The Neuroscience on the Web Series:
CMSD 636 Neuropathologies of Language and Cognition

CSU, Chico, Patrick McCaffrey, Ph.D.

Chapter 5. Aphasia-Concomitant Characteristics


Aphasia has been defined by a number of people for more than 100 years. I like Goodglass and Kaplan's definition best. According to Goodglass and Kaplan (2001, p. 5), "aphasia refers to the disturbance of any or all of the skills, associations and habits of spoken and written language produced by injury to certain brain areas that are specialized for these functions. Disturbances in communication that are due to paralysis or incoordination of the musculature of speech or writing or to impaired vision or hearing are not, of themselves, aphasic." Thus, aphasia can affect auditory comprehension, oral expression, reading, writing, and word finding, and can be accompanied by impaired vision, hearing, muscle weakness and paralysis or muscle incoordination.

Anomias, Agnosia, Paraphasias, and Executive Function

Word Finding Difficulty and Problems with Meaning

According to Keenan (1975), all aphasics experience some word finding problems. Anomia seems to affect some categories of words more than others. Nouns seem to be especially difficult for aphasic patients to retrieve from memory while the labels for numbers and letters are often recalled with relative ease (Goodglass & Kaplan, 1983). Some word finding difficulty can be norma,l especially after age 50. It is much more serious when an aphasic has agnosia (without meaning). So if an individual has problems finding the word cart or basket it may be just a temporary lapse, but if s/he doesn't know the meaning of cart or baske it is very serious.


"Paraphasia refers to the production of unintended syllables, words, or phrases during the effort to speak" (Goodglass & Kaplan, 1983, p. 8). Patients with fluent forms of aphasia exhibit many more paraphasias than do those with nonfluent types. There are three types of paraphasias, literal/phonological, neologistic, and semantic/verbal.

Literal/phonological paraphasia - More than half of the intended word is produced correctly. For example, a patient may say /pun/ instead of /spun/. In addition, transpositions of sounds can occur, e.g "tevilision" for television. (Brookshire, 1997).

Neologistic paraphasias - Less than half of the intended word is produced correctly. In some cases the entire word is produced incorrectly. Neologisms are also common in the speech of schizophrenics.

Verbal paraphasias are those in which another word is substituted for the target word. (The substitution must be a real word. If it is not, the paraphasia is classified as neologistic.)

There are two types of verbal paraphasias: within category called semantic paraphasias and remote paraphasias. Within category errors involve the substitution of a word that is closely related to the target word, as in cat/dog. Remote errors involve the substitutions of a word that is only distantly related to the target word, as in sink/dog. Remote paraphasias are, of course, indicative of more severe language problems than are within category substitutions.

Be careful not to confuse literal interpretations on the part of the patients with paraphasias. If the patient calls a pencil a "yellow stick", this does not qualify as a paraphasia. It may mean that the patient has anomia or even agnosia. Also, the distorted speech of patients with articulation disorders like dysarthria should not be mistaken for neologistic paraphasias.

Paraphasias occur in the speech of patients with Broca's aphasia,, Wernicke's aphasia, and apraxia. (Apraxics usually produce literal paraphasias.) Wernicke's aphasics have more paraphasias than Broca's or apraxics.

The Executive function is a component of cognition. According to Denckla, 1996, it regulates and directs the cognitive process. Injury to the pre-frontal cortex disrupts the regulation and initiation of behavior, including language, vocational behavior, learning/studying behavior, and social behavior, According to Wehmeyer and Schwartz, 1997 (in Chapey, 2001) executive functions are similar to the functions involved in self-determination. Cognitive rehabilitation must include aspects of executive function.

Emotional Aspects

After a stroke, many patients seem to lose some their inhibitions and may express their emotions to a much greater extent than they did before their illness. Sometimes, family members complain that the patient's personality has changed as a result of the stroke. When the cortex is damaged it may not be able to keep the limbic system in check.

Inability to cope with frustration. Aphasics may have "catastrophic" reactions to frustration. This is especially true of patients with Broca's aphasia who tend to be extremely aware of their deficits.

Emotional Lability. Aphasic patients may cry or become angry and swear very readily. It may be helpful to assure patients that these displays of emotion are to be expected after a stroke. (Male patients who are doing a lot of crying may find this information especially reassuring.) While it is important to be respectful and sympathetic, it is not necessary to spend half of a session counseling a patient who cries or yells every day. In such a case, the speech pathologist should do his/her best to carry on with therapy or testing.

Rigidity and Concreteness. Many aphasic patients tend to think very rigidly and may only grasp the literal interpretations of language.

Physical Aspects

Most aphasic patients will have some paralysis and some hyposthesia or lack or sensation on the right side. If paralysis is complete, it is called hemiplegia. Partial paralysis is referred to as hemiparesis. Generally, the leg will be less affected by these sensory and motor deficits than the arm. The principal reason is that the innervation to the legs is more gross motor than to the arms. Right hemianopsia (visual field deficit) is the disorder of vision that most often accompanies aphasia.

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Other courses in the Neuroscience on the Web series:
CMSD 620 Neuroanatomy | CMSD 642 Neuropathologies of Swallowing and Speech

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