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Main article: Aphasia
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Receptive aphasia, also known as Wernicke’s aphasia, fluent aphasia, or sensory aphasia, is a type of aphasia traditionally associated with neurological damage to Wernicke’s area in the brain,[1] (Brodmann area 22, in the posterior part of the superior temporal gyrus of the dominant hemisphere). However, the key deficits of receptive aphasia do not come from damage to Wernicke's area;[1] instead, most of the core difficulties are proposed to come from damage to the medial temporal lobe and underlying white matter. Wernicke's aphasia results from damage in the posterior one-third of the superior gyrus of the temporal lobe of the left hemisphere. Damage in this area not only destroys local language regions but also cuts off most of the occipital, temporal, and parietal regions from the core language region.[2]

People with receptive aphasia are unable to understand language in its written or spoken form, and even though they can speak with normal grammar, syntax, rate, and intonation, they cannot express themselves meaningfully using language. People with Wernicke's aphasia are typically unaware of how they are speaking and do not realize it may lack meaning. [3] Having a deficit and not knowing it exists or denying it exists is called anosognosia. People with Wernicke's Aphasia typically remain unaware of even their most profound language deficits. [4]

Receptive aphasia is not to be confused with Wernicke-Korsakoff syndrome.

Presentation

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Two cortical areas central for the understanding and production of language are Wernicke’s area, and Broca’s area. Wernicke’s Area is located posterior to the lateral sulcus, typically in the left hemisphere, between the visual, auditory, and somesthetic areas of the cerebral cortex. A person with this aphasia speaks with normal prosody and intonation but uses random or invented words; leaves out key words; substitutes words or verb tenses, pronouns, or prepositions; and utters sentences that do not make sense. Therefore, their expressive language is devoid of any meaning. This is referred to as empty speech. Other symptoms can include a loss of verbal pragmatic skills and conversational turn-taking. As a result, these individuals often display logorrhea, a nonstop output of speech. [5] A person with this aphasia cannot understand the spoken words of others or read written words. Speech is preserved, but language content is incorrect. Substitutions of one word for another (paraphasias, e.g. “telephone” for “television”) are common. Comprehension and repetition are poor.[6]

People with this type of aphasia can talk freely and excessively with numerous errors, but can no longer comprehend what is said to them and what they read.[7] People with Wernicke’s aphasia are known for saying many words that do not make sense. While they are saying these words that do not make sense, they sometimes fail to notice they are saying wrong words. This can be frustrating to the person. People with this type of aphasia may string together meaningless words making meaningless sentences. Patients who do recover from Wernicke’s aphasia report that, while aphasic, they found their speech to be unintelligible and sounding of an alien tongue. And, despite being cognizant of the fact that they were speaking, they could neither stop themselves nor understand their own words. [7] Unlike Broca's aphasia, Wernicke's aphasics tend to have anosognosia of their communication problems.[8] They usually seem unaware of their speech problems and may feel frustrated at times.


The ability to understand and repeat songs is usually unaffected as these processes are thought to be processed in the right hemisphere. There is no single area where understanding of songs is located; many different areas in the brain are affected when a song is being heard. For people with receptive aphasia, music therapy can be an effective tool to recovery. Melodic intonation therapy (MIT) is an intonation-based treatment method for nonfluent or dysfluent aphasic patients that was developed in response to the observation that severely aphasic patients can often produce well-articulated, linguistically accurate words while singing, but not during speech.[9] This therapy works to get the patient back to “normal” speech.

Patients also generally have no trouble purposefully reciting anything they have memorized[citation needed].

Patients who communicated using sign language before the onset of the aphasia experience analogous symptoms.[10]

While damage to the Wernicke’s area in the brain may produce a wide range of disabilities, profanity is, in most part, unaffected. People with left hemisphere brain damage experience verbal aggression and are able to still utter curse words because profanity is related to the right hemisphere.[11] Receptive aphasia commonly results in involuntary cursing. Cursing is frequent among Wernicke-type aphasics (found in 57% of people that suffer from this type of aphasia [11]). While cursing may be retained, the person cursing may not be able to comprehend their own profanity. [6]

Damage to the posterior portion of the left hemisphere’s superior and middle temporal lobe or gyrus and the temporoparietal cortex can produce a lesion to Wernicke’s area and may cause fluent aphasia, or Wernicke’s aphasia[citation needed]. If Wernicke’s area is damaged in the non-dominant hemisphere, the syndrome resulting will be sensory dysprosody[12] — the inability to perceive the pitch, rhythm, and emotional tone of speech.

Most therapists, clinicians and researchers in the aphasia field would probably agree that a treatment should be considered effective if a patient shows improvement in speech output. Besides Melodic Intonation Therapy listed above, other therapies that are used to help people recover from aphasia include, but are not limited to: operant conditioning, a cognitive approach using divergent thinking, Programmed stimulation approach, and pragmatic approaches, the most known being PACE which stands for promoting aphasics’ communicative effectiveness. PACE is based on four basic principles: the exchange of new information, equal participation, free choice of communicative channels, and functional feedback.[13] Age of patient has a bit of play as well when it comes to how well or fast someone recovers. Younger patients usually recover fully due to neuroplasticity while older adult recovery is often incomplete.[6] However, research is ongoing and new techniques and therapies will soon come to enhance the recovery of language.

Luria's theory

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Luria proposed that this type of aphasia has three characteristics.[14]

  • 1) A deficit in the categorization of sounds. In order to hear and understand what is said, one must be able to recognize the different sounds of spoken language. For example, hearing the difference between bad and bed is easy for native English speakers. The Dutch language however, makes a much greater difference in pronunciation between these vowels, and therefore the Dutch have difficulties hearing the difference between them in English pronunciation. This problem is exactly what patients with Wernicke’s aphasia have in their own language: they can't isolate significant sound characteristics and classify them into known meaningful systems.
  • 2) A defect in speech. A patient with Wernicke's aphasia can and may speak a great deal, but he or she confuses sound characteristics, producing “word salad” in extreme cases: intelligible words that appear to be strung together randomly.
  • 3) An impairment in writing. A person who cannot discern sounds cannot be expected to write.

See also

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References

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  1. ^ a b Kolb & Whishaw: Fundamentals of Human Neuropsychology (2003) page 505
  2. ^ Kolb & Whishaw: Fundamentals of Human Neuropsychology (2003) page 506
  3. ^ ASHA: American Speech and Language Association http://www.asha.org/Practice-Portal/Clinical-Topics/Aphasia/Common-Classifications-of-Aphasia/
  4. ^ Manasco, M. Hunter. (2014). Introduction to Neurogenic Communication Disorders. Jones and Bartlett Learning. Burlington, MA. Pg. 83
  5. ^ Manasco, Hunter. "The Aphasias". Introduction to Neurogenic Communcation Disorders. p. 93.
  6. ^ a b c Kirshner, Howard. "Aphasia". Access Science. McGraw-Hill Education. {{cite web}}: |access-date= requires |url= (help); Missing or empty |url= (help)
  7. ^ a b >. "Speech Disorder". Encyclopaedia Britannica Online Academic Edition. Encyclopædia Britannica Inc. Retrieved 27 March 2015.
  8. ^ McCaffrey, Patrik. Neuropathologies of Language and Cognition.
  9. ^ Schlaug, Gottfried (September 2010). "From singing to speaking: facilitating recovery from nonfluent aphasia". Future Neurol. 5 (5): 657–665. {{cite journal}}: |access-date= requires |url= (help)
  10. ^ http://pages.slc.edu/~ebj/IM_97/Lecture10/L10.html
  11. ^ a b Jay, Timothy. Why We Curse: a neuro-psycho-social theoru pf cursing. Philadelphia/Amsterdam: John Benjamins Publishing Compant. pp. 36–38.
  12. ^ Fix, James. Neuroanatomy (4th ed.). Baltimore: Lippincott Williams and Wilkins. p. 316. {{cite book}}: |access-date= requires |url= (help)
  13. ^ McCaffrey, Patrick. "Neuropathologies of Language and Cognition". Retrieved 30 March 2015.
  14. ^ Kolb & Whishaw: Fundamentals of Human Neuropsychology (2003), pages 503-504. The whole paragraph on Luria's theory is written with help of this reference.

Manasco, M. Hunter. (2014). Introduction to Neurogenic Communication Disorders. Jones and Bartlett Learning. Burlington, MA. Pg. 83

Further reading

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Klein, Stephen B., and Thorne. Biological Psychology. New York: Worth, 2007. Print. Saladin, Kenneth S. Anatomy & Physiology: the Unity of Form and Function. New York: McGraw-Hill Higher Education, 2010. Print.

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Category:Aphasias Category:Neuropsychology Category:Neurodevelopmental disorders Category:Stroke

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