SLP 564 - Quiz 1

aphasia

multidimensional concept that can be defined from neurological, neurolinguistic, cognitive, and functional perspectives

common accepted elements of an aphasia definition

- language level problem

- affects input and output modes

- multimodal

- caused by a CNS dysfunction

language

- comprehension

- expression

- phonology

- morphosyntax

- semantics

- pragmatics

cognition

- orientation

- attention

- perception

- memory

- concept formation

- executive functions

language and cognitive communication disorders

- aphasia

- TBI

- right hemisphere disorder

- dementia

motor speech disorders

- apraxia

- dysarthria

characteristics of aphasia

- auditory comprehension

- verbal expression

- reading

- writing

most affected characteristics of aphasia

verbal production and auditory comprehension

auditory comprehension

- severity depends on type of aphasia

- fluent aphasias struggle more

- conversation, sentence/phrase, grammar, commands

oral expression

- verbal fluency (long vs short pauses, phrase vs single words, etc.)

- anomia

- grammar

- repetition

- spontaneous speech

anomia

- word finding difficulties

- present in all aphasia types

reading/writing

- alexia, dyslexia

- recognition of letters and words

- agraphia, dysgraphia

- writing to dictation

- spelling

associated characteristics of aphasia

- physical/motor difficulties

- apraxia

- cognitive problems

- psychological/social problems

supramarginal gyrus (40)

- reading/writing

- some math

angular gyrus (39)

- phonological organization

- phoneme production

- maybe naming/word finding

Paul Broca

- localizationist

- posterior inferior frontal gyrus is the "faculty of articulate language"

- Broca's area

Carl Wernicke

- considered connectivity

- Brodmann area 22 (posterior segment of superior temporal gyrus)

- Wernicke's area

Ludwig Lichtheim

- adopted Wernicke's views

- expanded on connectivity

- identified global and transcortical motor/sensory aphasia

the Wernicke-Lichtheim (W-L) model

- most influential model of the neuroanatomical basis of speech processing

- Boston diagnostic and WAB influenced by this

dual stream of speech and language processing

- currently widely accepted model

- heavily influenced by W-L model

ventral stream

supports auditory comprehension

dorsal stream

- modification of spoken output

- online error detection

blood supply to the brain

- internal carotid arteries

- vertebral arteries

anterior cerebral arteries

- frontal and parietal lobes

- basal ganglia

- corpus callosum

middle cerebral arteries

- Broca's and Wernicke's areas

- primary motor cortex

- temporal lobes

- most common cause of aphasia

posterior cerebral arteries

- occipital lobes

- cerebellum

etiologies of aphasia

- stroke

- TBI

- tumor

- surgical trauma

- infections

stroke (CVA)

brain tissue is permanently destroyed or temporarily does not function due to decreased or absent blood supply to affect brain tissue

anoxia

complete lack of oxygen to a cell

hypoxia

partial loss of oxygen to a cell

ischemic stroke

- blood vessel gets occluded

- symptoms develop over minutes-hours

- one sided loss of sensation

- speech/language problems

types of ischemic strokes

- thrombotic

- embolic

- TIA

thrombotic stroke

narrowing due to atherosclerosis

embolic stroke

- blocking blood clot/thrombus

- travels from one place to another

transient ischemic attack (TIA)

temporary disruption to the blood supply (usually followed by a larger stroke)

hemorrhagic stroke

- blood vessel gets ruptured

- sudden, definitie, and severe symptoms

- can be fatal when intracranial pressure increases significantly

subarachnoid hemorrhage

bleed between the surface of the cerebrum and the skull

intracerebral hemorrhage

blood vessel bursts within the brain

aneurysm

abnormal stretching or ballooning out of the wall of a blood vessel

arteriovenous malformation (AVM)

abnormal tangle of blood vessels -> high pressure blood flow into low pressure areas -> stroke, seizure, or headache

traumatic brain injury (TBI)

- caused by forceful bump, blow, or jolt to head/body or object that pierces skull and enters brain

open head injury

- penetration to skull

- meningeal layers impacted

closed head injury

- no penetration to skull

- meningeal layers still intact

cortical aphasias are either...

- fluent/receptive aphasias

- non-fluent/expressive aphasias

cortical aphasia types

- Broca's

- Wernicke's

- Global

- Conduction

- TMA

- TSA

- MTA

fluent/receptive aphasias

- Wernicke's

- transcortical sensory

- conduction

- anomic

non-fluent/expressive aphasias

- Broca's

- transcortical motor

- mixed transcortical

- global

Broca's aphasia

- preserved auditory comprehension (unless complex speech)

- lack of fluency

- effortful speech

- agrammatism

- difficulty with function words

agrammatism

lack of grammatical elements

Wernicke's aphasia

- poor language comprehension

- fluent jargon/press for speech/logorrhea

- paragrammatism

- neologisms

logorrhea

talking too much, could be missing pragmatic cues or could be unable to stop

paragrammatism

grammatical elements are used but incorrect

neologisms

nonsense, made-up words

Global aphasia

- all language modalities are severely impaired

- can express through gestures and facial expressions

- extreme disorientation and confusion

- neologisms if any verbal output

- can improve and change into a different aphasia subtype

anomic aphasia

- mildest form

- fluent (minor grammar issues if any)

- utterances marked by word retrieval deficits

- intact comprehension

- circumlocutions, perseverations, paraphasias

manifestations of anomia

- circumlocution

- paraphasias

- perseverations

circumlocutions

- beating around the bush

- providing all other information except for the name itself

- can be seen in all aphasia types

paraphasias

- phonemic/literal paraphasia

- semantic paraphasia (within or remote category)

- neologistic paraphasia

- extended paraphasia

phonemic/literal paraphasia

- phoneme substitutions

- inconsistent errors

- ex: "bit" for "sit"

semantic paraphasia

- word substitutions

- within category: "table" for "chair"

- remote category: "table" for "beach"

neologistic paraphasia

single meaningless word substitutions

extended paraphasia

- jargon, connected speech

- stretch of meaningless word substitutions

perseverations

- continuous

- stuck-in

- recurrent

continuous perseverations

- inappropriate continuation of a response without a new intervening stimulus

- clinician presents stimulus once and waits for entire response

- "I took a bus, I took a bus, I took a bus"

stuck-in perseverations

- inappropriate maintenance of a framework of response after a new task is introduced

- ex: continues naming animals when asked to name days of the week

recurrent perseverations

- inappropriate occurence of part/whole of previous response for a new stimulus

- same task, new stimulus

ex: saying "beaf" for "leaf" right after naming "book"

conduction aphasia

- fluent

- intact comprehension (unless complex sentences or group convo)

- significant impairments in repetition

- frequent phonemic paraphasias

- conduit d'approche

- could progress to anomic aphasia over time

conduit d'approche

- repetitive effort to approximate the appropriate word/phase

- correcting oneself over and over again

transcortical motor aphasia (TMA)

- Broca's type but milder

- non-fluent, single word expressions

- agrammatism

- surprisingly good repetition

transcortical sensory aphasia (TSA)

- Wernicke's type but milder

- fluent

- comprehension affected

- paragrammatism

- echolalic repetition

mixed transcortical aphasia (MTA)

- global aphasia but milder

- AKA isolation aphasia

subcortical aphasia types

- thalamic

- anterior capsular

- posterior capsular

- global capsular/putnaminal

important subcortical language areas

- thalamus

- basal ganglia

- internal capsule

basal ganglia

- caudate nucleus

- putamen (striatum)

- globus pallidus

- subthalamic nucleus

- substantia nigra

striatum receives...

afferents from cortex, thalamus, and brain stem

basal ganglia transmits...

output to the thalamic nuclei that project this output back to the frontal cortex

subcortical connection loop

fronto-basal ganglia-thalamic-frontal loop

thalamic aphasia

- 2-4% of all ischemic strokes

- expression more impaired

- comprehension better but still affected

- variable fluency

- intact repetition

anterior capsular aphasia

- ~Broca's

- good comprehension

- borderline fluent (variable)

- intact repetition

posterior capsular aphasia

- ~Wernicke's

- poor comprehension

- borderline fluent

- impaired repetition

global capsular/putaminal aphasia

- ~global aphasia (less severe)

- comprehension better than expression but still impaired

- non-fluent

- limited verbal output

- impaired repetition

aphasia assessment protocols

- go beyond traditional medical model

- include formal and informal procedures

- identify activity and participation issues

- identify influential contextual factors

diagnostic process

ongoing assessment and interpretation of cognitive, linguistic, and communicative behaviors

informal assessment

- indirect observation

- direct observation

formal assessment

- screening measures

- test batteries

- specialized tests

indirect observation

- case history and medical records

- demographic information

- chief complaints of client and family

- focus on neurological history

direct observation (client interview)

- speech abilities and difficulties

- fluency, voice, articulation

- cog/ling abilities and difficulties

- awareness, attention, memory

- comprehension, expression

initial impressions (working diagnosis)

- acute vs chronic

- motor speech vs structure vs cog/ling

- aphasia vs dementia vs RHD vs TBI vs PPA

- fluent vs non-fluent

assessment of aphasia

- hearing, vision, and aphasia screening

- formal assessment batteries

- specializedtests

aphasia screenings and quick tests

- for bedside and/or acute care

- identify aphasia symptoms in a very brief test

- ex: Mississippi aphasia screener, bedside WAB, CLQT, quick aphasia battery

aphasia diagnostic test batteries

- administered when patients can tolerate testing for 30 minutes or more

- provide a diagnosis

- ex: WAB, BDAE, PICA, BASA, etc.

Western Aphasia Battery (WAB)

- 18-89 years

- assess linguistic skills which are affected by aphasia

- provides differential diagnosis

- provides language quotients

WAB subtests needed for aphasia quotient

- spontaneous speech (just fluency)

- auditory verbal comprehension

- repetition

- naming

fluency -> yes -> comprehension -> yes -> repetition -> yes

anomic aphasia

fluency -> yes -> comprehension -> yes -> repetition -> no

conduction aphasia

fluency -> yes -> comprehension -> no -> repetition -> yes

transcortical sensory aphasia

fluency -> yes -> comprehension -> no -> repetition -> no

Wernicke's aphasia

fluency -> no -> comprehension -> yes -> repetition -> yes

transcortical motor aphasia

fluency -> no -> comprehension -> yes -> repetition -> no

Broca's aphasia

fluency -> no -> comprehension -> no -> repetition -> yes

transcortical mixed aphasia