-Hypothesized localization of function

-Realization that some speech probs could arise independently of tongue paralysis

1. Unitary View

2. Syndrome View "Classical School"

3. Cognitive/Linguistic View (comparison of normal vs impaired language)

4. Social view (aphasic person in social context, burden on person and listener)

Classical School

Wernicke-Lichtheim Model

1. severity of comprehension deficit

2. variety of features related to spontaneous expression

3. repetition ability compared to spontaneous expression

Strengths and weaknesses in:

1. Auditory comprehension

2. Speech fluency

3. Word and sentence repetition

Processing that:

1. is subconscious (we are not aware of it)

2. it is obligatory

3. it takes up little to no room in working memory

-conscious

-can be intentional (therefore, optional)

-effortful and takes up room in working memory

*involved in "slow" tasks that allow for decision making and planning

word-finding difficulty associated with circumlocutions (ie. information about the concept is intact but the word cannot be located)

*seen to some extent in almost all aphasias

Semantic

Phonemic

Mixed

Unrelated

The error is related to the target in terms of the sound structure of both words (not related in meaning)

ie. pike/pipe

The error related to target in meaning and sound (ex. may be in same semantic category and sound similar)

ex. cat/rat

Error is not obviously related to the target

ex. bus/spoon

Phonemic

Neologistic

Nonword related to target in sound

ex. fow/cow

nonword error with no relationship to the target

ex. planker/comb

Exclusive use of stereotypic utterance, as if it is the only language form available

ex. one word all the time, or a phrase "That's the way it is"

Inability to recognize stimulus even though sensory transmission is intact (ie. visual, auditory, etc.)

*can see a pencil just fine but it does not look familiar

1. Broca's

2. Global

3. Transcortical Motor

4. Mixed Nonfluent

5. Anterior subcortical

1. Wernicke's

2. Anomia

3. Conduction

4. Transcortical Sensory

5. Posterior subcortical

1. Thalamic

2. Anterior Subcortical

3. Posterior subcortical

-Agrammatism

-Apraxia (common)

-Single word prod better than sentence prod

-Relative preservation of auditory comprehension

-Writing impairment usually parallels speech impairment

-Reading comprehension mildly impaired

-impaired auditory comprehension

-fluent artic (jargon) + preserved syntax

-speech is paraphasic (all kinds)

-writing parallels speech impairment

-reading comprehension impaired

-repetition impaired (esp phonemic paraphasia)

-fluency is only mildly impaired

-auditory comprehension only mildly impaired

-may see "conduite d'approche" (repetitive self corrections)

What is conduite d'approche? 

What type of aphasia is it commonly seen?

Conduite d'approche:  repetitive self correction (can hear mistakes, say out loud to correct)

*Seen in conduction aphasia

-word finding difficulty

-fluent artic + preserved syntax

-relative preservation of auditory comprehension

-circumlocutions

-reading & writing impairment variable

-all aspects of language severely impaired

-stereotyped utterances (usually well articulated)

-comprehension for personal info may be good compared to formal tests

-expression through facial, vocal, manual gestures

-repetition relatively intact

-other production abilities impaired

-auditory comprehension relatively spared

-word finding difficulty variable (phonemic cues help)

-preservation memorized material

-preservation of repetition

-otherwise similar to wernicke's aphasia

-echolalia prominent

-border between broca's and global aphasia

-sparse verbal output like broca's

-very impaired auditory comprehension

-some partially recovered global aphasics fit here

-good comprehension

-fluent semantic paraphasias + neologisms

-may have sparing of rep like transcortical aphasias

-impairment may be limited to word retrieval difficulties

-word retrieval difficulties can be category-specific (ex. medical terms)

-anterior

-posterior

-global capsular

-putaminal aphasias

Subcortical lesions, similar to broca's with slow, poorly articulated speech

-relatively intact syntax

White matter tracts connecting parietal lobe to temporal lobe

OR portions of inferior parietal lobe

1. mainly subcortical lesions

2. absence of damage to Wernicke's area

3. early responding improvement in auditory comprehension

What type of aphasia had poorer outcomes after 8 mos than others?

(Kertesz) Damage extending beyond Wernicke's area into supramarginal and angular gyri

*better prognosis the less of Wernicke's area is damaged (less than half is best)

-type of stroke

-severity of impairment/type of impairment

-site of lesion

-age at onset

-gender

-handedness

-race

-bilingual recovery

-other

Hemorrhagic

*but lots of variability has been found (Kertesz & McCabe)

Severity of auditory comprehension

*not as much in very severe aphasia

Negative.  The more severe the less recovery (and vice versa)

Prognosis is better if damage is borderline areas around primary language zone (around sylvian fissure) not to the primary language zone itself

-borderline damage leads to more transcortical aphasias

Undetermined.  Some find no correlation with age

*comorbid conditions (often related to age) may be more of a factor

Most studies find no correlation.

Luria found an impact of familial left-handedness in right-handers

Pitres

-for those under 60

-for multilinguals more than bilinguals

-knowledge of the meaning of words

-info about the meaning of all words known by the person

A discrete, two-step model

-computer simulation of how human cognitive processes work

-concept level-->word level-->phoneme level-->production

*when one unit is activated this activation spreads to other units and levels

*this decays over time so units must be triggered soon after activation

Incorporates feedback and interactivity between levels (multi-directional)

-allows for self-monitoring

-allows for errors

-general impairment to semantic representations or impairments can be more severe in some semantic domans than others

-poor at recognizing own naming errors

-perform poorly on tasks needing precise semantic knowledge

Impairment to semantic box but recognition and comprehension intact (retain conceptual recognition). 

-phonological forms of close semantic associates were activated (in phon'l lexicon)

-able to reject unrelated names but unable to distinguish between related ones (in same semantic category)

-semantic system

-phonological output lexicon

-semantic system

--phon'l input lexicon-- just repetition without understanding

-orthographic input lexicon (written words)

-word comprehension (even for those they can't access for speech) will be unimpaired

-word freq may impact probability of production

-will make approximations (paraphasias & neologisms) to target words

*ie. may be able to come up with all kinds of words (and sort pictures of them) except for a few categories

*likely able to sort within problem categories if presented in written form

-impairment on many verbal tasks (naming, oral reading)

-probs activating output lex (semantic paraphasias or no response)

-probs with internal structure of lex (neologisms)

-post-lex (planning) errors (phonemic paraphasias)

-words are likely stored in phonologically similar groupings

-root morphemes stored separately from affixes (even in neologisms, affixes are used appropriately)

-word class distinctions (nouns vs verbs) remain

Client must decide if something is a word or a nonword.

-tests phonological input lexicon

-info from the sound wave like suprasegmentals (gender, age, emotional state)

-"phoneme recognizers"

What are the symptoms of pure word deafness?

-impaired sp perception (can't understand heard words)

-can't repeat heard words

-understand loudness, tone of voice, accent

-recognition of nonspeech sounds is normal

-normal audiometry (*not a hearing imp)

-normal production, reading, writing

Speech reading!

-slower rates & context help sometimes

rare

-difficulty understanding speech

-spontaneous speech intact

-*repetition, writing, reading comprehension intact

*writing dictation is intact

Spontaneous speech is intact

-able to understand written words

-auditory analog to deep dyslexia

-semantic errors in repetition ex. balloon->kite

-semantic errors in writing dictation

-poor with grammatical functor words

-better with concrete than abstract words

-unable to repeat nonwords or new words

-helps determine tx options

-provices framework for research & education

-standardized (colleagues, drs, families)

-prognostic info

-some concordance with imaging

-categories don't account for heterogeneity

-imperfect correlations with lesions

-labels often overgeneralize or constrict

-categories aren't mutually exclusive

-categories are "unreal" - no invariant pattern for all members or need to share specific characteristics

The mind's language system is organized into separate modules of processing

-these modules can be selectively impaired by brain damage

The processing module needed to recognize that symbols are letters and that the same letter can be represented in many forms (upper vs lower case, cursive, typing)

-note position of letters in words

-does not involve naming letters

1. lexical (ortho input lex -> semantic system -> phon'l output lex)

2. ortho input lex -> phon'l output lex (speech)

3. nonlexical (abstract letter ident -> letter-to-sound rules -> phon'l output buffer)

The pathway: abstract letter identification -> letter-to-sound rules -> phon'l output buffer (speech)

results in _______

-neglect dyslexia

-attentional dyslexia

-LBLR (letter by letter reading "spelling dyslexia", pure alexia)

-surface dyslexia

-phonological dyslexia

-direct dyslexia

-deep dyslexia

-neglect the first letters

-errors are largely visual

-usually substitute for missing info (but words not always in same class ie. nouns for verbs)

-delete less (length of word preserved)

*common early after stroke but usually resolves on its own

-rare in pure form

-read words better than name letters

-letter migration occurs in words

-occurs in normals as well

-likely highlights exaggerated errors to the normal system

-serial, not parallel

-can only access semantics through spelling outloud (labourious)

-inability to activate low freq word forms in the lex

-may still have implicit semantic knowledge

-reading without access to lexicon (use the letter-to-sound rules path)

-regularize nonwords and real words ex. read 'have' to rhyme with 'save, wave, gave'

What does it mean to regularize when reading?

What type of dyslexia uses this?

-regularize nonwords and real words ex. read 'have' to rhyme with 'save, wave, gave'

-surface dyslexia

-lexical decision

-naming

-word comprehension

-speech production (spon sp should be intact)

What are possible damage areas for surface dyslexia?

(PALPA)

-ortho input lex and connection to semantics

-impaired semantics or access to semantics

-phon'l output system

-reading is done by meaning

-cannot read nonwords (will lexicalize them - ie pite = pike)

-nonword errors usually visually similar

-problems with grapheme-to-phoneme conversion (can't segment nonwords, translate it into phonemes, can't blend phonemes to prn)

What is grapheme-to-phoneme conversion?

-dementia patients can read reg & irreg words (lexically)

-can read without understanding (no semantic access)

-therefore, must be a connection directly from otho input lex to phon'l output lex

-same as phon'l dyslexia AND

-semantic errors (cost read as money)

-better at reading concrete words than abstract

-visual errors

-can't read nonwords

-errors on functor words

-GPC and semantics

OR

right hemisphere reading

Message Level ->

Functional level ->

Postional level ->

Phonemic level ->

Articulatory level

Memory demands: verbal, sequential

Sensory stim:  vision, taste, smell, aud (the enviro)

Discourse constraints:  speech acts, topicalization

-encodes conceptual content of message

-abstract lexical entries (all words associated with concepts)

-designates grammatical class of content words (ie. noun, verb)

-multiple possibilities generated, even more than one option for the central action (verb)

-hierarchy of syntactic constituents (NP, VP, PP) impose order on sentence elements

-lexical content is phonologically specified and inserted into a sentence frame formed by bound and free grammatical elements

-how is pretty much unspecified

1. reduced phrase length

2. simplified syntactic complexity

3. poor production of main verbs

4. omission and/or sub of free and bound grammatical morphemes

-strings of single words, phrases, and/or sentence frags

-"sentences" are simple and imcomplete

-limited variety of sentence structure (active, SVO)

-impairment in ordering of verbs and nouns

-limited use of verbs relative to nouns

1. Central syntactic deficit (good comprehension in general but poor syntax comp)

2. Problem of salience - functor words aren't salient, don't elicit mental images

3. Adaptation to various performance limits (not a syntactic loss) - subconscious strategy to choose simpler sentences for time reasons

4. positional (surface) level

5. mapping between func'l and positional levels

-lack of functor/closed class words (articles, prepositions)

-omissions/subs of inflectional affixes (-ed, -s, -ing) and aux verbs

-reduced use of main verbs

-relatively better use of nouns/content words than verbs

1. thematic roles

2. attribution of modification

3. co-reference

4. scope of quantification

What pronouns and reflexives refer to

ex. Susan said that a friend of Mary's did it

Which items are qualified by negative and other numerical elements

ex. They went to the store to buy a dozen eggs, rolls and jam

Constrained/Irreversible

ex. bone was eaten by the dog (easier)

Unconstrained/Reversible

ex. the cat was chased by the dog

1. Syntactic Route (parser)

2. Non-syntactic route

a) heuristic

b) lexico-pragmatic

-sentence-picture matching

-spontaneous convo

1. they didn't understand individual words (test semantics)

OR

2. they did not understand the syntax

-if the predictor is a verb or adj

-active vs. passive mood

-sentence length

-complexity (do they have to fill-in gaps?)

Garden path sentences

ex. the old man the boat (have to go back and find an alternate syntax)

Irreversible sentences are easier than Reversible

*people use real world knowledge to determine the meaning of sentences (ie that dogs eat bones, etc)

-generalized impairment in processing resources

-impairment in language-specific working memory resources

-timing/coordination syntactic and lexical processing

-surface structure impairments for particular sentence types

-impairment in mapping syntactic structure onto meaning

-on-line vs off-line impairment (ie automatic vs non-auto)

-function word problems

What should be tested before sentence comprehension?

-Semantics & Cognition/Memory

I & II = cerebral hemisphere

III = diencephalon

IV = hindbrain (behind the pons)

Primary motor cortex

Primary Olfactory cortex

Primary somatosensory cortex

Primary gustatory cortex

Primary sensory receives sensory info first

Primary motor ultimately sends commands to muscles

1.prefrontal cortex:  volitional control, executive functions like planning

2. limbic:  incorporates emotion and memory to interpretation of stimuli

3. parieto-temporo-occipital areas:  language processing

*no area specific to sensory or motor, receive input from many modalities (plan, think, respond, remember)

What lobe takes care of execution and planning?

What are the 3 major areas?

Frontal lobe

-primary motor cortex

-pre-motor cortex

-supplementary motor cortex

What does the supplementary motor cortex do?

aka secondary

Where is the prefrontal cortex?

What does it do?

Anterior portion of frontal lobe (ASSOCIATION AREA)

It is responsible for executive functions:  higher motor planning, behaviour, cognitive processes like thinking

DISINHIBITION!

Memory and cognition may remain intact but personality may change dramatically

Inferior frontal gyrus

Anterior to primary motor area for jaw, lips, tongue and vocal cords

What functions is the parietal lobe involved in? (4)

Reading, writing, language & calculation

*perceptual synthesis, spatial orientation, cross modality integration, cognition, memory

-process aud & visual input and language comprehension

-processes letters with corresponding sounds

-NB for reading, writing, abstract thinking & calculation

Reading (meaning & phonology)

-symbolic integration for writing

What is Ballint's syndrome? 

Where would the damage be?

Optic ataxia (hand & eye movement uncoordinated)

Occulomotor apraxia (can't change gaze fixation)

Damage to RIGHT parietal lobe

What is Gerstmann's Syndrome?

Where is the damage?

Right-left disorientation

Dyscalculia

Dysgraphia

Finger agnosia (doesn't recognize own fingers)

Damage to LEFT parietal lobe

Speech comprehension (semantic processing)

Integrates written & oral symbols to make meaningful

-houses primary and secondary auditory cortices

-hippocampus here (memory)

What is heschl's gyrus?

What brodmann area is it?

Primary auditory cortex

41 (&42)

What is the result of damage to brodmann's areas 41/42?

What are they?

Primary aud cortex & aud association cortex

Damage = PURE WORD DEAFNESS (can't understand words but can interpret nonword sounds)

What is the KEY function of wernicke's area?

What is its brodmann #?

Language Comprehension!

#22

Affects appreciation of music

-emotional/inferential understanding of language (like jokes & sarcasm) are impaired

-nonverbal memory impaired

colour agnosia

movement agnosia

agraphia

*can perceive stimuli but not RECOGNIZE them

What are association fibres?

Name some tracts

Communication within hemispheres

1. arcuate fasciculus

2. cingulum (medial frontal, parietal w temporal)

3. superior occipitofrontal

4. inferior longitudinal fasciculus (connects temporal to occipital)

Enters through the carotid canal

-runs through cavernous sinus

- passes through dura mater, arachnoid mater into subarachnoid space

-exits and ascends to split into anterior and middle cerebral arteries

4 arteries:

- 2 internal carotids make up the anterior system

- 2 vertebral arteries make up posterior system

What are commissural fibres?

Name some

Connect across hemispheres

1. corpus callosum

2. anterior commissure (connects middle & inf temporal gyri)

-vertebral arteries enter through foramen magnum

-join at pons/medullary junction = basilar artery

-basilar artery ascends to pons/midbrain junction

-splits into 2 post cerebral arteries

-**connects with posterior communicating arteries to complete the circle of willis

Paralysis of legs & feet (motor cortex)

-prefrontal area:  impaired thinking, reasoning, planning

1. thrombosis

2. embolis

3. TIA

A type of ischemic stroke

-a vessel is blocked (usually by plaque build-up) that cuts off blood supply to an area of the brain

RISK factors:  high cholesteral, smoking, heart disease, diabetes

Ischemic stroke

-particle that travels through bloodstream, lodges * blocks blood supply

RISK factor:  high blood pressure

A mini-blockage that resolves itself within 24hrs

What are the 3 types of hemorrhagic stroke?

Explain each

1. intracerebral: intracranial artery ruptures, blood accumulates

2. subdural:  traumatic injury to vessels in subarachnoid, damages brain tissue

3. aneurysm:  weakness in vessel wall

Can cause strokes,

congenital condition susceptible to hemorraging

*type of hemorrhagic stroke?

Contralaterality

Hemispheric specialization

Language

Math

Reading

writing

speech

nonverbal aspects of language

prosody

inference

spatial & perceptual info

1. behavioural

2. medically based techniques (lesions, direct stimulation)

3. imaging

High spatial/low temporal resolution

-CAT scan

-MRI

low spatial/high temporal res

-EEG (electroencephalograms)

-ERP (event-related potentials)

-MEG (magnetoencephalography)

-good for structure & function

-measures O2 uptake by each area

con:  time lag