Aquired Test 2

nonfluent aphasia          

impacts a person’s ability to express themselves using spoken or written language

speak in short phrases

omit function words

show good awareness of deficit 

non-fluent   

why type of aphasia has better self-monitoring and self-correcting ability?

broca’s

transcortical motor

global   

types of non-fluent aphasias

right   

left

patients with non-fluent aphasia may have hemiparesis/hemiplegia on the ______ side of the body because lesions are in the ______ side of the brain

apraxia of speech

may accompany non-fluent aphasia

motor speech disorder that affects the planning of speech movements

hallmarks include difficulty with coarticulation, false starts & reapproaches, effortful groping, slowed rate of speech, pausing, articulatory omissions, greater ease for automatic speech, and attempts to self correct   

dysarthria   

may accompany non-fluent aphasia

motor speech disorder resulting from damage to the parts of the nervous system that control muscles that help you speak

hallmarks include slurred/mumbled speech, speaking too quick or slow, speaking too quiet or loud, impaired voice quality (hoarse, strained, breathy, etc.), and speaking in short/choppy bursts with several pauses    

broca’s aphasia    

lesion in the left frontal lobe

characterized by non-fluent speech and halting verbal output

demonstrates agrammatic verbal output, prosodic deficits, and the presence of anomia

characteristics of broca’s aphasia   

• effortful speech

• agrammatism

• prosodic disturbances

• anomia

• awareness of the problem

• intact automatic speech

• variable presence of motor speech disorders

• fairly good auditory comprehension

• reading/writing similar to verbal output

• varying degrees of hemiplegia/hemiparesis

semantic content    

patients with broca’s aphasia can be effective communicators because the words they can produce have _______ so the listener can fill in the blanks

transcortical motor aphasia (TMA)

lesion site is smaller, in the anterior frontal lobe which interrupts link between broca’s area and motor cortex

lesions may cause motor speech deficits or lack of spontaneous speech

patient initially presents as mute and has difficulty initiating conversations & responding verbally

better prognosis

characteristics of TMA

• non-fluent language

• repetition intact

• paraphasia evident

• syntax errors

• perseverations

• difficulty initiating conversations

• persevered confrontation naming

• difficulty organizing responses in conversation

• excellent auditory comprehension

• fair-good articulation, rate may be slow

• possible presence of automatic echolalia

conversational level

deficits of TMA are most evident at which level?

short/structured communication

patients with TMA respond best to ________ and tend to be poor with open-ended, free-flowing verbal exchanges

global aphasia    

lesion site includes large portions of the left frontal, parietal, and temporal lobes stretching from wernicke’s area to broca’s area

large lesions up to 6cm

a severe, acquired impairment of communication that involves all language modalities

characteristics of global aphasia

• non-fluent speech with minimal speech output

• impaired auditory & reading comprehension

• impaired verbal repetition

• anomia

• recurrent stereotypical utterances

• unawareness of language errors

• perseverative responses with oral & written tasks

• difficulty monitoring perseverations

• produce neologistic speech

• prosodic speech patterns, but lack syntactic and semantic value

• cognitive deficits

nonverbal communication   

patients with global aphasia often rely on _________ such as tone, facial expressions, and gestures

auditory comprehension   

overtime, in patients with global aphasia, ________ will improve more than verbal expression

motor ability

prognosis for global aphasia is better is ______ is preserved

fluent aphasia

lesions posterior to central sulcus

affects an individual’s ability to use language, having well-articulated speech with little to no content

connected speech with normal prosody and inflection, but often characterized by jargon

poor awareness and self-monitoring skills

wernicke’s

transcortical sensory

conduction

anomic   

types of fluent aphasias    

wernicke’s aphasia

lesion site includes the posterior third of superior temporal gyrus   

characterized by effortless, jargon-filled speech

deficits primarily in receptive language (auditory and visual)

characteristics of wernicke’s aphasia

• poor auditory comprehension

• auditory agnosia

• poor self monitoring

• impaired reading comprehension

• intact oral reading

• severely impaired spelling

• jargon in writing

• effortless and melodic speech

• normal articulation

• can initiate verbal expression

• empty speech

• paraphasias

• paragrammatism

• logorrhea

auditory agnosia    

word deafness

a person with wernicke’s aphasia is able to hear, but may not be able to understand or repeat speech sounds

logorrhea

excessive and incoherent talkativeness/wordiness

resistant to therapy

patients with wernicke’s aphasia have a lack awareness to language deficits, and may not repair communication breakdowns or respond to listener cues, making them ________

transcortical sensory aphasia (TSA)   

lesion site includes the posterior parieto-temporal area, sparing wernicke’s area

a rare, less severe form of wernicke’s aphasia that may initially be mistaken with alzheimers

characterized by fluent, well-articulated speech, with frequent neologisms and paraphasias, and discourse tends to be incoherent with numerous circumlocutions

characteristics of TSA

• fluent, well articulated speech

• severe auditory comprehension deficits

• empty and circumlocutionary discourse

• lack semantic content

• neologisms and verbal paraphasias

• patient can usually repeat what is said

• word finding problems

• stereotypical speech

• echolalia

• writing errors

Gerstmann’s syndrome

a neurological disorder related to left parietal lobe damage resulting in cognitive impairment and aphasia that patients with TSA may have

4 main symptoms

• agraphia

• acalculia

• disorientation of left and right

• finger agnosia

agraphia

impaired writing/spelling

acalculia

impaired math skills

disorientation of left and right

the inability to distinguish left and right

finger agnosia

inability to distinguish, name, or recognize fingers

conduction aphasia

aka associative aphasia

lesion in the cortical region connect broca’s area to wernicke’s area

most salient feature is difficulty with repetition of words

characteristics of conduction aphasia

• difficulty repeating function words, multisyllabic words, and longer sentences

• phonemic paraphasias

• good intonation and fluency

• good auditory comprehension

• difficulty with word finding

• good recognition of errors

• intact reading comprehension

• oral reading deficits

• favorable spontaneous recovery pattern

anomic aphasia

lexical retrieval difficulties

lesion site is left inferior temporal cortex

pure anomia

type of anomic aphasia resulting from damage to the posterior cortex

access to the phonological word forms is impaired

semantic anomia

type of anomic aphasia resulting from damage to the anterior cortex

degredation of semantic knowledge

characteristics of anomic aphasia

• lexical retrieval deficits

• delayed response

• self-corrections

• circumlocutions

• neologisms

• paraphasia

• perseveration

• no response

• do best naming nouns, frequently used words, short words, personally meaningful words, and sentence completion tasks

confrontation naming

naming when a visual image is present

prompting aphasics’ communicative effectiveness (PACE)

an interactive approach intended to make therapy more like a real-life communication interaction

4 principles

• exchange new info

• equal participation

• free choice of communication channels

• giving feedback based on communication adequacy

response elaboration training (RET)

increases the amount of info contained in verbal expressions

components

• loose training/incidental treatment

• forward chaining

• shaping

• repetition

speech entrainment

utilizes an audio-visual speech model to enable people with nonfluent aphasia to produce fluent speech in real time

verbal action therapy

nonverbal therapeutic intervention specific for severe impairments

patients learn to produce hand/arm gestures that represent objects with the goal to improve functional communication

semantic feature analysis

improves lexical retrieval by accessing semantic networks

serves as a compensatory strategy

script training

focus is on a patient systematically learning to use personalized messages

short scripts are mastered through repetition until they are produced independently in real world situation

AAC

supports communication of basic needs, delivery of info, maintenance of social closeness, and social etiquette

can be low tech or high tech

melodic intonation therapy (MIT)

an approach that uses melodies and intonation based on the concept of right hemisphere prosodic functions supporting the left hemisphere for speech

steps

• humming

• unison intoning

• intoning with fading

• immediate repetition

• response to probe

subcortical aphasia

a language impairment caused by damage to deep brain structures

thalamic

non-thalamic

2 types of subcortical aphasias

ischemic strokes

etiology of subcortical aphasia

maintaining attention and focus

what is the key deficit associated with subcortical aphasia?

cloze

multisensory

cueing

3 techniques for subcortical aphasia

arousal

attention

conceptual representation and thinking

executive functioning

rehabilitation of patients with a subcortical stroke (A-ACE)

primary progressive aphasia

considered a form of dementia resulting from a degeneration of nerve cells in the language centers of the brain

degeneration in the left frontal-parietal-temporal regions of the brain

affects a person’s ability to speak, comprehend, read, and write

nonfluent/agrammatic PPA

slow rate

paragrammatism

articulatory distortions

limited linguistic complexity

semantic PPA

normal rate

few syntactic errors

loss of semantic knowledge about objects and people

logopenic PPA

normal speech rate and errors are less evident

speech characterized by hesitant and halting with long pauses

reduced repetition

criteria for PPA diagnosis

minimum of 2 years of declining language

language deficits are disproportionate to other abilities

activities of daily life are not generally affected

gradual and slow onset

a differential diagnosis is needed to rule out stroke, tumor, etc.

alexia

a loss of reading ability

agraphia

a loss of writing ability

phonological alexia

central alexia (w/ aphasia)

sound route is impaired

patient reads by sight and memory & cannot sound out words

surface alexia

central alexia (w/ aphasia)

sight words are impaired

patient reads by sounding out words & cannot read whole words

deep alexia

central alexia (w/ aphasia)

sound and sight words are impaired

patient has difficulty understanding meaning & difficulty sounding out words using letters/sound correspondence

global alexia

peripheral alexia (no aphasia)

patient is very slow or inaccurate in naming letters and reading words

pure alexia

peripheral alexia (no aphasia)

patient has slow and inaccurate reading

hemianopic alexia

peripheral alexia (no aphasia)

patient cannot see prefixes or suffixes

neglect alexia

peripheral alexia (no aphasia)

incorrectly reading initial or final consonants in a word

attentional alexia

peripheral alexia (no aphasia)

words appear merged with visual letter crowding

phonological agraphia

sound deficit

patient cannot match sounds with written letters in words

surface (lexical) agraphia

visual deficit

patient writes what they hear (inventive writing)

deep agraphia

patient has difficulty with writing words that convey the correct meaning

wrong words may be written

etiology of RHD

stroke

trauma

brain tumor

degenerative disease function

paralinguistic deficits

extralinguistic deficits

2 main deficit types for RHD

anosognosia

deny the existence or severity of their condition

does not recognize the need for treatment/medication

may resist therapy

hard to retain skills

why does anosgnosia make treatment difficult for patients with RHD?

visual agnosia

inability to recognie something by sight

tactile agnosia

inability to recognize something by touch

prosopagnosia

a person’s inability to recognize faces of individuals including one’s own face

may also be unable to read facial expressions

simultagnosia

a person’s inability to focus attention on the whole image

only focus on one part at a time

ex. recognize a nose, but not a whole face

visual integration

unable to form a cohesive visual percept

visual information is perceived as separate pieces

visual disorientation

unable to accurately perceive their position, orientation, and motion in relation to the environment

visuomotor deficits for RHD

difficulty constructing objects in space

difficulty producing an accurate and correct clock drawing

impacts a patient’s ability to dress themselves

auditory perceptual deficits for RHD

difficulty with sound localization

auditory agnosia

difficulty discriminating prosodic patterns

attention

executive functioning

memory

cognitive deficits for RHD

emotional factors for RHD

flat facial affect

flat emotional affect

difficulty conveying emotions

impaired ability to process and produce prosodic patterns & facial expressions

visual neglect

visuospatial deficit for attention

can impact attention during communication because patient has difficulty attending to/making eye-contact with their communication problem unless they are on the right side

neglect increases when greater attention is required to complete a task