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Individual differences
1. What individual characteristics may affect the way one processes language?
a. education, age, second language proficiency, cognitive resources,
socioeconomic status (modulates how much input you get)
2. Sources of language variation
a. External to the cognitive system - effects of experience, education and second
lang proficiency
b. Internal to the cognitive system - each of us are a bit different and have different
strengths
i.
Brain functioning, working memory capacity, and language aptitude
3. Study for education?
a. Pakulik & Neville language proficiency differences in English monolinguals
impacts syntactic processing in their native language = smarter kids better at
grammar
4. Study for age?
a. Park et. al.- cognition gets worse as we age (duh)
b. Ben-David et. al.- takes longer to recognize spoken words as we get older
c. Botezatu-older people slower at spoken-to-written word matching task
5. Study for cognitive resources?
a. Color Stroop Test: inhibition is one of the cognitive resources
6. Second language proficiency: both languages are activated all the time
a. Intuitively, lower L2 proficiency is associated with slower, more error-prone L2
retrieval.
b. Counter-intuitively, lower L2 proficiency is also linked to lexical retrieval difficulties
in the stronger native language.
7. What variables predict/modulate recovery from acquired language disorders?
a. Severity, motivation, therapy, access to services, family support
Aphasia Etiology and Recovery
1. Frontal lobe:
a. Executive functions- working memory, planning, memory, motor or social,
speaking, reasoning/judgement, voluntary motor activity,
b. Individuals with lesions- behavioral problems, apathy,
disinhibition/aggressiveness, loss of flexibility with thinking, limited attention to
task, mood changes
c. Broca's area → spoken area
2. Parietal lobe:
a. Sensation of touch, Spatial sense-proprioception/body orientation, reading
b. Primary motor and sensory area
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c. Impairment- inability to attend to more than one object at a time, difficulty
recognizing left v right, hand eye coordination problems, impaired perception of
touch, difficulty drawing objects
Temporal lobe:
a. Language comprehension, behavior, memory, hearing
b. Wernicke’s area-language comprehension
c. Primary and secondary auditory areas → auditory perception
d. Impairment- difficulties understanding spoken words, poor selective attention,
loss of short term memory, persistive talking, increased aggressive behavior
Occipital lobe:
a. Visual cortex-color shape and emotion distinguishing
b. Impair-vision right visual field, blind spots, locating objects, recognizing drawn
objects, inability to recognize movement of an object in space, difficulty
identifying color, word blindness, difficulty reading/writing
Cerebellum:
a. Doesn’t integrate motor activity, Coordinates and controls movements of fine
motor tasks (speaking), Regulates balance and posture
i. Helps provide smooth, coordinated body movement
b. Online correction planned movements
c. Impairment- lack of coordination, abnormal gait, errors in judgements of
movements
Brainstem:
a. Eye movements, sneezing, gagging, coughing, breathing, body temperature,
digestion, alertness/sleep
b. (midbrain, pons, medulla)
Insula
a. Also known as the 5th lobe
b. Placed “under” the lobes
c. Interception - how we tune into ourselves, feelings, emotions,
CVA
a. A disturbance in the blood supply to the brain, lasting only seconds, can cause
neurological symptoms and irreversible neuronal brain damage, in minutes.
b. A CVA occurs when there is a lack of blood flow to any area of the brain including
the brainstem.
c. CVAs are the 3rd most common cause of death in the U.S. with a mortality rate of
about 33%., It is the leading cause of disability in U.S., Approximately 550,000
strokes occur annually.
Risk of stroke
a. Gender- men
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b.
c.
d.
e.
Race- African American/ asian
Age- mortality rate 10% higher for people over age 65, increases
Family history of stroke
Medical conditions- diabetes, smoking, excessive alcohol consumption, obesity,
sedentary lifestyle
10. Symptoms of a Stroke:
a. Sudden numbness or weakness of face, arm or leg, especially on one side of the
body
b. Sudden confusion, trouble speaking or understanding
c. Sudden trouble seeing in one or both eyes
d. Sudden trouble walking, dizziness, loss of balance or coordination
e. Sudden severe headache with no known cause
11. Ischemic vs. hemorrhagic stroke
a. Ischemic strokes are caused by a clot that stops blood supply to an area of the
brain
i. Accounts for 85% of strokes
ii. If the clot is moving = embolism
iii. Clot is not moving = thrombus
iv. Transient Ischemic Attack (TIAs)
1. Warning stroke that says a bigger one is coming that will have
more lasting effects
2. Result of cerebroartery being temporarily blocked
3. Shorter than 5 min but average = 1 min
4. No permanent injury to the brain
5. Should cut down smoking and drinking and increase healthy
eating/living habits
v. Tissue Plasminogen Activator (tPA) - used to break down/dissolve blood
clot and limit extent of lesion
1. Brain needs to be reprofused
2. Only given if suffering from ischemia, if it is a hemorraghic stroke
then the damage would be catastrophic if given tPA
b. Hemorrhagic strokes are caused by blood leaking into brain tissue
i. Account for 15% of strokes
ii. Abnormal bleeding causes less blood elsewhere
iii. Damage where the blood enters the brain tissue and where blood is not
going
iv. Emergency surgery may be needed to resolve blood leakage and relieve
pressure on the brain
v. More dangerous than ischemic → 50% mortality rate
12. Middle cerebral artery (red) damage; aphasia
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a. Middle - largest of all cerebral arteries
b. Yellow - anterior cerebral artery
c. Blue - posterior cerebral artery
13. Brain Imaging tools to diagnose stroke
a. CT scan or CAT scan
b. MRI
c. MRA
d. Carotid doppler ultrasound (less invasive)
14. Global aphasia:
a. Lesion: Large portion of the perisylvian area
b. Blood Supply: total occlusion of the left MCA
c. Limited to stereotypical utterances (hohohho), song refrains, sequences (days of
the week)
d. Severe impairment in comprehension, production, reading and writing, severe
motor deficits to the right side of body, hemiparesis obvious
15. Broca’s Aphasia
a. Lesion: 3rd frontal convolution
b. Blood Supply: left MCA
c. Effortful speech, nonfluent, produce short phrases or single words, telegraphic
speech, communicate using nouns and verbs no function words, preservation of
counting, days of week, cursing (Norton),
d. Comprehension relatively spared but some difficulty with complex syntactic
structures
e. Writing also impaired, also naming
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16. Wernicke’s Aphasia
a. Lesion: posterior left perisylvian region
b. Blood Supply: left MCA
c. Difficulty understanding language, phonemic and semantic paraphasias,
utterances are void of meaning, can listen to speech and not understand, no
awareness of deficit, cannot monitor output, repeating and naming is impaired
17. Conduction Aphasia
a. Lesion: arcuate fasciculus
b. Blood Supply: left MCA
c. Fibers that connect brocas to wernicke's
d. Difficulties repeating what they heard, fluent speech, word finding difficulties, will
try to correct themselves, conducite d’approche- phonemic variations (try to say a
word like it but often fail phonemic like production error and not semantic like
circumlocution) comprehension spared
e. Word finding for ALL aphasia types
f. Fluent aphasia subtype
18. Anomic Aphasia
a. Lesion: varies (little or no localization value)
b. Blood Supply: left MCA
c. Tip of tongue effect most severe, circumlocution
d. The best one/easiest one to have
e. Word retrieval issues, aware of deficit
f. Aware of nature of object but cannot get it upon request (may be able to say
when they aren’t directly trying to find it)
g. Aware of name they are trying to say so they will try to do a roundabout way to
get there
h. Rarely Make phonemic and semantic errors
i. Good comp, reading, writing, repetition
j. Fluent subtype
19. Transcortical Aphasias
a. Results from an isolation of the perisylavian language zone of the left hemisphere
from the rest of the cortex.
b. Characterized by a disproportionately preserved capacity of repetition.
c. Disproportionate capacity to repeat
20. Transcortical Motor Aphasias:
a. Lesion: frontal region anterior/superior of Broca’s area.
b. Blood Supply: left ACA
c. Reading and writing impaired, able to repeat long complex sentences
d. Resembles Broca’s aphasia but difficulty with responding
21. Transcortical Sensory Aphasias
a. Lesion: posterior to the perisylvian region, in the parietal occipital region
b. Blood Supply: left PCA
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c. Comprehension impaired across the board, fluent but unintelligible and
meaningless → word salad
d. Can repeat but severe impairment in comprehension of oral and written naming
22. Recovery vs. Compensation
a. Recovery is the capacity to perform previous non impaired tasks as they were
before injury
b. Compensation is the use of a new strategy to perform old tasks -- part of brain
cannot perform previous duties so other tissue nearby takes over the some of
the function in order to carry through to produce the old ability
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23. Patterns of Recovery: repair, reorganize, rehabilitate
a. Repair - physical repair
i.
Disrupted physiologic functions improve
ii.
Scar tissue of dead tissue appear
iii.
First 3 mo
b. Reorganization
i.
Areas nearby start to take over
ii.
Many not be nearby
iii.
3-12 mo
c. Rehabilitation
i.
Retraining to perform specific tasks
ii.
Work on building new pathways to perform functions they have lost
iii.
1 year post-onset
d. Immediately there is a period of shock and functions will appear to be more
severe than they will end up having – swelling goes down, other places will try to
take on new functions,
e. Rapid recovery in hours and days following trauma
f. There is steady progress months
g. Improvement rates decrease as months and years go by
h. Recovery does not end after 1 year – people have been known to make progress
years and years after
24. Behavior Mechanisms of Recovery
a. Reactivation of temporarily impaired language function – direct simulation,
repetition, indirect simulation – cueing strategy that offers supports for retrieval,
b. Reorganization – fill in the missing blank of the functional system, phonemic self
cueing to overcome word finding difficulties,
c. Relearning - reestablish lost rules and info (grapheme-phoneme correspondence
d. Facilitation – when difficulty accessing information
e. Functional substitution – implies that a function cannot recover in original system
so another area substitutes for system loss – think AAC
25. Factors affecting recovery:
a. Neurologic
i. Etiology of injury (Ischemic vs. hemorrhagic)
ii. Size and site of the lesion
iii. Aphasia severity/type
b. Individual differences
i. Age
ii. Health status
iii. Gender
iv. Depression
c. Nonfluent aphasia has better prognosis
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d. Anomic have slower progress but better functional communication
Life Quality Approaches to Aphasia
1. Disempowerment
a. Intense feelings of frustration and depression
b. Less willing to take have the patients to wait for someone to get to where they
retrieve what they want to say or get to the point
c. What would they want to know about their deficits and treatment → 5 main
desires: access to information (therapist fail to explain what aphasia is and what
a the long term effects are), to regain control and independence (using the
phone, license, learning to use the bus, grocery shopping), lack of respect, loss
of worth and career opportunities (strong desire to return to some form of work,
reorient to a new career path, contribute to society),
Qualitative
1. Health Related Quality of LIfe: medical condition, structure function impairment, task
limitations, participation restrictions
a. Concern of impact on the health on their quality of life
b. This is based on subjective rating of the 4 above
c. All have a negative impact socially and personally
2. ICF: Body functions, activities, and participation
3. Framework for outcome measurement
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4. Emotional Responses to Aphasia
a. Those who have a stroke and aphasia are more likely to suffer from emotional
distress compared to those who had strokes without aphasia
b. Lower quality of life
c. Lower levels of engagement
d. Harder to make best of rehabilitation opportunities
e. These emotional responses will change over time
f. The symptoms are more dramatic in acute phases in comparison to subacute
g. Constant fatigue and feelings of disoriented
5. Factors predicting depression on those with aphasia
a. Outcome factors
b. Social factors
6. Purpose of assessing quality of life
a. In the acute phase -- assess/screen for depression, if they do then they would be
referred for treatment
b. In the rehabilitation hospital – need info for the purpose of treatment planning,
you wear two hats: clinician and researcher, they have predictive power over
outcome
Quantitative
1. Dartmouth COOP charts
a. Scale of 1-5 that is associated with pictures of stick figures
b. EX - during the past four weeks...has your physical and emotional health limited
your social activities with family, friends, neighbors or groups?
2. Stroke Specific Quality of Life Scale
a. Scale of 1-5 without pictures
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3. Stroke and Aphasia Quality of Life Scale
a. Scale of 1-5 from definitely yes to definitely no
4. ALA: Assessment for Living with Aphasia
a. Picture scale on a spectrum from 1-8
b. Aphasia is a big problem → no problem
c. Never → always
d. Happy → not happy
Cognitive Processes Word Recognition & Production
1. Word recognition
a. Cognitive model: concept->lexical->phonological->sound form
b. Fewer competitors easier to recognize than lots of competitors
c. Aging--you get worse
2. Word production
a. Semantic Feature Analysis
b. Lexical-Phonological Analysis
c. Lexical-Semantic Variable
i. Frequency
ii. Imageability
iii. Word length
iv. Lexicality
d. Retrieval practice better than imitation: errorless learning not as good
Client Centered Approach
1. Empathetic understanding, unconditional positive regard, therapeutic genuineness
2. Counseling → greive what they have lost, coping strategies to get resilience, reintegrate
into society
3. Consider relationships that are closest to them and help target strategies to make those
social interactions successful
Cognitive-Neurophysiological Approaches to Aphasia
1. People associated with the early identification of Aphasia
a. Franz Josef Gall:
i. Mental functions localized symmetrically on each side of the brain
ii. Language is innate -- independent of reason and intelligence
iii. Founder of phonology
b. Jean Pierre Flourens
i. Experimented on birds
ii. Says there’s no division of mental capacities into separate locations or
functions
c. Jean Baptiste Bouillaud
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i.
d.
e.
f.
g.
h.
i.
j.
k.
l.
Identified the connection between the loss of speech and frontal brain
damage
Paul Broca
i. Says “We speak with the left hemisphere”
ii. Brain reorganization following damage
M. Leborgne (Tan Tan)
i. Lost the ability to speak at age 30 - could only speak the syllable “tan”
ii. Broca term his disability aphimia or the loss of speech now known as
Broca’s aphasia
Carl Wernicke
i. Described patients whose speech was fluent but had no informational
value
Adolf Kussmaul
i. Individuals with “pure word deafness” can hear, speak, and read but
cannot understand speech
ii. The lesion isolates Wernicke’s area from the auditory cortex
Ludwig Lichtheim (See Wernicke-Lichtheim “House” Model)
i. Reported 2 cases: one of a patient who is unable to comprehend and
another who was nonfluent, despite preserved repetition in both cases
ii. Proposes a modification and extension of Wernicke’s arc by adding a new
module that stores concepts (meaning of words) that he calls semantic
fields
Sigmund Freud
i. Rejected the concept of speech centers
ii. Emphasized that language deficits should arise from disruption of
connecting fibers
Constantin von Monakow
i. Emphasized the interdependence of different regions of the nervous
system
ii. Believed that there is a delicate balance between different brain
components
Kurt Goldstein
i. Emphasized that after local injury, the function of more widespread brain
regions can be affected because of the interrelatedness of brain
components
ii. Also focused on how a person reacts after loss of function and described
what he called the “catastrophic reaction”
Alexander Romanovich Luria
i. Emphasized the importance of analyzing syndromes
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ii.
2.
3.
4.
5.
6.
7.
Importance of analyzing the qualitative nature of deficits resulting from
brain injury
m. Norman Geschwind
i. Attempted to explain why particular aspects of language function may
break down while others are preserved
ii. Parallel systems and alternative pathways
Signs and symptoms of Wernicke’s Aphasia
a. Speech appears to have not information content
b. Preserved function words, impaired content words
c. Comprehension impaired
d. Associated with left temporal lobe damage
e. Patient relatively unaware of deficit
Signs and symptoms of Conduction Aphasia
a. Damage to arcuate fasciculus
b. Fluent speech but containing many paraphasias
c. Impaired repetition of words
d. Normal language comprehension
e. Abnormal word finding / paraphasic
Wernicke’s arc hypothesis
a. Motor word images are stored in Broca’s area
b. Auditory word images are stored in Wernicke’s area
Wernicke-Lichtheim “House” Model
a. Proposed specific information processing centers each of which was specialized
in a specific function
b. Each normal higher function is explained in terms of an underlying neural
pathway that includes the input/output systems, related functions employ
portions of the pathways used for other functions, pathological syndromes are
explained by reference to where in the pathway damage occurred, and
previously unobserved pathological syndromes can be predicted.
What errors might one make when attempting to formulate single words?
a. Semantic paraphasia: Cat -> Dog
b. Phonemic paraphasia: Cat -> Cap
c. Mixed: Cat -> Rat
some semantic, some phonemic
d. Formal errors: Cat -> gad
e. Unrelated errors: Cat -> Mop
f. Language production is a semantically driven task
g. Language production → word meaning (conceptual preparation) → word
retrieval (lexical selection) → word sound (phonemic encoding)
Connectionist model:
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a. Language production is a combination of conceptual preparation, lexical
selection, phonological encoding, and motor programming and articulation
b. Two stage process:
i. Stage 1: lexical selection
1. Semantic description of item to be produced
2. Word that best matches semantic description
ii. Stage 2: Phonological retrieval
1. Phonological representation of word
c. Start with a concept
d. Activate the semantic features in relation to the concept and some features are
shared with other concepts
e. Select lemma based off of a set of words in which your target will be, the target
will have the strongest lemma which means it will win the competition
f. Phonological retrieval kicks in to retrieve the phonemes that make up the target
words and again wins the competition
g. If it fails→ it could happen at all levels
h. Strength of connections is important to win out at each step
i.
j. Bidirectional activation flow
i. Semantic features are described/seen
ii. Lexical selection
iii. Phonological retrieval
iv. Even before you make the selection of cat, the phonological retrieval will
occur for al the competing words
v. The bidirectional flow helps increase cat activation in comparison to
others
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My notes: In all the time it took to make these graphics she could have learned something
useful to teach us - lol
8. Cohort vs. Rhyme neighborhood
a. Cohort - words that begin with the same onset
b. Rhyme - words that end in the same rhyme
9. What types of brain injury can cause pure word deafness?
a. Disruption of auditory input to Wernicke’s area
b. Damage to Wernicke’s area itself
10. How can you assess pure word deafness?
a. Auditory word and non-word repetition tasks
b. Auditory discrimination
i. Minimal pairs
ii. Maximal pairs
c. Hearing acuity information
11. How to treat pure word deafness?
a. Use lip reading information and mouth drawings to provide additional
information about differences between phonemes to improve the client’s ability
to discriminate between similar-sounding words
12. Word level errors: Semantic
a. You activate semantic features which should boost the lemma selection meaning
cat should be a stronger activation
b. If the activation of lemma decays before one is able to retrieve phonology then
you have a problem
c. Not only the strength of connection at the level but the activation of phonemic
features to retrieve the word
d. Activation of a particular lemma should die down after a while, you should not
maintain activation of everything so once phonology is reached you let that shit
go àactivation of target and competitors all die out
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e. Strength between stage 1 can be weakened and you are more likely to make an
error
13. Models of spoken word production
Disorders of Auditory Comprehension -- needs to be added
Disorders of Word production -- needs to be added
1. Lexical-phonological variable: Word length
a. Longer words are harder to produce and to repeat than shorter words. Errors will
be phonological.
2. Lexical-phonological variable: lexicality
a. Comparison of word and nonword repetition can provide information about the
route being used
3. Describe errorless learning
a. Presenting trails in a way that the learner does not have the opportunity to give
or choose a wrong answer through repeated exposure to the correct answer and
use of prompting