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Aphasia Diagnosis with Psycholinguistic Model

What is Aphasia?

Aphasia is defined as a neurological disorder caused by damage to the portions of the brain that are responsible for language production and processing. Damage is more frequently on the left hemisphere and caused by a stroke, but this is not always true.

Identifying Aphasia

  • The Syndrome-Orientated Approach

  • The Psycholinguistic Approach

Problems with Syndrome-Orientated

  • Lesion site classifications can not be easily identified or are inconsistent
  • The same symptoms may occur for different reasons and occur in a variety of syndromes
  • Syndromes don't account for characteristics of impaired function
  • Syndromes are big pictures only, not detailed enough when looking at a person

Psycholingusitc Approach

  • Looks for breakdowns or lesions within the language network
  • Focuses on the individual
  • Requires multiple different testing strategies
  • Therapist works as a detective to find the source of breakdown
  • It's time consuming but more individualistic and detailed

Types of Aphasia

There are many different types of aphasia and ways to diagnosis characteristics of aphasia. It is key to remember that people do not typically fit into nice and neat profiles of aphasia and it is necessary to look at all the signs and symptoms, which is why we use a psycholinguistic model. To identify aphasia we need to look at the 4 language modalities: naming, fluency, repetition, and auditory comprehension...

Broca's

Broca's

  • Awkward Articulation
  • Agrammatism
  • Limited Vocabulary - mostly nouns
  • Good auditory comprehension
  • Reading comprehension mildly impaired
  • Writing impairment matches speech impairment.

Damage to 3rd frontal convolution

Wernicke's

Wernicke's

  • Impaired Auditory Comprehension
  • Fluent speech and good syntax
  • Speech contains multiple paraphasias
  • Writing parallels speech impairment
  • Reading comprehension impaired

Damage to posterior half of first temporal gyrus

Transcortical Motor

  • Repition relatively intact
  • Other production abilities impaired
  • Auditory comprehension spared
  • Word finding difficulties variable to individual
  • Preservation of highly memorized materials

Damage outside broca's area, anterior superior frontal lobe

Transcortical Sensory

  • The same as wernicke's
  • PLUS preservation of repetition

Damage to inferior parietal or connection between parietal and temporal lobes

Conduction

  • Repetition impaired
  • Many phonemic paraphasias
  • Fluency mildly impaired
  • Auditory comprehension mildly impaired
  • Speech may contain conduite d'approche or lots of circumvention

Damage to connection between frontal and temporal lobes, the arcuate fasciculus

Conduction

Anomic

  • Word finding difficulties
  • Fluenct articulation and good syntax
  • Good auditory comprehension
  • Some circumlocutions
  • Reading and writing impairments

Damage looks like a small/mild lesion, maybe in multiple locations

Global

  • All aspects of language impaired
  • Stereotyped utterances
  • May be better at very familiar/frequent/personal information than testing.

Damage to large portion of the perisylvian assocation cortex

The Ellis and Young Model

The Ellis and Young Model

AudiTory Phonological AnalysiS

Job: Parse out the signal

Routes: 1st step in "hearing" a word, connects to both lexical and bypass route.

Lesion Symptoms: Pure-Word Deafness

  • Impaired auditory analysis
  • Impaired speech perception
  • Impaired repetition
  • Good speech production, reading and writing
  • Can hear but do not understand
  • More difficulty with consonants than vowels

Testing to Identify: BDEA-None directly, need to test other boxes in routes. PAL-Phoneme Discrimination. PALPA-Word and Nonword Minimal Pairs

Phonlogocal/Auditory Input Buffer

Job: Identify the sounds/phonemes

Routes: Heard words, for speech or written production.

Lesion Symptoms: Short term memory for holding onto phonemes impaired.

**This box is not represented in textbook/all route diagrahms.

Testing to Identify: PALPA-Digit Span/Matching Span.*

*Tests also used for auditory output buffer

Phonological/Auditory Input Lexicon

Job: Is this a familiar or new/false word? Which route do I take?

Routes: Heard words, to speech or writing.

Lesion Symptoms: Word Meaning Deafness

  • Rare condition
  • Can repeat words but can't understand or write them
  • Intact repetition shows auditory analysis intact
  • Impairment can occur in auditory input lexicon OR connection to semantics

Testing to Identify: BDEA-Auditory Lexical Decision Task. PAL-Auditory Lexical Decision, Auditory Lexical Decision Affixed Words. PALPA-Auditory Lexical Decisions: ImageabilityXFrequency, Auditory Lexical Decision: Morphological Endings.

Semantic System

Job: Pull out learned meaning, IMPORTANT BOX!!!

Routes: Anything needing lexicon, heard, picture, or written.

Lesion Symptoms: Unable to access lexicon/meaning.

  • Deep Dysphasia-semantic errors, impaired function words, *unable to repeat nonsense words too

*Deep Dysphasia occurs when lesions occur both to the semantic system and in the bypass route.

Testing to Identify: BDAE-Basic Word Discrimination, Word Comprehension with Semantic Distractors, Semantic Probe with Pictures. PAL-Auditory Word Picture Matching, Forced-Choice Attribute Verification, Relatedness Judgment Abstract Words, Relatedness Judgment Affixed Words. PALPA-Spoken Word Picture Matching, Auditory Synonymy Judgement. ??-Semantic Probe Questions

Phonological output lexicon

Job: Storage of spoken word forms, do you know what sounds are in this word and how to put them in appropriate sequence?

Routes: In order to say anything/speech production of any input route.

Lesion Symptoms: Impaired word retrieval

  • delays in word retrieval
  • circumlocutions
  • semantic errors
  • phonological errors

Testing to Identify: Picture homophone judgment, rhyme judgment*. *Not a great test.

phonological Output Buffer

Job: Assemble and sequence the phonemes for the word production

Routes: In order to say anything/speech production of any input route.

Symptoms: Affects all spoken word tasks. Lesion here has phonological errors and neologisms. Shorter words may be easier than longer words.

Testing to Identify: Effect of number of syllables on word production tasks.

Acoustic To Phonological Conversion

Job: Avoid semantic system and just hear phonemes and repeat phonemes without lexical meaning.

Routes: Indirect/Bypass Route of Word Repetition

Lesion Symptoms:

Testing to Identify:

Visual Object Recogition System

Job: Picture Recognition

Routes: Picture Naming or Picture Based Reasoning

Lesion Symptoms: Unable to "see" picture.

Would not be able to access the lexicon.

Testing to Identify: PAL-False Animals, Front to Back.

Visual Object Recognition System

Job: Visual object recognition

Routes:

Lesion Symptoms:

Testing to Identify:

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