Wernicke s broca s aphasia
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Wernicke’s & Broca's aphasia. Brain & Language LING 411/412/489 NSCI 411/611/489/689 Harry Howard Tulane University. Wernicke’s aphasia. aka posterior aphasia aka receptive aphasia. Introduction. Imagine your favorite doctor joke.

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Wernicke’s & Broca's aphasia

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Wernicke s broca s aphasia

Wernicke’s & Broca's aphasia

Brain & Language

LING 411/412/489

NSCI 411/611/489/689

Harry Howard

Tulane University


Wernicke s aphasia

Wernicke’s aphasia

aka posterior aphasia

aka receptive aphasia


Introduction

Introduction

  • Imagine your favorite doctor joke.

  • They usually begin with “a guy walks into a doctor’s office …”

  • Now imagine that the guy, or woman, is a patient with Wernicke’s aphasia …

Brain & Language, Harry Howard, Tulane University


Short samples of wernicke s aphasia

Short samples of Wernicke’s aphasia

  • Clinician: “Tell me where you live.”

  • Patient: “Well, it’s a meender place and it has two … two of them. For dreaming and pinding after supper. And up and down. Four of down and three of up …” (Brookshire 2003:155)

  • Clinician: “What’s the weather like today?”

  • Patient: “Fully under the jimjam and on the altigrabber.” (Brookshire 2003:155)

  • What is broken? What is preserved?

Brain & Language, Harry Howard, Tulane University


A long sample of wernicke s aphasia

A long sample of Wernicke’s aphasia

  • Patient is asked what brought him to the hospital.

  • “Is this some of the work that we work as we did before? … All right … From when wine [why] I’m here. What’s wrong with me because I … was myself until the taenz took something about the time between me and my regular time in that time and they took the time in that time here and that’s when the the time took around here and saw me around in it’s started with me no time and I bekan [began] work of nothing else that’s the way the doctor find me that way…” (Obler & Gjerlow 1999:43)

Brain & Language, Harry Howard, Tulane University


Phonemic paraphasia neologism

Phonemic paraphasia & neologism

  • Errors in the selection of phonemes include addition, omission, or change in position. For instance, Damasio (1992:535) cites

    • trable for table

    • pymarid for pyramid.

  • Clearly, the more such phonemic paraphasias accumulate in a word, the harder it is to understand it, to the extent that the intended word may become unidentifiable.

  • This is the point of neologism, illustrated in another of Damasio’s examples:

    • hipidomateous for hippopotamus.

  • Patients with severe Wernicke’s aphasia may produce strings of neologisms with a sprinkling of connecting words, known as jargon

Brain & Language, Harry Howard, Tulane University


Wernicke s aphasia on youtube

Wernicke's aphasia on YouTube

  • http://www.youtube.com/watch?v=B-LD5jzXpLE

Brain & Language, Harry Howard, Tulane University


Semantic paraphasia

Semantic paraphasia

  • A patient with damage to Wernicke’s region may also fail to select the proper words with which to convey her ideas, though this deficit can be compensated for by the usage of paraphrases.

  • Such semantic paraphasias (or empty speech) are often quite simple, such as relying on generic terms like thing or stuff to stand in for the more specific words that do not spring to mind.

  • Other times, they become quite elaborate.

    • Kandel (1995:640) cites the example of a Wernicke’s patient who was asked where he lived and answered:

    • “I came there before here and returned there.”

    • “A patient with moderate Wernicke’s aphasia was attempting to explain what he had done on a shopping trip the previous day. He concluded with,

    • ‘I went down to the thing to do the other one and she was only the last one that ever did it, so I never did.’” (Brookshire 2003:155)

Brain & Language, Harry Howard, Tulane University


Circumlocution

Circumlocution

  • Some Wernicke’s patients talk around missing words, a behavior called circumlocution.

  • A patient with moderate Wernicke’s aphasia was attempting to tell the examiner what she had had for breakfast that morning:

  • Patient: “This morning for – that meal – the first thing this morning – what I ate – I dined on – chickens, but little – and pig – pork – hen fruit and some bacon, I guess.” (Brookshire 2003:156)

Brain & Language, Harry Howard, Tulane University


Wernicke s aphasia on youtube1

Wernicke's aphasia on YouTube

  • http://www.youtube.com/watch?v=aVhYN7NTIKU

Brain & Language, Harry Howard, Tulane University


Logorrhea press of speech

Logorrhea, press of speech

  • The ease with which Wernicke’s patients produce speech, their circumlocution, and their deficient self-monitoring may contribute to their inclination to run on when they talk.

  • Such an overabundance of speech is referred to as logorrhea or press of speech.

  • Clinician: “Tell me what you do with a comb.”

Brain & Language, Harry Howard, Tulane University


Logorrhea press of speech1

Logorrhea, press of speech

Patient: “What do I do with a comb … what I do with a comb. Well a comb is a utensil or some such thing that can be used for arranging and rearranging the hair on the head both by men and by women. One could also make music with it by putting a piece of paper behind and blowing through it. Sometimes it could be used in art – in sculpture, for example, to make a series of lines in soft clay. It’s usually made of plastic and usually black, although it comes in other colors. It is carried in the pocket or until it’s needed, when it is taken out and used, then put back in the pocket. Is that what you had in mind?” (Brookshire 2003:155)

Brain & Language, Harry Howard, Tulane University


Reading

Reading

  • Reading can also be disrupted?

  • Why?

    • Because reading connects to speech for the pronunciation of letters and the storage of words

Brain & Language, Harry Howard, Tulane University


Aphasia checklist wernicke s

comprehension of spoken material

comprehension of written material

segmental phonology

word selection

word semantics

fluency (production of speech)

production of writing

use function words

grammaticality

repetition of what others say

conversational proficiency, e.g. turn taking

concern about impairment

concern about errors

short-term retention & recall of verbal materials

impaired, mild to severe

impaired

impaired: phonemic paraphasia, neologism, jargon

impaired: circumlocution

impaired: semantic paraphasia, empty speech

(overly) fluent: logorrhea

normal

normal

normal or mildly impaired: paragrammatism

impaired: (no evidence)

normal

little to none

little to none

impaired: (no evidence)

Aphasia checklist: Wernicke’s

Brain & Language, Harry Howard, Tulane University


The effect of wa on cerebral function

The effect of WA on cerebral function

Brain & Language, Harry Howard, Tulane University


Broca s aphasia

Broca's aphasia

  • aka expressive aphasia

  • aka anterior aphasia

  • aka agramamtic aphasia

Brain & Language, Harry Howard, Tulane University


Describe this picture silently

Describe this picture (silently!)

Brain & Language, Harry Howard, Tulane University


Broca s aphasia sample 1

Broca's aphasia sample #1

  • Examiner: Describe this picture.

  • Patient: kid … kk … can … cookie … caandy …well I don’t know but it’s writ … easy does it … slam … early … fall … men … many … no … girl. Dishes … soap … water … … water … falling pah that’s all … dish … that’s all. Cookies … can … candy … cookies cookies … he … down … That’s all. Girl … slipping water … water … and it hurts … much to do. Her … clean up. Dishes … up there … I think that’s doing it

  • Examiner: What is she doing with the dishes?

  • Patient: discharge no … I forgot … dirtying clothes [?] dish {?} water …

  • Examiner: What about it?

  • Patient: slippery water … [?] scolded … slipped

Brain & Language, Harry Howard, Tulane University


Broca s aphasia sample 2

Broca's aphasia sample #2

  • Examiner: Describe this picture.

  • Patient: uh … mother and dad … no … mother … dishes … uh … runnin[g] over … water … and floor … and they … uh … wipin[g] dis[h]es … and … uh … two kids … uh … stool … and cookie … cookie jar … uh … cabinet and stool … uh … tippin[g] over … and … uh … bad … and somebody … gonna get hurt.

Brain & Language, Harry Howard, Tulane University


Broca s aphasia on youtube

Broca's aphasia on YouTube

  • Broca's aphasia (1)

  • Broca's aphasia (2)

Brain & Language, Harry Howard, Tulane University


Background word classes

Content words

noun

verb

adjective

adverb

Function words

article

demonstrative

conjunction

coordinating

subordinating

pronoun

preposition

Background: word classes

Brain & Language, Harry Howard, Tulane University


Background morphology

Background: morphology

  • Inflectional

    • noun

      • plural

    • verb

      • present and past tenses

      • present and past participles

    • adjective

      • comparative, superlative

  • Derivational

    • un-, -ify, etc., etc

Brain & Language, Harry Howard, Tulane University


Breakdowns in grammar

Breakdowns in grammar

  • Breakdown in morphology

    • Patients express nouns in the singular and verbs in the infinitive or participle

  • Breakdown in modifying parts of speech

    • Patients often eliminate articles, adjectives, and adverbs altogether.

    • Instead of saying “I saw some large gray cats”, a patient with Broca’s aphasia might say “see gray cat”.

Brain & Language, Harry Howard, Tulane University


The overall result

The overall result

  • All this leads to a breakdown in syntax

    • For the sentence, “Ladies and gentlemen, you are now invited into the dining room”, a patient with Broca’s aphasia may only be able to say “Ladies, men, room.”

    • When asked his occupation, a mailman with Broca’s aphasia said “Mail … mail … m ….”

  • The examples are remarkable in that they appear to be constructed almost entirely by juxtaposition of isolated words.

  • They are practically devoid of the markers of grammatical relationships that bind together normal English – with the exception of and.

  • They also involve distortion of word order.

    • Damasio, 1992, p. 533, cites the attempt of a Broca’s aphasiac to express I will go home tomorrow coming out as Go I home tomorrow.

  • Altogether, this is called agrammatism or telegraphic speech

Brain & Language, Harry Howard, Tulane University


Reversible sentences

Reversible sentences

  • The (b) sentences of each pair are difficult for Broca's patients to understand compared to the (a) sentences:

  • 1a) The boy ate the apple.

  • 1b) The clown chased the violinist.

  • 2a) The cop shot the robber.

  • 2b) The robber was shot by the cop.

  • 3a) It was the cop who __ shot the robber.

  • 3b) It was the robber who the cop shot __.

Brain & Language, Harry Howard, Tulane University


Repetition of one s own speech

Repetition of one's own speech

  • The most famous case is that of Broca’s first patient, who could only say the (French) word "tan", which he repeated often, and so was known as "Tan".

  • Uncontrollable repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, usually caused by brain injury or other organic disorder.

  • This is know as perseveration.

Brain & Language, Harry Howard, Tulane University


Summary of main symptoms

Summary of main symptoms

  • Impaired production of speech

    • mild: non-fluent

    • severe: Broca’s Tan (perseveration)

  • Non-fluent speech:

    • effortful: slow, deliberate, halting, with pauses between words and even syllables, false starts

    • misarticulated: distorted consonants and vowels, called phonetic dissolution

  • Laconic speech:

    • short utterances with few function words (agrammatism or telegraphic speech)

  • Good short-term retention & recall of verbal materials

    • may generalize treatment skills & strategies to daily life

  • Great concern about their impairment and the errors they make

Brain & Language, Harry Howard, Tulane University


Broca s aphasia checklist

comprehension of spoken material

comprehension of written material

segmental phonology

word selection

word semantics

fluency (production of speech)

production of writing

use function words

grammaticality

repetition of what others say

conversational proficiency, e.g. turn taking

concern about impairment

concern about errors

short-term retention & recall of verbal materials

other

normal

normal

impaired: phonetic dissolution

normal

normal

impaired: mild to severe (perseveration)

impaired

impaired: agrammatism or telegraphic speech

impaired

impaired (no evidence)

normal

yes

yes

normal

--

Broca's aphasia checklist

Brain & Language, Harry Howard, Tulane University


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