Aphasia

What is aphasia?

Aphasia is a loss or diffuctuly w/ language that happens after a brain injury

Is aphasia an intellectual or cognitive disorder?

NO, its a language disorder

What is the MOST COMMON cause of aphasia?

Stroke!! (although any injury to the brain can result in aphasia)

What is aphasia NOT?

- dementia (decline in thinking, memory, and everyday functioning aka cognition)

- dysarthria (speech dis. caused by weak or uncoordinated muscles)

- psychiatric or psychological condition (changes in emotions or behavior that affect mental health)

What are some common deficits of aphasia?

- anomia

- alexia

- agraphica

- jargon

- neologism

- praphasis

Define anomia

inability to name or find words

ex. a person sees a pen and says "I know what this is...but i cant think of the word."

define alexia

difficulty comprehend written words (aka reading)

define agraphica

difficulty with writing

define jargon, given ex.

someone uses made-up or incorrect words that follow normal speech patterns but are hard or impossible to understand.

ex. The flinder gopped over the brast.

define neologism

made up words that don't exist

ex. "flinder" instead of "phone"

define paraphasis

word substitutions

What are the 2 kind of paraphasic errors? give ex.

semantic: use the wrong word, but it's related in meaning or category

- pt calling a pencil a "marker"

Phonemic: using the wrong sound in a word

- pt. says "fable" instead of "table"

What are the subcategories aphasia is split up into?

1. fluent or non-fluent

2. Comprehension?

3. Can repeat words?

What is the difference between fluent and non-fluent?

fluent: smooth, flowing speech with longer sentences (5+ words), but does not make sense

non-fluent: slow effortful speech with short phrases (1-3 words), often sounding choppy of "telegraphic"

How is aphasia traditionally associated with? give ex.

lesion site

ex. lesion in Broca's area = broca'a aphasia

What has changed the thought that lesion site = type of aphasia?

- improved brain imaging (we can see exactly which areas are involved and how networks connect)

- neuroplasticity (brains ability to reorganize itself, so other areas can take over language functions)

Clinically, what are 2 primary categories of aphasia? (This is ok for early stages of admission or dx of aphasia)

fluent or non-fluent

Why is further differential dx needed for aphasia (rather than just fluent vs non-fluent)

Just labeling aphasia as fluent or non-fluent ONLY looks at speech output. It doesn't tell us about auditory comprehension

What are the 3 fluent aphasias we are going to talk about in class?

- Wernickes

- Conduction

- Anomic

What are the 2 non-fluent aphasias we are going to talk about in class?

- Broca's

- Global

Why is Broca's aphasia considered controversial?

Because damage in the primary motor cortex (very close to each other) = apraxia, people were unsure if it was truly aphasia or a severe apraxia where they can not get the words out (not due to language, but a motor deficit)

What are the characteristics of Broca's aphasia

- non-fluent (Telegraphic, halting)

- slow, effortful rate

- fair ability to repeat immediately

- fairly preserved auditory comprehension

- can't read very well, but may have preserved reading comprehension (simple or functional phrases)

- unable to write (Broca's aphasia typically means right hemiparesis, so they are unable to use the right extremities)

Do people who have Broca's aphasia aware of their errors?

Yes (becasue temporal lobe is still intact), this leads to high frustration & high risk of depression

What is the treatment aim for individuals with Broca's aphasia?

- restore fluent spoken language

Because individuals who have Broca's aphasia typically have good auditory comprehension, what is the typical prognosis for these patients?

typically improve better because...

- understand what they are saying is wrong

- can follow directions, cues, and tx recommendations

What did Carl Wernicke define Wernicke's aphasia as?

"sensory aphasia"

Where is the injury typically located for Wernicke's aphasia?

superior temporal gyrus

What are some characteristics of Wernicke's aphasia?

- logorrhea (aka diarhea of the mouth lol)

- rapid rate of speech

- severe work finding problems

- "Empty Speech"

- Profound deficits in auditory comprehension

- Poor reading comprehension

define logorrhea

excessive or nonstop talking

define "Empty Speech."

filled with paraphasias, jargon, and neologisms

What are some examples of an individual w/ wernicke's aphasia deficits in auditory comprehension?

- can't understand others

- can't repeat

- trouble with turn-taking

- trouble with following directions

What are the main goals for an individual with Wernicke's aphasia? why?

- #1 -> AUDITORY COMPREHENSION(most difficult skill, due to a lack of comprehension, they often do not realize their problem and may not be compliant or seem confused)

Which aphasia is considered the most severe/ worst prognosis subtype? why?

Global Aphasia, due to a lack of awareness, all areas affected, and major deficits in comprehension

What area is typically (neuroanatomy-wise) affected in indivuduals w/ global aphasia?

entire left hemisphere

What are some characteristics of global aphasia?

- speaking, understanding, reading writing, all signigicalltly impaired

- elements of non-non-communication language may not work

Can global aphasia improve?

Some can, or "transition" to another subtype of aphasia

Why is it not uncommon for the original diagnosis of aphasia to change?

aphasia dx. can change as patient moves between setting (assessments become more thorough and specific) and because of recovery and healing of the brain over time.

How would a patient IDEALLY be assessed for aphasia? BUT why might we not do this?

norm-referenced tool (like BDAE, WAB, BNT, BASA), BUT they take a LONG amount of time (45 mins) and are more expensive to get

How would a patient PRACTICALLY be assessed for aphasia?

Pt. usually dx through assessment (by clinical data at bedside or during functional tasks)

What are some common tasks done in the assessment of aphasia?

- confrontation naming

- responsive naming

- convergent naming

- divergent naming

define confrontation naming

I SHOW an object, and Pt. has to name it

ex. you show a pt. a pen, and they are asked, "what is this?"

define responsive naming

I DESCRIBE an object, and Pt. names it

ex. "what do you write with?" -> pen

define convergent naming

pt. is given a group of items and asked how they are related

ex. You show a pt. an apple, banana, and orange -> Pt. says "fruit"

define divergent naming

Pt is given a category and asked to name items that fall in that category

ex. Category: fruits -> pt. says "apple, banana, orange, grapes"

What are some tasks we will do with a patient with aphasia?

- auditory comprehension (helps determine anterior (non-fluent) or posterior (fluent) aphasia)

- Repetition and copy exercise

- automatic speech tasks (ex. count to 10)

- reading speech tasks (letters, short words, sentences, paragraphs)

What is written choice?

asking them a question while writing down their 2 options to answer the question

What does treatment for aphasia look like?

- moving away from "treat the deficits" to "use their strengths."

- life participation goals (LPAA)

- modify the environment style as much as possible (if using AAC, make it function and effective)