HESP Final 05 12 2014 Left hemisphere Controls Language o Specialization within hemisphere Brain damage occurs from Blood flow problems Pressure against brain cells from injury Swelling all lead to death of brain cells Two centers for language in the brain both on the left side Broca s Area In the frontal lobe anterior Wernicke s Area o o In the temporal parietal lobe posterior Wernicke s Area Information from the outside what you hear see allows us to understand what we read or hear Area for language comprehension Broca s Area Important for expressive language and production of speech o Ability to put words into sentences morphemes Aphasia 05 12 2014 A language disorder that results from damage to the left hemisphere Can affect o Expressive language Spoken language o Receptive language Ability to understand spoken language Understanding written information o Reading o Writing Providing written information Ex A person with aphasia may not be able to write words but could o Damage affected patients writing modality but not the spell them out loud ability to spell out loud Caused by o Stroke Hemorrhagic stroke Bleeding in brain Ischemic stroke Blockage of arteries in brain o Brain tumors loss of oxygen and disease Wernicke s Aphasia Damage seen in Wernicke s area Results in o Poor comprehension of language Can affect both spoken and written language o Can t name objects people Describe something without being able to use the exact word for it o Language is jumbled and doesn t make sense Use neologisms new made up words Patient is unaware of language problem No general movement problems because movement is controlled by a different part of the brain Referred to as fluent aphasia because speech is fluent and has normal intonation Broca s Aphasia Comprehensive but not perfect Agrammatic o Speech is telegraphic and doesn t contain grammar Ex Mom kid dog play Word endings are left out Struggle to find the word they want to use Patient is oftentimes frustrated because they re aware of their errors Referred to as Non fluent aphasia because it s slow labored and May result in hemiparesis and hemiparalysis because the Broca s doesn t flow like normal speech area is close to the motor cortex o Movement problems occur on the right side of the body because damage is on the left side of the brain Global aphasia Symptoms of both Broca s and Wernicke s Aphasia Damage to both language and speech areas Language o Poor auditory comprehension o Poor expressive language o May use jargon Depending on area of legion may have speech deficits REVIEW Any time there is damage to LEFT hemisphere it affects someone s speech and language and its called aphasia If damage is on the RIGHT hemisphere they may have language problems but its not called aphasia Can affect any of the language areas expressive receptive reading writing o Expressive and writing often go together o Receptive and reading go together In aphasia testing you don t have the patient read out loud because its not a skill adults use o Instead you want to know how well they understand what they read Treatment Restorative treatment o One part of the brain takes over for the damaged part Compensatory treatment o Working on alternative ways to communicate in order to compensate for the problem Experiment to test for efficacy of therapy o Put 10 stroke patients in the group with therapy o Put 10 stroke patients in the group without therapy o See results of both groups o HOWEVER it s unethical 05 12 2014 Risk factors that can lead to strokes History of stroke o 5 times more likely to have a stroke if you ve already had one o Pressure in arteries makes arteries weaken and can High blood pressure potentially burst Smoking o Weakens arteries High Cholesterol o Arteries become clogged Diabetes Obesity Age Severity of damage General health Family support Early speech language therapy Prognostic Factors factors that can predict the rate of recovery Spontaneous recovery First language deficits are seen immediately Then swelling decreases and blood in brain is reabsorbed Finally rapid improvement is seen Traumatic Brain Injury 05 12 2014 Most often seen in males 18 35 Caused by concussions Results in cognitive linguistic disorders Brain Damage When you have a small part of your brain cut off from oxygen because of a clogged artery a small part of brain dies o It occurs in a particular place with a particular function That function is lost Ex o If a person has a car accident and hits their head on the windshield the first thing that happens is bruising in the brain where they were hit Since the brain is floating around in fluid brain goes forward as you go forward and then comes back and damages the back of the brain as well Damage is seen on both sides of the brain Bleeding will likely occur Worse thing that could happen is that the brain stem swells and tearing occurs which can result in death Patients with traumatic brain injury suffer from cognitive linguistic disorders Cognitive linguistic disorders o Attention o Memory Don t have a high attention span Don t remember incident that occurred that resulted in brain injury o Learning problems o Decreased inhibition Say things that they otherwise wouldn t of said o Poor pragmatic skills Can t use language appropriately o Organizational problems Cant initiate plan or problem solve Recovery from traumatic brain injury Progressive recovery Need an ongoing evaluation Some people enter with a coma and are treated until they re ready to go out into the community May result in speech and or swallowing problems Often do not have a complete recovery depending how severe and the location of the damage 05 12 2014 Right Hemisphere Disorders Not considered aphasia Specific kinds of tests used to identify problems on right side of brain Results in deficits o Visual neglect o Cognitive linguistic deficits Problems with memory orientation and awareness Unilateral vision on one side o Poor visual recognition of both objects and people o Poor visual perception o Expressive language is confused irrelevant tangential go off on tangents and confabulatory lying Treatment of Right Hemisphere Disorder Work on visual problems with particular attention to the left visual side o Get patients to look all the way to the left when they read so they don t miss information that they wouldn t see otherwise Teach pragmatics so patients can initiate conversations as well as Progress depends on severity of damage and ability to recognize have