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Speech disorders

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Speech disorders
1. Central Mechanisms:
Depending on the integration of the higher brain centers for symbolization (speech centers), mainly in the dominant hemisphere.
Lesion leads to Dysphasia or Aphasia.
2. Peripheral Mechanisms:
A. Articulation:
Lesion leads to Dysarthria or Anarthria.
B. Phonation:
Lesion leads to Dysphonia or Aphonia.

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Speech disorders

  1. 1. Amr Hassan, MD,FEBN Associate professor of Neurology Cairo University SPEECH DISORDERS
  2. 2. Definition of Speech Speech is the communication of meanings by means of symbols, which usually take the form of spoken or written words.
  3. 3. Mechanisms of Speech : 1. Central Mechanisms: Depending on the integration of the higher brain centers for symbolization (speech centers), mainly in the dominant hemisphere. Lesion leads to Dysphasia or Aphasia. 2. Peripheral Mechanisms: A.Articulation: Lesion leads to Dysarthria or Anarthria. B. Phonation: Lesion leads to Dysphonia or Aphonia.
  4. 4. Aphonia  Phonation is lost but articulation is preserved  The patient talks in whisper Types and Causes: A. Hysterical (can phonate when coughing) B. Organic 1. Bilateral paralysis of the vocal cords 2. Diseases of larynx 3. Paresis of respiratory movements 4. Spastic dysphonia 5. Glottis spasm
  5. 5. Dysarthria Dysarthria=Disorder of articulation Types and Causes: 1. LMN Dysarthria 2. UMN (spastic) Dysarthria 3. Extra-pyramidal Dysarthria a. Rigid dysarthria: Parkinsonism b. Hiccup speech: Chorea and myoclonus 4. Cerebellar Dysarthria a. Syllabic (or scanning) b. Explosive c. Stacatto
  6. 6. Mechanisms of Speech : 1. Central Mechanisms: Depending on the integration of the higher brain centers for symbolization (speech centers), mainly in the dominant hemisphere. Lesion leads to Dysphasia or Aphasia. 2. Peripheral Mechanisms: A.Articulation: Lesion leads to Dysarthria or Anarthria. B. Phonation: Lesion leads to Dysphonia or Aphonia.
  7. 7. Speech Centers I. Sensory Centers: A.Visual Centers: Area 17 for visual reception. Area 18 for visual perception (recognition). Area 19 for visual recall. Area 39 for recognition and recall of mathematic numbers and figures. B.Auditory Centers: Area 41 & 42 for auditory reception. Area 22 for auditory perception (recognition) and recall.
  8. 8. II. Motor Centers: A. Speech Motor Center: Area 44 B.Writing Motor Center: Area 45 III.Associative Center: Area 37 Speech Centers
  9. 9. 37 39 18 19 2241 42 45 44 17
  10. 10. Border Zone Territory
  11. 11. Connectionist model of language
  12. 12. Aphasia Classification: Basic Classification Dysphasia or Aphasia Sensory = Receptive = Posterior = Temporoparietal = Fluent Auditory Agnosia = Wernick’s Aphasia (Lesion: area 22) Visual Agnosia (Lesion: areas 18, 19) Motor = Expressive = Anterior = Frontal = Non – Fluent Verbal Aphasia = Broca’s Aphasia (Lesion: area 44) Writing Aphasia (Lesion: area 45) Global or Total Aphasia (Lesion: area 37 or extensive in all areas)
  13. 13. Connectionist model of language
  14. 14. 28/02/2006 Developing a Model of Language in the Brain  Concept center – place where meanings are stored
  15. 15. Connectionist model of language ‫الترديد‬
  16. 16. Repetition Lesions involving speech areas in the immediate perisylvian region interfere with this language function and produce aphasia with repetition disorder.
  17. 17. Aphasia Classification: Benson & Geschwind Classification Dysphasia or Aphasia Aphasia With Repetition Disorder Broca’s Aphasia Wernick’s Aphasia Aphasia Without Repetition Disorder Transcortical Motor Aphasia Transcortical Sensory Aphasia Disturbances affecting a single language modalitiy Ant. Ant.Post. Post. Global Aphasia Isolation of Speech Area Conductio n Aphasia Anomic Aphasia
  18. 18. Evaluation of Aphasia & speech I. Spontaneous Speech: Rate of output Pronunciation Effort in initiation Press of speech Phrase length Prosody Paraphasias Word content
  19. 19. Evaluation of Aphasia & speech II. Comprehension III. Repetition IV. Naming V. Reading VI.Writing
  20. 20. Language Deficits  Aphasia – spoken language  Alexia – reading  Agraphia - writing  Anomia - naming  Dysarthria - articulation
  21. 21. Types of Language Errors  Paraphasia:  Neologism:  Paraphasia with a completely novel word
  22. 22. Paraphasia  Substitution of a word by a sound, an incorrect word, or an unintended word  It is common with posterior aphasias. Varities: 1. Phonemic or Literal (e.g. open the boor) 2. Semantic orVerbal (e.g. open the glass) 3. Neologistic (e.g. open the blastorole)
  23. 23. Jargon aphasia  Speech is totally incomprehensible.  It may occur in cases of Wernicke’s and global aphasia. Nonfluent speech  Talking with considerable effort
  24. 24. 28/02/2006 Converging Evidence Wada Test  Left hemisphere role in language  Wada technique using sodium amobarbital  Crossed aphasia – aphasia arising from right hemisphere damage
  25. 25. Right Hemisphere Contribution to Language  Narrative – ability to construct or understand a story line  Inference – ability to “fill in the blanks”  Prosody
  26. 26. Prosody (Monrad krohn, 1947) • The intonation pattern, or sound envelope, of an utterance (interpreting whether the tone is friendly, sarcastic, condescending or excited) • It is the melody of speech (“we need to talk” vs.“we need to talk”) • It is more common with anterior aphasias. • Thought to be mainly a function of the nondominant cerebral hemisphere.
  27. 27. Broca’s Aphasia  Patient “Tan”  Brain tumor in Left frontal brain region  Broca: Lesion disrupted speech
  28. 28. 28/02/2006  Associated with damage in the frontal lobe  Not due to damage to the motor strip Broca’s Aphasia
  29. 29. Transcortical Motor Aphasia  Transcortical motor aphasia: Comprehension and repetition are preserved, however, speech is nonfluent
  30. 30. Transcortical Sensory Aphasia  Transcortical sensory aphasia: Repetition is preserved, speech is fluent but comprehension is impaired
  31. 31.  CarlWernicke  2 patients – fluent, but nonsensical sounds, words, sentences  Damage in the posterior region of the superior temporal gyrus. Wernicke’s Aphasia
  32. 32. 28/02/2006  Problems in comprehending speech – input or reception of language  Fluent meaningless speech (Word salad).  Paraphasias – errors in producing specific words Semantic paraphasias – substituting words similar in meaning (“barn” – “house”) Phonemic paraphasias – substituting words similar in sound (“house” – “mouse”) Neologisms – non words (“galump”)  Poor repetition  Impairment in writing Wernicke’s Aphasia
  33. 33.  Left temporal lobe damage Wernicke’s Aphasia
  34. 34. Fluent Aphasia Conduction Aphasia  Difficulty in repeating what was just heard (no repetition or paraphasias).  Comprehension and production intact.
  35. 35. Fluent Aphasia Anomic Aphasia  “Amnesic aphasia”  Comprehend speech  Fluent speech  Repetition OK  Cannot name objects  Naming problems tend to be a result of temporal damage, whereas verb finding problems tend to be a result of left frontal damage. “What is this object called?” “I know what it does…You use it to anchor a ship”
  36. 36. Global Aphasia  Associated with extensive left hemisphere damage  Deficits in comprehension and production of language
  37. 37. 28/02/2006 Summary of Symptoms Disorders of Comprehension • Poor auditory comprehension • Poor visual comprehension Disorders of Production • Poor articulation • Word-finding deficit (anomia) • Unintended words of phrases (paraphasia) • Loss of grammar or syntax • Inability to repeat aurally presented material • Low verbal fluency • Inability to write (agraphia) • Loss of tone in voice (aprosidia)
  38. 38. The basis of benson & geschwind classification Three Main Steps: 1.The presence or absence of repetition disturbance. 2.Whether the aphasia is anterior or posterior. 3. Identifying disturbances limited to a single language modality.
  39. 39. Anterior Posterior Good retention of comprehension Marked affection of comprehension Marked difficulty of: Naming Reading Writing Less degrees of affection of: Naming Reading Writing
  40. 40. Anterior Posterior Spontaneous Speech •Sparse output (usually less than 50 words/min, often 3-12 words/min) •Difficult initiation of speech •Poor pronunciation •Severe dysprosody •No paraphasia Spontaneous Speech •Abnormal or high output (100-200 words/min) •Easy initiation of speech •Normal pronunciation •Normal prosody •Often with paraphasia
  41. 41. Anterior Posterior Spontaneous Speech •Short phrase length (1-2 words phrases) •No logorrhea •The anterior aphasic responds by a single word which carries a great deal of meaning but lacking grammer =Telegraphic Speech (e.g. noun, action verbs). Spontaneous Speech •Phrase length above 3 words (up to 8-10 words/phrase oftenly) •Logorrhea in some cases •The posterior aphasic uses many words but fails to convey a full message (circumlocations, more grammatical & filler words)
  42. 42. Transcortical Motor Aphasia Transcortical Sensory Aphasia Anomic Aphasia Isolation of Speech Area •Doesn’t speak unless spoken to •Attempt conversation •Fluent •Word finding difficulty •Emptiness •Circumlocation •Paraphasias •Substitution •Fluent •Word finding difficulty •Emptiness •Circumlocation •No paraphasias •Shortage of substitutive words Echolalia Comprehension sufficient for conversation Abnormal limited comprehension Normal comprehension Failure of comprehension •Reading: Slow difficult •Writing: Affected •Reading: Impossible •Writing: Inable Can’t read or write Repetition remarkably good Normal repetition Normal repetition Excellent repetition
  43. 43. Transcortical Motor Aphasia Transcortical Sensory Aphasia Anomic Aphasia Isolation of Speech Area Association cortex of frontal lobe Posterior border zone (Angular gyrus + Postero-inferior temporal lobe) Less localizing Involving border zone but sparing perisylvian area •Vascular •Trauma •Tumor •Vascular •Trauma •Tumor •Carbon monoxide •Acute left ICA occlusion •Severe cerebral edema
  44. 44. 28/02/2006 SUMMARY Type of Aphasia Spontaneous speech Paraphasias Comprehension Repetition Naming Broca’s Nonfluent - Good Poor Poor Global Nonfluent - Poor Poor Poor Transcortical motor Nonfluent - Good Good Poor Wernicke’s Aphasia Fluent + Poor Poor Poor Transcortical sensory Fluent + Poor Good Poor Conduction Fluent + Good Poor Poor Anomic Fluent + Good Good Poor
  45. 45. THANK YOU
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Speech disorders 1. Central Mechanisms: Depending on the integration of the higher brain centers for symbolization (speech centers), mainly in the dominant hemisphere. Lesion leads to Dysphasia or Aphasia. 2. Peripheral Mechanisms: A. Articulation: Lesion leads to Dysarthria or Anarthria. B. Phonation: Lesion leads to Dysphonia or Aphonia.

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