wernicke’s & broca's aphasia brain & language ling 411/412/489 nsci 411/611/489/689...

Wernicke’s & Broca's aphasia

Brain & Language

LING 411/412/489

NSCI 411/611/489/689

Harry Howard

Tulane University

Wernicke’s aphasia

aka posterior aphasia

aka receptive aphasia

04/18/23 Brain & Language, Harry Howard, Tulane University 3

Introduction

Imagine your favorite doctor joke. They usually begin with “a guy walks into a

doctor’s office …”Now imagine that the guy, or woman, is a

patient with Wernicke’s aphasia …


Short samples of Wernicke’s aphasiaClinician: “Tell me where you live.”Patient: “Well, it’s a meender place and it has two …

two of them. For dreaming and pinding after supper. And up and down. Four of down and three of up …” (Brookshire 2003:155)

Clinician: “What’s the weather like today?”Patient: “Fully under the jimjam and on the

altigrabber.” (Brookshire 2003:155)

What is broken? What is preserved?


A long sample of Wernicke’s aphasiaPatient is asked what brought him to the hospital.“Is this some of the work that we work as we did

before? … All right … From when wine [why] I’m here. What’s wrong with me because I … was myself until the taenz took something about the time between me and my regular time in that time and they took the time in that time here and that’s when the the time took around here and saw me around in it’s started with me no time and I bekan [began] work of nothing else that’s the way the doctor find me that way…” (Obler & Gjerlow 1999:43)


Phonemic paraphasia & neologismErrors in the selection of phonemes include addition, omission,

or change in position. For instance, Damasio (1992:535) cites trable for table pymarid for pyramid.

Clearly, the more such phonemic paraphasias accumulate in a word, the harder it is to understand it, to the extent that the intended word may become unidentifiable.

This is the point of neologism, illustrated in another of Damasio’s examples: hipidomateous for hippopotamus.

Patients with severe Wernicke’s aphasia may produce strings of neologisms with a sprinkling of connecting words, known as jargon


Wernicke's aphasia on YouTube

http://www.youtube.com/watch?v=B-LD5jzXpLE


Semantic paraphasia

A patient with damage to Wernicke’s region may also fail to select the proper words with which to convey her ideas, though this deficit can be compensated for by the usage of paraphrases.

Such semantic paraphasias (or empty speech) are often quite simple, such as relying on generic terms like thing or stuff to stand in for the more specific words that do not spring to mind.

Other times, they become quite elaborate. Kandel (1995:640) cites the example of a Wernicke’s patient who was asked

where he lived and answered: “I came there before here and returned there.” “A patient with moderate Wernicke’s aphasia was attempting to explain what

he had done on a shopping trip the previous day. He concluded with, ‘I went down to the thing to do the other one and she was only the last one that

ever did it, so I never did.’” (Brookshire 2003:155)


Circumlocution

Some Wernicke’s patients talk around missing words, a behavior called circumlocution.

A patient with moderate Wernicke’s aphasia was attempting to tell the examiner what she had had for breakfast that morning:

Patient: “This morning for – that meal – the first thing this morning – what I ate – I dined on – chickens, but little – and pig – pork – hen fruit and some bacon, I guess.” (Brookshire 2003:156)


Wernicke's aphasia on YouTube

http://www.youtube.com/watch?v=aVhYN7NTIKU


Logorrhea, press of speech

The ease with which Wernicke’s patients produce speech, their circumlocution, and their deficient self-monitoring may contribute to their inclination to run on when they talk.

Such an overabundance of speech is referred to as logorrhea or press of speech.

Clinician: “Tell me what you do with a comb.”


Logorrhea, press of speech

Patient: “What do I do with a comb … what I do with a comb. Well a comb is a utensil or some such thing that can be used for arranging and rearranging the hair on the head both by men and by women. One could also make music with it by putting a piece of paper behind and blowing through it. Sometimes it could be used in art – in sculpture, for example, to make a series of lines in soft clay. It’s usually made of plastic and usually black, although it comes in other colors. It is carried in the pocket or until it’s needed, when it is taken out and used, then put back in the pocket. Is that what you had in mind?” (Brookshire 2003:155)


Reading

Reading can also be disrupted?Why?

Because reading connects to speech for the pronunciation of letters and the storage of words


Aphasia checklist: Wernicke’s

a) comprehension of spoken materialb) comprehension of written materialc) segmental phonology d) word selectione) word semanticsf) fluency (production of speech)g) production of writingh) use function wordsi) grammaticalityj) repetition of what others sayk) conversational proficiency, e.g. turn takingl) concern about impairmentm) concern about errorsn) short-term retention & recall of verbal materials

a) impaired, mild to severeb) impairedc) impaired: phonemic paraphasia, neologism, jargon

d) impaired: circumlocutione) impaired: semantic paraphasia, empty speechf) (overly) fluent: logorrheag) normalh) normali) normal or mildly impaired: paragrammatismj) impaired: (no evidence)k) normall) little to nonem) little to nonen) impaired: (no evidence)


The effect of WA on cerebral function

LH RH

Anteriorgrammatical rules

function wordsconversational rules? motivation to speak?

Posteriorconvergent word semantics

categorical phonology

divergent word semantics

coordinate phonology


Broca's aphasia

aka expressive aphasiaaka anterior aphasiaaka agramamtic aphasia


Describe this picture (silently!)


Broca's aphasia sample #1Examiner: Describe this picture.Patient: kid … kk … can … cookie … caandy …well I don’t

know but it’s writ … easy does it … slam … early … fall … men … many … no … girl. Dishes … soap … water … … water … falling pah that’s all … dish … that’s all. Cookies … can … candy … cookies cookies … he … down … That’s all. Girl … slipping water … water … and it hurts … much to do. Her … clean up. Dishes … up there … I think that’s doing it

Examiner: What is she doing with the dishes?Patient: discharge no … I forgot … dirtying clothes [?] dish

{?} water … Examiner: What about it?Patient: slippery water … [?] scolded … slipped


Broca's aphasia sample #2

Examiner: Describe this picture.Patient: uh … mother and dad … no …

mother … dishes … uh … runnin[g] over … water … and floor … and they … uh … wipin[g] dis[h]es … and … uh … two kids … uh … stool … and cookie … cookie jar … uh … cabinet and stool … uh … tippin[g] over … and … uh … bad … and somebody … gonna get hurt.


Broca's aphasia on YouTube

Broca's aphasia (1)Broca's aphasia (2)


Background: word classes

Content wordsnounverbadjectiveadverb

Function wordsarticledemonstrativeconjunction

coordinatingsubordinating

pronounpreposition


Background: morphology

Inflectionalnoun

pluralverb

present and past tensespresent and past participles

adjectivecomparative, superlative

Derivationalun-, -ify, etc., etc


Breakdowns in grammar

Breakdown in morphologyPatients express nouns in the singular and verbs in the

infinitive or participle

Breakdown in modifying parts of speechPatients often eliminate articles, adjectives, and adverbs

altogether. Instead of saying “I saw some large gray cats”, a patient

with Broca’s aphasia might say “see gray cat”.


The overall result

All this leads to a breakdown in syntax For the sentence, “Ladies and gentlemen, you are now invited into the

dining room”, a patient with Broca’s aphasia may only be able to say “Ladies, men, room.”

When asked his occupation, a mailman with Broca’s aphasia said “Mail … mail … m ….”

The examples are remarkable in that they appear to be constructed almost entirely by juxtaposition of isolated words.

They are practically devoid of the markers of grammatical relationships that bind together normal English – with the exception of and.

They also involve distortion of word order. Damasio, 1992, p. 533, cites the attempt of a Broca’s aphasiac to express I

will go home tomorrow coming out as Go I home tomorrow. Altogether, this is called agrammatism or telegraphic speech


Reversible sentences

The (b) sentences of each pair are difficult for Broca's patients to understand compared to the (a) sentences:

1a) The boy ate the apple. 1b) The clown chased the violinist. 2a) The cop shot the robber. 2b) The robber was shot by the cop. 3a) It was the cop who __ shot the robber. 3b) It was the robber who the cop shot __.


Repetition of one's own speech

The most famous case is that of Broca’s first patient, who could only say the (French) word "tan", which he repeated often, and so was known as "Tan".

Uncontrollable repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, usually caused by brain injury or other organic disorder.

This is know as perseveration.


Summary of main symptoms

Impaired production of speech mild: non-fluent severe: Broca’s Tan (perseveration)

Non-fluent speech: effortful: slow, deliberate, halting, with pauses between words and even

syllables, false starts misarticulated: distorted consonants and vowels, called phonetic

dissolution Laconic speech:

short utterances with few function words (agrammatism or telegraphic speech)

Good short-term retention & recall of verbal materials may generalize treatment skills & strategies to daily life

Great concern about their impairment and the errors they make


Broca's aphasia checklist

a) comprehension of spoken materialb) comprehension of written materialc) segmental phonology d) word selectione) word semanticsf) fluency (production of speech)g) production of writingh) use function wordsi) grammaticalityj) repetition of what others sayk) conversational proficiency, e.g. turn takingl) concern about impairmentm) concern about errorsn) short-term retention & recall of verbal materialso) other

a) normalb) normalc) impaired: phonetic dissolutiond) normale) normalf) impaired: mild to severe (perseveration)g) impairedh) impaired: agrammatism or telegraphic speechi) impairedj) impaired (no evidence)k) normall) yesm) yesn) normalo) --

wernicke’s & broca's aphasia brain & language ling 411/412/489 nsci 411/611/489/689...

Documents

wernickes aphasia slide

wernickes patient

severe wernickes aphasia

moderate wernickes aphasia

receptive aphasia slide

posterior aphasia

wernickes region

ld5jzxple slide