Lâm sàng, hình ảnh, và nhận thức khoa học thần kinh điều tra trong 25 năm qua đã được mài sắc sự hiểu biết của chúng ta TCMA và làm rõ các thành phần của nó thần kinh và tâm lý, mặc dù characterizations cơ bản của Luria vẫn còn cơ bản ngay cả khái niệm hiện đại. Đặc tổn thương đã được làm rõ. | Michael P Alexander 168 in the left lateral frontal lobe. TCMA or Luria s dynamic aphasia represents the range of aphasic disorders in which the fundamental processes semantics phonology articulation grammar and concatenation are normal but the utilization of them is impaired. Clinical imaging and cognitive neuroscience investigations in the past 25 years have sharpened our understanding of TCMA and clarified its neural and psychological components although Luria s basic characterizations remain fundamental even to modern concepts. Lesion specificity has been clarified. The roles of different regions of the frontal lobes in discrete aspects of language are better understood. Insights from other domains of cognitive neuroscience have illuminated the mechanisms of planning and intention in speech. Lesion-Anatomy Correlations in TCMA Any analysis of the language disorders due to frontal lesions must begin with Broca s aphasia. The eponymous area is usually marked with a B and lies over the frontal operculum roughly Brodmann areas 44 and 45 sometimes it includes the lower motor cortex area 4 and the anterior superior insular cortex continuous with the inferior opercular surface. Damage restricted to these areas produces a somewhat variable clinical picture sometimes called Broca s area aphasia Mohr et al. 1978 . In the acute phase these patients have more similarities than differences. They are often briefly mute then show effortful speech with articulation and prosody impairments reduced phrase length syntax errors and mixed paraphasias all variably but modestly benefited by repetition. Thus Broca s area lesions produce acute Broca s aphasia. In the chronic phase these patients diverge along several paths Alexander Naeser Palumbo 1990 . Lesions centered in the posterior operculum and the lower motor cortex are likely to cause persistent articulation and prosody impairments with rapid recovery of lengthy grammatical utterances. Lesions centered in the anterior superior
