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Ling 411 – 04. Aphasia: Symptoms and Syndromes. Simple Functions / Complex Functions.

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Aphasia symptoms and syndromes

Ling 411 – 04

Aphasia:Symptoms and Syndromes


Simple functions complex functions
Simple Functions / Complex Functions

A question came to me in class when you mentioned that localization does not work for complex functions (e.g. rats navigating mazes), because the brain can compensate with other brain areas. It seems to me that "understanding speech“, localized in Wernicke's area, is actually a pretty complex process...how is simplicity/complexity determined?

This is a general question, but I'm interested in the implications of this question to also the Broca's area and any other

relevant areas. Either a general explanation or a point in the right direction to what sort of researchers work I want to look at would be greatly appreciated.

Thanks!

Halle


Simple functions complex functions1
Simple Functions / Complex Functions

Complex function

Simple function


Phonological production speaking
Phonological Production / Speaking

  • Speaking is a complex process

    • Therefore, involves multiple areas

  • Phonological production is a simple process

    • Broca’s area

      • together with parts of primary motor area and subcortical areas

  • Other processes in speaking

    • (other than phonological production)


Phonological recognition understanding
Phonological Recognition / Understanding

  • Understanding speech is a complex process

    • Therefore, involves multiple areas

  • Phonological recognition is a simple process

    • Wernicke’s area

      • together with primary auditory area and subcortical areas

  • Other processes in understanding

    • (other than phonological recognition)


Doubts about wernicke s area
Doubts about Wernicke’s Area

Steven Pinker:

Wernicke’s area …was once thought to underlie language comprehension. But that would not explain why the speech of these patients sounds so psychotic.

The Language Instinct (1994)

Friedemann Pulvermüller:

…patients with Wernicke’s aphasia have difficulty speaking…. These deficits are typical…and cannot be easily explained by assuming a selective lesion to a center devoted to language comprehension.

The Neuroscience of Language (2002)


Erratic speech in wernicke s aphasia
Erratic Speech in Wernicke’s Aphasia

“I feel very well. My hearing, writing been doing well. Things that I couldn’t hear from. In other words, I used to be able to work cigarettes. I didn’t know how…. Chesterfeela, for 20 years I can write it.”

From Harold Goodglass

Understanding Aphasia (1993)


Lessons from carl wernicke
Lessons from Carl Wernicke

Carl Wernicke:

Primary functions alone can be referred to specific areas…. All processes which exceed these primary functions…are dependent on the fiber bundles, that is, association.

Aphasia Symptom Complex (1874)

Any higher psychic processes exceeding these primary assumptions cannot be localized but rest on the mutual interaction of these fundamental psychic elements which mediate their manifold relations by means of the association fibers.

Recent Works on Aphasia (1885-86)


Wernicke and connectionism
Wernicke and Connectionism

Kandel, Schwarz, and Jessel:

“…Wernicke proposed (1876) that only the most basic mental functions, those concerned with simple perceptual and motor activities, are localized to single areas of the cortex, and that more complex intellectual functions result from interconnections between several functional sites. In placing the principle of localized function within a connectionist framework, Wernicke appreciated that different components of a single behavior are processed in different regions of the brain. He thus advanced the first evidence for the idea of distributed processing, which is now central to our understanding of brain function.”

Essentials of Neural Science and Behavior (1995:13)


Basic functions and complex functions
Basic functions and complex functions

  • Phonological recognition is a basic function

  • It is 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


Wernicke s area and speaking
Wernicke’s Area and Speaking

  • Phonological images guide speech production

  • Phonological recognition monitors production

  • Compare..

    • Painting without visual perception

    • Playing a piano without auditory perception

  • Conclusion: Of course phonological recognition (i.e. Wernicke’s area) plays a role in speech production


Pulverm ller s statement
Pulvermüller’s Statement

…patients with Wernicke’s aphasia have difficulty speaking…. These deficits are typical…and cannot be easily explained by assuming a selective lesion to a center devoted to language comprehension.

The Neuroscience of Language (2002)


Paraphrasing pulverm ller
Paraphrasing Pulvermüller

…patients with Wernicke’s aphasia have difficulty speaking…. These deficits are typical…and cannot be easily explained by assuming a selective lesion to a center devoted to language comprehension.

The Neuroscience of Language (2002)

Altered quote:

…patients with damage to the occipital lobe have difficulty drawing pictures…. These deficits are typical…and cannot be easily explained by assuming a selective lesion to a center devoted to visual perception.


Aphasic symptoms

Aphasic Symptoms

Varieties of language deficits

Inferences from language deficits

Problems of interpretation


Some speech of a broca aphasic
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.)


Speech production a complex process
Speech production: a complex process

  • 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)


More from a different broca s apasic
More, from a (different) Broca’s apasic

  • "Me ... build-ing ... chairs, no, no cab-in-ets. One, saw ... then, cutting wood ... working ..."


Attempt to describe cookie theft picture broca s aphasic
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


Agrammatism in broca s aphasia
Agrammatism in Broca’s aphasia aphasic)

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)


Some speech of a wernicke aphasic
Some speech of a Wernicke aphasic 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


Another wernicke aphasic
Another Wernicke aphasic 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.”


Examples of anomia
Examples of anomia aphasic)

I gave him a … Oh God! I know it! Why can’t I say it?

I lost my … I keep my money in it.


Some speech of a conduction aphasic
Some speech of a conduction aphasic aphasic)

Patient: I came into the hospital for some tecs ... Some secs … tesk … T E S … tests.

Goodglass 73


Paraphasia
Paraphasia aphasic)

  • 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)


Examples from a picture naming test
Examples from a picture-naming test aphasic)

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)


Phonemic paraphasia in a conduction aphasic
Phonemic paraphasia in aphasic)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)



The most common perisylvian aphasias in order of frequency of occurrence
The most common perisylvian aphasias aphasic)in order of frequency of occurrence

  • Broca Aphasia

  • Wernicke Aphasia

  • Conduction Aphasia


Characteristics of broca aphasia
Characteristics of Broca Aphasia aphasic)

  • 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


Word classes in broca aphasia
Word classes in Broca aphasia aphasic)

  • Mostly nouns

  • Some adjectives

  • A few verbs

    • Generally uninflected or in ‘-ing’ form

  • Function words few or non-existent


Comprehension in broca aphasia
Comprehension in Broca aphasia aphasic)

  • 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


Verbal short term memory deficit in broca aphasia
Verbal short-term memory deficit aphasic)(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?


Subtypes of broca aphasia
Subtypes of Broca aphasia aphasic)

  • 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


Conduction aphasia
Conduction Aphasia aphasic)

  • Originally postulated by Wernicke

  • Good comprehension

  • Poor repetition

    • Many phonemic paraphasias

  • Defective production

    • Many phonemic paraphasias

  • Different subtypes

    • Different areas of damage

  • 5 to 10 percent of all aphasias


Pronunciation deficits
Pronunciation deficits aphasic)

  • Broca’s aphasia

    • Correct phonemes, faulty articulation

    • The problem is more phonetic than phonemic

  • Conduction aphasia

    • Correct articulatory realization of phonemes

    • But incorrect phonemes

    • The problem is phonemic, not phonetic

      • I.e., phonemic paraphasia

      • (B&A call it ‘literal paraphasia’)

How to explain?


Areas of damage in conduction aphasia
Areas of damage in conduction aphasia aphasic)

  • 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



end aphasic)


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