Wernickes & Broca's
aphasia
Brain & Language
LING 411/412/489
NSCI 411/611/489/689
Harry Howard
Tulane University
Wernickes aphasia
aka posterior aphasia
aka receptive aphasia
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Introduction
Imagine your favorite doctor joke.
They usually begin with a guy walks into a
doctors office
Now imagine that the guy, or woman, is a
patient with Wernickes aphasia
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Short samples of Wernickes
aphasia
Clinician: Tell me where you live.
Patient: Well, its 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: Whats the weather like today?
Patient: Fully under the jimjam and on the
altigrabber. (Brookshire 2003:155)
What is broken? What is preserved?
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A long sample of Wernickes
aphasia
Patient 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] Im
here. Whats 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 thats when the the time
took around here and saw me around in its started
with me no time and I bekan [began] work of nothing
else thats the way the doctor find me that way
(Obler & Gjerlow 1999:43)
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Phonemic paraphasia &
neologism
Errors 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
Damasios examples:
hipidomateous for hippopotamus.
Patients with severe Wernickes aphasia may produce strings
of neologisms with a sprinkling of connecting words, known
as jargon
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Wernicke's aphasia on
YouTube
http://www.youtube.com/watch?v=B-
LD5jzXpLE
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Semantic paraphasia
A patient with damage to Wernickes 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 Wernickes patient who was asked
where he lived and answered:
I came there before here and returned there.
A patient with moderate Wernickes 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)
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Circumlocution
Some Wernickes patients talk around missing words,
a behavior called circumlocution.
A patient with moderate Wernickes 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)
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Wernicke's aphasia on
YouTube
http://www.youtube.com/watch?v=aVhYN7N
TIKU
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Logorrhea, press of speech
The ease with which Wernickes 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.
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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. Its usually made of plastic and usually black, although
it comes in other colors. It is carried in the pocket or until its
needed, when it is taken out and used, then put back in the
pocket. Is that what you had in mind? (Brookshire 2003:155)
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Reading
Reading can also be disrupted?
Why?
Because reading connects to speech for the
pronunciation of letters and the storage of words
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Aphasia checklist: Wernickes
a) comprehension of spoken material
b) comprehension of written material
c) segmental phonology
d) word selection
e) word semantics
f) fluency (production of speech)
g) production of writing
h) use function words
i) grammaticality
j) repetition of what others say
k) conversational proficiency, e.g. turn taking
l) concern about impairment
m) concern about errors
n) short-term retention & recall of verbal materials
a) impaired, mild to severe
b) impaired
c) impaired: phonemic paraphasia, neologism, jargon
d) impaired: circumlocution
e) impaired: semantic paraphasia, empty speech
f) (overly) fluent: logorrhea
g) normal
h) normal
i) normal or mildly impaired: paragrammatism
j) impaired: (no evidence)
k) normal
l) little to none
m) little to none
n) impaired: (no evidence)
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The effect of WA on cerebral
function
LH RH
Anterior
grammatical rules
function words
conversational rules?
motivation to speak?
Posterior
convergent word semantics
categorical phonology
divergent word semantics
coordinate phonology
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Broca's aphasia
aka expressive aphasia
aka anterior aphasia
aka agramamtic aphasia
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Describe this picture (silently!)
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Broca's aphasia sample #1
Examiner: Describe this picture.
Patient: kid kk can cookie caandy well I dont
know but its writ easy does it slam early fall
men many no girl. Dishes soap water
water falling pah thats all dish thats all. Cookies
can candy cookies cookies he down Thats all.
Girl slipping water water and it hurts much to do.
Her clean up. Dishes up there I think thats 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
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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.
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Broca's aphasia on YouTube
Broca's aphasia (1)
Broca's aphasia (2)
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Background: word classes
Content words
noun
verb
adjective
adverb
Function words
article
demonstrative
conjunction
coordinating
subordinating
pronoun
preposition
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Background: morphology
Inflectional
noun
plural
verb
present and past tenses
present and past participles
adjective
comparative, superlative
Derivational
un-, -ify, etc., etc
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Breakdowns in grammar
Breakdown in morphology
Patients express nouns in the singular and verbs in the
infinitive or participle
Breakdown in modifying parts of speech
Patients often eliminate articles, adjectives, and adverbs
altogether.
Instead of saying I saw some large gray cats, a patient
with Brocas aphasia might say see gray cat.
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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 Brocas aphasia may only be able to say
Ladies, men, room.
When asked his occupation, a mailman with Brocas 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 Brocas aphasiac to express I
will go home tomorrow coming out as Go I home tomorrow.
Altogether, this is called agrammatism or telegraphic speech
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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 __.
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Repetition of one's own
speech
The most famous case is that of Brocas 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.
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Summary of main symptoms
Impaired production of speech
mild: non-fluent
severe: Brocas 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
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Broca's aphasia checklist
a) comprehension of spoken material
b) comprehension of written material
c) segmental phonology
d) word selection
e) word semantics
f) fluency (production of speech)
g) production of writing
h) use function words
i) grammaticality
j) repetition of what others say
k) conversational proficiency, e.g. turn taking
l) concern about impairment
m) concern about errors
n) short-term retention & recall of verbal materials
o) other
a) normal
b) normal
c) impaired: phonetic dissolution
d) normal
e) normal
f) impaired: mild to severe (perseveration)
g) impaired
h) impaired: agrammatism or telegraphic speech
i) impaired
j) impaired (no evidence)
k) normal
l) yes
m) yes
n) normal
o) --
