1. Aphasia Aphasia Presented by: Eitan Gordon

2. A Definition  Aphasia is a disruption of language associated with brain damage. A comprehensive explanation of aphasia is given in a book by M.N. Hedge, he says, “an impairment in understanding and formulating complex, meaningful, and ordered or sequenced elements of language including words, phrases and sentences; a difficultly in remembering words, saying the correct words, or saying words in correct satanic order; a difficulty in talking grammatically; difficultly in reading and writing in conjunction with the described oral language problems; and difficulty understanding or expressing through gestures” (Hedge, 1995).

3. Causes  Aphasia is caused by brain damage usually related to an injury; many times aphasia is caused by Traumatic Brain Injury (TBI). The most common type of injury for people with aphasia is stroke “[i]n the distribution of the left middle cerebral artery, which is the main blood supplier of the perisylvian cortical areas” (Snyder et al., 1998).  Though many leading neurologists, “attempting to explain the pathology of speech from these standpoints regarded aphasia purely as a disturbance of ‘intellectual schemes’ or of abstract sets. Abandoning all attempts to localizing these disturbances in particular brain zones, they limited themselves to the highly controversial correlation of these disturbances with the brain ‘as a whole’, at best correlating a disturbance of these higher forms of speech activity with the mass of brain substance damaged” (Luria, 1973).

4. Causes, Continued…  The main area of the brain that is the cause of aphasia is damage to the perisylvian language areas. These areas include, “Broca’s area, which is involved in the motor programming of speech; Wernicke’s area, which is critical for the auditory comprehension of spoken words; and the arcuate fasciclus, which links these two areas and is thought to play an important role in repetition. Aphasia may also be caused by lesions that do not directly damage the perisylvian language areas but isolate them from brain regions involved in semantic processing and the production of volitional speech. The extraperisylvian aphasias are referred to as transcortical aphasias” (Snyder et al., 1998).

5. Types of Aphasia  Because of the damage to these different areas there are any different types of aphasia that are classified into to two categories, both having to do with speech, which are fluent aphasias and non-fluent aphasias:  Fluent aphasia are determined by patients who display normal length phrases and sentences which are well articulated and easily understandable, these are connected with posterior lesions that spare anterior cortical regions critical for motor control for speech;  Non-fluent aphasias are the opposite and are characterized by sparse, hard to understand utterances or sentence usually short in length, these are determined by anterior or pre-rolandic lesions that comprise motor and pre-motor cortical regions involved in speech production.

6. Types of Aphasia, continued…  In addition to the effect to the fluency part of aphasia there is also damage to the auditory possessing. Damage to the anterior region causes mild impairment in the auditory comprehension, whereas posterior lesions result in severe impairment to the comprehension. When there is damage to any of the areas mentioned above then also there is likely to be distortion to repetition. Also, people who have aphasia also experience a naming impairment.

7. Types of Aphasia, continued…  Within each type of category of aphasia there are a few different types or subcategories: Fluent and Non-Fluent. There are four types in the fluent aphasia category, which include Anomic aphasia, Conduction aphasia, Transcortical sensory aphasia, Wernicke’s Aphasia.  Four types of non-fluent aphasias, which include Transcortical Motor aphasia, Broca’s aphasia, Mixed Transcortical aphasia and Global aphasia.

8. Types of Aphasia, continued… Fluent Aphasia  Anomic aphasia has good auditory comprehension and repetition, but is caused “by lesions of the angular gyrus, it may be associated with the Gerstmann syndrome and limb apraxia” (Snyder et al., 1998).  Conduction aphasia has good auditory comprehension but poor repetition. This results from “posterior perisylvian lesions affecting primarily the supramarginal gyrus in the parietal lobe and the underlying white matter (arcuate fascuculus)” (Snyder et al., 1998).  Transcortical sensory aphasia has impaired comprehension and preserved repetition. This type of aphasia results form lesions in the temporoparieto-occipital region, usually located posterior and deep to Wernicke’s area.  Wernicke’s aphasia has both poor auditory and repetition. This results from “large posterior perisylvian lesions encompassing the posterior superior temporal gyrus (Wernicke’s) and often extending superiorly into the inferior parietal lobe” (Snyder et al., 1998).

9. Types of Aphasia, continued… Non-Fluent Aphasia  Transcortical Motor aphasia (TcMA) has relatively good auditory comprehension and reserved repetition. TcMA is caused by lesion in the frontal lobe.  Broca’s aphasia had good auditory comprehension and poor repetition. This results from “large lesions encompassing the entire territory of the superior division of the middle cerebral artery” (Snyder et al., 1998).  Mixed Transcortical aphasia (MTcA) is also known as ‘isolation syndrome,’ has poor auditory comprehension and preserved repetition. “MTcA is seen in association with diffuse or multifocal lesions that result in anatomic isolation of the perisylvian language zone from surrounding cortical areas” (Snyder et al.)  Lastly, Global aphasia has both poor repetition and auditory comprehension. This type results form lesions typically involve the entire perisylvian language zone and are usually extensive.

10. Research  A Yale study- Does Intensive Therapy help?  Does President Bush have brain damage?

11. What can we do?  Children of all ages engage in play that might cause a fall, riding a bike or climbing a tree when children are younger; if they are older, car accident or rough play (sports injury of some sort).  When injury report right away.  If speech problem, look at history on injury, from school and parents.

12. What can we do?, continued…  Also for school psychologist using the right type of assessment to analyze any possible brain damage or impairment to an area that results in aphasia:  Boston Diagnostic Aphasia Examination (Goodglass and Kaplan, 1983)  Western Aphasia Battery (Kertez, 1982)  Aphasia Diagnostic Profiles (Helm-Estabrooks, 1992).

13. What can we do?, continued…  An assessment that will test for impairment in naming is the Boston Naming Test (Kaplan, Goodglass and Weintraub, 1983).  Auditory comprehension is something that needs to be tested for also an impairment, an assessment that tests for this is the Token Test of the Multilingual Aphasia Examination (Benton, deHamster and Siven, 1994).  Reading and writing are also affected in aphasia and the Psycholinguistic Assessment of Language Processing in Aphasia (PALPA; Kay, Lesser and Coultheart, 1992).

14. What can we do?, continued…  When someone is diagnosed with aphasia there are assessment that help explain the damage or impact of the aphasia diagnosis; these assessment are the American Speech-Language-Hearing Association Functional Assessment of Commutation skills for Adults (Frttalli, Thompson, Holland, Wohl and Ferketic, 1995) and the Communicative Abilities in Daily Living (Holland, 1980; Holland,Fromm and Frattali, in press).

15. Where to go with this…  The next place aphasiac study should go is to the school. I believe a nation wide study of children who have aphasia of aphasiac symptoms should be investigated and looked at to see how school officials of all kinds could help future children with any aphasia or aphasiac symptoms.

16. Work Citied  Furman, J. (1992). The Speech Thing. New Republic, 207 (8/9).  Hedge, M.N. (1995). Introduction to Communicative Disorders, Second Edition. Texas: Pro-Ed.  Luria, A.R. (1973). The Working Brain: An Introduction to Neuropsychology. New York: Basic Book.  Raloff, J. (1982). Aphasia: Therapy Helps, seldom cures. Science News, 122 (24).  Snyder, P.J. & Nussbaum, P.D. (1998). Clinical Neuropsychology: A Pocket Handbook for Assessment. Washington D.C.: American Psychological Association.