Paraphasia is a type of language output error commonly associated with
aphasia
Aphasia is an inability to comprehend or formulate language because of damage to specific brain regions. The major causes are stroke and head trauma; prevalence is hard to determine but aphasia due to stroke is estimated to be 0.1–0.4% in th ...
, and characterized by the production of unintended syllables, words, or phrases during the effort to speak. Paraphasic errors are most common in patients with
fluent forms of aphasia, and come in three forms: phonemic or literal, neologistic, and verbal.
Paraphasias can affect
metrical information,
segmental information,
number of syllables, or both. Some paraphasias preserve the meter without segmentation, and some do the opposite. However, most paraphasias affect both partially.
The term was apparently introduced in 1877 by the German-English physician
Julius Althaus
Julius Althaus (31 March 183311 June 1900) was a German-English physician. He conducted early electrical treatment of patients at King's College Hospital and he was mainly instrumental in creating the Maida Vale Hospital for Nervous Diseases.
...
in his book on ''Diseases of the Nervous System'', in a sentence reading, "In some cases there is a perfect chorea or delirium of words, which may be called ''paraphasia''".
Causes
Paraphasia is associated with fluent aphasias, characterized by “fluent spontaneous speech, long grammatically shaped sentences and preserved
prosody abilities.”
[Sinanovic O, Mrkonjic Z, Zukic S, Vidovic M, Imamovic K. 2011. Post-stroke language disorders. Acta clinica Croatica 50:79-94] Examples of these fluent aphasias include
receptive or Wernicke’s aphasia,
anomic aphasia
Anomic aphasia (also known as dysnomia, nominal aphasia, and amnesic aphasia) is a mild, fluent type of aphasia where individuals have word retrieval failures and cannot express the words they want to say (particularly nouns and verbs). By contra ...
,
conduction aphasia
Conduction aphasia, also called associative aphasia, is an uncommon form of difficulty in speaking (aphasia). It is caused by damage to the parietal lobe of the brain. An acquired language disorder, it is characterised by intact auditory comprehen ...
, and
transcortical sensory aphasia Transcortical sensory aphasia (TSA) is a kind of aphasia that involves damage to specific areas of the temporal lobe of the brain, resulting in symptoms such as poor auditory comprehension, relatively intact repetition, and fluent speech with semant ...
, among others. All of these lead to a difference in processing efficiency, which is often caused by damage to a cortical region in the brain (in receptive aphasia, for example, the lesion is in or near Wernicke’s area);
lesion
A lesion is any damage or abnormal change in the tissue of an organism, usually caused by disease or trauma. ''Lesion'' is derived from the Latin "injury". Lesions may occur in plants as well as animals.
Types
There is no designated classifi ...
location is the most important determining factor for all aphasic disorders, including paraphasia - the location of the lesion can be used to hypothesize the type of aphasic symptoms the patient will display.
This lesion can be caused by a variety of different methods: malfunctioning blood vessels (caused, for example, by a
stroke
A stroke is a medical condition in which poor blood flow to the brain causes cell death. There are two main types of stroke: ischemic, due to lack of blood flow, and hemorrhagic, due to bleeding. Both cause parts of the brain to stop functionin ...
) in the brain are the cause of 80% of aphasias in adults, as compared to head injuries,
dementia
Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
and
degenerative diseases
Degenerative disease is the result of a continuous process based on degenerative cell changes, affecting biological tissue, tissues or Organ (anatomy), organs, which will increasingly deteriorate over time.
In neurodegenerative diseases, cells of ...
,
poisoning
A poison can be any substance that is harmful to the body. It can be swallowed, inhaled, injected or absorbed through the skin. Poisoning is the harmful effect that occurs when too much of that substance has been taken. Poisoning is not to ...
,
metabolic disorders
A metabolic disorder is a disorder that negatively alters the body's processing and distribution of macronutrients, such as Protein, proteins, Fat, fats, and Carbohydrate, carbohydrates. Metabolic disorders can happen when abnormal chemical react ...
,
infectious diseases
An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dise ...
, and
demyelinating diseases
A demyelinating disease is any disease of the nervous system in which the myelin sheath of neurons is damaged. This damage impairs the conduction of signals in the affected nerves. In turn, the reduction in conduction ability causes deficiency i ...
.
Lesions involving the
posterior superior temporal lobe are often associated with fluent aphasias.
Damage to the brain's language centers
Two areas of the brain, Broca’s area and Wernicke’s area, are responsible for various disruptions in speech when damaged. Each is defined by their distinct characteristics.
Broca’s aphasia
Expressive aphasia, also known as Broca's aphasia, is a type of aphasia characterized by partial loss of the ability to produce language ( spoken, manual, or written), although comprehension generally remains intact. A person with expressive aphas ...
is characterized by non-fluent or telegraphic-type speech - where articles, conjunctions, prepositions, auxiliary verbs, pronouns and morphological inflections (plurals, past tense) are omitted. The word substitutions are infrequent and distortion of consonants and simplification of consonant clusters is frequent. Content words such as nouns, verbs and adjectives may be preserved. Subjects of this aphasia are aware of their errors in speech. Damage to the Broca’s area does not affect comprehension of speech.
Wernicke’s aphasia is characterized by fluent language with made up or unnecessary words with little or no meaning to speech. Those who suffer from this type of aphasia have difficulty understanding others speech and are unaware of their own mistakes. When corrected they will repeat their verbal paraphasias and have trouble finding the correct word. Wernicke’s area is found in the dominant hemisphere of the posterior gyrus of the first temporal convolution of the brain, whereas Broca’s area is found anterior to the Wernicke’s area.
Symptoms
Phonemic paraphasia
Phonemic paraphasia, also referred to as phonological paraphasia or literal paraphasia, refers to the substitution of a word with a nonword that preserves at least half of the segments and/or number of syllables of the intended word. This can lead to a variety of errors, including formal ones, in which one word is replaced with another phonologically related to the intended word; phonemic ones, in which one word is replaced with a nonword phonologically related to the intended word; and approximations, an attempt to find the word without producing either a word or nonword.
These types of errors are associated with Wernicke's aphasia, among others.
Phonemic paraphasias are often caused by lesions to the
external capsule
The external capsule is a series of white matter fiber tracts in the brain. These fibers run between the most lateral (toward the side of the head) segment of the lentiform nucleus (more specifically the putamen) and the claustrum.
The white matt ...
, extending to the posterior part of the
temporal lobe
The temporal lobe is one of the four Lobes of the brain, major lobes of the cerebral cortex in the brain of mammals. The temporal lobe is located beneath the lateral fissure on both cerebral hemispheres of the mammalian brain.
The temporal lobe ...
or
internal capsule
The internal capsule is a white matter structure situated in the inferomedial part of each cerebral hemisphere of the brain. It carries information past the basal ganglia, separating the caudate nucleus and the thalamus from the putamen and the g ...
.
This type of paraphasia also occurs in other languages as well. For example, case studies have been performed with German speakers, which demonstrated that 30.8% of paraphasias occurred at the beginning of the word in patients with Wernicke's aphasia and 22.6% for patients with Broca's aphasia. In English speakers this tendency to create errors at the beginning of the word remained.
* Types of phonemic paraphasias
** Anticipatory errors occur when a syllable from later in the word replaces a syllable from earlier in the word - "papple" for apple or "lelephone" for telephone.
** Perseverative errors occur when a syllable from earlier in the word replaces a syllable from later in the word - for example, "gingerjed" for gingerbread.
** Paradigmatic errors based on similarity in how the sounds are formed can also occur - "marmer" for barber, i.e.
** Addition errors, in which a segment is added that bears no relation to the intended word, are much rarer than anticipatory, perseverative, or paradigmatic errors, though they do occur. Most often what can be mistaken for an addition error is an anticipatory error from the words surrounding the intended one. However, an example of a possible addition error could be "selezant" for elephant.
** Substitution errors involve a clear phonological substitution, such as "ragon" for wagon.
** Epenthetic errors are the insertion of a segment into the target, as in the case of "plants" for pants.
** Finally, metathetical errors are the full exchange of segments like "deks" for desk.
Neologistic paraphasia
Neologistic paraphasias, a substitution with a non-English or gibberish word, follow pauses indicating word-finding difficulty.
They can affect any
part of speech
In grammar, a part of speech or part-of-speech (abbreviated as POS or PoS, also known as word class or grammatical category) is a category of words (or, more generally, of lexical items) that have similar grammatical properties. Words that are assi ...
, and the previously mentioned pause can be used to indicate the relative severity of the neologism; less severe neologistic paraphasias can be recognized as a distortion of a real word, and more severe ones cannot. The hypothesized source for these neologisms is “a device which quasirandomly combines English
phonemes
In phonology and linguistics, a phoneme () is a unit of sound that can distinguish one word from another in a particular language.
For example, in most dialects of English, with the notable exception of the West Midlands and the north-west o ...
in a phonotactically regular way.”
A neologistic paraphasia can be thought of as a
neologism
A neologism Greek νέο- ''néo''(="new") and λόγος /''lógos'' meaning "speech, utterance"] is a relatively recent or isolated term, word, or phrase that may be in the process of entering common use, but that has not been fully accepted int ...
resulting from aphasia, rather than any other of the sources with which they are associated. Neologistic paraphasia is often associated with
receptive aphasia
Wernicke's aphasia, also known as receptive aphasia, sensory aphasia or posterior aphasia, is a type of aphasia in which individuals have difficulty understanding written and spoken language. Patients with Wernicke's aphasia demonstrate fluent s ...
and
jargon aphasia
Jargon aphasia is a type of fluent aphasia in which an individual's speech is incomprehensible, but appears to make sense to the individual.
Persons experiencing this condition will either replace a desired word with another that sounds or looks l ...
.
* Types of Neologistic paraphasias
** There are also various types of neologistic paraphasias. They can be phonologically related to a prior word, a following word, the intended word, or another neologism. The neologistic paraphasia shares phonemes or the position of phonemes with the related word. This most often occurs when the word and neologistic paraphasia are in the same clause.
Neologistic paraphasias have a less stringent relationship with the target word than phonological paraphasias - where a phonological paraphasia has more than half of the target word’s phonemes, a neologistic paraphasia has less than half.
Verbal paraphasia
Verbal paraphasias are confusions of words or the replacement of one word by another real word; another definition is that of a contextually inappropriate English word or an English word of a syntactically incorrect class - the wrong part of speech, for example.
Verbal paraphasias do not often preserve length, although the gender of the target word was preserved in more than half of the errors in one case study. It is hypothesized that verbal paraphasias are not the result of a random process but from a precise deficit in a single area.
Verbal paraphasias are the only type of paraphasias that can also be linked to nonfluent aphasias, and they are mainly caused by lesions to the
posterior temporal region of the brain, the head of the
caudate nucleus
The caudate nucleus is one of the structures that make up the corpus striatum, which is a component of the basal ganglia in the human brain. While the caudate nucleus has long been associated with motor processes due to its role in Parkinson's di ...
, or both.
* Examples
** These errors can be semantic, in which the meaning of the word is related to that of the intended word (car for van, for example).
Semantic paraphasias can be further subdivided into six different types.
*** Coordinate semantic paraphasias replace the target word with one that is from the same category, such as tiger for lion.
*** Associate semantic paraphasias replace the target word with one that is related to the target but is not of the same category, like replacing foot with shoe.
*** Superordinate semantic paraphasias replace a specific target word with a more generalized group to which the target word involves, such as replacing pear with fruit.
*** Subordinate semantic paraphasias are the opposite of superordinate semantic paraphasias and replace the target word with one that is more specific - rose, for flower, for example.
*** Part-whole semantic paraphasias replace the "whole" with the "part" as in finger for hand; or, conversely, the part with the whole, in the case of leg for foot.
*** Finally, a visual semantic paraphasia replaces the target word with a word that shares visual features with the target, such as knife for nail.
** Random errors, in which the word has no relation to the target, also occur.
Perseverative paraphasia
Perseverative paraphasia is a type of paraphasia in which the previous response persists and interferes with retrieval of new responses. (See the experimental case study D.L.A published by Dennis in 1976.) It is associated with lesions in the
left caudate nucleus.
Treatment
Many language impairments, including paraphasic errors, are reduced in number through spontaneous recovery of neurological function; this occurs most often with stroke patients within the first three months of recovery. Lesions associated with
ischemic strokes have a shorter spontaneous recovery time, within the first two weeks; on the other hand, lesions associated with
hemorrhagic strokes have a longer period for spontaneous recovery, from four to eight weeks. Whether spontaneous recovery occurs or not, treatment must begin immediately after the stroke, with support from a
speech therapist
Speech is a human vocal communication using language. Each language uses phonetic combinations of vowel and consonant sounds that form the sound of its words (that is, all English words sound different from all French words, even if they are th ...
or
speech pathologist
Speech is a human vocal communication using language. Each language uses phonetic combinations of vowel and consonant sounds that form the sound of its words (that is, all English words sound different from all French words, even if they are th ...
. A traditional approach requires treatment beginning at the level of breakdown—in the case of paraphasia, at the level of the phoneme. There are commercially available workbooks that provide various activities such as letter, word-picture, or word-word matching, and sentence completion, among other things. The difficulty of these activities varies with the level of treatment. However, these treatments have not been proven to be clinically productive.
A 1988 study by Mary Boyle proposed a method focused on oral reading to treat phonemic paraphasias, which was partially successful, resulting in fewer phonemic paraphasias but a slower rate of speech. Treatments lasted for 50 minutes and occurred once a week. During these treatment sessions, the patient was instructed to look at twenty different phrases, each consisting of one to three syllables, then read the phrase. If the patient failed to read the phrase, the process was repeated. If the patient failed to read the phrase again, the process was abandoned. To progress from a set of one syllable phrases to two syllable phrases and two syllable phrases to three syllable phrases, an 80% success rate was necessary. This treatment was partially successful. Although fewer phonemic paraphasias were produced due to this treatment, speaking efficiency was not improved by this study. This is partially because the focus of the treatment was on sound production rather than semantic content. Improvements lasted for six weeks before the patient regressed.
[Boyle M. 1988. Reducing Phonemic Paraphasias in the Connected Speech of a Conduction Aphasic Subject. In Clinical Aphasiology Conference, pp. 379-93. Cape Cod, MA]
Experimental (magnetic-stimulation-induced) paraphasias
Transient paraphasias (as well as other language defects such as speech arrest) can be generated by artificially activating the brain's language network with
Transcranial magnetic stimulation
Transcranial magnetic stimulation (TMS) is a noninvasive form of brain stimulation in which a changing magnetic field is used to induce an electric current at a specific area of the brain through electromagnetic induction. An electric pulse gener ...
(TMS). With navigated TMS (nTMS), nodes of the language network can be located presurgically so that critical areas can be saved when performing tumor or epilepsy surgery.
[T. Picht, S. M. Krieg, N. Sollmann, J. Rösler, B. Niraula, T. Neuvonen, P. Savolainen, P. Lioumis, Pantelis, J. P. Mäkelä, V. Deletis, B. Meyer, P. Vajkoczy, and F. Ringel, A comparison of language mapping by preoperative navigated transcranial magnetic stimulation and direct cortical stimulation during awake surgery, Neurosurgery 72, 808–819 (2013).
] Marketed by
Nexstim, this method has received
Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a List of United States federal agencies, federal agency of the United States Department of Health and Human Services, Department of Health and Human Services. The FDA is respon ...
(FDA) clearance in the United States.
See also
*
Ganser syndrome
Ganser syndrome is a rare dissociative disorder characterized by nonsensical or wrong answers to questions and other dissociative symptoms such as fugue, amnesia or conversion disorder, often with visual pseudohallucinations and a decreased state ...
*
Language disorder
Language disorders or language impairments are disorders that involve the processing of linguistic information. Problems that may be experienced can involve grammar (syntax and/or morphology), semantics (meaning), or other aspects of language. ...
*
Lists of language disorders
The following is a list of language disorders. A language disorder is a condition defined as a condition that limits or altogether stops natural speech
Speech is a human vocal communication using language. Each language uses Phonetics, phone ...
*
Malapropism
A malapropism (also called a malaprop, acyrologia, or Dogberryism) is the mistaken use of an incorrect word in place of a word with a similar sound, resulting in a nonsensical, sometimes humorous utterance. An example is the statement attributed to ...
*
Speech disfluency
A speech disfluency, also spelled speech dysfluency, is any of various breaks, irregularities, or non-lexical vocables which occur within the flow of otherwise fluent speech. These include "false starts", i.e. words and sentences that are cut of ...
*
Paragraphia Paragraphia is a condition which results in the use of unintended letters or phonemes, words or syllables when writing. This is typically an acquired disorder derived from brain damage and it results in a diminished ability to effectively use writte ...
- Similar to Paraphasia, but for written languages
References
Sources
*
*
"I Can't Come Up with the Right Word..." by William Barr, Ph.D., ABPP*
Nov 5, 2008
*
ttps://www.sciencedaily.com/releases/2008/12/081224111644.htm Science Daily - Area Of Brain Key To Choosing Words Identified Dec 30, 2008
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Aphasias
Speech error