Motor aphasia
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NINDS aphasia information motor Broca aphasia
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Motor aphasia usually refers to Broca aphasia, an expressive, nonfluent language disorder caused by damage to the dominant (usually left) inferior frontal speech area, Broca area.
Features
- Speech is slow, effortful, and nonfluent
- Short, “telegraphic” phrases: “Want... water”
- Grammar is impaired (agrammatism)
- Naming and writing are often impaired
- Comprehension is relatively preserved, especially for simple sentences
- Repetition is impaired
- The person is usually aware of the difficulty and may be frustrated
- Often associated with right face/arm weakness because of nearby motor-cortex involvement
Localization and cause
Most often due to an infarct in the superior division of the left middle cerebral artery affecting the posterior inferior frontal gyrus. The region organizes skilled speech-motor patterns for the lips, tongue, larynx, and respiratory muscles. Guyton and Hall Textbook of Medical Physiology, p. 722.
Important distinction
Transcortical motor aphasia also has markedly reduced spontaneous speech and relatively good comprehension, but repetition is preserved. It commonly results from a lesion anterior or superior to Broca area, often in an anterior cerebral artery-middle cerebral artery watershed region. Adams and Victor’s Principles of Neurology, p. 511; Localization in Clinical Neurology, p. 1277.
Management
- Acute-onset aphasia is a possible stroke emergency. Seek emergency care immediately, especially with facial droop, arm weakness, sudden confusion, or severe headache.
- Treat the underlying cause and begin speech-language therapy early. The ASHA aphasia guidance outlines assessment and rehabilitation approaches.
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