BROCA’S APHASIA

•Broca,s aphasia also known as Motor ,

Expressive and Non-fluent aphasia
•Broadman area 44
Common pathology
•Left posterior-inferior frontal cortex
and underlying white matter
involvement.
•Stroke of upper division of left middle
cerebral artery
BROCA’S APHASIA
•Patients present with a non fluent
speech. patient may be presented
with no speech at all or may only utter
yes or no
•They speak without intonation and
have difficulty producing spontaneous
speech
•Repetitions are impaired
•Comprehension is relatively intact. .
Spontaneous Language: ‘Cookie jar theft’: Boston
Diagnostic Aphasia Examination
 Common Symptoms
•Speech in Broca’s aphasia is spare
(10 to 15 words per minute as
compared with the normal 100 to
115 words per minute

•Reading ALOUD is impaired

 Broca’s aphasia: Writing
•Poor form, may be due to hemiplegia (forced
to use non-dominant hand)
•Even if right hand spared, writing is diff
•Pts. Write as they speak: slowly and
laboriously
•Strings of content words sprinkled with
misspellings, distortions/omissions of letters.
•The dysgraphia usually corresponds in degree
to the severity of the spoken disturbance
Broca’s writing style
ADVANCED FORM OF THE
SYNDROME
•NO SPEECH AT ALL
•MAY UTTER YES OR NO
•HABITUAL EXPRESSIONS
• HI, FINE, THANK YOU
•WORDS OF WELL KNOWN
SONGS
•PATIENT RECOGNIZES HIS Name
•Right faciobrachial paresis
•left-sided manual-brachial
apraxia (sympathetic
apraxia)
•Commands to purse, smack,
or lick the lips or to blow and
whistle are poorly executed
 CHARACTERISTICS OF BROCA
APHASIA
Non-fluent speech
Sparse verbal output
Poorly articulated
Consists of short phrases
Produced with effort
Absent or deficient syntactic
structure
 COMPREHENSION IN BROCA
APHASIA
Generally good
More or less impaired for syntactically
complex sentences
Difficulty in comprehending the same
words that are omitted in speech
production
•Also, difficulty with repetition of these words
Difficulty understanding relational words
•E.g. bigger/smaller, up/down, within/without
 VERBAL SHORT-TERM MEMORY
DEFICIT
Patients can readily point to
individual objects or body parts
named by the examiner
But when asked to point to the
same items in a specific
sequence they often fail at the
level of only two or three items
 BREAKDOWNS IN GRAMMAR
•Breakdown in modifying parts of
speech
•Patients often eliminate articles,
adjectives, and adverbs altogether.
•Instead of saying “I saw some large
gray cats”, a patient with Broca’s
aphasia might say “see gray cat”.
•All this leads to a breakdown in syntax
• For the sentence, “Ladies and gentlemen, you are
now invited into the dining room”, a patient with
Broca’s aphasia may only be able to say “Ladies,
men, room.”
• When asked his occupation, a mailman with
Broca’s aphasia said “Mail … mail … m ….”
•They also involve distortion of word order.
• Broca’s aphasiac to express I will go home
tomorrow coming out as Go I home tomorrow.
•Altogether, this is called agrammatism or
telegraphic speech
 AGRAMMATISM IN BROCA’S APHASIA
Examiner: Can you tell me about why you came back to the
hospital?
Patient: Yes … eh … Monday … eh … dad … Peter Hogan and
dad .. hospital. Er … two … er … doctors … and … er … thirty
minutes … and … er … yes … hospital. And .. Er … Wednesday
… Wednesday. Nine o’clock. And … er … Thursday, ten o’clock
… doctors … two … two … doctors… and … er… teeth … fine.
E: Not exactly your teeth … your g-
P: Gum … gum …
E: What did they do to them?
P: And er … doctor and girl … and er .. And er gum …

(Goodglass 105)
 Some speech of a Broca aphasic
Examiner: What brought you to the hospital?
Patient: Yes ... Monday ... Dad, and Dad ...
hospital, and ... Wednesday, Wednesday, nine
o'clock and ... Thursday, ten o'clock ... doctors,
two, two ... doctors and ... teeth, yah. And a
doctor ... girl, and gums, and I
(Patient was trying to explain that his father had
brought him into the hospital on Wednesday to
have some work done on his teeth.)
 Reversible sentences
• The (b) sentences of each pair are difficult for Broca's
patients to understand compared to the (a)
sentences:
•1a) The boy ate the apple.
•1b) The clown chased the violinist.
•2a) The cop shot the robber.
•2b) The robber was shot by the cop.
•3a) It was the cop who __ shot the robber.
•3b) It was the robber who the cop shot __.
 Repetition Of One's Own Speech
•The most famous case is that of Broca’s
first patient, who could only say the
(French) word "tan", which he repeated
often, and so was known as "Tan".
•Uncontrollable repetition of a particular
response, such as a word, phrase, or
gesture, despite the absence or cessation
of a stimulus, usually caused by brain
injury or other organic disorder.
•This is know as perseveration.
 Summary Of Main Symptoms
•Impaired production of speech
•Mild: non-fluent
•Severe: broca’s tan (perseveration)
•Non-fluent speech:
•Effortful: slow, deliberate, halting, with
pauses between words and even
syllables, false starts
•Misarticulated: distorted consonants
and vowels, called phonetic dissolution
 Cont..
•Laconic speech:
•short utterances with few function
words (agrammatism or telegraphic
speech)
•Good short-term retention & recall of verbal
materials
•may generalize treatment skills &
strategies to daily life
•Great concern about their impairment and the
errors they make
 Broca’s Aphasia
Clinical Feature Observation

Speech non fluent, telegraphic character, effortful, despair

Comprehension Relatively normal, deficit in complex grammatical structures
(auditory/written)

Repetition Impaired
Naming Impaired but improves with cues
Reading Impaired reading aloud
Writing Impaired, poorly formed letters
Typical localization of Left posterior-inferior frontal cortex
lesion

Typical Pathology Stroke of upper division of left middle cerebral artery

 BROCA'S APHASIA CHECKLIST
• comprehension of • Normal
spoken material • Normal
• comprehension of • impaired: phonetic
written material dissolution
• segmental phonology • normal
• word selection • normal
• word semantics • impaired: mild to
• fluency (production severe
of speech) (perseveration)
• production of writing • impaired
• use function words • impaired
• Grammaticality • agrammatism or
• repetition of what telegraphic
others say speech
• conversational • Impaired
proficiency, e.g. turn • impaired (no
taking evidence)
• concern about • Normal
impairment
• yes
• concern about errors
• yes
• short-term retention
• normal
& recall of verbal
materials