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Aphasia

Presented by: Eitan Gordon

A Definition
Aphasia is a disruption of language associated
with brain damage. A comprehensive
explanation of aphasia is given in a book by M.N.
Hedge, he says, an impairment in understanding
and formulating complex, meaningful, and
ordered or sequenced elements of language
including words, phrases and sentences; a
difficultly in remembering words, saying the
correct words, or saying words in correct satanic
order; a difficulty in talking grammatically;
difficultly in reading and writing in conjunction
with the described oral language problems; and
difficulty understanding or expressing through
gestures (Hedge, 1995).

Causes

Aphasia is caused by brain damage


usually related to an injury; many times
aphasia is caused by Traumatic Brain
Injury (TBI). The most common type of
injury for people with aphasia is stroke
[i]n the distribution of the left middle
cerebral artery, which is the main blood
supplier of the perisylvian cortical areas
(Snyder et al., 1998).
Though many leading neurologists,
attempting to explain the pathology of
speech from these standpoints regarded
aphasia purely as a disturbance of
intellectual schemes or of abstract sets.
Abandoning all attempts to localizing
these disturbances in particular brain
zones, they limited themselves to the
highly controversial correlation of these
disturbances with the brain as a whole,
at best correlating a disturbance of
these higher forms of speech activity
with the mass of brain substance
damaged (Luria, 1973).

Causes, Continued

The main area of the brain that is the


cause of aphasia is damage to the
perisylvian language areas. These
areas include, Brocas area, which is
involved in the motor programming
of speech; Wernickes area, which is
critical for the auditory
comprehension of spoken words; and
the arcuate fasciclus, which links
these two areas and is thought to
play an important role in repetition.
Aphasia may also be caused by
lesions that do not directly damage
the perisylvian language areas but
isolate them from brain regions
involved in semantic processing and
the production of volitional speech.
The extraperisylvian aphasias are
referred to as transcortical aphasias
(Snyder et al., 1998).

Types of Aphasia
Because of the damage to these different areas there
are any different types of aphasia that are classified
into to two categories, both having to do with speech,
which are fluent aphasias and non-fluent aphasias:
Fluent aphasia are determined by patients who display
normal length phrases and sentences which are well
articulated and easily understandable, these are connected
with posterior lesions that spare anterior cortical regions
critical for motor control for speech;
Non-fluent aphasias are the opposite and are characterized
by sparse, hard to understand utterances or sentence usually
short in length, these are determined by anterior or prerolandic lesions that comprise motor and pre-motor cortical
regions involved in speech production.

Types of Aphasia,
continued
In addition to the effect to the fluency part
of aphasia there is also damage to the
auditory possessing. Damage to the anterior
region causes mild impairment in the
auditory comprehension, whereas posterior
lesions result in severe impairment to the
comprehension. When there is damage to
any of the areas mentioned above then also
there is likely to be distortion to repetition.
Also, people who have aphasia also
experience a naming impairment.

Types of Aphasia,
continued
Within each type of category of aphasia
there are a few different types or
subcategories: Fluent and Non-Fluent. There
are four types in the fluent aphasia category,
which include Anomic aphasia, Conduction
aphasia, Transcortical sensory aphasia,
Wernickes Aphasia.
Four types of non-fluent aphasias, which
include Transcortical Motor aphasia, Brocas
aphasia, Mixed Transcortical aphasia and
Global aphasia.

Types of Aphasia,
continued
Fluent Aphasia

Anomic aphasia has good auditory comprehension and repetition,


but is caused by lesions of the angular gyrus, it may be
associated with the Gerstmann syndrome and limb apraxia
(Snyder et al., 1998).
Conduction aphasia has good auditory comprehension but poor
repetition. This results from posterior perisylvian lesions affecting
primarily the supramarginal gyrus in the parietal lobe and the
underlying white matter (arcuate fascuculus) (Snyder et al.,
1998).
Transcortical sensory aphasia has impaired comprehension and
preserved repetition. This type of aphasia results form lesions in
the temporoparieto-occipital region, usually located posterior and
deep to Wernickes area.
Wernickes aphasia has both poor auditory and repetition. This
results from large posterior perisylvian lesions encompassing the
posterior superior temporal gyrus (Wernickes) and often extending
superiorly into the inferior parietal lobe (Snyder et al., 1998).

Types of Aphasia,
continued
Transcortical
Motor aphasia (TcMA)
has relatively good auditory
Non-Fluent
Aphasia
comprehension and reserved repetition. TcMA is caused by

lesion in the frontal lobe.


Brocas aphasia had good auditory comprehension and poor
repetition. This results from large lesions encompassing the
entire territory of the superior division of the middle cerebral
artery (Snyder et al., 1998).
Mixed Transcortical aphasia (MTcA) is also known as isolation
syndrome, has poor auditory comprehension and preserved
repetition. MTcA is seen in association with diffuse or
multifocal lesions that result in anatomic isolation of the
perisylvian language zone from surrounding cortical areas
(Snyder et al.)
Lastly, Global aphasia has both poor repetition and auditory
comprehension. This type results form lesions typically involve
the entire perisylvian language zone and are usually extensive.

Research
A Yale study- Does Intensive
Therapy help?

Does President Bush have brain


damage?

What can we do?


Children of all ages engage in play that
might cause a fall, riding a bike or
climbing a tree when children are
younger; if they are older, car accident
or rough play (sports injury of some
sort).
When injury report right away.
If speech problem, look at history on
injury, from school and parents.

What can we do?,


continued
Also for school psychologist using the
right type of assessment to analyze any
possible brain damage or impairment to
an area that results in aphasia:
Boston Diagnostic Aphasia Examination
(Goodglass and Kaplan, 1983)
Western Aphasia Battery (Kertez, 1982)
Aphasia Diagnostic Profiles (HelmEstabrooks, 1992).

What can we do?,


continued
An assessment that will test for impairment in
naming is the Boston Naming Test (Kaplan,
Goodglass and Weintraub, 1983).
Auditory comprehension is something that needs
to be tested for also an impairment, an
assessment that tests for this is the Token Test of
the Multilingual Aphasia Examination (Benton,
deHamster and Siven, 1994).
Reading and writing are also affected in aphasia
and the Psycholinguistic Assessment of Language
Processing in Aphasia (PALPA; Kay, Lesser and
Coultheart, 1992).

What can we do?,


continued
When someone is diagnosed with aphasia
there are assessment that help explain the
damage or impact of the aphasia diagnosis;
these assessment are the American
Speech-Language-Hearing Association
Functional Assessment of Commutation
skills for Adults (Frttalli, Thompson, Holland,
Wohl and Ferketic, 1995) and the
Communicative Abilities in Daily Living
(Holland, 1980; Holland,Fromm and Frattali,
in press).

Where to go with this


The next place aphasiac study
should go is to the school. I believe
a nation wide study of children who
have aphasia of aphasiac symptoms
should be investigated and looked
at to see how school officials of all
kinds could help future children with
any aphasia or aphasiac symptoms.

Work Citied
Furman, J. (1992). The Speech Thing. New
Republic, 207 (8/9).
Hedge, M.N. (1995). Introduction to Communicative
Disorders, Second Edition. Texas: Pro-Ed.
Luria, A.R. (1973). The Working Brain: An
Introduction to Neuropsychology. New York: Basic
Book.
Raloff, J. (1982). Aphasia: Therapy Helps, seldom
cures. Science News, 122 (24).
Snyder, P.J. & Nussbaum, P.D. (1998). Clinical
Neuropsychology: A Pocket Handbook for
Assessment. Washington D.C.: American
Psychological Association.