APHASIA

“Aphasia is an acquired language disorder resulting from damage to

brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

Image: Diagnostics CDS 520

Broca’s: Nonfluent, YES comprehension, NO repeating

Phonemic paraphasias
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global
Transcortical Motor: Nonfluent, YES comprehension, YES repeating
Mixed Transcortical: Nonfluent, NO comprehension, YES repeating
Global: Nonfluent, NO comprehension, NO repeating

Wernicke’s: Fluent (paraphasic), NO comprehension, NO repeating

Transcortical sensory: Fluent, NO comprehension, YES repeating
Semantic paraphasias
Conduction: Fluent, YES comprehension, NO repeating
Anomic: Fluent (pauses), YES comprehension, YES repeating (word
finding)

CLASSIFICATION OF MULTIDIMENSIONAL TYPES OF APHASIA: FLUENT (CHAPEY, 2008)

(Provided by Mayne shhhhhh)

Wernicke’s Aphasia

•Impaired auditory and reading comprehension

•Fluently articulated but paraphasic speech-sound transpositions, word substitutions,
neologism (new words)
•Logorrhea (excessive speech)
•Difficulty with reading, writing, repeating words
•“Receptive aphasia”
•Lack of awareness of deficits
•Temporal lobe a classic form of “posterior” aphasia

Conduction Aphasia

•Fluent less excessive than Wernicke’s

•Impaired repetition of words and sentences
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global
•Paraphasia-phonemic, linguistic

Transcortical Aphasia

•Fluent
•Global paraphasia
•Intact repetitive ability
•Poor auditory comprehension is poor
•Impaired confrontational naming – irrelevant response or echolalia

Broca’s Aphasia

•Non-fluent
•Apraxia of speech
•Restricted vocabulary
•Agrammatism
•Aware of deficits-prone to depression
•Frontal lobe-“anterior” aphasia

Transcortical Motor Aphasia

•Repetition is intact, limited speech, difficulty with writing

•Phonemic and global paraphasia, syntactic errors, perseveration, difficulty initiating and
organizing responses in conversation
•Frontal lobe – anterior superior
•Confrontation naming is preserved but auditory comprehension is impacted
Global Aphasia

•Severely impaired linguistic comprehension and expression

•Wernike’s/Broca combination
•Produce few utterances-highly restricted lexicon
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global
Anomic Aphasia

•Significant word-finding issues

•Grammar is generally intact
•Fluent speech except for word finding hesitancies

Primary Progressive Aphasia

•Insidious onset of language deficits

•Cognitive skills are intact
•Degenerative-leads to dementia

Alexia and Agraphia

•Alexia - deficits in reading ability

•Agraphia – deficits in writing ability

Exceptions: TBI, right or bilateral cerebral dominance for language function, subcortical lesions,
degenerative diseases, multiple or unknown sights of lesions

*Bold = hallmark feature/”only” deficit

*Transcorticals “light” because you can repeat.

•Estabrooks et al suggest an additional nonfluent aphasia type:

Mixed Nonfluent Aphasia
•“somewhere between global aphasia and Broca’s aphasia” pg. 40
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global
•Severe anomia
•Relatively poor auditory comprehension
•Poor repetition of words/phrases
•Possible stereotypic verbal utterances; sometimes sparse meaningful
speech
Helms-Eastbrooks CDS 540

Lesion Site:
Brocas: Left inferior frontal, subcortical white matter
Transcortical motor: Left medial frontal or anterior border zone. “Anterior and
superior to Brocas” -Helms
Mixed transcortical:
Global: Major occlusion of the MCA; frontotemperoparietal gyrus. “Deep into the
subjacent white matter” -Helms

Wernicke’s: Posterior third of the superior temporal gyrus

Transcortical sensory: Left medial parietal or posterior border zone. “Posterior
parietotemporal sparing Wernicke’s” -Helms
Conduction: Left superior temporal and supramarginal gyrus
Anomic: Left temporal, left angular gyrus
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

Image: Neuro CDS 530

 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

Image: Diagnostics CDS 520

 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

Paraphasias
CSU, Chico, Patrick McCaffrey, Ph.D.;
http://www.csuchico.edu/~pmccaffrey//syllabi/SPPA336/336unit5.htm
l

•"Paraphasia refers to the production of unintended syllables, words,

or phrases during the effort to speak" (Goodglass & Kaplan, 1983, p. 8).
Patients with fluent forms of aphasia exhibit many more paraphasias
than do those with nonfluent types. There are three types of
paraphasias, literal/phonological, neologistic, and semantic/verbal.
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global
•Literal/phonological paraphasia - More than half of the intended word
is produced correctly. For example, a patient may say /pun/ instead of
/spun/. In addition, transpositions of sounds can occur, e.g "tevilision"
for television. (Brookshire, 1997).

•Neologistic paraphasias - Less than half of the intended word is

produced correctly. In some cases the entire word is produced
incorrectly. Neologisms are also common in the speech of
schizophrenics.

•Verbal paraphasias are those in which another word is substituted for

the target word. (The substitution must be a real word. If it is not, the
paraphasia is classified as neologistic.)

•There are two types of verbal paraphasias: within category called

semantic paraphasias and remote paraphasias.
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global
Semantic paraphasia: Within category errors involve the
substitution of a word that is closely related to the target word, as in
cat/dog.
Remote errors involve the substitutions of a word that is only
distantly related to the target word, as in sink/dog. Remote paraphasias
are, of course, indicative of more severe language problems than are
within category substitutions.

•Be careful not to confuse literal interpretations on the part of the

patients with paraphasias. If the patient calls a pencil a "yellow stick",
this does not qualify as a paraphasia. It may mean that the patient has
anomia or even agnosia (inability to process sensory information i.e.
inability to recognize sounds, shapes, objects, people, etc) . Also, the
distorted speech of patients with articulation disorders like dysarthria
should not be mistaken for neologistic paraphasias.
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global
•Paraphasias occur in the speech of patients with Broca's aphasia,
Wernicke's aphasia, and apraxia. (Apraxics usually produce literal
(phonological) paraphasias.) Wernicke's aphasics have more
paraphasias than Broca's or apraxics.

•The Executive function is a component of cognition. According to

Denckla, 1996, it regulates and directs the cognitive process. Injury to
the pre-frontal cortex disrupts the regulation and initiation of behavior,
including language, vocational behavior, learning/studying behavior,
and social behavior, According to Wehmeyer and Schwartz, 1997 (in
Chapey, 2001) executive functions are similar to the functions involved
in self-determination. Cognitive rehabilitation must include aspects of
executive function.
CDS 520 PPT Week 9 Motor Speech Disorders
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

Image: CDS 510

 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

Image: CDS 510

 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

Image: CDS 510

 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

CDS 540
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

CDS 540
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

CDS 540
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

• Arcuate Fasciculus - A white matter tract that connects Broca’s Area

and Wernicke’s Area through the Temporal, Parietal and Frontal
Lobes. Allows for coordinated, comprehensible speech. Damage may
result in:
Conduction Aphasia - Where auditory comprehension and speech
articulation are preserved, but people find it difficult to repeat heard
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global
speech.

CDS 540 Extended Study of Cerebellar Functions

PRIMARY AND SECONDARY LOBE FUNCTIONS:

Frontal lobe
Primary functions

Control of voluntary movement at primary

motor cortex

Secondary functions (higher cortical function)

Critical role in language Supplementary motor

cortex-initiation of motor activity; Frontal

premotor cortex – coordinate sensory stimuli

with plans for action for executive functions

Executive Functions: prefrontal areas:

Abstract thinking, problem solving, judgment

Also: working memory, emotionality

 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

Parietal lobe
Primary functions

Perception, elaboration of sensation-at

primary sensory cortex

Secondary functions (higher cortical function)

Association cortex Analysis, elaboration and

synthesis of perceptions and sensations

Body image

Position in space

Appreciation of spatial concepts

Temporal lobe
Primary functions

Hearing
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global
Analysis of auditory signals

Secondary functions (higher cortical function)

Auditory association area (Wernicke’s)

Analysis of auditory stimuli for comprehension

Hippocampal areas – supports formation of

new memories, storage of memory

Occipital lobe
Primary functions
Vision received at primary visual cortex
Secondary functions
(higher cortical function)

Visual association cortex – supports reading, analysis of visual

information
Also important: LIMBIC SYSTEM
Memories, feelings, desire to produce language, emotional color of
thought

CDS 540 See Week 1 or 2 Powerpoint

 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

CDS 540
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

CDS 540

Bilingual/Multilingual Aphasia

(60% of people)

(18% of people)
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global

(7% of people)

(5% of people)

(9% of people)
Urgesi and Fabbro (2009)

Factors affecting recovery patterns:

Premorbid proficiency
Age and method of L2 acquisition
 APHASIA
“Aphasia is an acquired language disorder resulting from damage to
brain areas that subserve the formulation and understanding of
language and its components” -Helm-Eastbrooks
Aphasia is an acquired neurogenic disorder resulting from damage to
the brain that affects language expression and/or comprehension. –My
words
Fluent: Wernicke’s, Transcortical Sensory, Conduction, Anomic
Non-fluent: Broca’s, Transcortical Motor, Mixed Transcortical,
Global
Emotional link to languages/motivation
Language of the environment/use
Right hemisphere involvement
Similarity of languages
Cognitive control system
(Ansaldo et al. (2008)