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ACQUIRED CHILDHOOD APHASIA - Coggle Diagram
ACQUIRED CHILDHOOD APHASIA
ACCURATE
CLINICAL PICTURE
Lesions in the left hemisphere cause a variety of aphasic symptoms
Recovery depends on a number of interrelated factors (etiology, site and size of the lesion, diaschisis, etc.)
Neologisms, jargon, and logorrhoea can be noticed.
Recovery may be slow and incomplete
Besides nonfluent types, fluent types also exist!
Besides telegraphic style, also fluent paragrammatic speech
Auditory comprehension disorders can be found in varying degrees, from mild to total loss of comprehension
Crossed aphasias are rare!
CAS DOCTRINE
Absence of neologisms, jargon, and logorrhoea
Verbal comprehension remains largely preserved.
Aphasic children speak in telegraphic style.
Clinical presentation is not dependent on the lesion's location
Speech is invariably nonfluent and markedly reduced, ranging from articulatory problems to mutism
After a right-hemispheric lesion, crossed aphasia is common!
Basically: abnormal behaviours on top of normal behaviours!
Historical Developments
1940: Incidence dropped to 5%, thanks to vaccines and mass immunisation programmes
1962: Equipotentiality Hypothesis (Basser)
1967: Progressive Lateralisation Hypothesis (Lenneberg)
1927: discovery of Penicillin, which solved disorders that had been previously misdiagnosed as ACA
1978: Woods & Teuber's landmark paper!
'Changing Patterns of Childhood Aphasia'
Since then: fluent aphasia, rare crossed, =adults
1878-1890: very frequent occurence (33%)
Bernhardt: selection bias, hemiplegia
Sachs & Peterson: hemiplegia, basis hypotheses
New insights thanks to medical progress, non-selection bias, neuroimaging techniques, aphasia test batteries, antiviral medication, rebuttal of historical misconceptions
1897: Crossed ACA common
Prognosis - Outcomes
Poor outcomes associations:
Poor verbal comprehension
Involvement of Wernicke's Area
Traumatic infectious Etiologies
Co-occurence of epilepsy
In adulthood
Women dependent on husbands,
Men dependent on parents
No new and/or stable relationships
Lower SES than parents
Difficulty following normal progress at school
Test batteries are not sensitive enough to differentiate between normal and near-normal performance
no correlation age of onset and recovery
(Woods & Teuber >< Lenneberg)
Growing into deficits phenomenon +
Illusory Recovery
Incidence
Not rare if lesion is unilateral and encroaches upon language areas (Satz & Bullard Bates)
Risk is approx. the same as for adults (less vascular etiologies
43% of children will have an aphasia during the acute phase after a stroke, higher than for adults!
Terminology debate: acquired based on timing
regression/loss, not the timing of the lesion!
(difference developmental and congenital!)