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Aphasia; Acquired Alexia and Agraphia


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Alexia = ?
Agraphia = ?
Alexia = Reading
Agraphia = Writing
Do most aphasics have alexia or agraphia?
Most aphasics have BOTH alexia AND agraphia.
"Usually part of the aphasia syndrome but can exist separately. Usually from a small, left-hemisphere inferior parietal lobe lesion involving the angular gyrus.
What is Acquired Alexia?
-Lang. based disorder highly associated with aphasia
-Some aphasics will benefit from the written word, as in Wernicke's, and some may not.
-In some cases, you can show a written word to get a verbal response
What is Deep Dyslexia?
-Impaired greapheme-phoneme conversion
-**Reads only content words**
-More difficulty with functor words (either omitted of misread as another functor word)
-Damage to mapping input to semantics
-Semantic errors ("tall" for "long"). May be called PARALEXIAS
-Strong word superiority effect
-Strong Concreteness
-Tends to omit inflectional and derivational errors ("entertain" for "entertainment")
-May have errors based on visual similiarity ("crown" for "crowd")
-Great difficulty with nonsense words
-More difficulty with verbs and adjectives than nouns
-Poor ability to select a work from a semantically related list
-Promarily reads from a whole-word approach
-Most Broca's Aphasics have this
What is Phonological Dyslexia?
-Exists on a continuum from deep to surface dyslexia (a "recovering" deep dyslexic)
-Occasional difficulty reading grammatical functor words
-Poor ability to apply grapheme-phoneme rules to read pseudowords
-Familiarity strong factor
-**Few semantic Errors**
-Reading impariment-mild
-Read words easier
What is Surface Alexia?
-Spelling sound regularity
-Can read nonwords/functor words better than content words
-Use of grapheme-to-phoneme conversion
-Frequent regularization errors ("choir" pronounced "choyer") - apply phonetic rules when the shouldn't apply them
What is Alexia without Agraphia?
-Person can't read what they write well. Usually occurs with right visual field deficirs. May also have difficulty naming visually presented colors (color Agnosia)
-Reads letter-by-letter (every single letter read out loud before word is read)
-No semantic errors
-Disassociation b/t occipital association cortex and the dominant angular gyrus
-Very obsolete, small lesion
-Typically do not have any other aphasia symptoms
-Can write words, but can't read what they wrote
When assessing Alexia without Agraphia, what things should you keep in mind?
-Do not confuse reading orally with reading comprehension
-Note error types or do an error analysis to try to discern the type of alexia
When assessing reading, what factors do you need to consider?
-Word Frequency or occurance
-Part of speech
-Emotional Valence
-Personal Relevancy
-Syntactic Complexity
-Length of word
-Degree of interference required for interpretation
-Regularity of Spelling
-Morphological and syntactic complexity
When reading aloud, what factors do you need to consider?
-Personally relevant names
-Words with emotional valence
-Concrete nouns and verbs
-Abstract nouns and verbs
-Grammatical words
-Numbers and letters (Arabic & Roman)
-Phrases/sentences with sunstantive words
-Phrases/sentences with functor words
-Nonsense words
When assessing reading comprehension, what factors do you need to consider?
-Match word with picture or oject
-May want to present target words vertically to minimize the problems of hemianopsia or inattention to one side
-Should include phonemically and semantically related words
-May want to read a command
-Sentence comprehension with 4 choices
-Paragraph comprehension with 4 choices
Typically with aphasics, writing is better than speech.
Typically, what one hears verbally will be what one sees graphically. Broca's aphasics will write primarily nouns or first letter words. Posterior lesion aphasic may write with a variety of paraphasic errors.
"What comes out of the mouth comes out of the pen."
What is the definition of Agraphia?
-An acquired writing disorder characterized by errors in spelling, semantics, or syntax and poor construction of the physical features of the written word.
-Language-based disorder closely associated with aphasia.
When assessing writing, what factors do you need to consider?
-Word frequency or occurrence
-Part of speech
-Emotional valence
-Personal relevancy
-Syntactic complexity
-Length of word
-Degree of inference required for interpretation
-**Regularity of spelling**
-Morphological and syntactic complexity
What are the 4 types of agraphia?
1. Apraxic Agraphia
2. Deep Dysgraphia
3. Surface Dysgraphia
4. Phonological Dysgraphia
What is Apraxic Agraphia?
-Inability to use a writing tool to form graphic symbols when a model is provided.

-May be part of ideomotor apraxia or constructional apraxia
-Imparied ability to form letters wven when copying
-Better ability to spell with anagrams or a typewriter or to spell aloud
-Difficulty in controlling and producing the graphomotor patterns required for writing
What is Deep Dysgraphia?
-Produces spelling errors that are semantically related but not phonologically related (ie "school" for "class")

-Best at writing concrete nouns vs abstract nouns or verbs
-Impaired phoneme-to-grapheme conversion
-**Can not write functor words**
What is surface dyslexia?
-Makes phonetic spelling errors (ie "skool" for "school") because of an over reliance on phoneme-to-grapheme conversion
-Impaired whole word lexical route
-Can write pseudowords "flig"
What is phonological dysgraphia?
-Uses a lexical-semantic whole word spelling approach
-Relative preservation of ability to write real words
-Unable to write pseudowords "fling" vs "flig"

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