1. SPEECH BY JOSHUA BOWER (PEER SUPPORT 2014)

2. What hemisphere of the brain is involved in language? Left (for the majority)

3. Broca’s Primary auditory cortex Angular gyrus Wernicke’s Primary motor cortex Primary sensory cortex Primary visual cortex

4. Our focus for now… Broca’s Wernicke’s

5. What connects the two areas? Arcuate fasciculus

6. Speech pathway What would damage to the angular gyrus result in?

7. What does Broca’s area do? Motor control of language

8. What does Wernicke’s area do? Formulation of language

9. Define dysphasia Difficulty using language

10. A patient can understand everything which you are saying, but has difficulty responding. What form is dysphasia is this? Broca’s (aka expressive)

11. What is Wernicke’s dysphasia? Aka receptive dysphasia Patient can form fluent speech, but has difficulty understanding Articulation, rhythm and grammar are reasonable, but speech is largely meaningless

12. What form of aphasia would you have with damage to both Broca’s and Wernicke’s areas? Global aphasia - loss of speech production and comprehension

13. What is conduction aphasia? Lesion to the arcuate fasciculus Patient can comprehend and form fairly fluent speech, but will have difficulty repeating words said to them

14. Define dysprosodia Difficulty interpreting the emotional emphasis of language Can be sensory or motor

15. A patient has known damage to Wernicke’s area. What form of dysprosodia would they have? Sensory/receptive dysprosodia - difficulty interpreting emotion And so motor/expressive dysprosodia (difficulty conveying emotion) would be damage to Broca’s

16. GOING SLIGHTLY OFF TOPIC…

17. Are you more likely to have speech difficulties in Alzheimer’s or Parkinson’s? Alzheimer’s Alzheimer’s is more a cortical disease, whereas PD is more subcortical

18. With what subtypes of strokes are you likely to have dysphasia? Total anterior circulation syndrome (TACS) Partial anterior circulation syndrome (PACS) ACA-MCA watershed infarct

19. You notice a patient has difficulty forming words and his speech is very slurred. On examination, you notice he can’t flap his hands rapidly over one another, and his eyes flick from side to side when you examine them. What is your diagnosis? What else would you expect to see? Cerebellar ataxia Dysarthria, dysdiadochokinesia, ataxia, nystagmus, intention tremor, scanning speech, hypotonia (DANISH)