ADULT LANGUAGE DISORDERS. SPECCH LANGUAGE PATHOLOGY

1. TOPIC
BROCA’S APHASIA

2. INTRODUCTION
Aphasia can be defined as the loss of impairement of language
caused by brain damage.
(Benson & Ardila,
1996)
The modern conception of aphasia began in 1861 when Paul
Broca presented the case of an individual who suffered a loss of
language associated with brain pathology at the
anthropological society of Paris, However, before Broca some
older reports described language impairments observed after a
pathological brain condition.

3. INCIDENCE AND PREVELANCE
 Approx 35-40% of patients who suffer a strole are diagnosed
with some form of aphasia. (Dickey et al., 2010; Pederson,
Jorgensen, Raaschou , & Olsen , 1995)
 It is estimated that there are 80,000 new cases per year in the
United States (National stroke association, 2008).
 The National Institute of Neurological Disorders and Stroke
(NINDS) estimates that approximately 1 million people, or 1 in
250 in the united states today, suffer from aphasia (NINDS,
n.d.).

4. DOMINANT HEMISPHERE
• Language lateralize to the
dominant hemisphere
• 80% of the people are right
handed
• 96-99% of right handed people
in the left hemisphere
• 60% of the left handed people
also lateralize to the left
hemisphere
• 25% of left handed shows right
dominancy
• The remaining are mixed
dominancy

5. WHAT IS APHASIA ?

6. APHASIA
WHAT IS APHASIA?
 Aphasia is an impairment of language. An acquired
communication disorder that impairs a person’s ability to
process language, but does not affect intelligence
 Impairs ability to speak and understand others and most
people with aphasia experience difficulty in reading and
writing

7. • ETIOLOGY OF APHASIA
 Seizure disorders ( LANDAV- KLEFFNER SYNDROME)
 Vascular disorders (ISCHEMIC STROKE/ HEMORRAGIC
STROKE)
 Traumatic disorders (HEAD INJURY)
 Brain tumors
 Cancer treatments (RADIOTHERAPY/ CHEMOTHERAPY
 Infectious conditions (VIRAL, BACTERIAL, MICRO-
ORGANISMS)
 Metabolic disorders (FARAH & FEINBERG 2000)

8. TYPES OF APHASIA
 BROCA’S APHASIA
 WERNICKE’S APHASIA

9. BROCA’S APHASIA

10. BROCA’S APHASIA
 Broca’s aphasia is also known as expressive aphasia
 It was found out by the French surgeon PAUL BROCA in 1861. By examining the
brains of deceased individual who acquired expressive aphasia.
 Language ability was localized in the ventroposterior region of frontal lobe.
 Broca examined patients after a stroke, who were not often capable to express
themselves by more than a word at a time.
 Although, nouns & verbs usually pronounced, they had difficulties in articles,
conjuctions & agrammatical infections (CANOLL, 1999)
 Broca’s aphasia is a non-fluent type of aphasia that is commonly associated with
verbal apraxia, relatively good auditory comprehension, agrammatic speech, and

11. BROCA’S APHASIA
 Broca’s area is one of the main language areas in the cerebral cortex because it
controls the motor aspects of speech. Thus, other names for this disorder are
“expressive” and “motor” aphasia. Depending on the severity of lesion to Broca’s
area, the symptoms can range from the mildest type (cortical dysarthria) with intact
comprehension and the loss of speaking out loud
 Expressive aphasia, known as Broca’s aphasia in clinical neuropsychology
 Agrammatic aphasia in cognitive neuropsychology

12. LESIONS
 Traditional Broca Area “Brodmann’s 44 & 45”.
 Left frontoparietal lesions.
 Territory of the upper division of the left middle cerebral artery
 Damage to the Broca’s area alone is not enough to produce Broca’s aphasia
 Usually involves Broca’s area + surrounding areas including M1 & insula

13. BRODMANN’S AREA
..

14. BRODMANN AREA
 distinct brain areas identified in terms of anatomical
structure.
(picture shown in
previous slide)
So e.g . Broca’s area is sometimes defined as consisting of 44 &
45; much of the literature uses these numbers

15. SPEECH PATTERNS
 Effortless
 Excessively fluent (logorrhea)
 Paragrammatism
. A speaker of a foreign language would notice nothing a miss, but a listener
who shares the patient’s language detects speech empty of meaning, containing
verbal paraphasias, neologisms, and jargon production
Individuals with broca’s aphasia frequently speak short, meaningful phrases. That
are produced with great effort.
For them, speech is difficult to initiate non-fluent , laboured, and halting. Affected
people often omit small words such as “is”, “and” & “the”.

16. SPEECH PATTERNS
 Induviduals with Broca’s aphasia are able to understand the speech of others to
varying degrees.
 Because of this, they are often aware of their difficulties and can become easily
frustrated by their speaking problems.
 It is associated with right hemiparesis, meaning that there can be paralysis of the
patient’s right face and arm.
 Similarly writing is difficult as well, intonation and stress patterns are deficient.
 Naming is deficient, often with bizarre, paraphasic substitutions for the correct
name.
 Patients show greater deficit in one modality than in the other.

17. PATHOGENESIS AND ETIOLOGY OF
APHASIA
VASCULAR LESIONS
 Ischemic strokes, the most common cause of aphasia
 Clinical features of the aphasia are of crucial importance to the vascular diagnosis.
 Hemorragic strokes as an important cause of aphasia, most commonly the basal
ganglionic hemorrages associated with hypertension.
 AVM, Drugs, may cause hemorrages.
 Amyloid angiopathy
 Cerebral vasculitis

18. TRAUMATIC BRAIN INJURY
 Depressed skull fractures.
 Hemotemas of the intracerebral, subdural, and epidural
spaces.
 Gunshot wounds produce focal aphasic syndromes.

19. TUMORS OF THE LEFT HEMISPHERE
 The onset of the aphasia is gradual, and edema and mass effect may result in other
cognitive deficits.
 Enlarging tumor may be difficult to distinguish from a diffuse encephalopathy or
early dementia.
 Infections of the nervous system.
 Brain absecces can mimic tumors and present with aphasia.
 Chronic infections, such as tuberculosis or cyphilis, can result in focal abnormalities.

20. TUMORS OF THE LEFT HEMISPHERE
 Herpes, simplex encephalitis has a predilection for the temporal lobe and
orbital frontal cortex, and aphasia can be an early manifestation, along with
headache, confusion, fever and seizures.
.. Aphasia often is a permanent sequel in survivors of herpes
encephalitis.
 AIDS: either the AIDS dementia complex or the opportunistic infections.

21. DEGENERATIVE CENTRAL NERVOUS
SYSTEM DISEASES
 ALZHEIMER,S DISEASES may be more common in familial cases and may
predict poor prognosis
 DIALYSIS DEMENTIA syndrome : started with stuttering followed by true aphasia
and demenyia.
 SEIZURES:
Epileptic aphasia is important to recognize because antivascular drug therapy
can prevent the episodes.

22. TREATMENT APPROACHES
IMPAIRMENT BASED THERAPIES:
A person with aphasia initially wants to speak better and make sense of
language spoken by others. Therefore, speech language pathologies
attempts to repair what is broken .
Therapies focus an individual’s attention on tasks that allow him or her
to comprehend and speak as successfully as possible. A therapy session
may be the only time of the day in which the mental mechanics of
language are exercised with minimal frustration.
These include all RESTORATIVE APPROACHES.

23. COMMUNICATION BASED
THERAPIES.
Communication oriented treatments, in part, assist the person in conveying
messages and feelings with alternative means of communicating . In
addition , an individual is encouraged to use any remaining language
ability that succeeds in conveying messages . Therefore , communication –
incorporate impairment – based objectives simultaneously .
These accompanies
- COMPENSATORY STRATEGIES.

24. IMPAIRMENT BASED THERAPIES
 Constraint – induced movement Therapy
 Constraint – Induced language Therapy.
 Melodic intonation Therapy (MIT)
 Tele- rehabilitation.

25. MELODIC INTONATION THERAPY
 Best candidates are patients where Auditory comprehension is better than
their verbal expression and verbal expression is severely impairment .
STRATEGIES :
 Intonation pattern uses a range of 3 - 4 notes .
 Elements include an exaggerated melody line composed of at least 2
syllables . The rhythm and point of stress help to convey meaning .
 MIT is slower , similar , to chant talking .
 Program progresses to longer syntactic units and to clinician question ,
client answer using progressively faster melodic patterns .

26. MELODIC INTONATION THERAPY
MIT PROGRAM .
 Verbal material : numerous sentences of daily living
 Intoned pattern : exaggeration of normal prosody on two notes .
 Tapping with left hand
 Lip – reading allowed .

27. MELODIC INTONATION THERAPY
LEVEL - 1 until session score is
>90% for five consecutive
sessions
STEPS FOR EACH SENTENCE
• Int unison
• Int unison with fading
• Int repetition
• Int response to a question
• Humming
LEVEL – 2 until session score is
>90% for five consecutive
sessions
STEPS FOR EACH SENTENCE
• Int listening
• Int unison with fading
• Int delayed repetition
• Int response to a question
LEVEL – 3 until session score
>90% for five consecutive
sessions
STEPS FOR EACH SENTENCE
• Int delayed repetition
• Spg listening
• Spg unison with fading
• Nsp delayed repetition
• NSp response to a question

28. TELE – REHABILITATION
 Established procedures are provided over the
Internet with web cameras so that the therapist
and person with aphasia can see and hear each
other

29. COMMUNICATION BASED THERAPY
 Activities / Participation based Treatment
Augmentative and Alternative Communication (AAC)
Treatment involving the use of augmentative aids, such as picture
and symbol communication boards and electronic devices, to help
individuals with aphasia express themselves