Aphasia and Apraxia at a Glance

Patrick McCaffrey, Ph.D (pmccaffrey@csuchico.edu), Professor/Coordinator, Speech Pathology Graduate Program, California State University, Chico Copyright 2000. Patrick McCaffrey, Ph.D. This page is freely distributable. This chart was designed by Kaelin Lundgren, Fall 1999.
Broca's Site of Lesion 3rd frontal convolution of left frontal lobe Transcortical Motor Smaller than Broca's Aphasia, severs links to premotor and supplementary motor; basal ganglia and thalamus; Broca's and limbic system Yes, but responds well to cues Fair to excellent, normal in repetition Anomia Not easily localized, temporal and parietal areas, sometimes affecting the angular gyrus Conduction Arcuate fasciculus, may include superior temporal gyrus, insula primary auditory cortex; auditory association areas and supramarginal gyrus Common Global Anterior and posterior lesions Transcortical Sensory Vascular insufficiency to watershed areas, angular gyrus is undamaged, but cut off from Broca's and Wernicke's NA Normal, but only in repetition, automatic or memorized sp e e ch Wernicke's First gyrus of the left temporal lobe, often extends to parietal lobe affecting angular gyrus; i.e., reading and writing Verbal Apraxia Broca's area, Island of Reil

Anomia Articulation and Language

Yes, nouns and verbs are e a si e st Simplified consonant clusters, distorted, substitutions not common Common, differentiate as listed below Not normal

Hallmark, differentiate as noted below

Yes With stereotypical utterances

Pervasive Normal Substitution, consonantal, errors predominate, varies with word length and linguistic weight May also include oral, limb or gait apraxia (Also Aphasia) Better than speech production

Normal in repetition, in general Good but phoneme -- fair to good sequencing affected, repeated approximations Differentiate as listed for Broca's Relatively intact Typically normal, but breaks down in morphology

Apraxia Auditory Comprehension

Differentiate as listed for Broca's Fair to excellent

Differentiate as listed for Broca's Non-existent

Impaired Severe, even at one word level, moderate cases may have some, relative to expression Unaware, not concerned, occasionally frustrated

Deficit Aw areness or Emotional Concomitants Circumlocution Confrontational Naming Fluency and Production

Yes, catastrophic reactions Frequent Well preserved Nonfluent Both fluent and nonfluent, fragmented Fluent

Error awareness

Intact cognition, but inability to connect language to meaning

Patients recognize and struggle to avoid errors

Impaired, semantically inappropriate or paraphasic Nonfluent Fluent and empty, press of sp e e ch Fluent and empty Fluent and empty

Difficulty initiating Hallmark -- inconsistent errors, groping, visible searching, false starts, pauses Possible concomitant Prosodic alterations, equalization of stress may occur

Hemiparesis or Hemiplegia Melodic Line

Right face or arm common Flat Normal Unaffected

Rare Unaffected

Morphology Grammar Paraphasias and Types

Omitted Affected A few, literal Only in repetition Little or no

Unaffected Unaffected Rare Frequent literal, paraphasias may result in Wernicke's diagnosis NA, does not contain real syntax May be 50% or more, literal and verbal Increased error on nouns, verbs and adjectives Sound and syllable transpositions, literal paraphasias

Sentences Spontaneous Speech

Short Telegraphic, short, slow, labored Difficulty initiating and organizing, sometimes fluent, sometimes fragmentary Usually fluent Nonfluent, empty None Nonfluent, empty, tends to be equal to comprehension Automatic, reactive or emotional better than structured; instances of error free fluent speech; better in meaningful, unstructured sp e e ch

Syntax

Affected, only basic forms preserved

Variety is present

Aphasia and Apraxia at a Glance (continued)

Broca's Reading Repetition BDAE Score Often impaired to the degree of spontaneous speech 1 or 2, may improve to 3,4,5 Transcortical Motor Anomia Range from normal to very poor Good, better than spontaneous Good Rare to have low scores Conduction Variable with severity, good but not aloud Very poor -- a hallmark, intrusive additions When clear cut 2 or 4, 1 or 2 difficult to separate from Broca's Spelling errors, transpositions Rare less than 10% of aphasias, better than Broca's articulation, tone and syntax, worse with a model, conduit d'approche 3rd most common Aphasia other than Broca's and Wernicke's, neither fluent nor nonfluent P oor Global Transcortical Sensory Severely affected Hallmark, well preserved, echolalic 1 or 2 Wernicke's If angular gyrus is impaired Verbal Apraxia Better than speech production

Poor, augmentation may occur, Affected, better with repeated press of speech trials NA

Writing Notes Token Test to differentiate from Neither fluent nor nonfluent, Apraxia, good prognosis limbic system, changes may alter memory

May be preserved, but range from normal to very poor It is often the first language symptom of Aphasia, distinguished from Wernicke's by comprehension-expression level

Severely affected Extremely rare, repetition score used to differentiate from Wernicke's

Form normal, content equal to expression Lack of awareness gives poor prognosis, cocktail hour speech, model helps therapy Some have impaired oral and sensory perception