Wanda G. Webb

The naming disorder of dementia

Naming impairment is a common feature of the language disorder of dementia, yet agreement has not been reached on its mechanisms. In this study, the confrontation naming performance of twelve demented subjects was compared to that of age-matched controls. Naming deficits were studied in relation to overall language and cognitive dysfunction and analysed to assess the importance of both perceptual and linguistic factors. Naming dysfunction occurred even in mild dementia, in patients whose overall language function remained normal, and worsened in proportion to the degree both of language deficit and overall cognitive dysfunction. Perceptual difficulty and word frequency, but not word length, were important determinants of naming performance in demented patients.

Inter- and Intrajudge Reliability for Videofluoroscopic Swallowing Evaluation Measures

Abstract Interjudge reliability for videofluoroscopic (VFS) swallowing evaluations has been investigated, and results have, for the most part, indicated that reliability is poor. While previous studies are well-designed investigations of interjudge reliability, few reports of intrajudge reliability are available for VFS measures derived from frame-by-frame analysis that clinicians typically employ. The purpose of this study was to examine the inter- and intrajudge reliability of VFS examination measures commonly used to assess swallowing functions. No training to criteria occurred. VFS examinations were conducted on 20 patients who had suffered a stroke within six weeks and had no structural abnormalities or tracheostomies. Three clinical judges served as subjects and rated the VFS examinations from videotape using frame-by-frame analysis. A clinicians repeated review of measures employed in the 20 examinations indicated high intrajudge reliability for a number of measures, suggesting that an experienced clinician may employ consistent standards for rating certain VFS measures across patients and time. These standards appear to vary among clinicians and yield unacceptable interjudge reliability. The need to train clinicians to criteria to improve interjudge reliability is discussed.

Alexia without agraphia: An experimental case study

Abstract A 51-year-old right-handed male experienced reading difficulty and an upper right visual field cut after a head injury. The patients letter naming was impaired and word naming was painstakingly slow. Words were decoded in a letter by letter sequence and performance varied directly with word length. Apart from his reading difficulties the patient was linguistically competent. He was sensitive to manipulations of word frequency and orthographic regularity. He wrote spontaneously and could identify the written counterpart to a spoken word with relative ease. Computerized axial tomography revealed damage to the posterior temporal-parietal region of the left hemisphere.

Word deafness in Wernicke's aphasia.

Three patients with otherwise typical Wernickes aphasia showed consistent superiority of visual over auditory comprehension. The precedents for and anatomical basis of a selective auditory deficit in Wernickes aphasia are discussed, including the relationship to pure word deafness. One implication of spared visual language function may be the use of gesture in language therapy for such patients.

Alexia and agraphia in Wernicke's aphasia.

Three patients with otherwise typical Wernickes aphasia showed consistently greater impairment of reading than auditory comprehension. While this syndrome resembles alexia with agraphia, the paraphasia of speech, repetition, and naming underline the aphasic nature of the disorder. Together with previous reports of isolated word deafness in Wernickes aphasia, these cases suggest a relative independence of auditory and visual language processing.

Anomia in cerebral diseases

Naming performance was studied in demented patients, age-matched controls, left-hemisphere stroke patients with aphasia and right-hemisphere stroke patients. The experimental naming test compared four levels of perceptual difficulty and two language variables: word frequency and word length. Naming accuracy and error types were compared among subject groups. Perceptual difficulty influenced naming in the demented and right-hemisphere stroke patients, but not in aphasics and controls. Visual errors, likewise, characterized the former two groups. Semantically-related errors and circumlocutions characterized the naming of aphasic and demented patients, while phonemic errors were common only in aphasics. The results suggested differing patterns of anomia in different patient groups.

The Cranial Nerves

Publisher Summary This chapter highlights the parts of the nervous system involved in the act of speaking. The cranial nerves make up a part of the peripheral nervous system that provides crucial sensory and motor information to the oral musculature. The cranial nerves are vital for speech production, and the speech-language pathologist must be knowledgeable about their functions. There are 12 pairs of cranial nerves and 6 of them are directly related to speech production—cranial nerves V (trigeminal), VII (facial), VIII (acoustic-vestibular), IX (glossopharyngeal), X (vagus), and XII (hypoglossal). This chapter refers to the embryologic origin of the cranial nerves, explaining those which are somatic or branchial in origin and those which are solely special sensory nerves. The chapter also discusses the anatomy, innervation, function, and testing of each of the nerves associated with speech. It describes the cooperation of several cranial nerves in the act of swallowing.

1 – Introduction to Speech-Language Neurology

This chapter presents an introduction to speech-language neurology. The brain is the source of all speech and language behavior. Hence, current knowledge concerning its anatomy and functioning must be studied and absorbed by a speech-language pathologist. But it is not the responsibility of the clinical speech-language pathologist to diagnose a neurologic disorder. This function is in the realm of the physician. Nevertheless, it is the responsibility of the speech-language pathologist to assess all relevant aspects of speech and language in those with a known or suspected neurologic disorder. The study of the relationship between the brain and speech and language function has a rich history in the past hundred twenty-five years, and the disciplines of speech-language pathology and neurology have often cooperated in the study of neurologically based communication disorders. Employing both verbal reasoning (left-hemisphere function) and visual imagery (right-hemisphere function) contributes to a successful experience.

Neurosensory Organization of Speech and Hearing

This chapter discusses the neurosensory organization of speech and hearing. Three major pathways carry sensory impulses from the extremities and trunk to higher levels of the nervous system. One of these is the spinothalamic tract that has two divisions—the lateral spinothalamic tract and the ventral spinothalamic tract. The lateral spinothalamic tract conveys impulses of pain and temperature. The ventral spinothalamic tract conveys impulses of light touch, light pressure, and tactile discrimination. The second major pathway is known as the dorsal column. The two tracts of the dorsal column are the fasciculus gracilus and the fasciculus cuneatus. The third major pathway includes the spinocerebellar tracts. The dorsal pathway ascends contralaterally. Both pathways end in the cerebellum and are thought to mediate conscious proprioception of movement. Cerebral lesions, marked by language loss, may have accompanying sensory loss involving the parietal lobe or subcortical pathway. The oral cavity is very rich in sensory receptors. Tactile receptors of the mouth, tongue, pharynx, and teeth play a significant role in the articulation of speech.

The Neuromotor Control of Speech

This chapter discusses the neuromotor control of speech. The neuromuscular control for speaking occurs in three classic motor systems: (1) the pyramidal, (2) extrapyramidal, and (3) cerebellar systems. When the corticospinal tract of the pyramidal tract is damaged by an upper motor neuron lesion, a contralateral hemiplegia (one-sided paralysis) may result. The corticobulbar tracts are the voluntary motor pathways for speech; they are part of the pyramidal system. Corticobulbar fibers innervate the cranial nuclei in the pons and medulla for the cranial nerves that control speech. The crossed and uncrossed fibers of the corticobulbar tracts are arranged so that the midline speech muscles function in bilateral synchrony for many functions. Some speech muscles show mixed bilateral synchrony and contralateral independence. The cerebellum is responsible for synergistic motor coordination and plays an important part in guiding the rapid, alternating, repetitive movements of speech. It provides afferent and efferent information to the corticobulbar fibers.