in 19th century, GAll theorized that the brain has specific parts for specific functions

Churchy  types dislikes b/c saw the brain as holistic and spiritually guided

1.) Unitary View

2.)Syndrome View (Classical School)

3.) Cognitive/linguist view (PALPA)

4.) Social View

asserts that the impairment is a general intellectual capacity issue. 

(Head, Schuell)

this is an anatomically based account of the symptomology

'the classical school'

more theoretical

PALPA is example

Places person with aphasia an in context of their social community

Impairment in communication seen as beloning to 'community' (ie: friends, relatives, not just person with aphasia)

1.) Severity of comprehension deficit

2) Spontaneous Expression

3) Repetition ability

Auditory Comprehension

Speech Fluency

Word and Sentence Repetition

(looking for abilities that are preserves or impaired compared to others)

a common symptom

- word finding difficulty associated with circumlocutions

- An unintentional substitution of an incorrect word/non word for a target word.

Types::

1.) Lexial (word) - 4 subtypes

2.) Sublexical (non word) -2 subtypes

1.) Semantic - error is semantically related to target (wife/husband)

2.) Phonemic - error rel to target in terms of sound structure of both words (pike/pipe)

3.)Mixed - error rel to target in both meaning and sound (rat/cat)

4.) Unrelated - Error is not obviously rel to target  (fork/door)

1.)phonemic - non word related to target in sound (lat/cat)

2.) Neologistic - non word error with no reln to target (blib/toothbrush)

A symptom of aphasia

- speech characterized by nouns and main verbs, omission of 'functor' words and grammatical morphemes

A symptom of aphasia

- errors made in use of grammatical elements (rather than omissions)

a symptom in aphasia

- lengthy fluently articulated utterances, preserved syntax, but makes no sense

 a symptom in aphasia

- exclusive use of stereotypic utterance, as if only language form available

(remember 'tan')

- not aphasia (but good term to know)

Motor speech disorder resulting in impaired muscular control rel to weakness, slowness, and incoordination of speech musculature

- not aphasia (but good to know)

Motor speech disorder resulting in inability to program positioning of articulators

-not aphasia symptom but good to know

Inability to recognize stimulus even though sensory transmission is intact (can be visual, auditory or tactile)

anomia

paraphasias (lots of types under here)

Agrammatism

Paragrammatism

Jargon

Verbal Stereotypes

Brocas

Global

Transcortical Motor

Mixed Non Fluent

Anterior Subcortical

Wernickes

Anomia

Conduction

Transcortical Sensory

Posterior Subcortical

Thalamic

Anterior Subortical - non fluent

Posterior Subcortical - fluent

* Thalamic can be both non fluent or fluent

What are the main features of Broca's

-symptoms

- fluent or non fluent

- non-aphasia co-issues

- preserved vs impaired

Symptoms -Agrammatism

-Non fluent

-Co-issues: Apraxia often present

- Preserved: auditory comprehension

- Impaired: expression, writing

-Single word better than sentence production

- Reading comprehension mildly impaired

What are the characteristics of Wernicke's Aphasia?

 -impaired vs preserved

-writing

-fluent or non fluent

- Impaired - auditory comprehension, reading comprehension

- Preserved - fluency or artic, syntax

Symptoms - lots of paraphasias

Writing impairment similar to speech one

- fluent

What are the main characteristics of conduction aphasia?

-fluet or non fluent

-symptoms

-impairments vs preservations

Lots of phonemic paraphasias (some semantic too)

Impaired - repetition

Fluency is only mildly impaired (considered fluent)

Conduite D'Approche - repetitive self corrections

-Fluent

- Preserved: articulation and syntax, auditory comprehension (relatively)

- circumlocutions

-impairment to reading and writing is variable

What are the main characteristics of global aphasia?

impairments vs preservations

comprehension

fluent vs non fluent

- Impairments- all aspects of language severely impaired

- Preserved - stereotyped utterances are usually well articulated

Comprehension - for personal info it may be good compared to formal testing

- Will see expression through facial, vocal, manual gestures

-non fluent

What is transcortical motor aphasia?

 -fluent or non fluent

- what's preserved/intact

preserved: repetition relatively intact, auditory comprehension (relatively), memorized material preserved

impaired: orther production abilities, word finding diffs (but this is variable, phonemic cue helps)

-non fluent

preserved: repetition

Echolalia is prominent feature

* similar to Wernicke's aphasia

What are the characteristic of mixed nonfluent aphasia?

- between what two types?

- what is impaired?

- this one is between Broca's and Global

- Sometimes partially recovered global aphasics fit here

- Sparse verbal output (like Broca's)

- Auditory comprehension v impaired (below 50%)

non-fluent

preserved: comprehension, repetitions

symptoms: fluent semantic paraphasias, neologisms

impairment: word retrieval (can be category specific)

Thalamic can be fluent or non-fluent

- caused by subcortical strokes

Posterior syndrome - is like Wernicke's

Anterior syndrome - is like Broca's with slow and poor artic, but still has intact grammar

Similar - slow, poorly articulated speech

Unlike - ANTA will have intact grammatical form

the thalamus

OR

the caudate, putamen, internal capsule, basal ganglia

a - auditory imput

A - auditory word impressions

B - elaboration of concepts

M - kinesthetic word-impressions

m - motor input to articulators

a lesion from a to A would be what?

(ie auditory input to auditory word impressions)

what would a lesion between A and B be?

(ie: auditory word impressions and elaboration of concepts)

What would a lesion from B to M be?

(ie: Elaborations of concepts to Kinesthesic word impressions)

What would a leasion from A to M be?

(Auditory Word Impressions to Kinesthetic Word Impressions)

What would a lesion to A be?

(Auditory Word Impressions)

What would a lesion at M be?

(Kinesthetic word impressions)

What path do you need for comprehension 

(In Wernicke-Lichtheim Model)?

Auditory input (a)

to

Auditory Word-Impressions (A)

to 

Elaboration of concepts (B)

What do you need for repetition?

(in the wernicke lichteim model)

a - auditory word impressions

A - Auditory Word Impressions

M - Kinesthetic word impressions

m - motor output to articulators 

poorest prognosis

they made the least improvement

- better prognosis if lesion that is subcortical and there isnt damage to Wernicke's

- better prog is have early improvement in auditory comprehension

- patients with higher initial scores and less jargon did better

- some have found wernickes has poorer outcomes at 8 mos than other syndromes ( could be rel to damage close to wernickes, supramarginal and angular gyri)

-others found better prognosis for those with damage to less than half of wernicke's area

-greatest amount compared to others =)

- patients often remain with Broca's or progress to a milder, more fluent form

-similar to brocas

most anomic , conduction and transcortical aphasias have the best outcomes

- between broca's and anomic in severity

- patients often evolve to anomic aphasia

- age at onset

- bilingual recovery

- gender

- handedness

- race

-site of lesion

-type/severity of impairment

-type of stroke

thromboembolic  and hemorrhagic strokes have diff outcomes

- better recovery with hemorrhagic

- but still lots of variability

-larger lesions less recovery

- negatice correl bet severity of aphasia early on and overall recovery

- initial severity of auditory comp is factor in recovery

- good initial word comp is predictice of good recovery in naming

-this has a big effect

- subcortical and cortical lesions recover differently

Subcortical - usually recover dramatically over time

(this could be thalamic, nonthalamic, capsulostriatal)

- support for this is mixed

- found that lang severity was correlated with age but not correlated with functional communication measures

(ie: on a standardized test older folks do worse, but on a functional comm test they do fine)

evidence inconsistent

- some show that women have greater severity and poorer functional outcomes (this is to do with stroke in general though, not aphasia specifically)

-evidence scarce and mixed

-some find diffs some dont

- lots of diff reserach

 - some found that the most used lang comes back first (pitres) esp in multilinguals and those under 60

- some find that both come back in parallel

also called parallel

When the 2 languages were similarily impaired at the beginning and progress was same rate with similar recovery curves

pre-stroke: assoc with reduced stroke and aphasia recovery

post stroke: assoc with poorer functional outcomes

higher

-but successful tx can improve mood and functional outcomes

the evidence is mixed

some found a correlation, others didnt

components of the model

pathways of communication between the modules

what language-processing function depends upon each module or pathway

semantic system

to

phonological output lexicon

to 

speech

Knowledge of the meaning of words

Info about the meaning of all the words known by the person

representations of all the spoken words in a speaker's vocabulary

a store of words (representations are phonological, store is for output)

processes involved in realization of the word as part of an utterance

number of different operations likely involved here 

there is a word level (lemma)

and a phoneme level (lexeme)

There is spreading activation from lemma to lexeme level

Conceptual preparation (lexical concept)

lexical selection (lemma, syntactic word)

morphological encoding (morpheme)

phonolocical encoding (phonological word)

phonetic encoding (phonetic gestural score)

artic (sound wave)

Levelt is more specific (ie has morpological levels)

Levelt has self monitoring piece

there is feedback and interactivity in the IAM

info goes in all directions

(feedback allows you to check but can also force you to make mistakes)

-patient can present with general, non specific impairment to semantic representations

-patient can have impairment that's worse in one semantic domain then another

- usually will be poor at recognizing their errors

- perform poorly on tasks requiring precise semantic knowledge

-picture naming really poor

-comprehension of target items for naming is poor

- object recognition and comprehension good (pyramids and palm tree)

- no impairment of conceptual recognition

preservations (unrelated responses)

How do people with non-category specific semantic anomia do on the pyramids and palm tree test?

Why?

very well

client gets some semantic info but not enough to name specific target, enough to put in categories though

 - inability to name (medical terms, fruits etc)

- word generation for bad category will be poor

-sorting of bad category will also be poor

What is intact with those with category specific semantic anomia?

word picture matching within a semantic category (even their 'bad' category)

Written categorization of bad category also fine

What are characteristics of anomia without semantic impairment?

comprenesnion of words they cant access for speech will be unimpaired

word freq may affect probability of being ableto prod a wd

will make approximations to targets

-impaired on many verbal tasks (naming, oral reading etc)

- difficulty accessing output lexicon (shown by semantic paraphasias or no resp)

- disturbance affecting internal structure of the lexicon (shown by neologisms)

-post lexical (planning) phonemic process issues so will get phonemic paraphasias

words are stored together in phonologically similar groupings

root morphemes are separated from affixes

word class distinctions (nouns vs verbs) are represented

yes,

just cant say the words

non category specific semantic anomia

category specific semantic anomia

anomia without semantic impairment (could be at phonological output lexicon)

semantic system

speech output lexicon

auditory analysis system

auditory input lexicon

speech

auditory phonological analysis (parse sound wave)

phonological input lexicon (do we know the wd? is it a real wd)

semantic system (what does the wd mean?

parsing of the sound wave

info not specifically aobut words

Start to recog imp pieces of wds

Recognize other features of the signal (male, female, happy, mad, accent etc)

to decide if it is a word we know

(imp for the lexical descision task)

it stores all the sound patterns of the words we know

knowledge about the meaning of words

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

auditory phonological analysis

to

phonological input lexicon

1 acoustic-phonological conversion (bypass route)

2 phonological input lexicon (not sem syst)

3 Activate entries in APA then PIL then Semantic then POL

* 1 and 3 are the main route

Acoustic-Phonological conversion

- used to repeat words we dont knwo the meaning of as well as non words for which there is no meaning

- we bypass our store of words in this one

right from APA to ac to phon conversion to POL

extra step than the bypass route

goes to PIL (so we can decide if its a wd or non wd), but we never go access its meaning

Entries activated in PIL then go right to POL

Activate entries in APA then go to PIL then Semantic system then POL

(Accessing meaning)

impaired speech perception

cannot understand heard words

cannot repeat heard words

can understand loudness, tone and accent

can recog non-speech sounds normally

normal audiometry

normal production, reading and writing 

speech reading

slower rates of presentation

context sometimes

rare

difficulty understanding speech

spontaneous speech is intact

repetition is intact

writing intact

reading comprehension intact

*for the words then cant understand, they can still repeat them and write them

*tehy can write what we ask them to write, then they'll recognize it once they read it

the ability to repeat shows that acoustic an word analsyis is intact (In WMD)

Understanding of written words shows semantic system intact (In WMD)

Intact spontaneous speech shows semantic and speech output lexicon intact (in WMD)

-auditory analogue to deep dyslexia

-many semantic errors in repetition (baloon, kite)

-semantic erros in writing to dictation

- poor with grammatical function words

-better with concrete than abstract words

-unable to repeat nonwords or new words

-anomia arising at the semantic level (can be non category spec or category spec)

-anomic without semantic impairment

pure word deafness

word meaning deafness

deep dysphasia

ID of the component letters of words

Noting the position of letters in words

Recognice lower case, upper case and hand writing  versions as all the same letter

doesnt involve naming the letters

words that are recognized by sight hav representations here

input comes from 'letter recognizers' in the abstract letter id system, this activates stored meanings in the semantic system

letters are analyzed by the abstract letter ID system and then converted into sounds

- used for nonwords and unknown words

1.) the lexical route (through semantics)

2.) Direct route from orthographic input lexicon to pronunciation (bypassing semantics)

3.) Letter to sound conversion

peripheral dyslexia 

and central dyslexia

neglect dyslexia

attentional dyslexia

LBLR (letter by letter reading, spelling dyslexia or pure alexia)

surface dyslexia

phonological dyslexia

direct dyslexia

deep dyslexia

-neglecting the first letters 

(a type of peripheral dyslexia)

-usually will substitute not delete the neglected letters

-common in R hemisphere lesions

-deficits largely visual

(a type of peripheral dyslexia)

patients read words better then they name letters

letter migration in words

occurs in normals too

abstract letter id system groups letters together

also called letter by letter reading

a type of peripheral dyslexia

can only read word aloud if able to say the letters alound slowly first

they can access semantics, just have a hard time getting there from print

laboriously spelling out an pronouncing

like reading without access to a lexicon

can read non words

often regularise non words and real words (ex would say have like cave or wave)

lexical descision tasks

naming

word comp

speech production

a type of central dyslexia

cannot read nonwords, they lexicalize them

probs with letter to sound conv (segmenting non word, translating into phonemes, inability to blend phonemes together)

a central dyslexia

can read without understanding (no semantic access)

goes direct from orthographic input to phonological output

- OR maybe it goes through semantics but the pers just can use that knoweldge

- common in dementia patients

same troubles as phonological dyslexia but also:

- make semantic errors (cost read as money)

-better at reading concrete things

- visual errors too

-cant read non words

- many errors on functor wds

(phonological dyslexia with semantic impairment)

the message level

the functional level

the positional level

the phonetic level

the articulatory level

-encoding of the conceptual content of the message

- abstract lexical entries

- designating the grammatical class of the content wd

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

-SYNTAX TREES =(

- hierarchy of snytactic constituents (NP, VP, PP) impose order on sentence elements at this level

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

- (details of how the lexical content is inserted and morphemes are compose not really specified in this model)

1) reduced phrase length

2)simplified syntactic complexity

3) poor production of main verbs

4)omission and/or substituion of free or bound morhpemes

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

-'sentences' are simple and incomplete

- limited variety of sentence structures

-impairment in ordering of verbs around nouns

-limited use of verbs relative to nouns

-lack of functor/closed class words

-ommision or sub of inflectional affixes and aux verbs

- reduced use of main verbs

- better use of content words, esp nouns

1) Thematic Roles

2)Attribution of modification

3)Co-reference

4)Scope of quantification

which adjectives are associated with which nouns.

what pronouns and reflexes refer to 

(susan said that a friend of mary's washed her)

which items are qualified by negative and other numerical elements

(they went to the store to buy a dozen eggs, rolls, and jam)

the cat (also the object)

the dog scratched the cat (the agent is the subject and the theme is the object)

The cat was scratched by the dog is non-canonical (the theme is the subject and the agent is the object)

constrained - the meaning you arrive at is constrained by the real world knowledge you have

unconstrained - could be reversed, much more difficult for someone to understand in the non-canonical form

1- syntactic route (parser)

2- non-syntactic route

*heuristic 

*lexico-pragmatic

-generalized impairment in processing resoursces

-impairment in lang-spec working memory resources

-timing/coordination in syntactic and lexical processing

-surface structure impairments for particular sentence types

impairment in mapping syntactic structure onto meaning

- online vs offline impairment

- function word problems