Aphasia 1

Aphasia 1

1. BRAIN

   • Cerebrum = big outer bits, L & R Hemispheres
     • Corpus Callosum (hard body) joins the two halves
     • Outer surface is cortex, made of grey matter
       • Sulci = groves
       • gyri = folds
   • FRONTAL: Voluntary movement, planning S&L production & understanding
     • Contains BROCA's A (44/45): Sentence production & understanding
       • Located in 3rd frontal convolution anterior to the pre-central gyrus - proximal to the pre-motor strip
       • "There is still some controversy about anotomical underpinnings of Broca's area" (Damasio, 2001, p.25)
     • Contains MOTOR CORTEX (4): Sends motor commands to body, including lips and tongue
   • TEMPROAL LOBE: Auditory perception & processing
     • Contains WERNIKE's AREA (42/22): Analysis auditory stimuli, plus comprehension of words and sentences
   • PARIETAL: Body awareness, touch, space perception
   • OCCIPITAL: Visual perception & processing
   • IMAGING
     • Computerised Tomography (CT) - path. indicated by by alterations in expected denisty. Infarct = decreased, haemorrhage = increased dens.
     • Cerebral angiography - X-ray with iodine fluid
     • Magnetic Resonance Imaging (MRI) Magnet manipulates spin of hydrogen mollecule. Superior to CT
       • Diffusion weighted imaging
         • Perfusion weighted imaging
       • fMRI (Functional MRI) diff oxygen levels in brain - regions activated whislt performing an activity.

2. Language Localisation

   • Anteriorly = Broca's
   • Posteriorly = Wernike's
   • Between the two = Arcuate Fasciculus (Curved bundle)
     • Connects posterior receptive areas with pre-motor / motor areas
   • Localisation hypothesis is disputed
   • DOUBLE DISSOCATION = Where one group produces a deficit in a task, but no deficit in another task, whilst another group produces the opposite pattern
   • Aphasic patients have diff dissociations e.g anomia vs agrammatism
   • Patterns between type of deficit and lesion sites

3. APHASIA

   • Manefestations will alter depending on aetiology
     • TBI
     • STROKE
     • PPA
     • Dementia
     • Parkinson's / Huntington's
     • MS
     • Tumour
   • Gershwind Model
   • TYPES
     • NON-FLUENT: Damage to frontal lobe / Broca's areas
       • Shorter sentences
       • May include Agrammatism of Broca's - Loss of grammatical markers / inflections
         • "Boy um... ladders um ladders... boy tooking um jar"
       • 4-5 words max
       • Prosody comprimised
       • Slow, effortful speech
       • More major lexical items
       • Verbs more affected than nouns
     • FLUENT: Temporal lobe damage / Wernike's areas
       • Longer sentences - WNL
       • Lacking in meaning
       • Fewer content words
       • Jargon Aphasia of Wernike's - Neologisms
         • "And looks like the lugyburgers..."
         • Can also pertain to conduction aph.
       • Good prosody
       • Often poor awareness
   • CLASSIFICATION process
     • 'BOSTON classification system' (Gershwind, Benson, Goodglass & Kaplan)
       • ASSESSMENTS such as:
         • BDAE (Boston Diagnostic Aphasia Examination
         • WAB (Western Aphasia Battery)
           • AQ < 93.8 = aphasic
         • MMSE (Mini - mental state examination) by Folstein, Folstein & McHugh 75)
     • 1. Determine phrase length
       • 2. Determine auditory comprehension skills
         • 3. Determining level of repetition skills
   • May be accompanied by hemiplegia / hemianesthesia
     • homonomous hemianopia

4. 150,000 people in the UK have a stroke every year.

   • 1/3 of people will have COMMUNICATION DIFFS post stroke ((Department of Health 2007) )
     • Half of recovery occurs within the first monht, but can continue up 6 months after and beyond (Greener 08)

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