Language I
Language: Key Brain Regions
Brocas area
Wernickes area
Two key brainsyndromes resultlanguage: different areas involved in from damage to the two key areas: 1. 2. Brocas aphasia - damage to Brocas area area language production Wernickes aphasia - damage to Wernickes area area language comprehension
Broca's Aphasia: Typical Features
In short fragments, with many pauses
Slowed, effortful Poorly articulated
Also called: Expressive Aphasia or Non-fluent Aphasia
Patient JHM: Um the woman ah daydroom daybroon ah she um... not um u- understood um water water um dripping o- on- the floor and um u- un- she doesnt notice drooning um the children ah, wo-... little boy girl um s- st- stealing ah cookies ..
Cookie Theft (Boston Diagnostic Aphasia Examination)
Broca's Aphasia: Typical Features
Speech sometimes telegraphic:
Jim Hurdle: "Ah... Monday... ah Dad and Jim Hurdle... and Dad... hospital. Two... ah... doctors... and ah... thirty minutes... and yes... ah... hospital. And er Wednesday... nine o'clock. And er Thursday, ten o'clock... doctors. Two doctors... and ah... teeth."
Comprehension relatively ok: Jim Hurdle: When the doctor discussed what a relief the weather was compared with the cold, hard winter that they had been experiencing, Jim pulled his sweater tightly around himself and imitated a shiver.
Wernickes Aphasia: Typical Features
Speech fluent, well articulated; function words present BUT speech may be empty or nonsensical
Also called: Receptive Aphasia or Fluent Aphasia
Patient LR: Its got the pig here. Why, what do you want? [Ex: Just everything you can see] its uh everythings fine I I can see whats going can be out there mmm, well its there, there being out out begging the gars shes there oh yea shes wonnawot head round on the floor it s a ba- , bess, bu-, basin? [Ex gestures to the girl] I m not sh- sleet-, chlorine, cronckers , oh god [Ex gestures to the stool] yea I show, showed you the right part, falling over
Cookie Theft (Boston Diagnostic Aphasia Examination)
Wernicke's Aphasia: Typical Features
Different individuals make different kinds of errors:
Phonemic paraphasias e.g expressions -> eksprehsez a) Patient CB (Buckingham, Neologisms e.g. kaynit 1981)
You mean like this boy? I mean noy , and this, uh, neoy . This is a kaynit , kahken . I dont say it, Im not getting anything from it. Im getting, Im dime from it, but Im getting from it. These were eksprehsez , ahgrashenz and with the type of mahkanic is standing like thisand then theI dont know what she goin other than. And this is deli this one is the one and this one and this one and I dont know.
Semantic paraphasias e.g. children -> boys b) Patient AM (Goodglass & Kaplan, 1983).
Other her work out ohere Well this ismother is away here workingword substitutions to get her better, but when shes looking, the two boys looking in the other part. On their small tile into her time here. Shes working another time because shes getting, too. So the two boys work together an one is sneaking around here, making hiswork an his further funnas his time he had. He an the other fellow were running around the work here, while mother another time she was doing that without everything wrong here... Omission of content words, empty speech c) Patient HG (Hillis, 1998) Its what you do. Its about that that I see. I didnt know what that what its about. Im sorry. Its not here. Today what youre thinking maybe I can understand what you did. I can know what youre talking, but theres something.
Wernicke's Aphasia: Typical Features
Comprehension of speech: Impaired Can't follow conversations Can't obey commands ("Put the pencil on the card)
Impaired on simple yes-no questions:
Will a cork sink in water? Is a hammer good for cutting wood? Do two pounds of flour weigh more than one? Will water go through a good pair of rubber boots?
Classical Model of Language
Broca's area = production Wernicke's area = comprehension Info is transmitted between the two:
Connecting fibre tract = Arcuate Fasiculus Brocas area
Wernickes area
Support for Classical Model
Damage to connecting fibres and angular gyrus will affect word repetition
Conduction aphasia, a repetition disorder
Angular gyrus Brocas area
Wernickes area
The Boston Diagnostic Aphasia Examination
Based on classical aphasia subtypes Also categorises syndromes into broader classes: - fluent (e.g. Wernicke's, conduction) vs nonfluent (e.g. Brocas) Diagnosis depends on: 1. Characteristics of speech (conversation, Cookie Theft picture) Phrase length Articulatory agility Proportion function vs. content words Number of outright errors 2. Auditory comprehension (words, sentences, short stories) 3. Ability to repeat phrases (e.g. I got home from work)
Classification of the Aphasias
Fluent Fluency Nonfluent
Good
Poor
Comprehension
Good
Poor
ok
poor
ok
poor
Repetition
ok
poor
ok
poor
Anomia
Transcortical Sensory Conduction Wernickes Transcortical Motor
Brocas
Transcortical Mixed
Global
Boston Diagnostic Aphasia Examination
Intonation Phrase length
Brocas aphasia
Articulatory agility Grammatical form Outright errors Repetition Content/function wds Auditory compn.
Boston Diagnostic Aphasia Examination
Intonation Phrase length Articulatory agility Grammatical form Outright errors
Wernickes aphasia
Repetition
Content/function wds Auditory compn.
BUT:
Aphasia can result from damage outside these key areas
Actually, about 40% of aphasic patients unclassifiable on BDAE!
Conclusions so far
Classical model is broadly correct but hugely incomplete:
Based on nave model of language (auditory vs articulatory processing of words)
Many patients not classifiable Actually, vast regions of (usually left) cortex involved in language processing By decomposing language into its cognitive components, we can build a richer model of language organisation in the brain.
