Lang Disorders ~ exam 4

Aphasia

a deficit in language abilities due to damage to the brain

Aphasia is an _____ disorder, often cause by Left ___

acquired

CVA

Aphasia is NOT the result of _____, _____, or _____ impairment

motor, intellectual, psychological

Aphasia can affect _____, _____ or both

expression

comprehension

Aphasia is a continuum of _____ dependning on ____ of lesions

severity

size

Expression language deficit for Aphasia

difficulty in formulation and production of language to communicate an intended meaning

*caused by lesions in the L hemisphere (Brocas)

Receptive language deficit for Aphasia

difficulty with the ability to get meaning from language

*lesions in the posterior portion of the L hemisphere (Wernickes)

Signs & Symptoms of Aphasia

Anomia

Verbal comprehension deficit

Paraphasias

phonemic/literal paraphasia

semantic paraphasia

unrelated verbal paraphasia

neologism/neologistic paraphasia

perseveration

agrammatism

repetition deficits

Alexia

Agraphia

All aphasia symptoms exist on a _____

spectrum of severity

Anomia

difficulty with word finding

some level in all aphasias

“on the tip of their tongue“

Verbal comprehension deficit

inability to comprehend spoken language

difficulty understanding long complex utterances

Paraphasias

errors in expressive language

syllables, words, phrases produced unintentionally

Phonemic paraphasia (literal paraphasia)

phonemic substitutions or transposition

half of word said incorrectly

Semantic paraphasia

one word is substituted for another word with similar meaning

Unrelated verbal aphasia

one word is substituted for another word which is unrelated

Neologism / Neologistic paraphasia

production of a completely new utterance

utterance is unintelligible

Perseveration

doing something repeatedly, redundantly, and often inappropriately

Agrammatism / telegraphic speech

lack of grammar

speech consists of context words, no function words

Repetition deficits

inability to repeat words

Alexia

difficulty reading

Agraphia

difficulty writing

Related behaviors to aphasia

self-repair

nonfluent aphasia

preserved & automatic language

Self-repair / self correction

when the PWA restates a word or phrase to hopefully produce it in an error-free fashion

Self repair decreases _____

rate of communication

Non-fluent aphasia

speech is not automatic requiring time and effort

results in anger or depression

Preserved and Automatic language

tends to remain

name, days of week, counting 1-10, happy birthday, cussing

The more preserved automatic speech a PWA has, the better their ______ of language

prognosis for recovery

Co-occuring deficits with aphasia

cognitive deficits

motor deficits

Aphasia classification system

non-fluent vs fluent

Non-fluent aphasia

lesions near brocas area (brocas aphasia)

transcortical motor aphasia

global aphasia

Fluent aphasia

lesions near wernickes area (wernickes aphasia)

transcortical sensory aphasia

conduction aphasia

anomic aphasia

PWA ____ fall neatly into one aphasia classification

doesnt

You can estimate the location of lesions based on the ____

deficits displayed by the PWA

Cortical aphasia

arising from damage to the cortex

ex: brocas, wernickes, arcuate fasciculus

Subcortical aphasias

arising from damage to subcortical structures

ex: thalamus, basal ganglia

Non-fluent Cortical aphasias

damage to L hemisphere

effortful speech, content words, short phrases

PWA is aware of their deficits

Non-fluent cortical aphasia includes:

brocas aphasia

transcortical aphasia

global aphasia

Brocas aphasia

written language usually mirrors verbal output

reading and vision deficits

attempt to use other strategies to communicate (gestures, pointing, shaking head

Brocas aphasia is often reffered to as

“poor speakers, good communicators“

Transcortical motor aphasia

same as brocas, except ability to repeat

Global aphasia

typically co-occur with motor and cognitive deficits

poorest recovery

may benefit from AAC

Fluent cortical aphasias

fluent speech but no clear meaning

damage to the midposterior L hemisphere

Types of fluent cortical aphasias

wernickes aphasia

transcortical sensory aphasia

conduction aphasia

anomic aphasia

Wernickes aphasia

unawareness of errors

impaired comprehension & repetition

Transcortical sensory aphasia

co-occur with visual deficits

impaired comprehension

intact repetition

Conduction aphasia

awareness of deficits

can be seen in all types of aphasia

relatively intact comprehension

impaired repetition

Anomic aphasia

damage to any language area

fluent speech, intact comprehension, naming deficits

Subcortical aphasia / Thalamic aphasia

damage to the L thalamus

Characteristics of thalamic aphasia

almost fluent speech

significant anomia in conversation;

better naming skills in confrontational naming;

impaired comprehension;

perseverative semantic paraphasias;

normal articulation;

hypophonic voice;

intact repetition;

intact grammar

Striatocapsular aphasia

damage to the striatum in the basal ganglia

Characteristics striatocapsular aphasia

loss of fluency,

rare phonemic paraphasias

intact repetition

mild anomia

2 types of Atypical aphasias

primary progressive aphasia (PPA)

crossed aphasia

Primary progressive aphasia

PPA in FTD: language disturbances without significant cognitive deficits at first

opposite of alzheimers dementia

very gradual onset

Frontotemporal dementia (FTD)

frontal and temporal lobes atrophy

runs in families

progressive, resulting in PPA

Two main forms of FTD

progressive confluent aphasia

semantic dementia

Progressive confluent aphasia

nonfluent PPA

more atrophy in frontal lobes

decresed rate of speech. simplified syntax, reduced phrases

Semantic dementia

fluent PPA

more atrophy in temporal lobe

excessive output with no filter

difficulty with conversational turn-taking

Assessment of aphasia

case history

functional communication and connected speech

standardized aphasia test

Case history looks at

chart review

patient/family interview

in-depth medical and social history

Functional communication and connected speech looks at

open-ended interview questions

picture description

story retelling

role playing

unstructured conversation

describing steps to a task

Standardized aphasia test

assess auditory comprehension, verbal expression, reading comprehension, and writing expression

Standardized aphasia tests are selected depending on ____ and take a ____ to administer

setting

long time

Common types of standardized aphasia tests

Boston diagnostic aphasia examination (BDAE)

Western aphasia battery (WAB)

Communication activities of daily living (CADL)

Quality of Life (QOL)

individuals perception of their condition in life in relation to culture, values, goals, expectations, standards, and concerns

QOL assessment for aphasia

will be different for each person

measured through scales

all goals include improving QOL

Factors affecting prognosis of aphasia

age

lesion size

lesion location

severity of aphasia

type of aphasia

Aphasia Therapy types

Spontaneous recovery

Restorative approach

Compensatory approach

Social Therapy approach

Restorative therapy approach

regaining a lost ability by reducing the level of deficit

Neuroplasticity

brains ability to reorganize itself following external stimuli

other areas jump in to try and take on damaged areas function

Restorative therapy approach examples

Schuells stimulation approach

Constraint-induced

Melodic Intonation

Errorless learning

Schuells stimulation approach

uses auditory stimuli to stimulate requisition of language in other modalities

uses Language activity resource kit (LARK)

Constraint Induced Aphasia Therapy

reversing individuals learned compensating for their deficit

dont use it, you lose it

CIMT & CIAT

Melodic Intonation Therapy (MIT)

using intact R hemisphere (music) to help retrieve words

uses singsong speech and tapping out syllables

Errorless learning therapy

preventing the pt from making errors

drill-based tasks

Compensatory therapy approach

AAC

Low-tech: gestures, pointing , drawing, board/book

Social Therapy approach

goal: improve QOL

increase confidence

increase opportunities for communication

increase sense of value and acceptance

With aphasia there is a risk of ____

social isolation

Communication partner training

training spouse/family

focuses on changing their behavior not PWA

Group Therapy

utilizes a social approach

everyone is an equal participant

safe place for PWA to practice

motivate each other

develop friendships amongst PWA

Group therapy can also provide friendships for _____

spouses/caregivers finding community

Prosopagnosia

neurological deficit in the ability to process info regarding faces of others for the purpose of recognition

Prosodic deficits

difficulty comprehending prosody

difficulty understanding emotional content of speech

Prosody

variations in pitch, stress, tibre, cadence, and tempo of speech

Inferencing deficits

difficulty “reading between the lines“

Discourse deficits

difficulty with the exchange of communicative information between a speaker and listener

Simultagnosia

inability to visually perceive many details at once

struggle putting pieces together to make a whole

Achromatopsia

color blindness OR color agnosia

Left neglect

inability to attend to sensory stimuli on one side of the body or environment

Hemibody neglect

inability to attend to one side of the body

Hemispatial neglect

inability to attend to one side of the environment

Asomatognosia

inability to recognize a part of the body as belonging to the self

Anosognosia

inability to recognize that there is a problem with ones abilities

Capgras delusion

belief that loved ones have been replaced by identical imposters

Fregoli delusion

belief that a loved on is able to take on the guise of another person or many other people

Visual hallucinations

perceiving something visually that doesn’t actually exist

Paranoid hallucinations

perceiving that soemthing is happening when in actuality it isn’t happening

auditory, visual, or both