Neurologically Based Communication Disorders

Cause

Related to underlying damage, disease or disorders of the nervous system Can include: Traumatic Brain Injury Brain tumors Dementia Primary Progressive Aphasia Stroke

Review of Neuroanatomy

Central nervous system Central-brain and spinal cord Key areas for speech and language Frontal lobe-Broca’s area, primary motor cortex Temporal lobe-Wernicke’s area, primary auditory cortex Parietal lobe-Primary sensory cortex? Occipital lobe-Primary visual cortex?

Generally the LEFT frontal and temporal lobes are primarily important for the production of speech and language Specific areas within these two lobes produce a variety of functions (grammar, motor commands for speech production, memory, etc). **However, there is much individual variability

What Can Lead to Stroke?

High blood pressure High cholesterol Smoking/Alcohol/Other Drugs Vascular disorders -Hardening of the arteries (arteriosclerosis) that causes blood flow to be restricted Stress Obesity Diabetes

What is a Stroke?

Two types ● Ischemic (blockage of blood flow) -Blood clot comes from another location and causes blockage -Blood clot develops in one of the arteries leading to the brain

Both of these cut off blood flow to the brain ● Hemorrhagic (ruptured blood vessel that damages surrounding tissue) Can be due to a aneurysm or just weakened arteries

Incidence/Prevalence

National Institutes of Deafness and Other Communication Disorder (NIDCD, 2015) Incidence-180,000 NEW cases per year in US Prevalence- 1,000,000 people in US or 1 in 250 living with aphasia No significant differences between men and women 25-40% of stroke survivors experience aphasia (National Aphasia Association) ● Higher prevalence of stroke in Black Americans, Hispanic Americans, Asian Americans as compared to whites

Symptoms of a Stroke

B-Balance Issues

E-Eyesight Changes

F-Facial Drooping

A-Arm Weakness

S-Speech Difficulty

T-Time to call 911

Brain Tumor

Can occur due to the location of the brain tumor or as a result of the treatment (mostly surgery) Can be a primary tumor (various types) or a metastatic tumor Metastatic means the brain tumor occurred due to cancer somewhere else in the body

How are strokes and tumors diagnosed?

Brain imaging-CT, MRI Usually by a neurologist, neurosurgeon, possibly oncologist (cancer doctor)

Aphasia

-acquired language disorder due to a neurological event typically in left hemisphere -Can be mild to severe -Can impact just language expression ( the words that we use), language comprehension (how we understand or process language), or both -Can also impact reading (alexia) and writing (agraphia)

Aphasia is not

A disorder of intelligence

A speech disorder (although it may look that way in severe cases)

Confused language or a cognitive disorder

Causes of aphasia

Stroke TBI Brain surgery Infections or viruses Viruses like meningitis and encephalitis Primary progressive aphasia (type of dementia)

Symptoms of Aphasia

Spoken Language Impairments

● Anomia-inability to name objects, things, or people

● Paraphasias- -Phonemic-Substitute a word that sounds similar (phonemic-hiss instead of kiss) -Semantic-Substitute a word that means something similar (semantic-knife/spoon) -Neologism-Create a whole new word (bees

● Agrammatism-May drop grammatical morphemes, short phrases, may lose intonation -May sound like a telegram

● Jargon-Fluent, but meaningless

● Perseverations-Get stuck on the same word or phrases and not used correctly in context

Symptoms of Aphasia

Receptive Language Impairments ● Difficulty answering questions, following directions

Reading and Writing Impairments ● Agraphia-Can vary from inability to write to deleting grammatical morphemes, impaired sentence order (syntax), and anomia ● Alexia-Acquired reading disorder

Aphasia Classification

Fluent-Varies from word-finding to meaningless verbal output

Nonfluent-Varies from effortful with good comprehension to severe deficits in comprehension and expression (global aphasia)

Good video examples on youtube through Tactus Therapy

Primary Progressive Aphasia

Language skills become slowly impaired with no other deterioration in function over 2 years

-Aphasia can also occur with progressive diseases like Alzheimer’s, Pick’s disease, Creutzfeldt Jakob disease, but there is typically other symptoms present besides aphasia (memory, reduced self care, mood changes)

Assessment

Case history-medical chart

Family and client interview

-Can help with setting functional goals

Orofacial exam-determining if there is any motor based neurological deficits

Comprehensive language assessment-

● Language sample including conversation

● Standardized tests (should include comprehension and expression

● Assess reading and writing

● Determine if other modalities of communication are needed (gestures, communication boards or devices)

Treatment planning

-Must be functional or based on what they need to do to function in their daily lives

-Individual or Group or both

-Counseling of family members

Treatment for PPA is focused on voice banking, compensatory strategies early in the disease

Diagnosis and Treatment of Neuro Communication Disorders

This area is unique as we are treating a symptom of the disease or a disorder

If someone presents to you with aphasia, memory loss, or impaired speech, you need to make sure they see a doctor if they have not already!

WHY?

-You have no idea how to treat it unless you know the cause

-There could be something that could be done medically to reverse it

-You could save their life