chapter 10 · chapter 10 aphasia in adults. 2 ... transcortical sensory aphasia. 27 11/30/05 comd...
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Chapter 10
Aphasia in Adults
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Landmarks
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Landmarks
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Motor Cortex
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Motor/Sensory Homunculushttp://www.cs.uta.fi/~jh/homunculus.html
http://mywebpages.comcast.net/epollak/PSY255_pix/homunculus.jpg
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Deficit Areas
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Blood Supply
Uses about 20% of blood at any one timeUses 25% of oxygen1. Internal Carotid Arteries and branches2. Vertebral artery and branches divides into:
Internal Carotid Arteries1. Anterior cerebral arteries
Supplies medial surface of cortex, leg area of motor strip, and portions ofcaudate nucleus, lentiform nucleus, and internal capsule
2. Middle cerebral arteriesSupplies most of lateral surface of hemisphere
3. Ophthalmic arteriessupplies eye, frontal scalp, dorsum of the nose, ethmoid, and frontal sinuses
4 & 5. Posterior & Anterior communicating arteriesForms circle of Willis
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Circle of Willis
Joining of the two internalcarotid arteries with thetwo vertebral arteries
Allows distribution of bloodto any part of bothhemispheres
Safety valve function forthe brain
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Cranial Nerves
I. Olfactory (S) II. Optic (S) III. Oculomotor (M) IV. Trochlear (M) V. Trigeminal* (B) VI. Abducens (M) VII. Facial* (B) VIII. Vestibulocochlear (S) IX. Glossopharyngeal* (B) X. Vagus* (B) XI. Accessory (M) XII. Hypoglossal* (M)
* Oral Musculature Nerves
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Aphasia
Impairment in the ability to understandand produce language as a result ofacquired neurological damage
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Etiology
Stroke CVA
1. Thrombotic stroke2. Embolic stroke3. Hemorrhagic stroke
Catagories1. TIA - transient ischemic attack2. RIND - reversible ischemic neurological deficit3. Stroke in evolution4. Completed stroke
CVA - cerebral vascular accident usually sudden onset involving blockage ofblood flow to brainThrombotic stroke - build-up of plaque on inner vessel walls blocking flow ofblood (ischemic - deficiency of blood)Embolic stroke - traveling clot (ischemic)Hemorrhagic stroke - bursting of arterial walls due to aging of high bloodpressure (hematoma - accumulation of blood in brain)TIA - less than 24 hoursRIND - days or weeks but with minimal or no damageEvolution - longer than 24 hours with associated progressive deteriorationCompleted - deterioration stops and patient stabilizes
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Cranial Nerve Assessment
Table 10-3 (p. 233)
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Brain Imaging Techniques
Angiography Radioisotope Scanning Computerized Tomography Magnetic Resonance Imaging Positron Emission Tomography (PET)
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Angiography
http://www.med.harvard.edu/JPNM/TF03_04/Feb3/CTA.gif
X-ray technique checking flow of blooddye inserted in artery and trackednot noted beyond blockage
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Radioisotope Scanning
www.smithsonianmag.si.edu/.../brain_jpg.html
Tracking of isotopes through the brain
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Computerized Tomography
www.med.harvard.edu/AANLIB/hms1.html
CT Scan - narrow x-ray beams focus on a single planeAccurate computerized reconstruction of cerebral structuresAreas of altered density indicate pathology
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Magnetic Resonance Imaging
www.med.harvard.edu/AANLIB/hms1.html
Large electromagnets manipulate spin of hydrogen molecules to differentiatebetween white and gray matterSuperior to CT Scan
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Positron Emission Tomography
www.med.harvard.edu/AANLIB/hms1.html
Radioactive chemicals injectedPatterns of brain activity examined
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Hemispheric Differentiation
EEG Dichotic listening tasks Wada test
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EEG
www.mrc-cbu.cam.ac.uk/EEG/doc/mmnlang.shtml
“The EEG, or electroencephalograph, deserves mention as one of the first --and still very useful -- ways of non-invasively observing human brain activity.An EEG is a recording of electrical signals from the brain made by hooking upelectrodes to the subject's scalp. These electrodes pick up electric signalsnaturally produced by the brain and send them to galvanometers (instrumentsthat detect and measure small electric currents) that are in turn hooked up topens, under which graph paper moves continuously. The pens trace thesignals onto the graph paper.”(http://www.pbs.org/wnet/brain/scanning/eeg.html)
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Dichotic Listening
UCLA LinguisticsDepartment dichoticlistening experimentof dominance
Ole Miss dichoticlistening experiment
dart.fine-art.com/aqd-asp-im_87237-buy-m.htm
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WadaTest
http://cnri.edu/Clinical_Studies/Independent_Studies/CNRI_Research_&_Development/Iridological_Evaluation_2003.htm
The Wada test (named for a neurologist, Juhn A. Wada) consists of behavioraltesting after the injection of an anesthetic (such as sodium amobarbital orsodium methohexital*) into the right or left internal carotid artery. Dependingon how the injection is made (and the quantity), we have a certain amount oftime during which the activities of one of the cerebral hemispheres aresuspended, so the abilities subserved by the other hemisphere can be tested inisolation. (http://www-personal.umich.edu/~gusb/wadadesc.html)
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Language Testing
Differential Diagnosis1. Naming2. Speech fluency3. Auditory comprehension (figure 10-1, p. 239)4. Repetition skills (figure 10-2, p. 240)
Standardized Assessment Tools Western Aphasia Battery Boston Diagnostic Aphasia Examination Porch Index of Communicative Ability
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Syndromes of Aphasia
For additional information seeChapter 13
Shames, Wiig, & Secord
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Speech and Language Areas
AA P
Anterior speech centerPosterior language area
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Fluent Aphasias
Wernicke’s Aphasia Conduction Aphasia Transcortical Sensory Aphasia
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Wernicke’s Aphasia
Ofter lacks contentJargonNormal intonational structureReading and writing similarRepetition impaired
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Anomic Aphasia
Otherwise normal language marred by word-retrieval difficultiesAuditory and reading comprehension near normalWord problems present in writingRepetition usually better than spontaneously produced speech
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Conduction Aphasia
Comprehension of language highSpeech often marred by inappropriate words (usually result of incorrectsounds in words)May include table for chairFrequent self correctionsDifficulty making use of cues and repeating information supplied by others
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Transcortical Sensory Aphasia
Rare syndromeIsolated language centers from other cortical centersDramatic preservation in ability to repeat
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Nonfluent Aphasias
Broca’s Aphasia Transcortical Motor Aphasia Mixed Transcortical Aphasia Global Aphasia
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Broca’s Aphasia
Paucity of speechDifficulties in word retrievalLabored and slow rate of speechBetter comprehension of spoken and written language
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Transcortical Motor Aphasia
Intact repetition with Broca’s like symptomsTrouble initiating speech and writing
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Mixed Transcortical Aphasia
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Global Aphasia