sensoryaphasiatxt

4 - Sensory aphasia
Receptive (or sensory) aphasia results from damage
to the auditory receptive area of the dominant
temporal lobe, which leaves the patient unable to
comprehend the speech of others. This form of
aphasia is also known as Wernicke's aphasia.
Wernicke (1874) pointed out that this form of aphasia
is often mistaken for psychotic confusion [1]. Others
have also made this connection [2, 3].

I work with patients who exhibit language dysfunction
of this type. The way they speak may be described as
rag-time or motor-mouth. Psychotic speech is
generally attributed to "thought disorder." Sometimes
asking a patient to slow down helps being able to
decipher what they are trying to say, or to explain
what they mean when they use a particular word
without any immediately recognizable connection to
context. These patients have not suffered a stroke,
but the language circuits of their brains would appear
to be impaired, sometimes to a greater degree than
when they are mainly lucid; their psychiatric label is
schizophrenia, and it might be of interest to
investigate similarities in the auditory and linguistic
impairments of schizophrenia with those of autism.

People with sensory aphasia retain fluent use of
idiomatic expressions but with strange word and
syllable substitutions. They often miss the point of
what they hear and respond with partial ready-made
phrases that include garbled use of vocabulary. The
same is true for people with the kind of psychotic
partial and intermittent aphasic disorder described
above. However, incorporation of nonsense words
and syllables indicates an intention to reformulate and
reword utterances to better fit a particular context.

The echolalic autistic child makes fluent use of often a
large repertoire of ready-made sentences and
phrases but without making any changes from one
context to another [4]. The question, "What's the
matter, did your wagon get stuck?" was adopted by
my son, Conrad, as an expression of frustration and
used in diverse situations. He remembered my asking
him this one time when his little wagon got caught on
the root of a shrub. From that time on, he uttered this
strange question often as a response to frustration or
disappointment. If he could not reach a toy on top of
the bureau, had trouble opening a door, or squeezing
toothpaste out of the tube, he would cry out, "What's
the matter, did your wagon get stuck?" Conrad was
the subject of the chapter on language by Brown
(1975), who suggested this phrase was actually used
with an approximate meaning, "Damn!" [5]. Conrad's
speech was not "metaphorical and irrelevant," as
described by Kanner [6].

Use of ready-made phrases represents lack of
analysis. Prizant (1982) has termed such phrases
gestalt forms [7]. As discussed above, Brown and
Bellugi (1964) determined that early language
development begins with recognition of stressed
syllables [8]. In part, recognition of stressed syllables
must take place in the brainstem auditory pathway; it
takes place at an age when myelination and
maturation of the language areas of the cortex are
just beginning.

Even in the language disorders caused by strokes in
older adults, Wernicke noted that not enough
attention was paid to the importance of the auditory
system through which most language must be
comprehended [1]. At that time, the course of the
auditory pathway had not been fully determined, and
connections from the cochlear nucleus were thought
to connect to higher centers through the cerebellum.
Wernicke also suggested that incoherent speech and
auditory hallucinations in psychotic disorders were
likely related to dysfunction of auditory processing.

Wernicke C (1874) Der aphasische Symptomencomplex, Breslau: Franck und Weigert.
Translation: The symptom complex of aphasia, in Cohen RS & Wartofsky MW, eds (1969)
Boston Studies in the Philosophy of Science, vol 4, pp 34-97
Anand A, Wales RJ. Psychotic speech: a neurolinguistic perspective. Aust N Z J Psychiatry.
1994 Jun;28(2):229-38.
Sambunaris A, Hyde TM. Stroke-related aphasias mistaken for psychotic speech: two case
reports. J Geriatr Psychiatry Neurol. 1994 Jul-Sep;7(3):144-7.
Simon N (1975) Echolalic speech in childhood autism, consideration of possible underlying
loci of brain damage. Archives of General Psychiatry 32:1439-1446.
Brown R (1975) A collection of words and sentences, an autistic child. In R Brown RJ
Herrnstein, Psychology (pp. 444-449). Boston: Little, Brown and Company.
Kanner L (1946) Irrelevant and metaphorical language early infantile autism. American
Journal of Psychiatry 103:242-246.
Prizant B (1982) Gestalt processing and gestalt language in autism. Topics in Language
Disorders 3:16-23.
Brown R, Bellugi U (1964) Three processes in the child's acquisition of syntax. Harvard
Educational Review 34:133-151.