SHS 485 Module 3

Bilingualism & Aphasia

45 million bilingual speakers in the US, there will be more thanks to the US not doing anything about immigration since the people in power want the country to be destroyed LOL Latinos are 2x as likely to experience a stroke than non-latino people. Wonder why.. Variety of recovery patterns and impairments seen in bilingual aphasia. Unfortunately, most bilingual aphasia research focuses on speech production, very little work has been done on how speech perception/understanding speech is affected. Bilingual: A person who speaks two or more languages. L1: First language acquired L2, L3, etc: Subsequent languages acquired. Early bilingual speakers: Acquired both languages BEFORE age 12 (roughly). Late Bilingual speakers: Acquired L2 after age 12 (roughly).

Bilingual Aphasia:

A bilingual's recovery may be related to:• more general cognitive functions:• cognitive control/selection issues• loss of inhibitory processes Factors related to L1 & L2 abilities post-stroke:• Amount of input from each language post-stroke/during rehab• Amount of each language spoken post stroke/during rehab• Memories & motivations tied to each language Other considerations:• Cultural differences• Effect of using translators/family members instead of the clinician/researcher directly interacting Generalization: treatment can, but doesn't always generalize from L1 to L2• Often depends on type of deficit &similarity of languages in that dimension.• e.g. phonological paraphasia• Spanish & English vs. English & Mandarin Interference: difficulties in L1 can affect L2• For example, word finding difficulties in L1 can affect word finding difficulties in L2• (particularly if L2 is acquired late)

Bilingualism and the Brain

Age of acquisition greatly affects how the brain processes each language. Language proficiency greatly affects how the brainprocesses each language

Code Switching

Alternative use of one's languages in healthy people, used to add emphasize, intent, emotional value, etc. Code switching requires linguistic competence across both languages.

What are problems with the House Model?

Anomia: Naming difficulties Agrammatism and Paragrammatism Paraphasia Comprehension Deficits in Broca's aphasia and conduction aphasia. Non-parallel of production deficits in conduction vs Wernicke's aphasia. Conduction aphasia is not a disconnection anymore

Pure Word Deafness

Bilateral STG damage. Some unilateral cases have been documented, but it is exceedingly rare in proportion to the number of unilateral lesions which do not produce word deafness. STG lesions lead to "Word Deafness". Normal hearing/audiograms. Profound auditory comprehension deficit (functionally deaf for speech) reading ability is good. Aka "Auditory Verbal Agnosia".

Transcortical sensory aphasia

Comprehension impaired - repetition is not impaired, speech production is not impaired. Caused by Variable lesion patterns, MOSTLY posterior to Wernicke's area. To summarize: Comprehension impaired. Patients produce long, empty speech. They have good repetition. Sometimes repeat back what is said to them involuntarily (Echolalia). Deficit tends to be transient evolving into anomic aphasia.

Broca's Aphasia

Damage to Broca's area alone is NOT enough to produce Broca's aphasia. usually involves broca's area + surrounding primary motor and somatosensory cortex, insula, and even Wernicke's area! Basically, the lesion will have to be quite large to cause it.

Conduction Aphasia

Damage to the arcuate fasciculus has NOT been associated with conduction aphasia. Usually two lesion patterns: posterior superior temporal gyrus and/or supramarginal gyrus. (Inferior parietal lobe)

Global Aphasia.

Deficits across modalities - comprehension, repetition, and production. Tend ot be large Peri-Sylvian lesaions, but small lesions can also cause this.

Edgar Zurif

First to ID that, yes, people with Broca's aphasia tend to have comprehension deficits. Same with conduction aphasia.

Wernicke's Aphasia (CONT)

Fluent Verbal Output Semantic and phonemic paraphasias. Impaired auditory and reading comprehension. Impaired naming and repetition. Excessive talking Empty speech/Jargon speech Writing resembles speech-- messy, fast, error-filled. Little frustration Syntax not too bad. -------------------------- No paralysis or paresis. Patient sounds confused. Fluent. Rapid rate. Articulation is intact. Speech is paraphasic - semantic and phonemic. Poor auditory comprehension. Impaired repetition of words and sentences. Writing problems mirror speech problems.

What is to note about classification system of aphasia:

IT does NOT cover all patient's symptoms. Heterogeneity of deficits across patients with the same syndrome. Broca's can have normal or disturbed comprehension levels for example. Syndromes may not localize in expected lesion sites. Only a general correlation. Note the attached image for lesion overlap.

What are recovery patterns for bilingualism aphasia?

Parallel: L1 and L2 recover at the same time and rate. Differential Recovery: One language more than the other. Antagonistic Recovery: L1 is initially better, but then L2 improves and L1 basically disappears. Alternating Antagonism Recovery: Image attached cause it's absurd Selective Aphasia: Deficits are only in one language. Successive Recovery: One language improves, then the other. Blending Recovery: Unintentional mixing of both languages words and grammatical constructions.

Agrammatic Comprehension

Particular difficulty with grammar where positional cues in a sentence are important. For example: The lion was killed by the tiger. Who died? Broca's sufferers would likely pick tiger. Refer to image. Higher percentage indicates better odds of correct ID.

Types of Paraphasias?

Phonemic Paraphasia: A phoneme based error. Strool --> Stool Errors can result in real words: Puck for Cup. If word is grossly distorted it is called a neologism. Verbal paraphasia: Incorrect word selection. Example: My mother --> My wife. Paragrammatism: Running speech that is incoherent. Might be incoherent for lots of different reasons. House model fails to explain these well.

Transcortical Motor Aphasia

Refer to image. This causes issues with spontaneous speeh. Decent understanding, but getting it out is difficult. Caused by damage often anterior and/or superior to Broca's Area. To summarize: Auditory comprehension, repetition are preserved. Speech is fluent and well-articulated, but sparse. Most utterances are 1-2 words long, complete sentences are rare. Patients can repeat long and complex sentences, but can't initiate/create them. Echolalia can be present.

Wernicke's Aphasia

Same thing as with Broca's - not small damage area, but rather large lesion. It'll be Wernicke's area + surrounding areas including the gyrus.

Classification of Aphasias:

Spontaneous Speech. Auditory Comprehension. Verbal Repitition.

Eleanor Saffran and Myrna Schw.

Theorized correctly that people with Broca's aphasia still have access to Syntax, they just can't correctly call upon it/use it.

Translation Deficits

see image

Anomic Aphasia:

No image because it cannot really be mapped on the house model. Relatively common. Variable lesion patterns. Good speech comprehension. Spontaneous speech is usually fluent and grammatically correct, except for substitution of nonspecific words (thing) and "talking around" missing words. Good repetition, cannot name objects. "Oh its uhm.. its that thing you know? the thing I use every day.."

Symptoms of Broca's Aphasia

Non-Fluent Speech: Slow, labored speech Struggle to retrieve words and form sentences. Lacks rhythm and intonation Semantic and Phonemic paraphasias. Agrammatism: Omission of grammatical elements. Short, unstressed words, such as articles or prepositions are left out. Often omit plural or past tense endings. Their comprehension is good generally, but impaired for syntactically complex sentences. Difficulty in comprehending the same words that are omitted in speech production. Difficulty repeating said words. Difficulty understanding relational words. EXAMPLE: Bigger/smaller, up/down, within/without.

Aphasia Typologies: Sub types of Aphasia

Non-Fluent: Broca's, Global, Transcortical Motor Fluent: Wernicke's, Conduction, Transcortical Sensory, Anomic, Pure Word Deafness.