CHAPTER 7 ADULT LANGUAGE IMPAIRMENTS Exam 4 Language Development through the Lifespan Use o Competent adults can influence others impart information and make their needs known o Communication may vary from direct to indirect o Adults continue to refine both their writing and reading abilities o Adult narratives improve steadily into middle age and early senior o Abilities decrease after the late 70s those over 75 have less flexibility and ease with word retrieval and make more language form errors years Content o Adults continually add to their personal vocabularies o Use between 30 000 and 60 000 words expressively o Specialized vocabularies develop for work religion hobbies and social and interest groups o Some words fade from the language and others are added o Seniors use more indefinite words Form o Adults continue to acquire prefixes morphophonemic contrasts and infrequently used irregular verbs o The length and syntactic complexity of oral sentences increases into early adulthood and stabilizes in middle age o Decline in both oral and written language comprehension understanding syntactically complex sentences and inferencing Aphasia in aphasia Aphasia means literally without language Results from localized brain damage however not all brain damage results Over 1 million Americans have aphasia Over 200 individuals primarily adults become aphasic in the U S each day Problems in two areas auditory comprehension and word retrieval seem to be common in varying degrees to all May affect listening speaking reading and or writing Expressive deficits may include o Reduced vocabulary o Omission or addition of words o Stereotypic utterances o Delayed and reduced output of speech or hyperfluent speech o Word substitutions Hyperfluent speech very rapid speech with few pauses may be incoherent inefficient and pragmatically inappropriate Language comprehension deficits spoken or written involve the impaired interpretation of incoming linguistic information o Difficulty comes in the interpretation or ability to make sense of the incoming signal Range in severity health of patient o Related to cause location extent age of brain injury age general Patterns of behavior can be used to categorize by type syndrome Concomitant Deficits o Hemiparesis a weakness on one side of the body in which strength and control are greatly reduced o Hemiplegia paralysis on one side of the body o Hemisensory impairment may accompany hemiparesis or hemiplegia is a loss of the ability to perceive sensory information o Hemianopsia Individuals with deep lesions in the left hemisphere interior to the ear and across the top of the brain may experience blindness in the right visual field of each eye o Dyshagia When paresis or paralysis and or sensory impairment involve the neck and face the client may have difficulty in chewing or swallowing may be drooling or gagging o Agnosia a sensory deficit accompanying some aphasias that makes it difficult for the client to understand incoming sensory information may be specific to auditory or visual information o Agrammatism Omission of grammatical elements o Agraphia difficulty writing o Alexia Reading problems o Anomia Difficulty naming entities o Jargon meaningless or irrelevant speech with typical intonational patterns o Neologism A novel word some individuals with aphasia may create novel words that do not exist in their language using these words quite confidently o Paraphasia word substitution found in clients who may talk fluently and grammatically o Verbal stereotype an expression repeated over and over Types of Aphasia verbose verbal output Fluent aphasia characterized by word substitutions neologisms and often o Lesions in fluent aphasia tend to be found in the posterior portions of the LEFT HEMISPHERE o Wernicke s aphasia rapid fire strings of sentences with little pause for acknowledgement or turn taking Near Wernicke s area posterior portions of the left temporal lobe Nonfluent Aphasias cerebral cortex o Anomic aphasia naming difficulties Brain damage is at the convergence of the parietal temporal occipital cortex above and posterior to the left ear o Conduction aphasia conversation that is abundant and quick filled with paraphasia May be severe enough to make the individuals speech incomprehensible Damage deep below the brain surface between areas where language is formulated and speech programmed o Transcortical sensory aphasia conversation and spontaneous speech as fluent as in Wenicke s aphasia but filled with word errors o Subcortical aphasia fluent expressive speech paraphrasia and neologisms repetition unaffected auditory and reading comprehension relatively unaffected and cognitive deficits and reduced vigilance Lesions occur deep in the brain without involvement of the o Broca s aphasia associated with damage to the anterior or forward parts of the frontal lobe of the left cerebral hemisphere centered in Broca s area which is responsible for both motor planning and working memory o Transcortical motor aphasia may have difficulty initiating speech Damage on surface of the brain o Global or mixed aphasia profound language impairment in all or writing modalities Considered the most severely deliberating form of aphasia Associated with a large deep lesion in an area below the brain s surface o Additional types of aphasia Alexia with agraphia reading and writing impairment Alexia without agraphia reading impairment with no accompanying writing difficulty Pure agraphia Severe writing disorder Pure word deafness Lack of auditory comprehension with error free spontaneous speech Crossed aphasia aphasia accompanying right hemisphere damage Causes of Aphasia o The most common cause of aphasia is a stroke or cerebrovascular accident o 3rd leading cause of death o Affects half a million Americans annually o 70 of strokes are in people over the age of 65 o As a result of strokes approx 100 000 people become aphasic each o Two types of strokes year Ischemic strokes result from a complete or partial blockage occlusion of the arteries transporting blood to the brain as in cerebral arteriosclerosis embolism and thrombosis Cerebral arteriosclerosis thickening of the walls of cerebral arteries in which elasticity is lost or reduced the walls become weakened and blood flow is restricted Embolism obstruction to blood flow caused by a blood clot fatty materials or an air bubble Thrombosis blocks blood flow plaque buildup or blood clot is formed on the site and does not