Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Speech, Language and Aphasia

10,023 views

Published on

Power point presentation on examination of a patient with Speech disorders and classification of Aphasia

Published in: Health & Medicine, Technology
  • Hello! Get Your Professional Job-Winning Resume Here - Check our website! https://vk.cc/818RFv
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • may you pls send a copy to my mail suvarna.narava@gmail.com
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • Hi Dr. AshwinKumar Suredran. I really liked this PPT and learned a lot for this . do you mind forward a copy to me. My email address is nagarajane@health.missouri.edu
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • may you please send me at soroush_mehdifard@yahoo.com -tnx
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here
  • sir cn u frwrd me a copy at shreya_pepy@rediffmail.com
       Reply 
    Are you sure you want to  Yes  No
    Your message goes here

Speech, Language and Aphasia

  1. 1. SPEECH LANGUAGE PATHOLOGY & CLASSIFICATION OF APHASIA<br />Hello<br />Dr. S. Aswini Kumar. MD<br />Professor of Medicine<br />Medical College Hospital<br />Thiruvananthapuram<br />
  2. 2. Definitions:<br />Speech is a highly evolved function of the cerebral cortex<br />Speech is the human faculty by which thought processes are symbolically expressed<br />Speech is the vocalization form of human communication<br />It is based upon the syntactic combination of lexicals and names that are drawn from very large vocabularies (usually &gt;10,000 different words)<br />Each spoken word is created out of the phonetic combination of a limited set of vowel and consonant speech sound units<br />
  3. 3. Components of Speech<br />Speech is the mechanical function of one’s ability to communicate in oral language<br />It includes<br />Language production<br />Phonation and <br />Articulation<br />
  4. 4. Language<br />Language is the symbolization of ideas<br />Ist is the ability to convert thought in to comprehensive words<br />It consists of five parameters<br />Speaking<br />Hearing<br />Repeating<br />Reading<br />Writing<br />
  5. 5. Dimensions of Language<br />
  6. 6. Speech and Hemispherical Dominance<br />Speech is the function of cerebral hemisphere<br />It is undertaken by the dominant hemisphere<br />9 out of 10 human have right handedness<br />90% of human also have left hemispherical dominance<br />Rest 10% have left handedness<br />7 out of these 10% have left hemispherical dominance<br />3 out of the 10% have right hemispherical dominance<br />Thus 97% of human have left hemispherical dominance<br />Only 3% have right hemispherical dominance<br />It also means speech is a function of Left hemisphere in 97 out of 100 and right hemispere in only 3%<br />
  7. 7. Wernickes Area<br />The auditory comprehension of spoken speech takes place in the posterior end of the superior temporal gyrus<br />Karl Wernicke<br />German Neurologist<br />Identified it <br />Described the pathway<br />Connection to Broca’s area<br />Arcuate fasciculus<br />This area is neuroanatomically described as the posterior part of Brodmann area 22<br />
  8. 8. Broca’s Area<br />The motor area for spoken speech which is situated in the posterior part of the left inferior frontal gyrus<br />Peirre Paul Broca<br />French Sugeon<br />Described it in 1865<br />Two patients who lost speech<br />Autopsy done showed<br />Lesion in lateral frontal lobe<br />This area is neuroanatomically described as the posterior part of Brodmann area 44 and 45<br />
  9. 9. Conduction Area<br />Adeep, white matter tract, connecting the Wernickes area to the Brocas area<br />Also called arcuate fasciculus<br />Latin word<br />Curved bundle<br />Neural tract<br />Important in dominant hemisphere<br />Lesion  Conduction Aphasia<br />Repetition deficits arise following damage to the arcuate fasciculus of the dominant hemisphere <br />
  10. 10. Exner’s Area<br />An area of the brain just above Broca&apos;s area and anterior to the primary motor control area.<br />Seigmund Exner <br />Austrian Physiologist<br />1846-1926<br />Area for writing<br />Close to area for hand movt<br />Damage results in agraphia<br />This area is neuroanatomically described as the posterior part of Brodmann area 6<br />
  11. 11. Reading Area<br />An area of the brain just medial to the left occipital lobe and in the spleniumof the corpus callosum.<br />Center for reading <br />Recieves impulses from eye<br />Transmits to area Assn area<br />Analyses red matter<br />Passes to arcutate fasciculus<br />Lesion – Pure word blindness<br />This area is neuroanatomically described as the posterior part of Brodmann area 17<br />
  12. 12. Speech Mechanism<br />Speech is the process by which a person can communicate with others effectively<br />
  13. 13. Information transmitted via arcuate fasiculus<br />Activation of Brocas area for word formation<br />To motor cortex that control speech muscles<br />
  14. 14. Areas of Brain<br />4, 6<br />39<br />45, 44<br />41<br />22<br />18, 19<br />17<br />
  15. 15. Speech in reponse to hearing<br />Primary Motor cortex<br />Arcuate fasciculus<br />Brocas Speech area<br />Wernickes Speech Area<br />Primary Auditory Area<br />Brainstem<br />Muscles of Larynx<br />
  16. 16. Pathway in the process of reading<br />Primary Motor cortex<br />Primary Visual cortex<br />Brocas Speech area<br />Wernickes speech Area<br />Visual<br />Association cortex<br />Brainstem<br />Muscles of Larynx<br />
  17. 17. Aphasia<br />Part II<br />
  18. 18. Definitions:<br />Loss of language due to a dysfunction of the central mechanism in the brain is called aphasia<br />Minor disorders of the same is called dysphasia<br />Eg: Right Hemiplegia producing dysphasia<br />Dysfunction of the peripheral mechanism of speech leading to defective articulation is termed dysarthria<br />Eg: LMN facial palsy, Pseudobulbar palsy <br />Loss of voice due to dysfunction of the voice producing mechanism is called dysphonia<br />Eg: Vocal cord palsy , Acute Laryngitis<br />Loss of ability to read: alexia<br />Loss of ability to write: agraphia<br />
  19. 19. Examination of Aphasia<br />Spontaneous speech<br />Whether patient spontaneously ask for food, urination etc<br />Comprehension<br />Whether patient can obey commands<br />Repetition<br />Whether patient can repeat phrases or numbers<br />Naming<br />Whether patient can name an object<br />Reading<br />Whether patient can read, understand and obey<br />Writing<br />Whether patient can write down the answers<br />
  20. 20. Testing Spontaneous speech<br />Fluency<br />Whether speech is fluent without hesitations<br />Uninterrupted by searching for a forgotten word<br />Effort taken for speech<br />See whether the patient has effortless/effortful speech<br />Vocabulary <br />See whether there is any word-finding difficulty<br />Whether patient stammers and stumbles<br />Ability to speak in full sentences<br />Or patient is able to talk only in phrases<br />Grammer <br />Whether the grammer is correct or not<br />
  21. 21. Testing Comprehension<br />Whether patient can hear and understand speech?<br />Tested by asking the patient to obey a command<br />Ask the patient to show the tongue, close eyes, lift a limb<br />Fluency is preserved or not<br />Speech whetherfluent without hesitations?<br />Is it incessant, rapid and uninterrupted? <br />Use of paraphasias<br />Use of a descriptive phrase instead of a forgotten word<br />Use of neologisms<br />Invented word and nonsense words<br />Jargon aphasia<br />Extreme example of the above speech devoid of meanings<br />
  22. 22. Testing Repetition<br />Patient is asked to repeat a simple sentence<br />It has to be clearly stated by the examiner<br />Eg: Today is Wednesday, the August 17th, 2009<br />See whether the patient is able to repeat what you say<br />Remember never to shout at a aphasic patient<br />Hearing is usually normal in these patients<br />In a patient with left frontal lesion<br />They can repeat simple words and phrases<br />In a patient with posterior lesions in the angular gyrus<br />They cannot repeat what the examiner says<br />This is the characteristic feature of conduction aphasia<br />This function is preserved in Trans-cortical aphasia<br />
  23. 23. Testing for Naming<br />Patient is shown an object and asked to name it<br />A commonly used object should be shown<br />Eg: Pen or match box<br />See whether the patient is able to name the object<br />Patient may be handed over the object<br />Or asked to demonstrate the use of the object<br />In Anomic aphasia or nominal aphasia<br />Patient is unable to name it, but use it even<br />Auditory comprehension, repetition, reading and writing<br />Thse are usually preserved in such a patient<br />Memory testing other wise will be normal<br />This function is preserved in Trans-cortical aphasia<br />
  24. 24. Other test done<br />Ask the patient to read from a command<br />See whether he answers a question written<br />See whether he obeys commands, written down<br />Now ask to read aloud<br />Ask the patient to write down<br />The name and address<br />Draw a picture of a clock face<br />Answer to a question put forward<br />Ask the patient to calculate<br />Subtract 7 from hundred<br />Ask for 4+4, then more complicated<br />
  25. 25. Aphasia syndromes<br />
  26. 26. Broca’s Aphasia<br />Non-fluent<br />Telegraphic speech<br />Reduced verbal content<br />Phrase length – generally less then four words<br />Agrammatical sentences (or frequent errors)<br />Mostly content words (nouns and verbs)<br />Absence of functional words ( prepositions & conjunctions)<br />The matter is conveyed any way<br />Functional comprehension is present<br />But trouble following complex grammatical statements<br />Reading loud is not possible; but can read and obey<br />MCA territory stroke – Left frontal lobe<br />
  27. 27. Wernicke’s Aphasia<br />Fluent<br />Increased verbal content<br />Para-grammatism – speech running<br />Phrase length – generally greater than five words<br />Grammatical sentences (or close to normal)<br />Paraphasic errors (literal or verbal)<br />Literal – sound substitution with errors (winging ringing)<br />Symantic – word substitution ( sister for mother)<br />Neologisms (made up words) <br />Logorrhea – Inability to stop speaking<br />Severely impared auditory comprehension<br />MCA territory stroke – Left superior temporal lobe<br />
  28. 28. Conduction Aphasia<br />Relatively uncommon<br />Spontaneous speech is fluent<br />Considerable word finding difficulty<br />Preserved auditory comprehension<br />Significan difficulty with repetition<br />Literal paraphasia<br />Self correction<br />Numerous pauses <br />Filled pauses – Aaaaa Aaaaa<br />Reading deficit - variable<br />Writing deficit – variable<br />Lesion: Left superior temporal area, supramarginal gyrus<br />
  29. 29. Nominal Aphasia<br />Primary deficit – word finding and naming<br />Speech output is fluent with numerous pauses<br />Pauses may be filled with circumlocutions<br />Describing the function of an object<br />But the name cannot be retrieved<br />Auditory comprehension is intact<br />Reading and writing are also intact<br />Last localized of all aphasias<br />Focal damage to left temoral and parietal<br />Usually residual of good recovery from other aphasias<br />Also indicates good prognosis if seen in acute stage<br />
  30. 30. Global Aphasia<br />Severe impairment in all modalities<br />Speaking, listening, reading and writing<br />Severely impaired auditory comprehension<br />Very limited speech output<br />Only few understandable utterances<br />Some areas of spared speech function<br />Utilized in communication<br />Brain damage resulting is massive<br />Fronto-tempero-parietal lesion<br />Complete occlusion of MCA<br />Rarely without hemiplegia<br />
  31. 31. Trans-cortical Motor Aphasia<br />Similarities to motor aphasia<br />But with intact repetition<br />Lesion in the border zone<br />Superior or anterior to Broca’s area<br />Non-fluent<br />Limited speech output<br />Auditory comprehension – good<br />Reading comprehension – good<br />Syntax not as bad as in Broca’s Aphasia<br />Occlusion of Anterior Cerebral Artery<br />
  32. 32. Trans-cortical Sensory Aphasia<br />Similarities to snsory aphasia<br />But with intact repetition<br />Deficits in all language modalities<br />Fluent aphasia<br />Echolalia<br />They can repeat; but cant understand it<br />Much difficulty in communicating<br />Syntax not as bad as in Broca’s Aphasia<br />Lesion in the border zone<br />Posterior and inferior to Wrnickes area<br />Occlusion of Anterior Cerebral Artery<br />
  33. 33. Aphasias - Comparison<br />
  34. 34. Related disorders<br />Part III<br />
  35. 35. Apraxia<br />Acquired disorder of learned skill affecting sequential motor movements which cannot be accounted by elementary disturbances of strength, co-ordination, sensation or comprehension<br />Inability to perform a learned motor activity in the absence of any motor, sensory or coordination defect<br />It is not a lower level motor disturbance but a deficit in the motor planning<br />Ideamotor apraxia is the most common type, fails to perform previously learned motor activity<br />Ideational apraxia is adisturbance of complex motor planning than ideamotor apraxia<br />
  36. 36. Agnosia<br />An acquired disorder of recognition in some sensory modality ie visual, auditory or tactile<br />Agnosia can be specific for a particular class within the modality of sensation – <br />Objects<br />Pictures<br />Faces<br />Colors<br />It is to important distinguish agnosia from agnosia, just as in case of apraxia<br />Patietns with auditory agnosia hear adoor bell ring; but does not recognise it meaning<br />
  37. 37. Thank You<br />

×