Aphasia defined, anomia, agnosia, dyslexia

An impairment as a result of acquired brain damage of the capacity to comprehend or express language (input & output)

Multi-modality disorder that results in:

• word-finding
• auditory comprehension
• syntactic
• speech/language formulation
• reading
• writing
• math deficits

Primary refers to:

• 1. Speech content/grammar/effort
• 2. auditory comprehension
• 3. word finding
• 4. repetition ability

Secondary refers to:

• 1. reading
• 2. writing
• 3. math
• 4. gesturing

Nearly all aphasics have both expressive and receptive problems to varying degrees.

Expressive aphasics: Refers to the difficulties with the speech/language output

Receptive aphasics:  Aphasics refer to the aphasic w/ problems in auditory comprehension & reading comprehension.

If you use these terms, you should qualify both terms when describing an individual aphasic (e.g. mild expressive & moderate receptive)

SLPs use the term nonfluent and fluent to lessen the confusion.

Speech/language output tends to consist of word selection dominated by substantive words, nouns & main verbs.

Hallmark features:  

Omission of grammatical markers (articles, prepositions, tense markers, adjectives, adverbs).

Marked speaking efforts  (struggle, awkward articulation, slow speaking rate)

Short phrase length (avg. 4 words or less)

Word-finding difficulties

Includes:  Broca's aphasia, Transcortical Motor Aphasia, Mixed Transcortical and Global.

Speech/Language produced with:

• Normal to near-normal articulation
• Accurate to near-accurate grammar
• Normal rhythm/prosody
• Frequent word-finding errors
• Average phrase length of 5 words or more

Fluent aphasias include:  Wernicke's Aphasia, Anomic aphasia, Transcortical Sensory Aphasia, Conduction Aphasia

Refers to aphasia in a right-handed individual resulting from right CVA.  This occurs in less than 1-2% of right-handed individuals (who are right-brain dominant for language).

Is defined as difficulty in word retrieval.

Word finding errors in aphasics are often classified as paraphasic errors (incorrect word and/or sound substitutions)

There are 3 types

• 1. Verbal or semantic paraphasics
• 2. Literal or phonemic aphasics
• 3. Neologisms

Other anomic errors: hesitating, circumlocution, and jargon.

Are related to word substitutions.

These word substitutions bear relationship to the intended word and usually being from the same semantic category or superordinate (category) name.

Examples:  "Fork" for spoon, "Key" for door, "Animal" for dog.

Unrelated verbal paraphasias:  Word substitution that does not bear semantic relationship to the intended word.  Example:  "Door" for Flower.

Are sound substitutions in a given word.

Example:  "Bable" for table, "spork" for fork.

Occurring in the context of nonfluent versus fluent aphasias may occur for different underlying reasons (phonetic vs. phonemic bias, respectively), but may present on the surface as the same form (e.g. 'bable' for 'table')

Is an unrecognized word.

Example:  'Flinger' for pen

50% or more of the intended sounds in a given word are in error the production is classified as as neologism rather than a literal paraphasic.

Therefore, 'ko' for 'no' is a neologism, but 'telarvision' for 'television' is not.

A significant hesitation that marks difficulty or slowness in a word retrieval.

Circumlocution is the use of a description, definition, or sound effect in place of the intended word.  They are signs of adequate access of the semantic lexicon but not the phonologic lexicon.

Jargon is a lengthy, fluently articulated utterance which makes no sense.  Related w/ paraphasic errors.  

There are two major types:

• 1. Phonemic/neologistic
• 2. Semantic

Is mostly unintelligible compilation of neologisms.

Contains a preponderance of semantic paraphasias and circumlocutions so numerous that the utterance do not make sense semantically.

Term used to describe a restricted form of verbal output in very severe aphasics

Verbal stereotypies may be neologisms ('waza, waza') or real words/phrases ('no,no,no' or 'I come') and uttered by the aphasic patient repeatedly for all or most speech attempt.

Found in nonfluent aphasics

Refers to a language pattern in which auxillary verbs, articles, tense markers, prepositions, adjectives, and adverbs tend to be omitted leaving predominantly content words (nouns, pronouns, and main verbs)  These content words may or may not be paraphasias.

The speech of agrammatic aphasias is often referred to as telegraphic due to its cryptic nature.

May be found in fluent aphasics

Language refers to misuse of grammatical markers rather than outright omission.

Example: "Mother are madeing a cake."

In the context of brain damage refers to acquired reading deficits (as opposed to developmental dyslexia in children)

There are 4 types of central dyslexia:

• 1. Phonologic or Visual Dyslexia
• 2. Surface Dyslexia
• 3. Deep Dyslexia
• 4. Direct Dyslexia

AKA Phonologic Dyslexia

Results from a deficit in visual information processing

Typically associated with developmental dyslexia problems where letters or words are misperceived (e.g. 'bug' for 'dug' or 'angle' for 'angel')

Usually the errors are produced as other real words

Key to identifying this type is that the patient has near inability to read psuedowords.

High frequency (more familiar) words are read more accurately than low frequency words.

Patients rely on the intact visual lexicon to perform the reading & thus errors produced look like intended word in some respect but sound different.

Results from loss of whole word visual recognition & the patient must rely on the phonological reading route.

Individuals perceive the letter correctly but their phonologic representation is disrupted

Key to distinguishing between a surface and visual dyslexic is that the surface dyslexic can read regular pseudowords and the visual dyslexic cannot.

Both surface & visual can can coexist in aphasics.  But if surface is the only form it usually is in the context of fluent  aphasia (left posterior form).

Results from a failure to accurately retrieve the correct word from the phonological lexical store.

The word read is semantically related to the target word (e.g. 'table' to 'chair')

Often will see visual dyslexic errors also in the reading of aphasics w/ deep dyslexia, and function words (prepositions, articles, conjunctions, etc.)

Are often read more inaccurately than words (nouns & verbs)

Often associated w/ progressive dementia such as in Alzheimer's Disease.

Is generally intact oral (out loud) reading of psuedowords, regular words, and irregular words, but w/ little or no comprehension.

Perform reading on a letter-by-letter basis.

Recognize letters but do not usually recognize the word as a whole.

Often read letters out loud one by one & then recognize the word they have spelled out loud (e.g. 'b'-'l'-'u'-'e'----blue)

May be seen in the syndrome of alexia without agraphia.

Writing disorder

Such disorders may include difficulty w/ letter formation, spelling, sentence structure (grammar) or semantics (word substitution)

e.g. 'cigeer' for 'cigarette', 'knik' for 'knife', 'toothbanse' for 'toothpaste'

Disturbance in numerical computational skills.

Result from an inability to visually perceive the number correctly, inability to write, inability to add/subtract, etc. or misalignment/inversion of numbers in multi-digit calculation.

Occurs frequently in aphasic populations & are very rare in relatively pure form.

Is simply defined as the failure to recognize (what something/someone is)

3 main types of agnosia in terms of the sensory modality in which they present:

• 1. Visual agnosia
• 2. Tactile agnosia
• 3. Auditory agnosia

Occurs when a personal fails to recognize a visual stimulus

Ex:  Set of 2 objects, asked patients to point to one (e.g. cup) & they respond w/ "there's not a cup there" (you must have ruled out problems w/ auditory comprehension)

More extreme examples:  Not visually recognize spouse or even of themselves.

Prosopagnosia:  Disorder of failure to recognize face when other visual recognition (i.e. of objects) is intact.

Less severe forms of visualagnosia may include the inability to match a pictured object to a real object (but the ability to match two real objects)

The inability to recognize object by touch.

Is the inability to recognize sounds.

In such a condition speech may sound like gibberish to the patient.

They may also not recognize environmental sounds such as ringing phone or a knock of the door.

Aphasia: A performance of language competency or language performance?

Language performance is your production of speech/language & your understanding or comprehension of what hear or read.

Most aphasics present as problems w/ language performance rather than language competence to varying degrees.

If underlying knowledge were lost the aphasic could never given the task correctly.

Aphasia:  A problem of language comprehension or language performance?

Language Competency is your acquired, fact knowledge of phonology, morphology, syntax, semantics, and pragmatics.

If aphasia were a problem w/ competency then it is assumed that the rules governing the components of language may be lost.  If such rules were lost then the aphasic individual would be totally incapable of the correct language performance.

Such is not the case expect, may be in the case of some chronic global aphasic.

Is a form of aphasia in which the person has overt expressive problems in speech/language production and writing.

Person may have fluent or nonfluent speech, but vary in the degree of word-finding difficulties, grammatical errors & agrahia.

Having varying degrees of auditory comprehension & reading comprehension deficits.

Wernicke's Aphasia

Anomic Aphasia

Transcortical Sensory Aphasia

Conductive Aphasia

Broca's Aphasia

Transcortical Motor Aphasia

Mixed Transcortical Aphasia

Global Aphasia

Broca's: Nonfluent, Mild-moderate auditory impairment, mild-moderate naming impairment, mild-sever repetition impairment.

Wernicke's: Fluent, Moderate-severe auditory impairment, moderate-severe naming impairment, moderate-severe repetition impairment.

Conduction: fluent, mild-moderate auditory impairment, mild-severe naming impairment, moderate-severe repetition impairment.

Transcortical Motor: Non-fluent, mild-moderate auditory impairment, mild-severe naming impairment, mild-moderate repetition impairment.

Transcortical Sensory: fluent, moderate-severe auditory impairment, moderate-severe naming impairment, mild-moderate repetition impairment.

Mixed Trans-cortical: Nonfluent, moderate-severe auditory impairment, Moderate-severe naming impairment, mild-moderate repetition impairment.

Anomic: fluent, mild-moderate auditory impairment, mild-severe naming impairment, mild repetition impairment.

Global: Nonfluent, severe auditory impairment, severe naming impairment, severe repetition impairment.