TEST 1 - CSCD612

mnemonic devices

A Compass SENSed West, MOre Bisons Mysteriously Grazed

Anomic, Conduction, Transcortical Sensory, Wernicke’s, Transcortical Motor, Broca’s, Transcortical Mixed, Global

anomia

word-finding difficulty
“what’s that thing called"?”

circumlocution

description of target word
"you know, that thing you sit on”

agrammatism/telegraphic speech

content words only, function words omitted
“sink on” instead of “the sink is on”

auditory comprehension deficits

impaired understanding of speech
trouble comprehending a spoken story

phonemic paraphasias

<50% of phonemes in target word (additions, substitutions, etc.)
“hak” or “tat” instead of “hat”

semantic paraphasias

substituting similar words
“cap” instead of “hat”

mixed paraphasias

both semantic & phonological errors
“hood” instead of “hat”, similar meaning and both have /h/ initial

neologistic paraphasias

nonwords, 50% < incorrect
jargon = lots of neologisms
“chith” instead of “hat”

perserverations

recurring, previously produced responses
“headphones” for every answer instead of what is actually in the image

stereotypy

frequently used word in place of target
using the word “hat” for answers in varying places

alexia

reading impairment

agraphia

writing impairment

BA 4

primary motor cortex (frontal lobe)
executing motor movements

BA 6 & 8

premotor + supplementary motor cortex (frontal lobe)
complex/coordinated movements

BA 44 & 45

broca’s area, inferior frontal gyrus (frontal lobe)
elements of language, motor planning for speech

BA 1, 2, & 3

primary somatosensory cortex (parietal lobe)
sensory perception, localization, etc.

BA 39 & 40

39 → angular gyrus, 40 → supramarginal gyrus (temporal lobe)
allows you to string words together

BA 22, 41, & 42

primary auditory cortex (temporal lobe)
22 → auditory/language comprehension
41 & 42 → first cortical destination of auditory info from thalamus

BA 9, 10 & 11

prefrontal cortex (frontal lobe)
executive functioning (decision making, memory, multitasking, etc.)

BA 17, 18, & 19

visual cortex, 17 is primary visual cortex (occipital lobe)
visual processing

references to cite for efficacy of aphasia treatment

Robey, R.R. (1994)
Holland, A et al. (1996)
Robey, R.R. (1998)
Brady, M.C. et al. (2016)

what brodmann area(s)

BA 4

what brodmann area(s)

BA 6 & 8

what brodmann area(s)

BA 44 & 45

what brodmann area(s)

BA 1, 2, 3

what brodmann area(s)

BA 39

what brodmann area(s)

BA 40

what brodmann area(s)

BA 22

what brodmann area(s)

BA 41, 42

what brodmann area(s)

BA 9, 10, 11

what brodmann area(s)

17, 18, 19

lesions in which locations cause Broca’s aphasia?

inferior frontal gyrus / Broca’s area (BA 44 & 45)
frontoparietal operculum (in insula)
subcortical lesion

lesions in which locations cause Wernicke’s aphasia?

auditory cortex (BA 22)
angular gyrus (BA 39)
supramarginal gyrus (BA 40)

Wernicke’s area (BA 39 & 40)

lesions in which locations cause Conduction aphasia?

arcuate fasciculus (connects Broca’s to Wernicke’s)
supramarginal gyrus (BA 40)
left primary auditory cortices

lesions in which locations cause Global aphasia?

large lesion including Broca’s, Wernicke’s, and possibly more
sometimes Wernicke’s is spared

lesions in which locations cause Anomic aphasia?

NO SPECIFIC LOCATION, can’t say for certain

Broca’s Aphasia (FCR, behaviors, signs)

Fluency: NO, Comprehension: YES, Repetition: NO

short phrase length, agrammatism/telegraphic speech, anomia, phonemic paraphasias

signs: apraxia, hemiparesis/sensory loss

Wernicke’s Aphasia (FCR, behaviors, signs)

Fluency: YES, Comprehension: NO, Repetition: NO

anomia, perseverations, jargon (neologisms), press of speech

signs: possible right hemianopia

Conduction Aphasia (FCR, behaviors, signs)

Fluency: YES, Comprehension: YES, Repetition: NO

anomia, conduite d’approche/d’ecart

signs: right hemiparesis, right hemisensory loss, right hemianopia

Global Aphasia (FCR, behaviors, signs)

Fluency: NO, Comprehension: NO, Repetition: NO

profound anomia, sterotypy, paraphasias, perseverations, echolalia

signs: right hemiparesis, right hemisensory loss, right hemianopia

Anomic Aphasia (FCR, behaviors, signs)

Fluency: YES, Comprehension: YES, Repetition: YES

anomia, circumlocution, word finding

signs: right hemiparesis, right hemisensory loss, right hemianopia

what is aphasia?

“Aphasia is a processing disorder of language, not a disorder of linguistic knowledge, representation, or rule governances. …Aphasia is a linguistic performance disorder”

biopsychosocial approach

therapy should take into account…

1. the biological impairment-based factors

2. the psycholinguistic and cognitive processes of language and communication

3. within the social context of the individual

4 parameters of the Wernicke-Lichtheim model

1. fluency

2. auditory comprehension

3. repetition

4. naming

what does FRAME stand for?

1. Familiarize

2. Reduce rate

3. Assist with communication

4. Mix communication modalities

5. Engage patient first

Familiarize (FRAME)

become familiar with your client’s established communication preferences

• modes of communication

• is it okay to guess or wait for you to finish

• hearing aids/glasses

Reduce rate (FRAME)

talking: slow down slightly, pause between phrases, one idea at a time

listening: increase wait time, maintain eye contact

Assist with communication (FRAME)

simplify speech, restructure/ask questions in different ways, acknowledge what you heard and communication breakdowns, ask clarifying questions

Mix communication modalities (FRAME)

acknowledging preferred modes of communication plus body language, facial expressions, gestures, writing, etc.

Engage the PWA (FRAME)

respect them and have a respectful tone of voice, use “semantics of competence” (avoid “good job”ing)

dimensions of fluency

phrase length, pauses, prosody, speaking rate, effort, intiation and elaboration

apraxia of speech

impairment of articulation and prosody due to an issue with motor planning
co-occurs with aphasia sometimes, especially Broca’s-like
3 NECESSARY CHARACTERISTICS:

• sound errors (distortions, distorted substitutions)

• slowed rate

• prosodic abnormalities (syllable segregation, equalized stress)

vascular distribution of the aphasias

MCA: Broca’s, Global

MCA & PCA: Wernicke’s, Conduction

Variable: Anomic

hemiparesis
hemiplegia
hemisensory loss
hemianopia

hemiparesis: one sided weakness
hemiplegia: one sided paralysis
hemisensory loss: one sided loss or limit of sensation
hemianopia: one sided visual field blindness

transcortical motor aphasia: features

Fluency: NO, Comprehension: YES, Repetition: YES

impaired initiation of speech, less articulatory effort, impaired reading and writing (especially oral reading)

transcortical sensory aphasia: features

Fluency: YES, Comprehension: NO, Repetition: YES

anomia, nonspecific words, semantic paraphasias, perseverations

transcortical mixed aphasia: features

Fluency: NO, Comprehension: NO, Repetition: YES

severe anomia, echolalia, preserved repetition, stereotypy

subcortical aphasias

lesion located in the thalamus, internal capsule putanimal, or basal ganglia
noted feature: hypophonia (reduced speech intensity, weak voice)

frontal lobe lesion features

expressive aphasia

contralateral paralysis, impaired cognition, inappropriate social behavior, etc.

temporal lobe lesion features

receptive aphasia

contralateral homonymous hemianopia, memory disturbances

parietal lobe lesion features

visual spatial deficits

contralateral hemisensory loss, tactile agnosia, inattention, anosagnosia (denial of impaired functioning)

occipital lobe lesion features

receptive aphasia

contralateral homonymous hemianopia, memory disturbances

cerebellar lesion features

reduced limb coordination and balance