BIOLOGICAL BASIS OF BEHAVIOR
Psychology 321
Spring, 2004
Dr. John M. Morgan MWF, 8am to 9:00 HGH 226
Neurosurgeon's perspective: Wernicke's aphasia
Velma Belchik
LOCATION
The posterior region of the left superior temporal gyrus or
the first gyrus of the temporal lobe (corresponding to
Broadmann's areas 22 and 42) is the region of the brain known as
Wernicke's area for its discoverer Carl Wernicke who first
described it in 1874. Cortical damage to this area can be caused
by acute head trauma (eg. gunshot wounds), tumor, cell damage
due to stroke (the most common cause), infection (eg. herpes
encephalitis), disease (eg. Alzheimer's), or can be a result of
surgical complication (particularly in surgery for aneurysmal
subarachnoid hemorrhage). Damage to this region produces
Wernicke's aphasia (aka Sensory, Receptive, or Posterior
aphasia), defined as either partial or total loss of
communication ability (oral, written, or both).
However, neurosurgery is only appropriate as a treatment for
Wernicke's aphasia on those occasions where either a brain tumor
or hematoma (blood clot) due to trauma is putting acute pressure
on this speech/language structure in the brain. Tumors in this
region are either: a) primary tumors, those that arise
organically within the brain, including astrocytomas (tumors in
astrocyte or neuroglial cells), and glioblastomas (fast-growing
astrocytomas comprised of necrotic cells); or b) secondary
tumors, which metastasize and travel to the brain from elsewhere
in the body. In these cases of Wernicke's aphasia due to tumor
or hematoma, surgery to diminish pressure can be therapeutic.
Because Wernicke's area is not a discrete, self-regulating
structure, but one part of a larger, interconnected language-
processing system, damage to this region also requires attention
to surrounding components of the temporoparietal cortex. Working
with Ludwig Lichtheim, Wernicke proposed a model of language
processing that classified all the aphasias. Based on
neuroanatomical structure, this model predicts the changes in
communication as a consequence of injury. This Wernicke-
Lichtheim model effectively maps language functions within the
brain.
Wernicke's area communicates bi-directionally with Broca's
area (Broadmann's areas 44/45) via the arcuate fasciculus, which
in turn communicates with nearby semantic regions of the
parietal area. In particular, damage to these connecting fibers
frequently also involves further deterioration, leading to both
motor and sensory transcortical aphasias, or, with a complete
severing of the arcuate connection, to connection aphasia.
Wernicke's aphasia, an ability to produce speech without the
ability to understand it; Broca's aphasia, which is the reverse
of Wernicke's; transcortical aphasia, in which word usage or
word comprehension is impaired, while the reverse is intact; and
connection aphasia, in which both understanding and production
of individual words is preserved, while repetition is impaired.
DIAGNOSIS
Diagnosis of Wernicke's aphasia typically occurs prior to
referral to the neurosurgeon, generally by a speech pathologist
or neuropsychologist. Diagnostic imaging, including computed
tomography scans (CT), magnetic resonance imaging (MRIs), and
cerebral angiography is typically used to examine the structure
of the brain and the tumor, as well as to study the blood supply
mechanisms feeding the lesion.
TREATMENT
Surgery to treat a tumor or blood clot in Wernicke's area is
most often performed as a craniotomy, a surgical removal of a
portion of the skull in order to expose the brain. The following
is an outline of a typical procedure.
Before undergoing surgery, patient preparation includes
administering steroids to reduce swelling of the brain tissue in
and around the tumor as much as possible; anticonvulsant
medication treatment to prevent or control seizures; and anti-
anxiolytics to calm the patient. Prior to this, radiation
therapy may be prescribed to reduce the size of the tumor.
During surgery, the patient is often given only a local
anesthetic and kept awake to assist in the electrophysiological
brain mapping by the neurosurgeon. First, the patient's scalp is
shaved for clear access to the skull. This is done immediately
prior to surgery, in the operating room, to reduce the chance of
infection from chance nicks of the skin. The neurosurgeon then
uses a pen to mark the large square area of the scalp comprising
the surgical area; the surgeon follows this mark, making a
curved incision reaching from behind the hairline, in front of
the ear, and arching above the eye; the incision cuts into the
skin, stopping at the thin membrane covering the bone of the
skull. Cauterization of the small arteries in the skin covering
the skull is done to stop bleeding; this skin covering can then
be folded back, exposing the bone beneath.
At this point, the neurosurgeon will use a high-speed hand
drill or a craniotome (an automatic surgical drill) to describe
a circle of holes in the skull, then insert a soft metal guide
under the bone, using the holes as points of entry. The use of a
fine wire saw, moved along this guide channel underneath the
bone between each hole, allows the surgeon to saw through the
bone of the skull until the bone flap can be removed and the
brain exposed. Reduction or excision of the tumor follows as
indicated. Following tumor reduction or excision, the piece of
skull removed to access the brain is replaced and surgically
wired in place. The neurosurgeon then sutures the membrane,
muscle, and skin covering the skull back on.
Post-surgical aftercare includes administering oxygen,
painkillers, and drugs to control swelling, seizures, and
infection. Typically, the patient can get out of bed within
approximately 24 hours and leave the hospital after
approximately one week. Changing of bandages on the skull is
done frequently. The sutures used to reattach the skin covering
the skull are removed, but the wires suturing the skull bones
are permanent. Speech therapy is also part of follow-up care.
PROGNOSIS
Re-acquisition of language skills in patients with
Wernicke's aphasia depends in large part on how much brain
damage occurred, the specific location of the lesion, and
original cause of the injury. Additional factors affecting
recovery include age, health, and motivation of the patient. As
stated earlier, surgical treatment is only used in cases where
the original cause was a tumor or hematoma; patients who undergo
craniotomy for removal of a tumor in Wernicke's area have
similar recovery rates as other brain tumor patients.
REFERENCES
Damasio, A.R. (1992). Aphasia. The New England Journal of
Medicine, 326, 531-539.
Gray, P. (1994). Psychology. New York: Worth Publishing.
Knepper, L.E., Biller, J., Tranel, D., Adams Jr., H.P., & Marsh
III, E.E. (1989). Etiology of stroke in patients with
Wernicke's aphasia. Stroke, 20, 1730-1732.
LaPointe, L.L. (Ed.). (1997). Aphasia and related neurogenic
language disorders. (2nd ed.). New York: Thieme.
National Aphasia Association's Aphasia Fact Sheet. (1999).
Retrieved May 2, 2004, from
http://www.aphasia.org/NAAfactsheet.html
Smeltzer, S., & Bare, B. (1992). Management of patients with
neurological dysfunction. In Brunner and Suddarth's Textbook of
Medical/Surgical Nursing, 7th ed. (pp. 1678-84). Philadelphia:
J. B. Lippincott Co.
Walchew, D. (11/2/04 last updated) Supervision Notes 15: Memory
and cognition (part 2). Retrieved May 2, 2004, from Cambridge
University, Department of Psychiatry, Neurophysiology
Supervision Information web site:
http://www-
staff.psychiatry.cam.ac.uk/~dew22/supervisions/pdf/dew-neuro-
week15a.pdf
Youngson, R., & The Diagram Group. (1993). The Surgery Book. New
York: St. Martin's Press.
Linsey Thomson
Neurologist Perspective
A neurologist is a medical specialist in the nervous system
and the disorders affecting it. The neurologist is also skilled
in the diagnosis and treatment of nervous disorders.
Our team focused on the Wernicke's area of the temporal
cortex. This area is found in the posterior, left portion of the
superior temporal gyrus, which is the first gyrus of the
temporal lobe. Wernicke's area, the auditory and language zone,
includes several different systems. These are responsible for
such tasks as recognizing spoken words, comprehension of the
meaning of words, and the process of conversion of thought into
words. The area contains images of sounds and memories of
sequences of sounds that constitute words thereby associating
speech sounds with meaning.
A lesion to this area can lead to many different
difficulties pertaining to language. The severity of damage
determines the amount of difficulties and the rate of recovery.
A person with damage to this area of the brain often loses the
ability to comprehend speech, both spoken and written. One
cannot comprehend the significance of spoken words or recall the
meaning of them. Difficulties may occur with reading, writing,
naming, and repetition in varying degrees of severity. Many
patients can still hear and recognize voices, but are unable to
understand the words and cannot repeat what was heard. The
patient's speech is relatively fluent, but is paraphasic. This
is characterized by many non substantive words and the words
themselves are often malformed or inappropriate. This speech can
be incomprehensible is severe cases. Known as jargon aphasia,
this is usually a syntactical defect in arrangement of words in
proper sequence and includes senseless combinations of sounds
and words. Jargon aphasia is typical with damage to structures
deep in the posterior temporal cortex. Brain damage in this area
generally deprives one of all means of communication although
physical ability of speech is not interrupted. A patient is
unable to understand what is said to them and their own
communication is meaningless to others and many times even to
themselves.
A lesion and other damage sustained to this area often
results in what is known as Wernicke's aphasia. In moderate
cases, the patient can understand the point of conversation, but
is unable to pick up any details. This disorder is mostly
characterized by a severe impairment of auditory comprehension.
Speech is fluent and well articulated, but semantically
inappropriate and paraphasic. Sentences can be long and
grammatically well formed, but contain no meaning. The patient
also has difficulties with word finding. Speech also contains
neologistic paraphasias in which less than half of a patient's
utterances are correct. An example would be the use of bort for
fork. A phenomenon called press of speech is also very common.
Patients speak very rapidly, interrupting others. They seem to
be striving for closure or a sense of actual communication of
intended speech. (McCaffrey) Patients also exhibit anosognosia,
in which patients are unaware of their deficit in understanding.
Wernicke's aphasia is sometimes characterized by a combination
of pure word deafness and Transcortical Sensory Aphasia (TSA).
Pure word deafness is the inability to comprehend the
spoken word, the written word, as well as the ability to
understand one's own speech. Patients are shown to still have
the ability to distinguish between different vowel sounds, but
are unable to distinguish between consonants. Yet, the patient
lacks the ability to distinguish sounds of words. This disorder
is very rare with damage to just the Wernicke's area, but is
characteristic of bilateral damage to the primary auditory
cortex. Some afflicted people are to understand speech through
reading lips or can read and write with comprehension. In
addition to pure word deafness, once damage extends past
Wernicke's area the other symptoms of Wernicke's aphasia become
apparent.
If the angular gyrus is compromised by the damage, reading
and writing becomes impaired. Damage to the lateral fissure,
just past Wernicke's area, causes TSA. This is a separation of
the arcuate fasciculus, Broca's area, and Wernicke's area from
the rest of the brain. These patients can repeat what other's
say, but they cannot comprehend the meaning of what they hear.
They contain well preserved repetition abilities, but cannot
read or write, alexia and agraphia respectively, and have no
auditory comprehension.
Anomic aphasia is very similar to Wernicke's aphasia and is
often misdiagnosed as it. Anomic aphasia is characterized by
naming and word finding difficulties. These patients are able to
perform repetition and their auditory comprehension is
relatively intact. Damage to the arcuate fasciculus, which
connects Broca's area to Wernicke's area, causes Conduction
aphasia. Speech here is fluent, yet spontaneous with frequent
literal paraphasia and poor repetition. These patients
comprehend nouns and verbs, but not such things as prepositions
or conjunctions. This person is aware of their paraphasic errors
and will try to "untangle" them. Damage may also cause verbal
paraphasia, substitution of one word or phrase for another
related in meaning or literal aphasia, which is substitution of
incorrect sounds in otherwise correct words.
The neurologist must determine exactly which part of the
brain is damaged through assessment of the patient's abilities.
Detection of damage incorporates the use of magnetic resonance
imaging (MRI), computerized tomography (CT), or positron
emission tomography (PET). Physicians typically perform tests
that require the individual to follow commands, answer
questions, name objects, and converse. Tests that can be run
include the Boston Diagnostic Aphasia Examination, the Porch
Index of Communicative Ability, or the Minnesota Test for
Differential Diagnosis of Aphasia. These tests use picture cards
and other verbal activities to identify which areas of
communication are most problematic.
Treatment success depends on the causes of the brain
damage, the area of damage, the extent of injury, and the age
and health of the patient. Other factors may include motivation,
handedness, and educational level. The size of the lesion has a
direct effect on comprehension levels. The neurologist refers
the patient to a speech-language pathologist for a comprehensive
examination of ability. Therapy helps individuals to utilize
remaining abilities, to restore language abilities as much as
possible to compensate for language problems, and to learn other
methods of communicating. Patients are to attend speech and
language therapists for rehabilitation programs to restore lost
cognitive and motor skills. A new and experimental method is the
use of pharmacotherapy. This is the use of drugs in combination
with speech therapy in hopes to increase task related flow of
activation to the left hemisphere of the brain. Natural recovery
can occur through recruitment of undamaged portions of the
cortex and in some cases through the use of an alternative store
of learning on the opposite side of the brain, which remains
dormant until the dominant side is injured. Children,
particularly younger than 8, often make an excellent recovery.
Left handed people or those with left handedness in the family
history also make better progress of recovery than right handed
patients. (Geshwind)
Neurologist is responsible to perform tasks to correctly
identify a patient's deficiencies and refer them to the proper
treatment for their ailment.
references
Geshwind. Linguistics Deficiencies, 72-78
www.sfu.ca/linguistics/mcfetridge/Ling100/Lectures/F%20Neurology
.pdf
Goldernberg, George(1994). Influence of Size and Site of
Cerebral Lesions on Spontaneous Recovery of Aphasia and on
Success of Language Therapy. Brain and Language, 47, 684-698.
Hillis, Argye(2001). Hypoperfusion of Wernicke's area predicts
Severity of Semantic Deficit in Acute Stroke. Annals of
Neurology, 50, 561-566.
Koch, Christof (1994). Large Scale Neuronal Theories of the
Brain. Cambridge, Mass: MIT Press.
Long, CJ. Brain Behavior Relationships. Neuropsychology
Behavioral Neuroscience.
http://neuro.psych.memphis.edu/neuropsych/np-12-wern.htm#lesions
McCaffrey, Patrick, Ph.D. (2003) Neuropathologies of Language
and Cognition. The Neuroscience of the Web Series, 17(2), 228-
231.
Peters, Alan (1984). Cerebral Cortex. New York: Plenum Press.
Whynot, Dr. James (2004). Aphasia. Research Center: Medical
Conditions.
A Neuropsychologist's perspective: Wernicke's aphasia
Stewart Smith
Wernicke's area is a specialized lobe in the temporal cortex.
Damage to this area of the brain causes severe language
impairment called fluent aphasia, receptive aphasia, sensory
aphasia, or Wernike's aphasia. Aphasia is a general category of
neurological brain impairments affecting language. Fluent
Aphasia is characterized by impaired ability to remember the
names of objects and impaired language comprehension (Kalat,
2004).
The job of a Neuropsychologist is to assess patients who have
received head trauma or strokes and show signs of behavioral
impairment. This can range from diagnosing Attention Deficit
Disorder to the many forms of Aphasia. Because a
Neuropsychologist makes their diagnosis from behavioral data and
interviews, rather than invasive medical techniques, it can be a
very powerful tool for diagnosing specialized brain damage. The
drawback of these methods is that the qualitative nature of data
requires a highly trained professional to draw any valid
conclusions.
There are a number of general characteristics known about
people who have received damage to Wernicke's area. Their
speech is still articulate. They don't stumble over
pronunciation or grammar. They do however have frequent pauses
in their speech while they try to find the words to fit the
message they wish to communicate. The inability of people
suffering from fluent aphasia to recall the words they need to
convey their meaning is Anomia. This can lead to them making up
nonsense words to try and communicate. While patients cannot
connect words to the meaning they wish to convey they have an
equally hard time extracting meaning from words they hear or
read. This severely damages their language comprehension.
Because of their inability to express language their
comprehension must be measured nonverbally. "Interestingly, a
common comorbid occurrence in receptive (aphasia) patients is
that they often seem unaware of their deficit (anosognosia)"
(Browndyke, 2002)
The following is an excerpt of dialog between an examiner and
a patient taken from "Aphasia Assessment" by J.N. Browndyke who
took it from Kertesz (1981)
Examiner: What kind of work did you do before you came into
the hospital?
Patient: Never, now mista oyge I wanna tell you this happened
when happened when he rent. His…his kell come down here and
is…he got ren something. It happened. In thesse ropiers were
with him for hi…is friend…like was. And it just happened so I
don't know, he did not bring around anything. And he did not
pay for it. And he roden all these arragjen from the pedis on
from iss pescid.
A Neuropsychologist can look for the patterns mentioned in the
above paragraph to try and diagnose patients that suffer from
fluent Aphasia. This is of course tricky because the damage and
resulting symptoms isn't likely to be exactly the same in any
two participants.
Browndyke talks about three different tests used by
neuropsychologists to detect and attempt to classify aphasia.
These testing batteries require a professional neuropsychologist
or speech pathologist that is trained in aphasiology to
administer them correctly.
The first test discussed is "Examining for Aphasia (Eisenson
1954) This test is composed of a receptive and expressive
aphasia portion, each of which is further split into high and
low symbolic areas. The examiner has the flexibility to
administer the test sections in any order. Browndyke quotes
Eisenson as stating, "Aphasic patients are characteristically
too inconsistent in their responses to permit formal scoring
standards to be developed meaningfully." This reinforced the
need for a trained professional to administer this test.
The Boston Diagnostic Aphasia Examination was designed by
Goodglass and Kaplan (1972). The authors stated aims of this
examination are, "(1) diagnosis of presence and type of aphasic
syndrome, leading to inferences concerning cerebral
localization; (2) measurement of the level of performance over a
wide range, for both initial determination and detection of
change over time; (3) comprehensive assessment of the assets and
liabilities of the patient in all areas as a guide to therapy."
The test is split into five sections; conversational and
expository speech, auditory comprehension, oral expression,
understanding written language, and writing. One of the main
strengths of this test is that it has standardized data and it's
ability to discriminate between different types of aphasia
(based on their typical characteristics).
The Communicative Abilities in Daily Living test designed by
Holland (1980) engages patients in role-playing of every day
situations. The patient is rated in each of these situations on
the effectiveness of their communication. The test provides
patterns for identifying the different types of aphasia, fluent
aphasia only being one of these.
Reference:
Browndyke, J.N., (2002). Apshasia assessment.
www.neuropsychologycentral.com
Kalat, J. (2004). Biological psychology (8th ed). Tomson
Wadsworth
Spouse and Other Family Members / Individual: Wernicke's
aphasia
Walter Kozuszek
When an individual suffers a stroke or suffers damage to
Wernicke's area of the temporal lobe, the resulting Wernicke's
aphasia can become a challenge to both the patient as well as
the patient's spouse and family members. The difficulties of
speech and communication associated with damage to this area, as
well as the problems caused by depression which often result in
frustration that the patient feels, may produce a profound
effect on recovery, or lack of it.
Darius F. Teter (1995) reported on the online Neurology
Web-Forum that his fifty seven year old mother suffered a stroke
and sustained damage to Wernicke's area in her brain. Teter
reported that initially his family had believed that because his
mother's speech was dramatically affected, she was also
suffering from a loss of memory. However, within two months
after the stroke and after sessions of speech therapy, his
mother recovered approximately 75% to her former abilities.
Teter's mother's speech pathologist explained that the family's
original belief that the patient had suffered memory loss was
actually a matter of language loss (Teter, 1995), and that her
problems with speaking were enhanced by difficulties that she
had in understanding complex commands.
The progress that Teter's mother had in the two year period
is consistent with a report by the Moss Rehab Resources Net
(1997) which states that recovery will often occur during the
first two year period post stroke. In this period patients may
find that their language abilities may return if speech-language
therapy occurs as soon as possible. Although the type and
extent of the brain damage is a huge factor in the amount of
recovery, as well as the age and health of the patient, the
patient's wiliness to work toward recovery is extremely
important (Moss Rehab Resources, 1997) to recovery.
Certain types of aphasia will result in a type of
spontaneous recovery, usually following a transient ischemic
attack (TIA). A TIA is a stoke where brain blood flow is
quickly stopped and then quickly restored. It is possible for
the patient to recover in a matter of a few days to a few weeks.
This type of recovery is rare, however, and the difficulties
associated with a lasting aphasia may cause stress or depression
in the patient, which may ultimately serve to impede the
progress of recovery.
Teter's mother experienced this depression as a result of
frustration which arose from her forced lifestyle change. Prior
to her stroke, Teter's mother served as a high-placed United
Nations official. Her inability to communicate effectively
placed her at home and in Teter's care. Teter stated that he
had "noticed that when she is upset, her speaking abilities
deteriorate very dramatically – almost to the point where she is
incapable of communicating" (Teter, 1995).
Spencer, Tompkins, and Schulz (1997) state that patients
who have suffered a stroke and who are forced to confront their
now limited verbal communication skills often are referred to as
having receptive aphasia and expressive aphasia. Those with
receptive aphasia suffer from difficulties with auditory
comprehension and those with expressive aphasia are, as is
Teter's mother, challenged with speech as a transmission of
language and this often results in an onset of depression
(Spenser, Tompkins, & Schulz, 1997). The patient may
experience depression immediately after a stroke, upon
attempting to talk. This "delicate time" (Spenser, Tompkins, &
Schulz, 1997) requires a speech pathologist to be ready to make
an assessment of the patient's language communication abilities
and to begin the process of treatment.
The stroke or accident survivor with aphasia may overcome
depression with support from family, like David Douglas Allard
(2003) who states in his essay on his battle with aphasia after
a stroke at the age of twenty four that "quit is a word that
never entered [his] mind" (Allard, 2003). Allard writes that
when he found he could not speak to the world he began to feel
as though he were hibernating. His recovery, helped by his
family and friends, was like emerging from behind an "invisible
wall" (Allard, 2003) and if, during the process of speaking,
someone were to interrupt him he felt as though he were spinning
within his thoughts and words. The confusion that Allard
experienced is typical of patients with aphasia who often become
disorientated and may even experience hallucinations (Allard,
2003) which may add to the overall sense of despair that both
patients and family members may feel regarding the challenge of
dealing with this disorder.
While Allard's experience was mostly a positive one, the
experience of living with a family member with aphasia may be
very difficult as spouses and mothers and fathers face "stress,
frustration, and even anger (Merck, 2002). Mary Flournoy is
responsible for caring for her son Delshon after a drive-by
shooting left him with damage to his temporal lobe (Rickabaugh,
2003). Mary Flournoy prepares meals for her son and puts lotion
on him, assisting him with his physical needs. Flournoy
maintains her positive attitude, but acknowledges that she needs
more help to help her son effectively (Merck, 2002).
Some family members and spouses complain about the lack of
information available to them regarding the treatment of aphasia
and general information regarding the injury. In an attempt to
warn those family care givers who are dealing with aphasia for
the first time, an anonymous posting from a "43 year old
caregiver" states that information that is accessible and
understandable to laypeople is difficult to acquire (Anonymous,
1995). This posting makes it clear that individuals who
discover that they are facing the difficult task of caring for a
family member are usually uninformed and unaware of how to
acquire necessary resources to meet their needs. However, thanks
to the world wide web and online newsletters such as the Harvard
Neuro Web Forum and the Aphasia Hope Foundation (Allard, 2003)
viable, pertinent information is becoming available to more
people.
For some, adapting the therapies and techniques learned
from healthcare professionals to suit the needs of the patient
proved to be successful in relearning speech and communication.
Incorporating these adapted techniques with family involvement
may lead to higher rates of success. Judith Russo developed a
scrapbook with pictures of her husband Hank's face on a stylized
drawing of a male body (Russo, 2003). When Hank experienced
pain or discomfort, he could point to an appropriate area on the
drawing, indicating where he ached. Pictures of grandchildren
were also put into the scrapbook, and special attention was
given to practicing speaking the names. Mrs. Russo also
insisted that her adult children visit their father each night
and spend time talking to him and each child devoted their visit
time to a specific area of the therapy that was of interest to
them, such as a son who helped his father speak the words "I
love you" to him (Russo, 2003).
References
Anonymous, (1995). 43 Year Old Male-Caregiver Reply, Neuro Web
Forum, Available:
http://neuro-
www.mgh.harvard.edu/neurowebforum/StrokeArticles/43 Year Old
Male-Caregiver Reply
Allard, D. D., (2003). Tools of the Thoughts, Aphasia Hope,
Available:
http://aphasiahope.org/experience.jsp?id=412
Aphasia Fact Sheet (1997), MossRehab Resources Net, Available:
http://mossresourcenet.org/aphasia.htm
Rickabaugh, G. (feb 22, 2003) A Life Sentence, The Augusta
Chronicle, Available:
http://aphasiahope.org/experience.jsp?id=34
Russo, J. (2003). Another Life, But Not Enough Time, Aphasia
Hope, Available:
http://aphasiahope.org/experience.jsp?id=41
Spenser, K. A., Tompkins, C. A., Schulz, R., (1997). Assessment
of Depression in
Patients With Brain Pathology: The Case of Stroke,
Psychological Bulletin, 122,
2, 132-152.
Teter, F. D., (1995). Stroke in 57 year old woman. Neuro Web
Forum, Available:
http://neuro-
www.mgh.harvard.edu/neurowebforum/StrokeArticles
/Strokein57yearoldwoman
Teter, F. D., (1995). Aphasia and Depression, Neuro Web Forum,
Available:
http://neuro-www.mgh.harvard.edu/neurowebforum/Stroke
Articles/AphasiaandDepression
The Merck Manual of Geriatrics Section 6, Ch. 45 (2002) Speech
Disorders, Available:
http://merck.com/mrkshared/mm_geriatrics/sec6/ch45.jsp
Employer / Social Worker: Wernicke's aphasia
David Huffman
Wernicke's Area is the portion of the brain located in the
left temporal lobe that is responsible for understanding
language as it is heard or read and the abilities to place words
together when trying to speak. Damage to this area, which
occurs primary through stroke or physical accidents, can cause
levels of impairment to these abilities. In this Wernicke's
Area does not affect the capability of actual speech or reading,
but rather the processing of language in the mind. Incoming
information from the audio and visual cortices still causes
Wernicke's area to send signal to Broca's Area for speech
preparation and on to the motor cortex (Wechsler, 2003).
Weakening of the fibers causes Wernicke's Area to not relay
information properly though. This condition is called Wernicke's
Aphasia.
In more severe circumstances person's who suffer from this
sort of damage can still speak fluently, but the content of
their speech is nonsensical. Those who have endured less severe
damage or are further along in recovery are able to talk and be
understood. Still in later stages of recovery people with
Wernicke's aphasia have a hard time identifying the names of
objects they see even if they very they understand what these
objects are. Until the fibers are strengthen all the information
is there, but the person cannot understand (Kalat, 2001).
People who have Wernicke's Aphasia need intensive support,
as they are not able to understand or use verbal communication.
This plays an important role in the workplace during a person's
rehabilitation. First of all it is important for employers and
fellow workers to know that the Wernicke's Aphasia by itself
does not do anything to impair the victim's intelligence, though
other conditions resulting from a stroke can. Also persons in
the work field should know that while some individuals
completely recover within months or even weeks, some individuals
will never completely recover.
If a person with Wernicke's Aphasia returns to work, it is
likely that they are on the road to recovery, as the workplace
will require at least some communication. Employers are to give
minimal tasks to a recovering person and using modeling behavior
to demonstrate how these tasks are to be done. Anything that
might be restrictive of the person's capabilities, such as the
telephone or e-mail should not be included in these tasks.
Employers also must remember that the employee may not
understand auditory or visual directions so it is vital that
they have supervision to aid them with and confusion or help
that they may need. Praise and other reinforcement are
important for the employee in helping them work. Lastly in
creating a working environment, the employer should place the
employee in a place that is free of external distractions such
as a radio or other loud stimulants that can also confuse the
person with aphasia (Wechsler, 2003).
Work will most likely be part time for a person in
recovery, at least initially. Part-time work and the removal of
obstacles are the highest predictors of success for persons with
aphasia reentering the work field (Garcia, Barrette, & Laroche,
2000). Of course self-employed people with aphasia have an
advantage and are more successful because they can set their own
job requirement and remove barriers that limit their
capabilities. Other things that can be done to help people with
aphasia to be successful work are encouraging communication by
giving them time to try to speak or show understanding in
reading. Success also increases when employer confirms with the
worker that their communication has been clear and understood.
Social workers are of major help for people with this
condition. Often people with the condition would like to go
back to work and normal life but feel too challenged by the job
they have been at. Social workers can help these individuals to
find other jobs that are more accommodating to their condition.
Social workers also can set up Employers with training on how to
work with people who have aphasia. Also, while it is the role
of a hospital to set patients up with Speech-language
pathologists, social workers can set up other trainers,
attendants and activities to help people in their
rehabilitation. Lastly, whether or not the person decides to go
back to work, social workers help the person find care providers
and/or help their family to find specialists who will train them
with what they can do to support any recovery that can happen
and also coping with the condition.
References
Garcia, L., J., Barrette, J., & Laroche, C. (2000). Perception
of the obstacles to work reintegration for persons with aphasia.
Aphasiology, 14 (3), 269-290
Kalat, J., W. (2001). Biological Psychology (7th ed.). Belmont,
CA. Wadsworth/Thomson Learning.
Wechsler, H., B. (2003). Wernicke's Area and reading.
http://speedlearning.org/columnboy.php?title=WERNICKE'S+AREA+and
+READING
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Copyright © 2004, Dr. John M. Morgan, All rights
reserved - This page last edited May 3, 2004
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