neuro eval lect 5a

• exchange of info thru common network or system of symbols
• speech is the art of communication

• formal set of rules used in communication for formation and transfrer of info by way of symbols
• can be verbal, speech, or non-verbal communication

hand gestures, sign language, eye contact, body language, written info, facial expresuions, gestures, nodding, intonation/pitch/loudness of voice

L side - in L middle cerebral artery

• receptive: hearing, comprehension, thought/word finding (when you're listening to someone and have to figure out what word she used)
• expressive: thought/word finding, voice production, articulation

• visual (ASL, watching nonverbal cues)
• auditory

• oral
• written
• gestures -- someone with expressive aphasia may need to use writing or gestures or
• symbols

Area 41 of Sub Temporal Gyrus (Heschi’s Gyrus)

Area 42 of Sup Temporal Gyrus (Heschi’s Gyrus)

Wernicke’s area – Post portion of area 22 of superior Temporal Gyrus

Broca's area: located in frontal lobe near primary motor cortex

• speech
• puts together info in front of brain on what you want to say
• coordinating the control of speech (speed of mouth, tongue movements, tone of voice, volume, etc)

connects Broca's area and Wernicke's area, carrying communication btwn them

verbal diarrhea

• problem with the receiving of language, both spoken and written
• pt can't understand the written and/or spoken word despite intact hearing and vision
• pt's speech is illogical sequence of words, though you might be able to pick out the intent - pt is unable to self-monitor this logorrhea
• a construction, not production, problem
• pt knows she's not making sense, so it's pretty frustrating for her

ask pt to read a word on a flashcard or read a written passage

ask pt to asociate  word w a picture on a card ("is this a pic of a bird?")

• say "point to..." the door, window, etc
• say "repeat what I say"

inability to recognize speech sounds or comprehend the spoken word

• Broca's aphasia
• non-fluent aphasia

• inability to produce word or words, but no problem with motor apparatus of speech
• pt will appear to hesitate, try to adjust for errors
• ranges from small word problems to complete loss of speech
• HOWEVER can comprehend just fine, so the pt will be aware of her sounds and be hesitant to hopen her mouth
• common in pt's w CVA

• automatic language is usually in tact (ie singing)
• can't write, can paint

• pt appears to know what to say but can't get words out
• test: listen to speach repetoir and ask pt to repeat what you say

• ask pt to write a thought or phrase
• pt may have agraphia

• seen in pts w Broca's aphasia
• can't write or print words despite strength and coordination in UE intact

both systems - Wernicke's and Broca's affected, so it's a combo of sensory and expressive aphasia

• a large cortical lesion (MCA)
• hemiparesis
• ability to gesture

• communication w gestures: test this w observation of whether pt understands your gestures.
• pt may not be able to intentionally formulate and respond w gestures, but may be able to make spontaneous meaningful gestures (pointing to water when thirsty)

discruption of arcuate fasciculus

• (pretty rare)
• speech is intact
• primary deficit is seen in repetition, paraphasias (reordering words or switching first letters of words), and substitutions (umbrella where she meant elevator)

ask pt to repeat a series of words, gradually increasing the difficulty