History And Definitions

A wide variety of language disorders has been noted for many centuries before the more recent interest in aphasia study. The formal delineation of aphasia as presently recognized dates from 1861. In the early nineteenth century, similarly to other brain functions, language was considered to be subserved by a specific area in the brain. Opponents of this localization approach considered mental function to be a product of the entire brain working as a unit. In 1861, Paul Broca presented to the French Society of Anthropology a case of a patient who became speechless and then died. Postmortem studies revealed a large frontal lesion supporting the localization viewpoint. After this case, multiple clinicopathological studies were reported, confirming Broca's finding and lateralizing language function to the left hemisphere. In 1874, Karl Wernicke distinguished two types of aphasia, motor and sensory, which were clinically and anatomopathologically separable. He also postulated the existence of a conduction aphasia based on a theoretical diagram linking the sensory and motor components of language. Technological advancements, including neuroimaging techniques and more standardized aphasia batteries, have helped considerably in assessing patients with language disorders and in elucidating the intricate subsystems subserving language function.

Speech is the ability to vocalize by coordinating the muscles controlling the vocal apparatus. It is the mechanical aspect of oral communication. Speech disorders are termed dysarthria, a disturbance in articulation, or dysphonia, a disturbance in vocalization or phonation. Patients with dysarthria or dysphonia retain their language ability despite their speech disturbance.

Language is the cognitive aspect of symbolic communication.

It is the ability to converse, comprehend, repeat, read, and write. Language ability depends on central processing for either comprehension or formulation for expression the sounds and symbols of prepositional communication. Language disorders are termed aphasias, and involve language disturbances in comprehension, production, or both.

This chapter reviews clinical syndromes of both speech and language disorders. An overview of anatomy and physiology of speech and language is a first step toward understanding the pathophysiology underlying these disorders. Examination of speech and language disorders is emphasized and forms the basis for diagnosis, lesion localization, and treatment.


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