Editing Expressive aphasia (section)

== Signs and symptoms ==
Broca's (expressive) aphasia is a type of non-fluent aphasia in which an individual's speech is halting and effortful. Misarticulations or distortions of [[consonant]]s and [[vowel]]s, namely phonetic dissolution, are common. Individuals with expressive aphasia may only produce single words, or words in groups of two or three.<ref name=":1" /> Long pauses between words are common and multi-syllabic words may be produced one syllable at a time with pauses between each syllable.<ref name=":1" /> The [[Prosody (linguistics)|prosody]] of a person with Broca's aphasia is compromised by shortened length of utterances and the presence of self-repairs and [[disfluencies]].<ref name=":3">Manasco, H. (2014). The Aphasias. In Introduction to Neurogenic Communication Disorders (Vol. 1, p. 91). Burlington, MA: Jones & Bartlett Learning.</ref> [[Intonation (linguistics)|Intonation]] and [[stress pattern]]s are also deficient.<ref name=":4">{{cite book|title=Handbook of Perception: Language and Speech. Vol VII|last=Goodglass|first=H.|author2=N. Geschwind|publisher=Academic Press|year=1976|editor=E. Carterette and M.P. Friedman|location=New York|chapter=Language disorders}}</ref>

For example, in the following passage, a patient with Broca's aphasia is trying to explain how he came to the hospital for dental surgery:{{blockquote|Yes... ah... Monday... er... Dad and Peter H... (his own name), and Dad.... er... hospital... and ah... Wednesday... Wednesday, nine o'clock... and oh... Thursday... ten o'clock, ah doctors... two... an' doctors... and er... teeth... yah.<ref name=":4" />}}The speech of a person with expressive aphasia contains mostly [[content word]]s such as nouns, verbs, and some adjectives. However, [[function word]]s like [[Conjunction (grammar)|conjunctions]], articles, and prepositions are rarely used except for "and" which is prevalent in the speech of most patients with aphasia. The omission of function words makes the person's speech agrammatic.<ref name=":1" /> A communication partner of a person with aphasia may say that the person's speech sounds [[Telegram style|telegraphic]] due to poor sentence construction and disjointed words.<ref name=":1" /><ref name=":4" /> For example, a person with expressive aphasia might say "Smart... university... smart... good... good..."<ref name=":3" />

Self-monitoring is typically well preserved in patients with Broca's aphasia.<ref name=":1" /> They are usually aware of their communication deficits, and are more prone to [[Depression (mood)|depression]] and outbursts from frustration than are patients with other forms of aphasia.<ref>{{Cite book|title = Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders|last = Chapey|first = Roberta|publisher = Lippincott Williams & Wilkins|year = 2008|isbn = 978-0-7817-6981-5|location = Philadelphia, PA|pages = 8}} {{verify source |date=September 2023 |reason=This ref was deleted Special:Diff/809386054 by a bug in VisualEditor and later restored by a bot from the original cite located at Special:Permalink/809384687 cite #7 - verify the cite is accurate and delete this template. [[User:GreenC_bot/Job_18]]}}</ref>

In general, word comprehension is preserved, allowing patients to have functional receptive language skills.<ref name="Manasco">{{cite book|title=INtroduction to Neurogenic Communication Disorders|last1=Manasco|publisher=William Brottmiller|year=2014|isbn=9781449652449|editor=Katey Birtcher|location=Pennsylvania, USA|pages=80–81|display-editors=etal}}</ref> Individuals with Broca's aphasia understand most of the everyday conversation around them, but higher-level deficits in receptive language can occur.<ref name=":6">{{cite book|title=Introduction to Neurogenic Communication Disorders|last1=Manasco|first1=M. Hunter|publisher=Jones & Bartlett Learning|isbn=9781449652449|page=80|date=2013-02-06}}</ref> Because comprehension is substantially impaired for more complex sentences, it is better to use simple language when speaking with an individual with expressive aphasia. This is exemplified by the difficulty to understand phrases or sentences with unusual structure. A typical patient with Broca's aphasia will misinterpret "the man is bitten by the dog" by switching the subject and object to "the dog is bitten by the man."<ref name=":7">{{cite web|url=http://bbsonline.cup.cam.ac.uk/Preprints/OldArchive/bbs.grodzinsky.html|title=Neurology of Syntax|work=Behavioral and Brain Sciences 23 (1)|archive-url=https://web.archive.org/web/20040518000003/http://bbsonline.cup.cam.ac.uk/Preprints/OldArchive/bbs.grodzinsky.html|archive-date=2004-05-18|url-status=dead|access-date=2006-05-10}}</ref>

Typically, people with expressive aphasia can understand speech and read better than they can produce speech and write.<ref name=":1" /> The person's writing will resemble their speech and will be effortful, lacking cohesion, and containing mostly content words.<ref name="Chapey 2008 8">{{Cite book|title=Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders|last=Chapey|first=Roberta|publisher=Lippincott Williams & Wilkins|year=2008|isbn=978-0-7817-6981-5|location=Philadelphia, PA|pages=8}}</ref> Letters will likely be formed clumsily and distorted and some may even be omitted. Although listening and reading are generally intact, subtle deficits in both reading and listening comprehension are almost always present during assessment of aphasia.<ref name=":1" />

Because Broca's area is anterior to the [[primary motor cortex]], which is responsible for movement of the face, hands, and arms, a lesion affecting Broca's areas may also result in [[hemiparesis]] (weakness of both limbs on the same side of the body) or [[hemiplegia]] (paralysis of both limbs on the same side of the body).<ref name=":1" /> The brain is wired contralaterally, which means the limbs on right side of the body are controlled by the left hemisphere and vice versa.<ref>{{Cite journal|last=Teasell|first=Robert|date=2003|title=Stroke recovery and rehabilitation.|journal=Stroke|volume=34 | issue = 2 |pages=365–366|doi=10.1161/01.str.0000054630.33395.e2|pmid=12574538|doi-access=}}</ref> Therefore, when Broca's area or surrounding areas in the left hemisphere are damaged, hemiplegia or hemiparesis often occurs on the right side of the body in individuals with Broca's aphasia.

Severity of expressive aphasia varies among patients. Some people may only have mild deficits and detecting problems with their language may be difficult. In the most extreme cases, patients may be able to produce only a single word. Even in such cases, over-learned and rote-learned speech patterns may be retained–<ref name=":5">{{cite web|url=http://www.csuchico.edu/~pmccaff/syllabi/SPPA336/336unit7.html|title=Specific Syndromes: The Nonfluent Aphasias|work=Neuropathologies of Language and Cognition|access-date=2006-05-10|archive-url=https://web.archive.org/web/20060427043927/http://www.csuchico.edu/~pmccaff/syllabi/SPPA336/336unit7.html|archive-date=2006-04-27|url-status=dead}}</ref> for instance, some patients can count from one to ten, but cannot produce the same numbers in novel conversation.

===Manual language and aphasia===
In deaf patients who use manual language (such as [[American Sign Language]]), damage to the left hemisphere of the brain leads to disruptions in their signing ability.<ref name="sciencedirect.com"/> [[Paraphasia|Paraphasic]] errors similar to spoken language have been observed; whereas in spoken language a phonemic substitution would occur (e.g. "tagle" instead of "table"), in ASL case studies errors in movement, hand position, and morphology have been noted. Agrammatism, or the lack of grammatical morphemes in sentence production, has also been observed in lifelong users of ASL who have left hemisphere damage. The lack of [[syntactic]] accuracy shows that the errors in signing are not due to damage to the motor cortex, but rather area manifestation of the damage to the language-producing area of the brain. Similar symptoms have been seen in a patient with left hemisphere damage whose first language was [[British Sign Language]],<ref name="ReferenceA">{{cite journal|last1=Marshall|first1=Jane|title=Aphasia in a user of British Sign Language: Dissociation between sign and gesture|journal=Cognitive Neuropsychology|date=15 June 2004|volume=21|issue=5|pages=537–554|doi=10.1080/02643290342000249|pmid=21038221|s2cid=27849117}}</ref> further showing that damage to the left hemisphere primarily hinders linguistic ability, not motor ability. In contrast, patients who have damage to non-linguistic areas on the left hemisphere have been shown to be fluent in signing, but are unable to comprehend written language.<ref name="sciencedirect.com"/>

===Overlap with receptive aphasia===
In addition to difficulty expressing oneself, individuals with expressive aphasia are also noted to commonly have trouble with comprehension in certain linguistic areas. This agrammatism overlaps with receptive aphasia, but can be seen in patients who have expressive aphasia without being diagnosed as having receptive aphasia. The most well-noted of these are object-relative clauses, object Wh- questions, and topicalized structures (placing the topic at the beginning of the sentence).<ref name="Friedmann">{{cite book | last1 = Friedmann | first1 = Naama | last2 = Gvion | first2 = Aviah | last3 = Novogrodsky | first3 = Rama | chapter = Syntactic Movement in Agrammatism and S-SLI: Two Different Impairments | editor = Adriana Belletti | title = Language Acquisition and Development: Proceedings of GALA2005 | publisher = Cambridge Scholars Press | year = 2006 | location = Newcastle, UK | pages = 197–210 | url = http://www.language-brain.com/docs/Friedmann_Gvion_Novogrodsky_movementSLI_agrammatism.pdf | access-date = 2024-02-21 | archive-url = https://web.archive.org/web/20141211030552/http://www.language-brain.com/docs/Friedmann_Gvion_Novogrodsky_movementSLI_agrammatism.pdf | archive-date = 2014-12-11 | url-status = dead | isbn = 9781847180285 |oclc=133524617 | display-editors = etal}}</ref> These three concepts all share phrasal movement, which can cause words to lose their thematic roles when they change order in the sentence.<ref name="Friedmann" /> This is often not an issue for people without agrammatic aphasias, but many people with aphasia rely heavily on word order to understand roles that words play within the sentence.<ref>{{Cite journal |last1=Bates |first1=Elizabeth A. |last2=Friederici |first2=Angela D. |last3=Wulfeck |first3=Beverly B. |last4=Juarez |first4=Larry A. |date=1988-03-01 |title=On the preservation of word order in aphasia: Cross-linguistic evidence |url=https://dx.doi.org/10.1016/0093-934X%2888%2990072-7 |journal=Brain and Language |language=en |volume=33 |issue=2 |pages=323–364 |doi=10.1016/0093-934X(88)90072-7 |pmid=3359173 |s2cid=23236428 |issn=0093-934X}}</ref>