Chapter 7 Adult Language Impairments Language Development Through the Lifespan Unless there is neuropathology adults continue to refine communication skills unless debilitated in some way through accident disease or disorder adults continue to refine their communication abilities throughout their lives o Even people with delayed development such as individuals with MR experience continued but SLOW language growth Use o Adults are skilled conversationalists Compared to children adults are very effective communicators and skilled conversationalists who have a variety of styles of talking from formal to casual o Narratives improve until the seventies Those over 75 have less flexibility and ease with word retrieval and make more language form errors Content o Some words fade and others are added Adults continue to add their personal vocabularies and most use between 30 000 and 60 000 words expressively o Deficits in accuracy and speed of word retrieval naming When compared to young adults seniors use more indefinite words such as thing and one in place of specific names Form o Continue to acquire some aspects of syntax Adults continue to acquire prefixes un pre dis morphophonemic contrasts real reality and infrequently used irregular verbs o Complex sentence construction declines with advanced age The length and syntactic complexity of oral sentences increases into early adulthood and stabilizes in middle age As mentioned older seniors experience a decline in complex sentence production that seems related to word retrieval problems Aphasia Literally without language o Although Aphasia results from localized brain damage the exact locations and the resultant severity and type of aphasia are not a perfect math nor does all aphasia result in brain damage Affects over 1 million people in the U S o Over 200 people mostly adults being aphasic in the US everyday May affect listening speaking reading writing Range in severity o Related to cause location extent age of brain injury age general health of patient o Problems in two areas auditory comprehension and word retrieval o Severity is related to several variables including the cause of the disorder the location and extent of the brain injury the age of the injury and the age and general health of the client Patterns of behavior can be used to categorize by type syndrome APHASIA cont Expressive deficits o Reduced vocabulary o Omission addition of words o Stereotypic speech o Delayed or reduced output of speech o Hyperfluent speech Very rapid speech with few pauses may be incoherent inefficient and pragmatically inappropriate o Word substitutions Language comprehension deficits Impaired interpretation of linguistic information o o Depression is common condition Position Emission Tomography a brain imagining technique has identified several regions of the brain that are active during speech sound processing CONCOMITANT DEFICITS greatly reduced Hemiparesis a weakness on one side of the body in which strength and control are Hemiplegia paralysis on one side Hemisensory impairment may accompany either and is a loss of the ability to perceive sensory information Hemianopsia this condition will affect the individuals ability to read Dyshpagia When paresis paralysis or sensory impairment involve neck and face client may have trouble with chewing or swallowing accompanied by drooling or gagging Agnosia A sensory deficit accompanying some aphasia aphasias that makes it difficult for the client to understand incoming sensory information The disorder may be specific to auditory or visual information Agrammatism Omission of grammatical elements Individuals with aphasia may omit short unstressed words such as articles or prepositions They may also omit morphological endings such as the plural s or past tense ed Agraphia difficulty writing Writing may be full of mistakes and poorly formed Clients may be unable to write what they are able to say Agramamtism jargon and neologisms may be present in written language as well as in spoken Alexia Reading problems Clients may be unable to recognize even common words they use in their speech and writing Paraphasia and neologisms may also be present Jargon Meaningless or irrelevant speech with typical intonational patterns Anomia Difficulty naming entities Neologism novel word Paraphasia word and phoneme substitutions Verbal stereotype an expression repeated over and over TYPES OF APHASIA Fluent Aphasias o Word substitutions neologisms and often verbose verbal output o Often posterior lesions in the left hemisphere o Wernicke s Aphasia characterized by rapid fire strings of sentences with little pause for acknowledgment or turn taking Fluent or hyper fluent speech Poor Auditory and visual comprehension Verbal paraphasia or unintended words and neologisms Sentences w unrelated words jargon Mild to severe impairment in naming and imitative speech o Anomic Aphasia characterized by naming difficulties Severe anomia in both speech and writing Mild to moderate auditory comprehension problems Fluent spontaneous speech marred by word retrieval difficulties o Conduction Aphasia characterized by conversation that is abundant and quick although Anomia Only mild impairment if auditory comprehension if any Extremely poor repetitive or imitative speech Paraphasia or the inappropriate use of words formed by the addition of sounds and incorrect ordering of sounds or by substituting related words o Transcortical Sensory Aphasia characterized by conversation and spontaneous speech as fluent as in Wenicke s aphasia but filled with word errors Unimpaired ability to repeat or imitate word phrases and sentences Verbal paraphasia or word subs Lack of nouns and severe anomia Poor auditory comprehension o Subcortical Aphasia lesions occur deep in the brain without involvement of the Fluent expressive speech cerebral cortex Paraphasia and neologisms Repetition unaffected Auditory and reading comprehension relatively unaffected Cognitive deficits and reduced vigilance Nonfluent Aphasia Slow labored speech word retrieval and syntactic problems Site of lesion often in or near the frontal lobe o Broca s Aphasia associated with damage to the anterior or forward parts of the frontal love of the left cerebral hemisphere centered in broca s area which is responsible for both motor planning and working memory short sentences w agrammatism in which auxiliary or helping verbs are omitted anomia problems with imitation of speech because of overall