Language and

Language
Assessment
Denise Carballea, Psy.D
 Table of contents

01 03
02 04
Hemispheres Assessments
Aphasias Considerations
Dominant Hemispheres
The hemisphere that controls language is referred to as the Dominant Hemisphere

The left hemisphere controls language in the vast majority of people– (but not all)

Anterior dominant cortex controls expressive language (including– writing)

Posterior dominant cortex controls receptive language (including– reading)

The right hemisphere plays a significant role in prosodic aspects of Language

Expressive prosody is controlled by the nondominant anterior cortex

Receptive Prosody is controlled by the nondominant posterior cortex

Language deficits are most commonly produced by focal lesions, but more diffuse lesions can
product subtle language deficits in high level Language skills such as organization and discourse
Dominant Hemispheres

● Left Hemisphere is dominant for language in over 95% of right-handers,

and in over 60-70% of left-handers.

● Lesions of the left hemisphere language areas usually cause language

dysfunction.

○ Interestingly, left-handed individuals have significant bilateral

representation of language, especially if family hx is significant
for ambidexterity

■ Meaning after left hemisphere lesion, they tend to recover

language more quickly than right-handed individuals.
 Dominant Hemispheres

Left Hemisphere Right Hemisphere

Language Prosody (emotion conveyed by tone of voice)

Skilled motor formation (praxis) Visual-spatial analysis and spatial attention

Arithmetic: sequential and analytical calculating Arithmetic ability to correctly line up column of numbers on a
skills the page

Musical ability: sequential and analytical skills in Musical ability: in untrained musicians, and for complex
trained musicians musical pieces in trained musicians

Sense of direction: following a set of written Sense of direction: finding one’s way by overall sense of
directions in sequence spatial orientation
 Prominent Disorders
● Aphasias: are prominent disorders of verbal functions
○ Types:
i. Fluent or nonfluent
ii. language comprehension
iii. repetition
○ Trouble with speaking, understanding speech, or reading or writing.
○ Difficulties appear to be clearly unrelated to hearing loss, attention or concentration defects, foreign
language, or thought disorder associated with a psychiatric condition.
i. May also show signs of right-sided weakness or complaining of sensory changes on the right
half of the body.
○ This condition is almost always a symptom of another problem due to neurological injury or disease
(i.e.,stroke, traumatic brain injury). It can also happen as a temporary effect of conditions like migraines.
○ Aphasia is often treatable, especially when the underlying condition is treatable or can heal on its own.
○ The location of the damage in your brain determines the type of aphasia you have.
 Broca’s Aphasia

left posterior frontal cortex

Brodmann area 44 and 45

**Expressive language difficulties

(speech and writing)**
● http://www.youtube.com/watch?v=1aplTvEQ6ew

● http://www.youtube.com/watch?v=f2IiMEbMnPM
 Wernicke’s
Aphasia

left posterior temporal–parietal area

Brodmann area 22

**Receptive language difficulties (comprehension)** http://www.youtube.com/watch?v=aVhYN7NTIKU&feature=youtube_gdata

 Conduction Aphasia

Mild and rare form of aphasia that causes difficulties with

Comprehension and production intact.
Example: if asked to say the word “refrigerator,” the patient
might say “Frigilator… no, frerigilator,” until they can say
the word correctly.
repeating words or phrases. It occurs due to a disconnect in
the language processing and language producing areas of
the brain.
Caused by damage to the fibres connecting the Broca’s and
the Wernicke’s area. (Lesions to the left supramarginal
gyrus, insula, or the underlying white matter).
 Global Aphasia

Example: may only say a few words, such as “no” or

A profound impairment of all modalities of receptive
“hey” or “what”, or they may speak in “stereotypies”.
and expressive language.
Stereotypies are words or phrases that are said over and
over with different intonation. Examples may be “ding da
Caused by a large lesion throughout the left-hemisphere
ding”, “I love you” or “something wonderful”.
brain lesion encompassing both Broca's and Wernicke's
areas, and may extend deep into the white matter
beneath the cortex, usually as a result of a totally
occluded middle cerebral artery
 Other Language Disorders
Alexia Agraphia
acquired disorder resulting loss or impairment in
in the inability to read or ability to write letters,
comprehend written symbols, words, or
language sentences, resulting from
damage to various parts of
the brain.
Dyslexia
a learning disorder that
involves difficulty reading
due to problems
identifying speech sounds
and learning how they
relate to letters and words
 Examination of Language Behavior
● Spontaneous speech.

● Repetition of words, phrases, sentences. “Methodist Episcopal”

and similar tongue-twisters elicit disorders of articulation and
sound sequencing.
Example: “No ifs, ands, or buts” tests for the integrity of
connections between the center for expressive speech
(Broca’s area) and the receptive speech center (Wernicke’s area).

● Speech comprehension:

a. Give the subject simple commands

(e.g., “Show me your chin.” “Put your left hand on your right ear.”).
b. Ask “yes-no” questions (e.g., “Is a ball square?”).
c. Ask the subject to point to specific objects
 Examination of Language Behavior
● Naming:

The examiner points to various objects and their parts asking, “What is this?” (e.g., glasses, frame,
nose piece, lens; thus asking for object names in the general order of their frequency of occurrence in
normal conversation). Ease and accuracy of naming in other categories, such as colors, letters,
numbers, and actions.

● Reading:

To examine for accuracy, have the subject read aloud.

For comprehension, have the subject follow written directions (e.g.,
Example: “Tap three times on the table”), explain a passage just read.

● Writing:

Have the subject copy a printed sentence, write to

dictation, and compose a sentence or two
 Language Assessments
The patient’s performance on tests involving verbal functions should help the examiner determine
whether a more thorough study of the patient’s language functions is indicated.

= =
● ● Wechsler Test of Adult Reading WTAR
Boston Diagnostic Aphasia Exam
● ● The Wide Range Achievement Test WRAT-4
Token Test
● ● ACS Test of Premorbid Functioning (TOPF)
Boston Naming Test
● ● Woodcock Johnson Test of Achievement
Controlled oral word association test
(COWAT) (FAS)
Considerations
 Quiz
● The patient’s speech is fluent but unintelligible. Words are paraphasias or
neologisms
○ (e.g., “whifel da pora at da sefa be fod the no…”).
●
●
●
Prosody and intonation intact.
Repetition is impaired.
Comprehension is impaired.
Wernicke’s
●
●
●
Patient is unable to follow basic commands.
Reading is impaired.
Writing is impaired, consisting of well-formed letter(s) and paraphasias
aphasia
.

and/or neologisms that does not make sense.

● Few if any real words. Naming is impaired.
 Quiz
● The patient is unable to speak, or speech is labored with a few words
(telegraphic) that are typically nouns.
● Prosody and intonation impaired (dysprosody).
● Repetition is disrupted.
●
●
Comprehension is grossly intact.
The patient is able to follow basic commands and understand simple
sentences, but some difficulty with grammatically complex sentences.
Broca’s
●
●
Writing impaired with poorly formed letters and few if any words.
The patient can comprehend simple words as indicated by motor or
gestural responses and reading comprehension is often intact for simple
aphasia .

commands.
● Patients may also be able to sing well-known songs.
Questions?