Transcript PowerPoint Presentation - Overview of the brain

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.
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 …
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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?
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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)
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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
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Wernicke's aphasia on
YouTube
http://www.youtube.com/watch?v=BLD5jzXpLE
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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)
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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)
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Wernicke's aphasia on
YouTube
http://www.youtube.com/watch?v=aVhYN7N
TIKU
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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.”
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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)
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Reading
Reading can also be disrupted?
Why?
Because reading connects to speech for the
pronunciation of letters and the storage of words
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Aphasia checklist: Wernicke’s
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
m)
n)
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
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a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
m)
n)
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)
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The effect of WA on cerebral
function
LH
RH
Anterior
grammatical rules
function words
conversational rules?
motivation to speak?
Posterior
convergent word semantics
categorical phonology
divergent word semantics
coordinate phonology
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Broca's aphasia
 aka expressive aphasia
 aka anterior aphasia
 aka agramamtic aphasia
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Describe this picture (silently!)
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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
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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.
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Broca's aphasia on YouTube
Broca's aphasia (1)
Broca's aphasia (2)
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Background: word classes
Content words
 noun
 verb
 adjective
 adverb
Function words
 article
 demonstrative
 conjunction
coordinating
subordinating
 pronoun
 preposition
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Background: morphology
Inflectional
noun
plural
verb
present and past tenses
present and past participles
adjective
comparative, superlative
Derivational
un-, -ify, etc., etc
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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”.
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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
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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 __.
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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.
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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
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Broca's aphasia checklist
a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
m)
n)
o)
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
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a)
b)
c)
d)
e)
f)
g)
h)
i)
j)
k)
l)
m)
n)
o)
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
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