The 149). This means that depending on where

The idea of language seems relatively
straight forward, as it appears to be just a means of communicating; however,
looking more in depth, it is a rather complex system, including several
underlying concepts and processes. One of these critical concepts is “linguistic
performance,” or “the actual use of language in concrete situations” (Chomsky,
1965, p. 4), which encompasses the language processes of both “production and
comprehension” (Pickering and Garrod, 2013, p. 329). Given that these processes
are vital for communicating, it can be assumed that any impairment directly
associated with linguistic performance would be detrimental. This idea comes
into question when dealing with aphasia, which is “a loss or impairment of
language due to some type of brain injury” that affects production,
comprehension, or both, depending on the type (Agranowitz and McKeown, 1968, p.
7). It is important to note that aphasia doesn’t just impact the “verbal
expression” and “auditory comprehension” of linguistic performance, but it
impacts other “modalities” as well, including “writing,” “reading,” and even
signing (Nance and Ochsner, 1981, p. 421). Therefore, to understand the effects
aphasia has on language and its different modalities, it is necessary to
distinguish the different types of aphasia as well as their individual
characteristics.

            Considering
that the language processes of production and comprehension are localised to
different areas of the brain, an understanding of the brain is needed when
classifying the different types of aphasia (Hudson, 2010, p. 65). The two
predominant language areas are “Broca’s” and “Wernicke’s area,” where production
is dealt with in “Broca’s area,” located in the frontal lobe, or the “anterior
portion of the left hemisphere,” and comprehension is dealt with in “Wernicke’s
area,” located in the temporal lobe, or the “posterior portion of the left
hemisphere” (Baker, LeBlanc, and Raetz, 2008, p. 149). This means that
depending on where the brain damage is located, whether it’s isolated to or
around Broca’s or Wernicke’s area, different symptoms heavily related to “expressive”
and “receptive” language will surface (Edwards, 2005, p. 8).

Because there are two main language sites
in which aphasia can occur, there are two main classifications of aphasia.
These include “non-fluent” and “fluent aphasia” (Edwards, 2005, p. 8), where
non-fluent aphasia is associated with damage to or around Broca’s area, and
fluent aphasia is associated with damage to or around Wernicke’s area. Obviously,
the main distinction between the two categories of aphasia has to do with
fluency, or the ease in which production of “many long runs of words in a
variety of grammatical constructions” is adequately articulated (Goodglass and
Kaplan, 1983, as cited in Gordon, 1998, p. 673), however, even though the
production aspect of language seems to be the identifying factor, comprehension
is just as central.

Regarding non-fluent aphasia, since it’s
specific to Broca’s and the surrounding area, much of the impairment is related
to production. Focussing on “the most widely discussed and researched” type (Edwards,
2005, p. 8), which is “Broca’s Aphasia,” while both reading and auditory comprehension
are mostly unaffected when considering simple constructions, speech is
“interrupted,” and “awkwardly articulated with great effort” and “abnormal
intonation” (Goodglass and Kaplan, 1983, as cited in Gordon, 1998, p. 673;
Baker et al., 2008, p. 149). Pretty much the syntactic system, or grammar, and
“access to vocabulary is compromised,” with the omission of “grammatical
features such as determiners, auxiliary verbs, and verb inflections” (Edwards,
2005, p. 8). Yet, the meaning of such productions is still comprehensible. As a
result, speech is ultimately reduced and telegraphic, making communication
strained, but not impossible. For example, a sentence a non-fluent aphasic
might produce would be: “‘I go car'” (Kearns, 2005, as cited in Baker et al.,
2008, p. 149). So, although the meaning is clear, it’s definitely lacking the
filler words, or grammatical morphemes, that link the lexical items together. Writing
ability is affected much in the same way, where text is rather disjointed and
agrammatic (Baker et al., 2008, p. 149). The silver lining of non-fluent
aphasia is that sufferers, since they have relatively good comprehension, can detect
when they make mistakes; however, since they lack grammar, they can only
correct the content words, or the words that contain semantically relevant
information (Murphy, n.d). Considering that getting one’s meaning across is the
ultimate goal, having the ability to correct errors regarding semantic intent
is overall pretty useful. So, even though production is heavily impaired, their
ability to communicate isn’t completely compromised.

Another modality, most people forget
about, that is greatly impacted by non-fluent aphasia, is sign language. Poizner
et al. (1987, as cited in Corina and Blau, 2016), explains that sign language,
resulting from aphasia in the frontal lobe, is produced in a “simplified” and
“agrammatic” way with “halting dysfluent…articulation” and improper hand
movements to indicate “morpho-syntactic inflection” (p. 432). Therefore, even
though sign language is relatively different from any kind of spoken language, “the
location of brain damage seems to have remarkably similar (and specific)
effects” (Campbell, MacSweeney, and Waters, 2007, p. 5), meaning that no matter
the language, expression is affected by non-fluent aphasia much in the same
way. 

Although many of these characteristics of
non-fluent aphasia refer to Broca’s Aphasia, they do apply to the other types
as well, more so with “transcortical motor aphasia” than with “global aphasia”
(Edwards, 2005, p. 8). Transcortical motor aphasia results from brain damage to
the “supplementary motor area in front of Broca’s” (Murphy, n.d.), and the only
aspect that truly separates this type from Broca’s, apart from the location of
damage, is that transcortical motor aphasics have far better repetition (Wertz,
Dronkers, and Ogar, 2004, p. 249-250); most other symptoms overlap. Global aphasics,
on the other hand, are basically void of language in all domains (Agranowitz
and McKeown, 1968, p. 37). With damage to their “perisylvian fissures” (Murphy,
n.d), thus both their frontal and temporal lobes, their speech is sparse, and
they have very little comprehension ability of both oral and written sources. Therefore,
while there is clearly a wide range of characteristics regarding non-fluent
aphasia, they impact all modalities of language in one way or another.

In contrast, fluent aphasia, in the
broadest of terms, can be viewed as far more detrimental. Given the most common
type, or “Wernicke’s Aphasia,” not only does it severely impair production, but
it compromises comprehension as well (Edwards, 2005, p. 9). This, in turn,
drastically limits the ability to communicate. With respect to speech, it is
fluent and verbose, “resembling English syntax and inflection,” “without the
effort and hesitation associated with non-fluent aphasia” (Kertesz, 1982, as
cited in Edwards, 2005, p. 17 – 8); however, it is unintelligible. Much of the
difficulty comes from the inability to recall lexical items, meaning that words
and phonemes, either meaningless in context or made up, are often substituted
and repeated (Edwards, 2005, p. 1). Therefore, several production errors, or
“paraphasias” are extremely common (Lehtihalmes, 2004, p. 252). The most severe
form, including vast “‘distortion of words'” and countless errors, is referred
to as “jargon aphasia” (Eggert, 1977, as cited in Edwards, 2005, p. 11), where comprehensibility
of the aphasics’ production completely falls short compared to the that of Wernicke’s
aphasics, which is severely impaired to begin with.

Now, Wernicke’s aphasics, compared to their
non-fluent counterparts, actually have some grammar. Grammatical morphemes may
often be omitted, within “‘confused and incomplete but not necessarily
simplified constructions'” (Goodglass and Hunt, 1958, as cited in Edwards,
2005, p. 12), but they are not fully agrammatic. However, even though they are
not completely void of grammar, with all the errors they produce, they can’t
seem to properly combine the jargon into cohesive and semantically coherent sentences.
For example, an utterance a Wernicke’s aphasic might produce could be: “‘You
know that smoodle pinkered and that I want to get him round and take care of
him like you want before'” (Hudson, 2010, p. 65). Just looking at the sentence,
given that it contains both content and function words, it seems to mirror
natural speech; however, looking closer, it is evident that there are in fact
made up words, substitutions, and improper grammatical features. Their writing
parallels this kind of speech, just like that of non-fluent aphasics’, meaning
they produce lengthy amounts of fluent substance that make little sense. Because
Wernicke’s aphasics produce incoherent speech and writing, this suggests that
they are not only “unware of their production” or written errors (Edwards,
2005, p. 18), let alone the content of their own output, they also understand
little of what is presented to them, both orally and written (Wertz et al.,
2004, p. 250). This complete lack of error awareness truly exhibits the severe
comprehension deficits this type of aphasia causes.

These impairments are also quite
noticeable with sign aphasics. Corina et al. (1992, as cited in Campbell et
al., 2007), discusses that when presented with prompts that elicit some type of
sign, even if the sign closely resembles their “real-world referents,” sign
aphasics are unable to understand the meaning, and thus unable to produce them
(p. 13 – 4). The fascinating aspect is that, although sign aphasics are unable
to produce the proper sign, they can easily produce the “pantomime gesture”
regarding the action of the intended sign (Corina et al., 1992, as cited in Campbell
et al., 2007, p. 14). The example she gives pertains to “a toothbrush,” where
sign aphasics couldn’t produce the sign for the word “toothbrush,” but they
could easily gesture the action of how to use one (Corina et al., 1992, as
cited in Campbell et al, 2007, p. 14). Sign aphasics could also more readily
comprehend the meaning of gestures presented to them rather than signs. For
instance, sign aphasics could easily comprehend a “frowning facial gesture” as
“negation,” yet they couldn’t comprehend the sign for “negation” (Atkinson et
al., 2004, as cited in Campbell et al, 2007, p. 15). It makes sense that, since
gesturing isn’t a language skill, it wouldn’t necessarily be impaired, but the
apparent “dissociation” between sign aphasics’ language and gesturing is
astounding (Campbell et al., 2007, p. 14).

Circling back, Wernicke’s aphasia,
although one of the most commonly diagnosed, is not the only type of fluent
aphasia. The other types include “conduction” and “transcortical sensory”
(Edwards, 2005, p. 7). Each of the different types vary to some degree, just
like that of non-fluent aphasias, but in terms of comprehension, it is
compromised throughout each (Edwards, 2005, p. 7). That being said,
comprehension in conduction and transcortical sensory aphasia is less severe
than in Wernicke’s aphasia. Focussing on conduction aphasia, it results from
lesions to the “arcuate fasciculus,” which is a “white matter” tract that
connects Broca’s and Wernicke’s area (Wertz et al., 2004, p. 250). This means
that there is definitely a disconnect between language production and
comprehension, which results in an inability to repeat heard speech and written
text. Considering that this kind of aphasia results from damage not
specifically isolated to either of the language areas, but to the connecting
pathway, it could be assumed that both production and comprehension would be of
good quality. However, that’s not necessarily the case. Although comprehension
of conduction aphasics is the best compared to that of the other fluent
aphasics, “it is not perfect” (Wertz et al., 2004, p. 250). Also, conduction
aphasic speech, while fluent, is filled with “numerous phonological errors” and
replacements of “words that sound familiar” to the intended words (Wertz et al,
2004, p. 250). Therefore, the language process of production is definitely not
unaffected either. 

In contrast, transcortical sensory
aphasics have excellent “verbal repetition” (Wertz et al., 2004, p. 250). This
is due to damage concentrated to the area “behind Wernicke’s area” (Murphy,
n.d.), which means that “phonological processing for … decoding” and thus some
level of comprehension is still intact (Liberman et al., 1967, as cited in Boatman
et al., 2000, p. 1634). Among other symptoms, they produce a large amount of
“stereotypic utterances, and verbal and syntactic paraphrases” (Baker et al.,
2008, p. 149), but overall, symptoms of this type of fluent aphasia, apart from
the repetition, are consistent with that of the others, in that the predominant
factors include those of impaired comprehension and fluent speech with “natural
speech prosody” (Edwards, 2005, p. 17).

            After dissecting the relatively
broad disorder of aphasia, it is apparent that the different types, regardless
of fluency, vary in severity, in that some have less desirable effects than
others on language. While non-fluent aphasia, apart from global, predominantly
affects production, fluent aphasia, more often than not, affects both the
processes of production and comprehension. In any case, whether diagnosed with
fluent or non-fluent aphasia, language across all modalities will definitely be
impacted.