Aphasia Midterm

What type of aphasia is fluent (with pauses), comprehends, and can repeat?

Anomic

What type of aphasia is nonfluent, comprehends, and has poor repetition?

Broca

What type of aphasia is fluent, comprehends, and can’t repeat?

Conduction

What type of aphasia is nonfluent, severly impaired comprehension, and can’t repeat?

Global

What type of aphasia is nonfluent, poor comprehension, can and can repeat?

Mixed Transcortical

What type of aphasia is nonfluent, can comprehend, and can repeat?

Transcortical Motor

What type of aphasia is fluent, poor comprehension, and can repeat (without understanding)?

Transcortical Sensory

What type of aphasia is fluent, cannot comprehend, and cannot repeat?

Wernickes

What syndrome is fluent at language level, cannot comprehend nonliteral language, have intact repetition, and impaired discourse, prosody, inference, and pragmatics?

Right hemisphere disorder

Decisive clue for Brocas?

agrammatism (telegraphic speech - dog run park)

Decisive clue for TMA?

poor inititation with strong repetition

Decisive clue for Wernicke?

empty/paraphasic output and poor comprehension

Decisive clue for TSA?

can repeat without understanding - echolalia

Decisive clue for Conduction?

phonemic errors and repeated self-corrections

Decisive clue for Anomic?

impaired word retrieval

Decisive clue for Global?

widespread severe langauge impairments

Decisive clue for Mixed Transcortical?

severe production/comprehension deficits with spared repetition

Decisive clue for RHD?

impaired discourse, prosody, inference, and pragmatics

Both Broca and Trancortical Motor are nonfluent and have intact comprehension. The differentiating factor is repetition; which one has intact repetition skills?

Transcortical Motor

Both Wernicke’s and TSA are fluent with poor comprehension. The differentiating factor is repetition; which one has intact repetition skills?

TSA

Both Conduction and Anomic are fluent with good comprehension. The differentiating factor is repetition and phonemic errors; which one has intact repetition skills and phonemic errors?

Anomic

What disorder is likely when language looks typical but communication fails in context/conversation?

RHD

The function and case clues for front lobe/prefrontal cortex?

executive control, planning, inhibition, flexibility, monitoring; social behavior, emotion, and decision-making. Motor regions support planning and voluntary movement.

The function and case clues for left inferior frontral gyrus (IFG), BA 44/45?

Broca-associated frontal language network - grammatical encoding and sequencing

What is BA 44? and what is it mainly involved in?

pars opercularis - phonological processing, speech-motor planning, and articulation

What is BA 45? and what is it mainly involved in?

pars triangularis - language processing, semantic and syntactic processing

The function and case clues for premotor cortex, anterior insula, basal ganglia, frontal white matter?

May be involved with Broca profiles, motor speech and sequencing difficulties can coexist. Severity reflects distributed damage and connectivity

The function and case clues for parietal lobe?

Somatosensation, spatial processing, object location, and movement coordination

What do the left supramarginal/inferior parietal regions of the parietal lobe contribute to?

phonological buffering

The function and case clues for posterior superior temporal gyrus (classically left BA 22)?

Wernicke-associated posterior language network - auditory comprehension, lexical-semantic and phonological processing involve a broader temporal/parietal network.

The function and case clues for temporal lobe and hippocampus?

Auditory processing and sound recognition

What does the hippocampus contribute to?

new episodic memories and spatial navigation

The function and case clues for occipital lobe?

Visual processing, object recognition, and interpretation of visual input. Naming can fail before language retrieval if the picture is not recognized.

The function and case clues for arcuate fasciculus and Sylvian parietal-temporal area (SPT)?

Dorsal sensorimotor integration/repetition network. Area Spt is in the posterior planum temporale - conduction aphasia is not limited to one white matter tract

The function and case clues for corpus callosum?

Communication between hemispheres - split-brain findings inform lateralization.

The function and case clues for gray vs white matter?

Gray: cell bodies/dendrites and processing, cortex plus deep nuclei

White: myelinated axons connecting regions

What are the two pathways in the dual stream model and what is their main function?

Ventral stream: takes speech sounds you hear and connects them to words and their meanings

Doral stream: turns the speech sounds you hear into the speech movements needed to say them

What regions are involved in the ventral stream and how does damage to it explain deficits in Wernicke’s?

temporal-lobe regions, relatively bilateral (both hemispheres contribute)

person hears the speech perfectly but has difficulty extracting its linguistic meaning

What regions are involved in the dorsal stream and how does damage to it explain deficits in Conduction?

temporal/parietal regions communicating with frontal speech-production regions, left/dominant hemisphere lateralized

person understands word, knows what they want to say, speak fluently, but cannot map phonological information onto speech production, hence poor repetition & phonemic errors

What does the middle cerebral artery (MCA) supply?

lateral (outer side) hemispheric surfaces

The left MCA supplies many of the major language areas, which explains why left MCA stroke commonly causes __________.

aphasia

Wernicke profiles commonly involve damage to the ________-_________ division of MCA.

posterior-inferior

Conduction profiles commonly involve damage to the _______ ____ division of MCA.

posterior left

TMA profiles commonly involve _________ ___________ regions of MCA.

anterior watershed

TSA profiles commonly involve ___________ ___-___ ___________ regions of MCA.

posterior MCA-PCA watershed

Tasks that reveal comprehension deficits?

words to sentences to paragraphs, single to multistep commands

check hearing, vision, visual-spatial skills, memory, word frequency, gestures helped cue the answer

Tasks that reveal naming deficits?

confrontation, responsive, and generative naming both objects and pictures

Tasks that reveal repetition deficits?

short words to complex sentences, high/low frequency of real and nonwords

Tasks that reveal reading deficits?

written word-picture matching and written directions

Tasks that reveal writing deficits?

name, copying, missing letters, dication, spontaneous writing

Tasks that reveal motor deficits?

OME reveals strength and range of muscles, speech sequencing/DDK, nonspeech oral and body movements, voluntary vs automatic performance

What does CT/structural MRI reveal?

location of structural lesion

MRI uses T1, T2, and FLAIR and is most sensitive to _______ ____________.

acute ischemia

What does fMRI/PET reveal?

which regions/networks are showing functional activity

What does DTI reveal?

what white matter connectivity is affected

When should the WAB-R or Boston Diagnostic Aphasia Examination (BDAE) be used?

broad classification of aphasia and its language profile

What is the WAB-R not sufficient for?

RHD deficits in pragmatics

When should the BNT-2 be used?

naming mechanism

Does the BNT-2 measure every language domain?

No

When should the BASA be used?

for patients with severe global aphasia to identify spared channels

When should the EFA-4 be used?

adult aphasia and related communication strengths/weaknesses

targets receptive/expressive tasks including recognition, reading, auditory comprehension and functional participation

When should the Aphasia Diagnostic Profile (ADP) be used?

to make profile of severity, modalities, errors, and behavior

When should the RCBA-2 be used?

nature and extent of reading impairment

When should the SCATBI be used?

cognitive-linguistic assessment following head injury

When should the CLQT+ be used?

cognitive-linguistic screening context

When should the Right Hemisphere Language Battery be used?

to measure metaphor, inference, humor, stress and discourse

When should the MEC Protocol be used?

measure RH discourse, prosody, and indirect meaning

What area is damaged in Broca’s?

dominant left inferior frontal gyrus (IFG) BA 44/45 and commonly extends into premotor cortex, anterior insula, basal ganglia and white matter

What areas are damaged in Transcortical Motor Aphasia?

areas anterior/superior to Broca’s, left frontal lobe, supplementary motor area (SMA), ACA–MCA watershed/border-zone regions

Why is repetition spared in Transcortical Motor Aphasia but not Broca’s?

BA 44/45 is damaged in Broca’s

Perisylvian repetition is spared in TMA

What area is damaged in Wernicke’s?

left hemisphere (dominant hemisphere), posterior superior temporal gyrus, BA 22, typically supplied by the inferior division of the left MCA

What area is damaged in Transcortical Sensory Aphasia (TSA)?

posterior/inferior to Wernicke’s area - posterior/inferior temporal regions, temporoparietal junction, MCA–PCA watershed territory

Wernicke’s area and the repetition pathway are relatively preserved

What area is damaged in Conduction Aphasia?

Arcuate fasciculus (white-matter pathway connecting posterior and anterior language regions)

damage to the left dorsal language network including Supramarginal gyrus (BA 40), Area Spt at the temporo-parietal junction

Predicted mechanism and errors for moderate-severe stroke anomia (MSAS)?

major phonological breakdown, neologisms, many sound errors, monitoring failure, verbs especially vulnerable

Predicted mechanism and errors for mild stroke anomia?

mild/residual phonological breakdown, semantics relatively stronger

Predicted mechanism and errors for multiple sclerosis?

semantic access/control impairments

Predicted mechanism and errors for Parkinson Disease?

cognitive/perceptual demands can affect naming

VNeST protocol and patient fit?

generate agent-verb-receiver networks, activate related words to build sentences/discourse

EX: chef cuts bread, gardener cuts branch

range of aphasia profiles with intact comprehension

Teaching of Underlying Forms (TUF) protocol and patient fit?

treat complex sentence structures so that improvement can generalize to simpler, related sentence structures and targets underlying syntactic structure that allows sentences to be constructed

EX: “The woman was kissed by the man.”, identify the verb, identify the agent, identify the receiver, and build the more basic sentence “man kiss woman”

for patients presenting with agrammatism (Broca’s)

Script training protocol and patient fit?

practicing personalized scripts that apply to patient’s life

fit for patients with cooccurring AOS, difficulty with fluent, organized speec

Response Elaboration Training (RET) protocol and patient fit?

use patient’s short response and ask elaborating questions

EX: “boy kick” - “what is the boy kicking” - “boy kicks ball”

expand on meaningful spontaneous information

patient with limited verbal output, nonfluent aphasia

Recursive self-feedback protocol and patient fit?

prompt, record response, playback, identify errors, revise repeatedly

patient who has good awareness/comprehension but needs to improve connected speech, learn to identify/correct own communication problems

Melodic Intonation Therapy (MIT) protocol and patient fit?

Intone meaningful phrases on two pitches, stress on high pitch, tap left hand once per syllable; progress short phrases to longer spoken phrases over three levels

good for patients with severe nonfluent aphasia (Broca)

Intention Manipulation Treatment (IMT) protocol and patient fit?

intentional left-hand action connecting to naming; if incorrect, repeat target and perform a different hand movement. Intention/attention may engage right frontal word-production mechanisms.

patients with nonfluent aphasia to improve initiation of spoken language

Semantic Feature Analysis protocol and patient fit?

recognize/generate category, properties, function, actions, location and associations of a word

patients with mild-severe anomia

Phonological Component Analysis protocol and patient fit?

presenting a word, ask patient to generate rhyme word, same first sound, another word starting with that sound

patient with Broca, TMA, Wernicke who know the concept but cannot retrieve the sounds

Phonomotor treatment protocol and patient fit?

build sound awareness/control through same-different auditory judgments (/p/ vs /b/ or /gl/ vs /kl/)

patient with anomia, phonemic paraphasias