Assessment of AphasiaAssessment of Aphasia

Objectives:• Introduction

– Definition– nature of the disorder

• Etiology

• Meaning of phonotactics

• Aphasic characteristics & behaviors

Introduction:Introduction:• Definition:

– is a communication disorder which occurs when damage (lesion) to the adult brain impedes the use of language understanding & production.

• All aspects of language are affected with variable degrees

– Phonetic, phonological, syntactic, semantic, and pragmatic processing & performance are affected in a range of ways

• i.e. different level, extent & complexity of phonetic, phonological, syntactic, semantic & pragmatic problems contribute to the disorder in a particular individual

Introduction (Cont’d)Introduction (Cont’d)• It is described as a multimodal disorder

– The linguistic deficit does not have to be confined to

the expression and comprehension of spoken language,

but may extend to the use of written, gestural & other

symbols

– Ex: reading and writing are different modalities of

language ( which might be affected as well)

• Ideas & Meanings are well preserved

– are conveyed by the use of non-verbal behaviors, such as facial expression, gesture, pointing and drawing

Introduction (Cont’d)Introduction (Cont’d)• Non-linguistic brain functions are most likely to be affected

as well

– such as attention, memory perception, sensory reception,

motor perception, motor skills and emotional responses

• A complex of linguistic as well as non-linguistic factors that together reduce the effectiveness of communication

• A person with aphasia is idiosyncratic in

– neurological impairment, linguistic & non-linguistic behaviors, psychological response, his/her needs & ability as a communicator

EtiologyEtiology::• Brain damage resulting in aphasia can be

caused by various problems such as:– tumor– blood clot– abscess– trauma (e.g. gunshot wound, road traffic

accident, surgical intervention– Infections (meningitis, encephalitis)

• Functions impaired & their severity depend on the location & extent of damage.

Classification of aphasia:Classification of aphasia:

– According to the area affected

– According to the function impaired

Phonotactics:Phonotactics:• Explained in Grundy (page 47)

• term used in phonology

• refers to the way in which a language combines phonemes to make words

• Phonotactic rules:– describe the permissible combinations in a

particular language

Phonotactics (Cont’d)Phonotactics (Cont’d)• Aspects of phonotactics:

1. syllable structure such as;

– CV, CCV open syllables

– CVC, CCVC, CVCC closed syllables

2. particular phonemes that may occur at each position in the syllable structure, e.g.;

– In English, nasals do not occur as the 1st phoneme of a cluster in syllable-initial position /mp-/, /nt-/

– but occur in a syllable-final position as in stamp, went

PHONOLOGY & PHONETICSPHONOLOGY & PHONETICS• Problems in language expression:

• Articulatory awkwardness

– is used to describe the speech sound errors that

contribute to non-fluent speech

– Person searches, visibly & auditorily, for

articulatory positions

– produces variable phonetic errors & also

phonological errors which generally fail to

comply with the phonotactics of the speaker’s

native language

PHONOLOGY & PHONETICS(Cont’d)PHONOLOGY & PHONETICS(Cont’d)

• Articulatory awkwardness (Cont’d)

– is due to a problem of phonetic planning

– Also called verbal apraxia, speech apraxia,

apraxia of speech, aphasic articulatory defect

– it is the exacerbated by an anticipation of error

& attempts to rectify errors as they are made

PHONOLOGY & PHONETICS(Cont’d)PHONOLOGY & PHONETICS(Cont’d)

• Phonemic paraphasia

– phonemic substitutions, rearrangements and

additions, with consonants being affected rather

than vowels, & segment production achieved

with ease or fluently

– phonemes & phoneme combinations that occur

are always consistent with the phonotactic rules

of the speaker’s language, e.g. ‘squottle’ for

‘bottle’, or ‘pusting’ for ‘putting’

PHONOLOGY & PHONETICS(Cont’d)PHONOLOGY & PHONETICS(Cont’d)

• Phonemic paraphasia (Cont’d)

– Presence of sufficient phonologically accurate

aspects of the target word remaining & which

would be identified from the speech context

– Lack of contextual knowledge to interpret

produced word affects how it would be

perceived ‘neologism’

PHONOLOGY & PHONETICS(Cont’d)PHONOLOGY & PHONETICS(Cont’d)

• Neologism

– affects content words making them appear

bizarre to the extent that no real word is

recognized

• i.e. seem as if they are new words

– Words not found in the speaker’s language

– is the result of severe phonemic paraphasia

PHONOLOGY & PHONETICS(Cont’d)PHONOLOGY & PHONETICS(Cont’d)

• Neologism (Cont’d)

– In some cases, neologisms might have structural

resemblance to words in the language that could be

used in the same position in the sentence

• E.g. ‘I am wickling the…’ phonological form is

known but phonemes were misselected/

misordered

– In other cases, neologisms appear to have no relation

to an appropriate type of word for the sentence

structure

• E.g. ‘I am swink that …’

PHONOLOGY & PHONETICS(Cont’d)PHONOLOGY & PHONETICS(Cont’d)

• Problems in language reception:– Phonological or semantic impairment can result

in an impaired single word comprehension

– A range of linguistic and non-linguistic

(context), information are used for

interpretation of the units of speech

SEMANTICSSEMANTICS• Problems in language expression:

• Word retrieval errors– Impairments in the ability to produce lexical

items (vocabularies)– Different behaviors will present depending on

the• person’s processing skills &

• ‘degree of awareness’ – If aware of difficulty

» blocking & search behaviors, such as pauses, hesitations & re-attempts at initial sounds & syllables or at whole words

SEMANTICS (Cont’d)SEMANTICS (Cont’d)

• Language features reflecting problems in lexical retrieval:

• Circumlocution– Subject talks around the target word

• Such as descriptions & definitions

• Semantic paraphrasia– A real word which has the same grammatical function as

the target & has semantic association with its substitute

• E.g. “walking” for “running”

– The phonological structure (number of syllables+ some similarity in the phonemes) of the substitute word is generally dissimilar to the target

SEMANTICS (Cont’d)SEMANTICS (Cont’d)• Language features reflecting problems in

lexical retrieval (Cont’d)

• Verbal paraphasia– A real word which has the same grammatical

function but there is no recognizable semantic association with the target

– The phonological structure of the substitute word may

• show some similarity to the target word– E.g. “walking” for “wishing” ; “chair” for “chalk”

• be dissimilar to the target word (i.e. unrelated in structure)

– E.g. “quiet” for “careful”

SEMANTICS (Cont’d)SEMANTICS (Cont’d)• Language features reflecting problems in

lexical retrieval (Cont’d)

• Perseverative paraphasia– A word which has been expressed in a previous

context is inappropriately repeated in a later utterance

– A result of failure in processing a new response

• Anomia– Refers to disorders of naming rather than word

retrieval in running speech

SEMANTICS (Cont’d)SEMANTICS (Cont’d)• Problems in receptive language:

– Failure to access the meaning of a heard word– Word will be either

• perceived as a meaningless nonsense word or

• interpreted as another concept from a related semantic field e.g. “turnip” for “potato”

– Difficulty in associating a heard word

(i.e. recall) with 1 of 2 closely related pictures/items rather than with 1 of 2 unrelated ones

SEMANTICS (Cont’d)SEMANTICS (Cont’d)• Problems in receptive language(Cont’d):

• E.g. “knife” more likely to be recalled knife-boat

• Less likely to be recalled knife, fork

– Impairment in the ability to interpret thematic relations of a particular verb –reversible verbs

• E.g. “chased” in the “the mouse chased the cat”

• Thematic role are understood if the lexical entry “chased” is understood

SEMANTICS (Cont’d)SEMANTICS (Cont’d)• Factors which affect semantic comprehension:

– Memory span– Information load

SYNTAXSYNTAX• Aggrammatism

– Nonfluent output characterized by speech produced in a disconnected manner

– Function words are omitted to a greater extent than content words

– Grammatical inflections are generally lacking

– Agreement (gender, number and case) is impaired

• Paragrammatism– Function words are distorted but not omitted

PRAGMATICSPRAGMATICS• Usually the least affected aspect of language

• Many clients are able to use non-verbal signals such as – eye-gaze– pause– gesture– prosody– facial expression to indicate meanings

PRAGMATICS (Cont’d)PRAGMATICS (Cont’d)• May also

– engage appropriately in discourse

– adopt effective repair strategies

– demonstrate a range of communicative acts

including;

• acknowledgement

• greeting

• request

• question

• command

PRAGMATICS (Cont’d)PRAGMATICS (Cont’d)• Individuals with severe jargon aphasia can often

convey– communicative intent– emotion– question forms– topic change

• A person with severe verbal comprehension deficits can often make appropriate responses to – yes-no or wh- question– commands etc

because he/she recognizes the meaning implied byProsodic features

Visual cues

Contextual information

PRAGMATICS (Cont’d)PRAGMATICS (Cont’d)

• May make relevant guesses about a message if have enough contextual information

– recognition of people & environment

– orientation in time & situation

PRAGMATICS (Cont’d)PRAGMATICS (Cont’d)

• Pragmatic problems:Pragmatic problems:

– failure to recognize situations

– feigning understanding

– ignoring turn taking signals

– continuing to jargon in spite of a negative feedback

from the conversational partner

– failure to

• initiate conversation

• change topic

• Employ a full range of communicative acts

OTHER SPEECH OTHER SPEECH BEHAVIORSBEHAVIORS

• Jargon

• It consists of fluent, generally incomprehensibles

utterances which may contain any type of paraphasia and

neologism

• Automatic speech

• Well preserved even in severe cases of aphasia

– Serial speech such as;counting and days of the week

– Social responses

– Familiar overlearned sayings

OTHER SPEECH BEHAVIORS OTHER SPEECH BEHAVIORS (Cont’d)(Cont’d)

• Repetitive verbal behaviorRepetitive verbal behavior• takes several forms ; ex.

– recurrent utterances

– Echolalia

– perseveration

– stereotypy• Echolalia; repetition of all/part of an utterance just spoken by

another person

• Perseveration; reproduction of a previous response in a new situation