UNIT -3

BRAIN DAMAGE AND FUNCTIONAL IMPAIRMENT

APHASIA

• An acquired language impairment that results from brain damage typically in the left
hemisphere. Common causes of damage include stroke, brain tumors, and cortical
degenerative disorders (e.g., Alzheimer’s disease).
• Language impairment is characterized by difficulties in verbal or written expression,
comprehension, or both. Most aphasia cases involve a combination of these
impairments, affecting multiple language functions.
• Patients may present with symptoms such as difficulty articulating words, forming
sentences, comprehension deficits, or a combination of these. Aphasia symptoms can
range from mild impairment to a complete loss of fundamental language components,
including semantics, grammar, phonology, morphology, and syntax. They may affect
verbal communication, written language, or, more commonly, both.

Classification

• The classical model of aphasia was developed by Wernicke and Lichtheim in the 19th
century and was further refined neuroanatomically by Geschwind in the 1960s. The
syndromes are categorized on the basis of disturbances in speaking, auditory
comprehension, reading, and writing.
Lichtheim’s Classical Syndromes (1885)
o Broca’s Aphasia
o Wernicke’s Aphasia
o Pure Motor Speech Disorders
o Pure Word Deafness Transcortical Motor Aphasia
o Transcortical Sensory Aphasia Conduction Aphasia

Later Extensions
o Anomic Aphasia
 o Global Aphasia
o Isolation of Language Area/ mixed transcortical aphasia – primary language
regions and the connections between them remain intact. However, because
they are disconnected from higher-level cognitive and associative brain areas,
patients exhibit a paradoxical mix of symptoms such as Echolalia with
preserved repetition but poor comprehension and production.

Examination

• Patients suspected of having an acute stroke are typically evaluated with a non-
contrast computed tomography (CT) scan, followed by an MRI, to identify the
precise location and nature of the lesion. Subsequently, speech-language pathologists
assess the patient to identify specific areas and types of language deficits. Several
formal assessments can diagnose aphasia, including the Boston Diagnostic Aphasia
Examination and the Western Aphasia Battery.
• The Boston Diagnostic Aphasia Examination offers a severity rating ranging from
slight to severe, whereas the Western Aphasia Battery determines whether the patient
is aphasic and, if so, identifies the type and severity of aphasia. Additionally, it
provides a baseline for future assessments, helping to track trends and improvements
while highlighting the patient's strengths and weaknesses.
• Key domains tested:
o Spontaneous Speech: fluency, grammar, articulation.
o Comprehension: yes/no questions, commands, narrative understanding.
o Repetition: single words, phrases, sentences.
o Naming: confrontation naming, responsive naming, word fluency tasks.
o Reading and Writing: aloud reading, comprehension, dictation, spontaneous
writing.
• Profiles across these domains help to classify aphasia type (e.g., fluent vs. nonfluent,
repetition preserved vs. impaired) .
Varieties of Aphasia and Their Neuroanatomical Locations

Varieties of Clinical Features Classical Lesion Example

Aphasia Site
Broca’s Nonfluent, halting Posterior inferior Normal: I want a glass of
Aphasia speech, impaired frontal gyrus water
repetition, telegraphic (Broca’s area)
speech, relatively good Broca’s aphasia: “want water
comprehension, now”
Agrammatism

Wernicke’s Fluent but meaningless Posterior superior Wernicke’s Aphasia:

Aphasia speech, poor temporal gyrus
comprehension, (Wernicke’s area)
impaired repetition

Conducion Fluent with phonemic Arcuate fasciculus / Normal: "The dog chased the
Aphasia errors, poor repetition, supramarginal gyrus ball"
preserved Conduction aphasia: "The
comprehension dog.. um.. chased.. the.. um..
biff."
Transcortical Reduced output, intact Anterior/superior if a therapist says, "How are
Motor repetition, relatively frontal lobe, near you feeling today?", the
Aphasia preserved Broca’s area person with TMA might
comprehension respond with, "How are you
feeling today?" instead of
giving a spontaneous answer.
Transcortical Fluent, poor Junction of parietal a person who speaks fluently,
Sensory comprehension, intact and temporal but their speech is filled with
Aphasia repetition regions (inferior errors (like saying "tree" for
parietal lobule) "train") and they struggle to
understand what others say.
Global Severe deficits in all Extensive a patient who can only say an
Aphasia language functions perisylvian damage automatic phrase like "no...
no... because" or "yes," but
 cannot understand simple
questions, name objects, read,
or write anything but
unintelligible scribbles
Anomic Word-finding difficulty, Inferior parietal or someone with anomic aphasia
Aphasia intact fluency, temporal regions might say "the red thing on
comprehension, and the tree that you can make a
repetition pie out of" instead of "apple,"
demonstrating difficulty with
word retrieval despite
maintaining grammar and
comprehension
Pure Word Impaired auditory word Disconnection of People struggling to
Deafness recognition, preserved auditory input to understand spoken words
speech and reading Wernicke’s area while still being able to hear
perfectly, recognize non-word
sounds (like a dog barking or
a doorbell), read, write, and
speak fluently. For instance, a
patient with PWD might
describe speech as sounding
like a foreign language or
gibberish, even though they
can hear the individual
sounds, while they can still
easily understand written
instructions or enjoy music
Pure Motor Pure motor speech Motor pathways An individual might intend to
Speech disorders primarily from cortex to say, "iced coffee, please," but
Disorders include Apraxia of brainstem nuclei their mouth forms the sounds
Speech (motor incorrectly like eye-coff-uh-
programming issues for fee.. They may have to search
speech) and Dysarthria
 (muscle control and grope for the correct
problems affecting mouth position for each sound
speech execution)

Disturbance of a Single Language Modality

• Certain aphasic disturbances affect only one modality, showing that language is
modular:
o Pure Word Deafness – only auditory comprehension is impaired.
o Pure Alexia (without agraphia) – reading impaired, writing preserved.
o Pure Agraphia – writing impaired, other modalities intact .
o Apraxia of Speech – articulation impaired, language planning intact.
• These “selective modality” syndromes demonstrate that different aspects of language
(input/output, auditory/visual/motor) are subserved by distinct but interconnected
cortical networks.