DISORDERS OF

LANGUAGE
PRODUCTION AND
COMPREHENSION
INTRODUCTION
Aphasia is the loss of the ability to understand speech or communicate using
language. It can occur when areas of the brain responsible for language become
damaged.
Causes
stroke
brain tumor
injury to the brain, such as from a severe blow to the head or gunshot wound
infection in the brain
progressive neurological conditions, such as Alzheimer’s disease
Temporary aphasia due to migraines, seizures or a transient ischemic attack (TIA).
TYPES OF APHASIA
01 Broca's Aphasia 04 Conduction Aphasia

02 Wernicke's Aphasia 05 Global Aphasia

03 Transcortical Sensory Aphasia

 Left frontal lobe- posterior
inferior frontal gyrus

BROCA'S APHASIA
You know what you want to say and can understand others. However, speech is
difficult and requires great effort. Short phrases are often used, such as “Want
food.” Some weakness or paralysis of the limbs on one side of the body may also
be present.

Lesions in Broca's area, regions surrounding frontal lobe and to the underlying
cortical matter; lesions of the basal ganglia-especially the head of the caudate
nucleus can also produce Broca's-like aphasia

Wernicke (1874) suggested that Broca’s area contains motor memories—in

particular, memories of the sequences of muscular movements that are needed to
articulate words.

Brain
 BROCA'S APHASIA
Three major speech and language deficits are produced by lesions in and
around Broca’s area: agrammatism, anomia, and articulation difficulties

Agrammatism refers to a patient’s difficulty in using grammatical constructions.

Picture of a boy being hit in the head by a baseball

The boy is catch . . . the boy is hitch . . . the boy is hit the ball (Saffran
et al., 1980, p. 229)

Schwartz et al. (1980) showed people with Broca’s aphasia pairs of pictures in
which agents and objects of the action were reversed: a truck pulling a car and a
car pulling a truck.

Brain
 BROCA'S APHASIA
Anomia refers to a word-finding difficulty; because all people with aphasias omit
words or use inappropriate ones, anomia is actually a primary symptom of all
forms of aphasia.
The third major characteristic of Broca’s aphasia is difficulty with articulation.
Patients mispronounce words, often altering the sequence of sounds. For example,
lipstick might be pronounced “likstip.”
Direct control of articulation would involve the face area of the primary motor
cortex, portions of the basal ganglia, and the left precentral gyrus of the insula,
while the selection of words, word order, and grammatical markers would involve
Broca’s area and adjacent regions of the frontal association cortex.

Brain
 BROCA’S APHASIA
kid. . . . kk . . . can . . . candy . . . cookie . . . candy . . . well I don’t
know but it’s writ . . . easy does it . . . slam . . . early . . . fall . . .
men . . . many no . . . girl. Dishes . . . soap . . . soap . . . water . . .
water . . . falling pah that’s all . . . dish . . . that’s all.
Cookies...can...candy...cookiescookies...he...down...
That’sall.Girl...slippingwater...water...andithurts... much to do . . .
Her . . . clean up . . . Dishes . . . up there . . . I think that’s doing it.
(Obler and Gjerlow, 1999, p. 41)
B W
 Superior temporal gyrus of the
left hemisphere

WERNICKE'S APHASIA
You can speak in long sentences. However, these sentences have no obvious
meaning and can contain unnecessary or even made up words. Trouble with
understanding language and with repeating things is also present.
Wernicke's area- location of memories of the sequences of sounds that constitute
words- recognition.
Wernicke's aphasia consists of several deficits in -recognition of spoken words,
comprehension of the meaning of the words and the ability to convert thought into
words.

Brain
 WERNICKE'S APHASIA
Damage to left temporal lobe can produce disorder of auditory word recognition
called as 'pure word deafness'.

It's not an inability to comprehend the meaning of words; if it were people with this
condition wouldn't be able to read lips or read written words. Their speech deficit is
restricted only to the recognition of spoken words.

Two types of injury cause pure word deafness: disruption of auditory input to the
superior temporal cortex or damage to the superior temporal cortex itself.

Brain
 WERNICKE'S APHASIA
Failure to comprehend the meaning of words and inability to express thoughts in
meaningful speech—appear to be produced by damage that extends beyond
Wernicke’s area into the region that surrounds the posterior part of the lateral
fissure, near the junction of the temporal, occipital, and parietal lobes. Referred as
the posterior language area (Carlson, 2016).

Place for interchanging information between the auditory representation of words

and the meanings of these words, stored as memories in the rest of the sensory
association cortex.

Brain
 WERNICKE'S APHASIA
The third ability that is disrupted in Wernicke’s aphasia is the ability to convert
thoughts and memories into words. Words refer to objects, actions, or relationships
in the world. Thus, the meaning of a word is defined by particular memories
associated with it.
They often employ circumlocutions (literally, “speaking in a roundabout way”) to get
around missing words.
Anomic aphasia alone is different from Wernicke’s aphasia. Unlike patients with
Wernicke’s aphasia, people with anomic aphasia can understand what others say,
and what people with anomic aphasia say makes sense, even if they often choose
alternative ways to say it.

Brain
 ANOMIC APHASIA
It’s a woman who has two children, a son and a daughter, and
her son is to get into the . . . cupboard in the kitchen to get out
[take] some . . . cookies out of the [cookie jar] . . . that she
possibly had made, and consequently he’s slipping [falling] . . .
the wrong direction [backward] . . . on the . . . what he’s standing
on [stool], heading to the . . . the cupboard [floor] and if he falls
backwards he could have some problems [get hurt], because that
[the stool] is off balance.
TRANSCORTICAL SENSORY APHASIA
Damage to the posterior language area alone, which isolates Wernicke’s area from
the rest of the posterior language area, produces a disorder known as transcortical
sensory aphasia.
The difference between transcortical sensory aphasia and Wernicke’s aphasia is that
patients with transcortical sensory aphasia can repeat what other people say to
them; therefore, they can recognize words. However, they cannot comprehend the
meaning of what they hear and repeat; nor can they produce meaningful speech of
their own.

Brain
TRANSCORTICAL SENSORY APHASIA
The fact that people with transcortical sensory aphasia can repeat what they hear
suggests that there is a direct connection between Wernicke’s area and Broca’s area
—and there is: the arcuate fasciculus.

The arcuate fasciculus appears to convey information about the sounds of words but
not their meanings.

Brain
CONDUCTION APHASIA
It is produced by damage to the inferior parietal lobe that
extends into the subcortical white matter and damages the
arcuate fasciculus.

Conduction aphasia is characterized by meaningful, fluent

speech and relatively good comprehension but very poor
repetition.

Brain
CONDUCTION APHASIA
Examiner: The auto’s leaking gas tank soiled the roadway.

Patient: The car’s tank leaked and made a mess on the street.

When patients with conduction aphasia hear a word or a

sentence, the meaning of what they hear evokes some sort of
image related to that meaning. They are then able to describe
that image.
The symptoms that are seen in transcortical sensory aphasia and conduction
aphasia lead to the conclusion that there are pathways connecting the speech
mechanisms of the temporal lobe with those of the frontal lobe.

Production of spontaneous speech involves the flow of information concerning

perceptions and memories from the sensory and motor association cortexes to the
posterior language area to Broca’s area.
The direct pathway through the arcuate fasciculus simply conveys speech sounds
from Wernicke’s area to Broca’s area (to repeat unfamiliar words, eg., when
learning a new language)
The second pathway, between the posterior language area and Broca’s area, is
indirect and is based on the meaning of words, not on the sounds they make.

Brain
BROAD CATEGORIES OF APHASIA

NON-FLUENT APHASIA FLUENT APHASIA

Speech is difficult or halting, and some Speech flows more easily, but the
words may be absent. However, a content of the message lacks
listener can still understand what the meaning.
speaker is trying to say.
DIAGNOSIS TREATMENT

CT Speech-language
MRI therapy
Neurological tests Some drugs such as
Comprehensive speech piracetam &
and language memantine
examination. TMS & transcranial
direct current
stimulation (tDCS)