Language areas

¹ Language refers to the vocabulary and syntactic rules needed for communication

¹ Speech refers to the production of spoken language

¹ Dysarthria can be defined as a disturbance in the execution of speech and often occurs without a disorder of language

¹ Aphasia: a disorder of language caused by a defect either the production or the comprehension of vocabulary or syntax. Aphasia appears only if a lesion involves the language areas of the dominant hemisphere

Broca’s area:

û Areas 44 and 45 of Brodmann are larger on the left side in right handers

û Adjacent to the oral motor area of the primary center

û Lesions involving Broca’s area are associated with expressive aphasia (motor aphasia)

a. patient has difficulty in expressing what he/she wants to say

b. speech is labored, slow, and characteristically “telegraphic” in style

c. the patient comprehends what other people are saying and is well aware of being unable to speak fluently

d. an agraphia (inability to express thoughts in writing) is usually associated

Wernicke’s area:

Ø The posterior part in the superior temporal gyrus of the left hemisphere is a sensory area concerned with understanding the spoken word

Ø Wernicke’s aphasia (sensory aphasia):

a lesion in Wernicke’s area is accompanied by a deficit of auditory comprehension. (If the lesion includes the angular gyrus, the ability to read will be compromised.)

patients also lose the ability to monitor their own conversation and usually have difficulty in retrieving correct descriptive name

speech fluency is normal but 2 kinds of abnormalities occurs in the use of nouns:

1) verbal paraphrasia: use of words usually of allied meaning (instead of “use a knife”, “use a fork”)

2) phonemic paraphrasia: use of made-up but similar sounding syllables (instead of “knife and fork”, “ bife and dork”)

the patient may be quite unaware of making mistakes, despite garbling to the point of being unintelligible (jargon aphasia)

Ø Conduction aphasia

results from transection of the arcuate fascicular

is a fluent aphasia associated with poor repetition of spoken language

speech comprehension and expression are relatively good

object-naming is impaired

patient is aware of the deficit

Ø Transcortical aphasia

heard voice can be repeated, but other linguistic functions are impaired

transcortical motor aphasia (syndrome similar to Broca’s aphasia)

transcortical sensory aphasia (syndrome similar to Wernicke’s aphasia)

Questions addressed during the bedside assessment of aphasia:

The bedside test

Questions	Clinical test
Does the patient understand? Is the patient able to talk?   Can the patient repeat? Can the patient read? Can the patient write?	Give verbal commands, ask patient to point to objects. Ask the patient to name objects, describe them, and count. Listen for spontaneous speech. Ask the patient to repeat words. Give commands in writing. Ask the patient to copy or to write dictated words.

Дата добавления: 2015-10-30