it. Mine goes tick, tick”
“clock” when thinking about a watch  word substitution errors

19. Aphasia Symptomatology
B. Paraphasias
1. Commission error in which incorrect word or sound is substituted for intended or target word
2. Produced unintentionally
3. Major types: Based on the linguistic relationship between target word and the error.

20. Paraphasias Type Target Error Phonemic Tiger Kiger Semantic Lion
Mixed semantic & phonemic
Telephone
Telegraph
Unrelated
flag
Neologistic
Floosis
Davis, A. (2007). Aphasiology, 2nd Edition. Pearson

21. Aphasia Symptomatology
Spoken Language
Sentence production
Right after stroke, Martin’s utterances were similar to nonfluent aphasia, in which patients produce fewer words than normal.
Bathroom ….. Shave
Sleeping…..get up….bathroom….fall down….um….wife….um….ambulance…
I was standing mirror…..shave…the…uh….fall on floor…..and I did, too…..I could not talk.

22. Aphasia Symptomatology
Spoken Language
D. Agrammatism
1. Inadequacies in sentence production
2. content words are produced but function words and bound morphemes are omitted
3. similar to telegraphic speech
4. utterances are described as nonfluent
5. same pattern may also be observed in reading aloud
6. agrammatic speakers may also have difficulty processing function words in comprehension

23. Aphasia Symptomatology
Spoken Language
Another style of sentence production
When you get into the car, close your door. Put your feet on those two things on the floor. So all I have to do is pull…I have to put my… You just put your thing which I know of which I cannot say right now, but I can make a picture of it…you put it in…on your…inside the thing the thing that turns the car on. You put your foot on the thing that makes the stuff come on. It’s called the , uh….

24. Aphasia Symptomatology
Spoken Language
Problem with selection of words.
When a word does not come to them, they often resort to vague wording or circumlocution.
E. Paragrammatism
1. occurs in primarily fluent form with complete sentences
2. mistakes are made in the use of grammatical elements
Postieror portion of the brain

25. Aphasia Symptomatology
Spoken Language
Jargon
Another type of fluent production, makes little sense.
1. lengthy, fluently articulated utterance making little or no sense to the listener
2. contains verbal paraphasias and neologisms and an excess of words
3. tendency to start talking before another speaker has relinquished his turn in conversation (press for speech)

26. Aphasia Symptomatology
Spoken Language
C. Jargon
4. Types
a. Neologistic jargon: high proportion of neologisms in patient’s speech
b. Semantic jargon: contains a higher proportion of semantic paraphasias
Semantic and neologistic jargon may represent different stages in recovery of language

27. Aphasia Symptomatology
Example of mainly semantic jargon with one neologism tossed in:
Oh sure, go ahead, any old think you want. If I could I would. Oh, I’m taking the word the wrong way to say, all of the barbers here whenever they stop you it’s going around around, if you know what I mean, that is tying and tying for repucer, repuceration, well, we were trying the best that we could while another time it was with the beds over there same thing…
paragramatacism

28. Aphasia Symptomatology
Traditional contrasting features of agrammatism (nonfluent) and jargon (fluent)
Utterance length
Content words
Grammatical morphemes
Initiation and flow
prosody
Agrammatism Jargon
Reduced normal or increased
On target paraphasic substitutions
Omissions or errors Occasional substitutions
Hesitant, slow smooth
Reduced seemingly normal

29. Aphasia Symptomatology
Recurring or stereotypic utterances
Some people with severe aphasia are unable say anything except some repeated involuntary and seemingly subpropositional utterances.
These occur at the onset and persist for months
E.g., dee, dee, dee
use of yes or no incorrectly

30. Aphasia Symptomatology
Behavioral Symptomatology: Written Language
A. Description
1. aphasic writing usually shows patterns which are similar to speaking impairment
2. usually called agraphia
3. because writing is usually more severely impaired than speech, examination of writing is valuable for detection of mild aphasia
Graphic word retrieval errors are called paragraphias
Written and spoken langauge parallel each other in features and abulities.

31. Aphasia Symptomatology
Reading
1. reading problems are referred to as alexia or acquired dyslexia
2. observed either during silent reading for comprehension or during reading aloud
3. in reading aloud, dyslexias are inferred from patient’s incorrect verbalizations (paralexias)

32. Aphasia Symptomatology
Auditory comprehension
1. mild problems are usually reflected in delayed responses or requests for repetitions
2. failure to follow instructions correctly
3. patient may comprehend words but not sentences or paragraphs
4. may be unable to process sentences containing particular units of speech such as function words
5. may have difficulty answering questions
6. very important measure when dealing with severity of aphasia

33. Neurological Explanation for Aphasia
Features and severity of neurogenic communication disorders depend on location and magnitude of the damage… (Brookshire, 1997)
Focal lesions, multifocal lesions, and diffuse lesions
Anterior regions – motor functions
Posterior regions – sensory function
Left H – language functions
Anterior lesions- nonfluent aphasia
Posterior lesions – fluent aphasia
Right H – nonverbal functions

34. Cognitive Explanation for Aphasia
Relationship between ideas and words

35. Cognitive Explanation for Aphasia
Two features of cognition
Knowledge (stable storage) – about the world and language we speak
Process – transient activity of mind, a response to stimulus
Memory is the key to carryout all cognitive functions

36. Memory Long-term memory (LTM) Different types of knowledge
Episodic memory
Semantic memory- common knowledge
Procedural memory
Lexical memory- words and knowledge about words

37. Memory Working memory (WM) – work space of any cognitive activity
Short-term memory is one component of WM

38. Aphasia Cognitive processing including language processing In aphasia
Constrained by the capacity of WM
Draws knowledge from LT storage
Operates at automatic and controlled levels
In aphasia
language storage system is relatively intact
Impairment of processing

39. Aphasia
Aphasia is a selective impairment of the cognitive system specialized for comprehending and formulating language, leaving other cognitive capacities relatively intact. (Davis, 2007, p.15)
Aphasia movie (INSIDE APHASIA – YOUTUBE)
Cognitive skills are not affected. One may have other problems that affect cognition but its not aphasia.