Good Morning, and Welcome to Neurology Grand Rounds here at Blogmocracy General Hospital. Today’s Topic is Aphasia in general and Wernicke’s Versus Broca’s Aphasia in particular. Please enjoy the snacks and macaroni art provided by the residents of Bedlam in the main hall as you leave for Grand Rounds.
First is a bulletin from the NIH for background:
This is your Brain:
… 
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Now, the bulletin.
What is aphasia?
Aphasia is a disorder that results from damage to portions of the brain that are responsible for language. For most people, these are areas on the left side (hemisphere) of the brain. Aphasia usually occurs suddenly, often as the result of a stroke or head injury, but it may also develop slowly, as in the case of a brain tumor, an infection, or dementia. The disorder impairs the expression and understanding of language as well as reading and writing. Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage.
Who has aphasia?
Anyone can acquire aphasia, including children, but most people who have aphasia are middle-aged or older. Men and women are equally affected. According to the National Aphasia Association, approximately 80,000 individuals acquire aphasia each year from strokes. About one million people in the United States currently have aphasia.
What causes aphasia?
Aphasia is caused by damage to one or more of the language areas of the brain. Many times, the cause of the brain injury is a stroke. A stroke occurs when blood is unable to reach a part of the brain. Brain cells die when they do not receive their normal supply of blood, which carries oxygen and important nutrients. Other causes of brain injury are severe blows to the head, brain tumors, brain infections, and other conditions that affect the brain.
What types of aphasia are there?
There are two broad categories of aphasia: fluent and non-fluent.
Damage to the temporal lobe (the side portion) of the brain may result in a fluent aphasia called Wernicke’s aphasia (see figure). In most people, the damage occurs in the left temporal lobe, although it can result from damage to the right lobe as well. People with Wernicke’s aphasia may speak in long sentences that have no meaning, add unnecessary words, and even create made-up words. For example, someone with Wernicke’s aphasia may say, “You know that smoodle pinkered and that I want to get him round and take care of him like you want before.” As a result, it is often difficult to follow what the person is trying to say. People with Wernicke’s aphasia usually have great difficulty understanding speech, and they are often unaware of their mistakes. These individuals usually have no body weakness because their brain injury is not near the parts of the brain that control movement.
A type of non-fluent aphasia is Broca’s aphasia. People with Broca’s aphasia have damage to the frontal lobe of the brain. They frequently speak in short phrases that make sense but are produced with great effort. They often omit small words such as “is,” “and,” and “the.” For example, a person with Broca’s aphasia may say, “Walk dog,” meaning, “I will take the dog for a walk,” or “book book two table,” for “There are two books on the table.” People with Broca’s aphasia typically understand the speech of others fairly well. Because of this, they are often aware of their difficulties and can become easily frustrated. People with Broca’s aphasia often have right-sided weakness or paralysis of the arm and leg because the frontal lobe is also important for motor movements.
Another type of non-fluent aphasia, global aphasia, results from damage to extensive portions of the language areas of the brain. Individuals with global aphasia have severe communication difficulties and may be extremely limited in their ability to speak or comprehend language.
There are other types of aphasia, each of which results from damage to different language areas in the brain. Some people may have difficulty repeating words and sentences even though they can speak and they understand the meaning of the word or sentence. Others may have difficulty naming objects even though they know what the object is and what it may be used for.
How is aphasia diagnosed?
Aphasia is usually first recognized by the physician who treats the person for his or her brain injury.Frequently this is a neurologist. The physician typically performs tests that require the person to follow commands, answer questions, name objects, and carry on a conversation. If the physician suspects aphasia, the patient is often referred to a speech-language pathologist, who performs a comprehensive examination of the person’s communication abilities. The examination includes the person’s ability to speak, express ideas, converse socially, understand language, read, and write, as well as the ability to swallow and to use alternative and augmentative communication.
How is aphasia treated?
In some cases, a person will completely recover from aphasia without treatment. This type of spontaneous recovery usually occurs following a type of stroke in which blood flow to the brain is temporarily interrupted but quickly restored, called a transient ischemic attack. In these circumstances, language abilities may return in a few hours or a few days.
For most cases, however, language recovery is not as quick or as complete. While many people with aphasia experience partial spontaneous recovery, in which some language abilities return a few days to a month after the brain injury, some amount of aphasia typically remains. In these instances, speech-language therapy is often helpful. Recovery usually continues over a two-year period. Many health professionals believe that the most effective treatment begins early in the recovery process. Some of the factors that influence the amount of improvement include the cause of the brain damage, the area of the brain that was damaged, the extent of the brain injury, and the age and health of the individual. Additional factors include motivation, handedness, and educational level.
Aphasia therapy aims to improve a person’s ability to communicate by helping him or her to use remaining language abilities, restore language abilities as much as possible, compensate for language problems, and learn other methods of communicating. Individual therapy focuses on the specific needs of the person, while group therapy offers the opportunity to use new communication skills in a small-group setting. Stroke clubs, regional support groups formed by people who have had a stroke, are available in most major cities. These clubs also offer the opportunity for people with aphasia to try new communication skills. In addition, stroke clubs can help a person and his or her family adjust to the life changes that accompany stroke and aphasia.
Family involvement is often a crucial component of aphasia treatment so that family members can learn the best way to communicate with their loved one.Family members are encouraged to:
- Simplify language by using short, uncomplicated sentences.
- Repeat the content words or write down key words to clarify meaning as needed.
- Maintain a natural conversational manner appropriate for an adult.
- Minimize distractions, such as a loud radio or TV, whenever possible.
- Include the person with aphasia in conversations.
- Ask for and value the opinion of the person with aphasia, especially regarding family matters.
- Encourage any type of communication, whether it is speech, gesture, pointing, or drawing.
- Avoid correcting the person’s speech.
- Allow the person plenty of time to talk.
- Help the person become involved outside the home. Seek out support groups such as stroke clubs.
Other treatment approaches involve the use of computers to improve the language abilities of people with aphasia. Studies have shown that computer-assisted therapy can help people with aphasia retrieve certain parts of speech, such as the use of verbs. Computers can also provide an alternative system of communication for people with difficulty expressing language. Lastly, computers can help people who have problems perceiving the difference between phonemes (the sounds from which words are formed) by providing auditory discrimination exercises.
What research is being done for aphasia?
Scientists are attempting to reveal the underlying problems that cause certain symptoms of aphasia. The goal is to understand how injury to a particular part of the brain impairs a person’s ability to convey and understand language. The results could be useful in treating various types of aphasia, since the treatment may change depending upon the cause of the language problem.
Other research is attempting to understand the parts of the language process that contribute to sentence comprehension and production and how these parts may break down in aphasia. In this way, it may be possible to pinpoint where the breakdown occurs and help in the development of more focused treatment programs.
Although different languages have many things in common when specific portions of the brain are injured, there are also differences. Scientists are trying to understand the common (or universal) symptoms of aphasia and the language-specific symptoms of the disorder. Other researchers are examining whether people with aphasia may still know their language but have difficulty accessing that knowledge. These studies may help with the development of tests and rehabilitation strategies that focus on specific characteristics of one language or multiple languages.
Researchers are exploring drug therapy as an experimental approach to treating aphasia. Some studies are testing how drugs can be used in combination with speech therapy to improve recovery of various language functions.
Researchers are also looking at how treatment of other cognitive deficits involving attention and memory can improve communication abilities.
To understand recovery processes in the brain, some researchers are using functional magnetic resonance imaging (fMRI) to better understand the human brain regions involved in speaking and understanding language. This type of research may improve understanding of how these areas reorganize after brain injury. The results could have implications for both the basic understanding of brain function and the diagnosis and treatment of neurological diseases.
Now onto something even more interesting:
Presentation
When we want to speak, we formulate what we are going to say in Wernicke’s area, which then transmits our plan of speech to Broca’s area, where the plan of speech is carried out[citation needed]. Wernicke’s Area is located posterior to the lateral sulcus, typically in the left hemisphere, between the visual, auditory, and somesthetic areas of the cerebral cortex. A person with this aphasia speaks normally but uses random or invented words; leaves out key words; substitutes words or verb tenses, pronouns, or prepositions; and utters sentences that do not make sense. They have normal sentence length and intonation but without true meaning. They can also have a tendency to talk excessively. A person with this aphasia cannot understand the spoken words of others or read written words. Speech is preserved, but language content is incorrect. Substitutions of one word for another (paraphasias, e.g. “telephone” for “television”) are common. Comprehension and repetition are poor.[citation needed]
Patients who recover from Wernicke’s aphasia report that, while aphasic, they found the speech of others to be unintelligible. And, despite being cognizant of the fact that they were speaking, they could neither stop themselves nor understand their own words.[citation needed]
The ability to understand and repeat songs is usually unaffected, as these are processed by the opposite hemisphere. Melodic intonation therapy (MIT) has been pursued for some years with aphasic patients under the belief that it helps stimulate the ability to speak normally. There is some question as to the effectiveness of MIT.[3] But more recent, and more rigorously conducted, research has revealed that MIT can be very effective at recovering language function.[4]
Patients also generally have no trouble purposefully reciting anything they have memorized. The ability to utter profanity is also left unaffected, however the patient typically has no control over it, and may not even understand their own profanity.
Damage to the posterior portion of the left hemisphere’s superior and middle temporal lobe or gyrus and the temporoparietal cortex can produce a lesion to Wernicke’s area and may cause fluent aphasia, or Wernicke’s aphasia. If Wernicke’s area is damaged in the non-dominant hemisphere, the syndrome resulting will be sensory dysprosody — the inability to perceive the pitch, rhythm, and emotional tone of speech.
Patients who communicated using sign language before the onset of the aphasia experience analogous symptoms.[5]
The symptoms of Wernicke’s Aphasia reveal how important language is because people with the aphasia cannot express their thoughts. Some patients with the disorder do find a way to overcome this road block, and use facial expression and motor gestures to communicate instead.
WOW, just what I needed on a Saturday morning with a hangover! How dare you make me think CW?
Well now that we’ve gotten past Black Friday, I guess it’s only fitting that we have White Saturday. Or would that be raaaaacist?
AZOlddog wrote:
suck it up and drive on!
Captain Nick Crews unloads on his idiot children:
The Email:
I think the worst hangover I ever had was on my 22nd birthday in Thailand. There was a bunch of us that went down to a restaurant in a little village called Bon Chon. We invited a bunch of our Thai troops and they were most generous with the rice whiskey called Mekong. They refused to let my glass go empty. We were munching on various Thai delicacies, one of which was water buffalo beef jerky. I don’t remember how I got back to the base, but the next morning I woke up and there was water buffalo beef jerky all over the sheets and floor. The house girl was pissed.
@ coldwarrior:
@ coldwarrior:
Glad Capt’n Nick got that off his shoulders. I have a sister who’s brood is exactly as described above. A bunch of whahoos.
@ coldwarrior:
looks like his son is an ass:
freddy, my boy, you need a swift kick in the gob.
wife sez that if i go with her for a quick trip to the store, we can go here:
Quaker Steak and Lube
@ coldwarrior:
The Thai wings are pretty good.
Bumr50 wrote:
Beware the water buffalo beef jerky.
@ huckfunn:
And rice liquor.
Not a fan of sake, so I’m sure “rice whiskey” would be worse.
Actually, Mekong is a deceptively smooth drink. You only understand how deceptive it is when you wake up the next day.
What a frustrating condition.
Nice example of “word salad.”
Thanks for the brain jolt this morning CW.
Well. I am going to shower up and slide on down to the Sportbar in Wiesbaden that will allow me to watch my beloved Buckeyes curb stomp TTUN live. Will take the laptop as they have free wireless.
Hope the Irish do the same to USC, but it will way past my bed time to stay up for that.
Enjoy the T-day leftovers!
coldwarrior wrote:
I recall going to one of those in Grand Rapids, but I think I just had the lube.
A family friend’s mother had dementia. Never swore in her life until her mental state started to decay and then it was every other word. I kid you not. I heard her on the phone once and it was the most creative cussing you can imagine. Hilarious, but sad at the same time. The woman she had been 5 years prior would have been mortified.
@ huckfunn:
One of my brothers in law seems a bit like that. He’s Mrs MF’s older brother, currently making less than $10/hr. It’s not that he’s not smart, or can’t do good work, it’s that he doesn’t want to bother. He (temporarily) had a job selling cars, and I think he would have been good at it, but didn’t bother.
What p*ssed my wife & her younger brother off was how this brother scammed stuff from their mother- borrowing money from what little she had to buy crap they wanted but didn’t need and taking money to do work on her house that never got done. I can’t remember how many IOU’s we found after mom passed, but it was in the thousands of dollars.
@ Buckeye Abroad:
I’ve got mixed feelings about bringing my laptop to a place where I’m drinking.
The wife and I went to a performance of “Jersey Boys” yesterday afternoon. I haven’t had so much fun in years! If you have a chance to see it, do it, you’ll not regret it!
Bumr50 wrote:
That’s why they invented iPads!
@ mfhorn:
My sister’s kids are actually the progeny of her husband’s previous relationships. 4 kids (3 boys, 1 girl), 3 different mothers. The daughter married some guy and had a kid with him. He was useless and she threw him out but had not yet divorced him. She was working at a convenience store and had struck up a relationship with a co-worker. The estranged husband walked into the store and blew away the co-worker and then killed himself. This was 3 or 4 years ago in Arkansas. Pretty rough deal all the way around.
huckfunn wrote:
I feel fortunate, the worst thing in my family (at least the ones that I know) are just oddballs and entertaining eccentrics.
@ huckfunn:
Damn. So sorry to hear that.
@ MacDuff:
Yeah, we’ve got oddballs & eccentrics on both sides here, too. Her aunt has serious issues, and I’ve got a bunch that I haven’t seen in forever that at least from what I’ve heard are pretty strange.
Not like the Mrs & I are completely normal ourselves…
Off to cash my check from working election day, then hit the used bookstore. Maybe put up Christmas decorations later on.
@ MacDuff:
@ mfhorn:
Yep; those kids are pretty damned useless. One of the boys has been kicked out of the Army… twice. I keep reminding myself that they are not blood relatives.
eaglesoars wrote:
While I have no memory of my paternal grandmother, i hear that she did the same thing. always prim and proper (not that she couldn’t be harsh with her 14 children), and then when she got sick she “cursed like a sailor” they said.
there is a local story of an on-air radio personality who, while on the air, a doctor was listening and called the wife or something and insisted they take him to the hospital immediately. turns out it was some sort of brain injury / stroke. quite possibly it was one of these. fascinating and horrifying. i mean, how would you function? especially if you lived alone? you’d turn on the news and they’d be speaking in gibberish. you’d think the world had gone mad! i wonder if this part means that they understood their thoughts, you know, inside their heads before they verbalized them:
@ coldwarrior:
now i’m somewhat inclined to say it’s partially the parents fault. However, it sounds like the kids are all grown into adulthood and it’s now on them. what a nightmare. and i know all about nightmarish families. criminals, drug addicts, the lot of ‘em are related to me. my sisters spoiled their kids rotten and then wonder why they are 1) still living with them (even before the economy was a disaster) and even bringing their whore girlfriends in to live with them (!!!) or 2) living in a house owned by the parents while raising two kids of their own. it’s insanity. the kids never had to work for a damn thing. all they ever had to do was say they wanted it. when that didn’t work, they’d throw a fit and get what they wanted. and the parents wonder why they are not yet productive adults even though they are all between 20 and 30. now, my brothers kids are a completely different story. the daughter did have a baby without bothering to get married but she has a full time job and supports them herself and her child. his two sons are Marines and NOT because they had no other opportunities.
talking to myself, whoa, oh, talking to myself. heh.
like that’s not a normal occurrence.
Caturday is up.