Neurogenic Communication Disorders - COMPs

Working Memory

ability to hold a given amount of info for immediate processing

Short-term Memory

retention of info for longer than 30 seconds lasting hours

Long-term Memory

retention of info for months and/or years

Declarative Memory

recall of facts

Episodic Memory

recall of specific and recent events

Procedural Memory

recall of sequences necessary for given task(s)

Focused Attention

The ability to “focus” on and respond to stimuli and information

Sustained Attention

The ability to “sustain” or hold and manipulate information

Selective Attention

The ability to attend and “select” information within a larger set

Alternating Attention

The ability to switch or “alternate” attention between tasks

Divided Attention

The ability to attend and “divide” focus on multiple things at once

Non-fluent Aphasia

• also known as Broca’s or Expressive Aphasia

• posterior inferior frontal gyrus in left hemisphere (Broca’s area)

• effortful, telegraphic speech; impaired grammar

• auditory comprehension > expression

Fluent Aphasia

• also known as Wernicke’s or Receptive Aphasia

• posterior, superior left temporal lobe (Wernicke’s area)

• fluent, copious verbal output

• poor auditory comprehension

Dementia

• persistent or progressive deterioration of cognitive functions

• memory deficits are most characteristic

• may also impact language, emotional, personality, etc

RHD

• right hemisphere damage/disorder, acquired following brain injury

• visuospatial deficits, visual (left) neglect

• anosognosia: denial and poor awareness of impairment

• prosodic, inferencing, and discourse deficits

• sustained and selective attention deficits

Apraxia

• inferior posterior left hemisphere damage

• deficit of motor planning with normal speech musculature

• articulation characterized by groping, inconsistency, and errors of sound/syllable sequencing

• treatment may focus on: auditory visual stimulation, oral motor repetition, phonetic placement, and slowing down rate of speech

Dysarthria

• type of dysarthria will depend on site of damage

• slowness, weakness, and incoordination of speech musculature

• flaccid, spastic, ataxic, hypokinetic, hyperkinetic, unilateral UMN

TBI

• penetration (scalp/skull broken, fractured, open TBI)

• non-penetrating (skull is not broken or fractured, closed TBI)

• Possible deficits following TBI:

  • word retrieval and naming deficits

  • pragmatic deficits (e.g., impaired prosody, topic maintenance, etc.)

  • irritability and unreasonable behaviors

  • dysarthria (type will vary based on site of TBI)

  • perseverations, poor attention

  • reading and writing deficits

Anomia

• problem with word finding

• anomia is a symptom of aphasia

• anomic aphasia: only deficit is word retrieval

Paraphasia

• error in which an incorrect word, part of word, or sound is substituted for an intended target word

• phonemic paraphasia: few phoneme mistakes, mostly correct word

• semantic paraphasia: word substituted for word with similar meaning

• neologistic paraphasia: word substituted for a made up word

Perserveration

• inappropriate repetition of a word or idea previously produced 

• for example, patient said the word “car” earlier in session and now it is the only fluent word that he/she can verbalize

• may be helpful to switch attention to another activity or task

Agrammatism

• grammar deficits, inadequate sentence production

• typically individual uses content words and omits function words

Alexia

• acquired reading impairment following brain damage

• also called word or visual blindness

Agraphia

• acquired writing impairment following brain damage

• motor dysfunction or spelling impairment deficits

Neologism

• error type in which a new word is created; the word has no meaning to the speaker and is entirely different from intended word

Circumlocution

• talking around the intended word or idea

• used as a strategy in speech therapy to improve word finding

Jargon

• continuous fluent utterances that make little sense but appear to make sense to the speaker, typically seen in fluent aphasia

Phonemic Paraphasia

• client response: “lork”

• phoneme /f/ substituted for /l/

Semantic Paraphasia

• client response: “spoon”

• semantic substitution to spoon

Neologistic Paraphasia

• client response: “fannak”

• made up word with no meaning

Neurogenic Communication Disorders

communication problems that arise following damage to the brain/nervous system

Damage region: Frontal Lobe

• executive function deficits (i.e., problem solving, reasoning)

• memory loss, consciousness, impulse control

• motor planning candor programming (i.e., Apraxia, Dysarthria)

Damage region: Parietal Lobe

• sensory deficits

• difficulty reading/writing, spatial relationship

• mathematical deficits

Damage region: Temporal Lobe

• deficits in auditory perception/sensation/integration

• categorization difficulties, memory and recognition deficits

• left temporal = verbal info; right temporal = nonverbal info

Damage region: Occipital Lobe

• visual deficits

• Alexia = word blindness, reading impairment

• Agraphia = writing impairment

Damage region: Basal Ganglia

• Hypokinetic dysarthria = slow limited movements

• Hyperkinetic dysarthria = quick, involuntary movements

Damage region: Hippocampus

• memory impairments

• fears and anxieties may increase

Damage region: AVA CVA

• Anterior Cerebral Artery Stroke (ACA CVA)

• may have deficits, consciousness, non-voluntary function damage

• cortical = apraxia; subcortical = dysarthria

Damage region: Brainstem

• attention deficits, consciousness, non-voluntary function damage

• CN damage = can present as dysarthria and/or dysphagia

• midbrain (dopamine producer): Parkinson’s (hypokinetic dysarthria)

Damage region: Cerebellum

• motor coordination and balance deficits

• Ataxia = slurred speech, stumbling, incoordination (appears drunk)

Left Hemisphere Damage

• expressive deficits

• receptive deficits

• global deficits

• cognitive impairment

• right visual field impairment

Right Hemisphere Damage

• spatial + perceptual deficits

• discourse + pragmatic deficits

• impulse behavior +attention difficulty

• judgement + reasoning problems

• poor awareness of deficits

Ischemic CVA

• occurs due to blockage of a blood vessel

• most common cause of stroke

  • Thrombotic: blood clot develops in blood vessels inside brain, interrupted blood flow

  • Embolic: blood clot develops elsewhere in body + travels to brain through brainstem

Hemorrhagic CVA

• occurs due to bleeding, blood vessel rupture

• high blood pressure is most common cause

  • Intracerebral: most common, artery bursts; flooding tissues with blood

  • Subarachnoid: bleeding in area between arachnoid matter + pia matter

Transient Ischemic Attack

• TIA, often called “mini stroke”

• temporary clot

• may be warning sign for future stroke(s)

Posterior Cerebral Artery (PCA)

• temporal + occipital lobes

• writing deficits

• memory + cognitive communication deficits

Middle Cerebral Artery (MCA)

• hemiplegia

• dysphagia

• Broca’s/Wernicke’s aphasia

• Impaired vision

Anterior Cerebral Artery (ACA)

• hemiplegia

• flat affect

• impulsivity

• auditory comprehension deficits

Anoxia

• lack of oxygen to brain

• types: anoxia, anemic, toxic, stagnant

• symptoms/treatment will vary based on cause + length of time without oxygen

Ataxia

• degenerative disease of nervous system

• symptoms will mimic being drunk (e.g., lack of coordination, slurred speech, falling, fine motor deficits eye movement abnormalities)

Aneurysm

abnormal ballooning, forms in blood vessel

Encephalitis

inflammation of the brain and/or spinal cord

Types of Dysarthria: Flaccid

• Location of lesion: Lower Motor Neuron

• Main Etiologies:

  • Surgical Trauma

  • Neuropathies (e.g., Bell’s Palsy)

  • Muscle disease

  • Myasthenia Gravis

  • Degenerative disease

  • Brainstem stroke (CVA)

• Speech Characteristics:

  • Hypenasality

  • Nasal emissions

  • imprecise consonants

  • breathy, wet, hoarse, voice

  • mono pitch/loudness

  • slow and slurred DDKs (rapid, clear, and precise, speech movement)

  • tongue fasciculations

Types of Dysarthria: Spastic

• Location of Lesion: Bilateral Upper Motor Neuron

• Main Etiology:

  • Cerebrovascular (CVA)

  • Degenerative disease

  • Traumatic Brain Injury (TBI)

  • Infection (e.g., Meningitis)

  • Cerebral Palsy (CP)

• Speech Characteristics

  • Hypernsality

  • harsh, breathy voice

  • strained and strangled voice

  • mono loudness

  • low pitch, mono pitch

  • imprecise consonants

  • excess and equal stress

Types of Dysarthria: Ataxic

• Location of Lesion: Cerebellum

• Main Etiology:

  • Cerebellar stroke or injury

  • Cerebellum atrophy

• Speech characteristics:

  • slowed, slurred speech

  • excess and equal stress

  • irregular, incoordination

  • imprecise consonants

  • distorted vowels

  • mono pitch, mono loudness

  • prolonged phonemes

Type of Dysarthria: Hypokinetic

• Location of Lesion: Basal Ganglia (dopamine depetion)

• Main Etiologies: Parkinson’s disease (PD)

• Speech Characteristics:

  • mono pitch, mono loudness

  • short rushes of speech

  • low, flat pitch

  • variable rate of speech

  • breathy, harsh voice

  • reduced stress

  • inappropriate silences

  • DDKs - fast and imprecise

Types of Dysarthria: Hyperkinetic

• Location of lesion: Basal Ganglia (excess dopamine)

• Main Etiologies: Huntington’s disease (HD)

• Speech Characteristics:

  • involuntary movement at rest and during speech articulatory breakdowns

  • Voice stoppages

Types of dysarthria: Unilateral UMN

• Location of Lesion: Unilateral Upper Motor Neuron

• Main Etiologies: Unilateral stroke (CVA)

• Speech Characteristics:

  • unilateral facial weakness 

  • harsh voice

  • articulatory imprecision

Flaccid Dysarthria

• Location of Lesion: Lower Motor Neuron

• Primary Deficit: Weakness

Spastic Dysarthria

• Location of Lesion: Bilateral Upper Motor Neuron

• Primary Deficit: Spastic

Ataxic Dysarthria

• Location of Lesion: Cerebellum

• Primary Deficit: Incoordination

Hypokinetic Dysarthria

• Location of Lesion: Basal Ganglia (dopamine depletion)

• Primary Deficit: Rigidity and decreased ROM (range of motion)

Hyperkinetic Dysarthria

• Location of Lesion: Basal Ganglia (excess dopamine)

• Primary Deficit: involuntary movements

Unilateral Dysarthria

• Location of Lesion: Unilateral Upper Motor Neuron

• Primary Deficit: weakness, incoordination, spasticity

Dysarthria Assessment: Formal Assessment

• Assessment of Intelligibility of Dysarthric Speech (AIDS)

• French Dysarthria Assessment (differential diagnosis between types)

Dysarthria Assessment: Structure and Function

• Oral Facial Sensory Motor Examination (OFSME)

  • facial symmetry, labial movement, mandible, dentition, tongue, palate, speech

• Assess 6 cranial nerves for lower motor/upper motor neuron damage

  • muscle appearance and/or function; strength, range of motion, speed

• Diadochokinetic Rates (DDKs)

  • evaluate speech like movements (e.g., pa, patuh, patuhkuh)

Dysarthria Assessment: Phonatory Assessment

• pitch and quality

• pitch variability and loudness variability

Treatment for Dysarthria: Restorative Treatment

goal is to improve and restore lost function

Treatment for Dysarthria: Compensatory Treatment

goal is to compensate for deficits and reduce overall impact

Treatment for Dysarthria

• improve respiratory support for speech

• management and treatment of resonance

• phonation and speech intelligibility

• TREATMENT SHOULD NOT INCLUDE NON-SPEECH ORAL MOTOR EXERCISES (NO RESEARCH)

Treatment for Dysarthria: maximum vowel prolongation

• Sustained vowel; target duration and loudness 

• feedback - SLP cues, recording, volume meter

Treatment for Dysarthria: diaphragmatic breathing

proper breathing for speech

Treatment for Dysarthria: postural adjustment

optimize physiological support for speech

Treatment for Dysarthria: bearing down, pulling, and pushing

achieve vocal fold medialization

Treatment for Dysarthria: pacing and phrasing

planning breaths for speech to avoid running out of air

Treatment for Dysarthria: vocal function exercises

to improve phonation, loudness; inappropriate for spastic dysarthria

Treatment for Dysarthria: over-articulation

over emphasizing articulatory movements to improve speech intelligibility