Aphasiology Midterm

What are the treatment focuses for Aphasia?

supported conversation for Aphasia (SCA) Techniques

What does ICF stand for?

International classification of functioning, disability, and health

What are some strategies to improve communication?

honesty, openness, patience, team work, trial & error, give & take, , humor, acceptance, positivity

What are the two main goals for SCA?

1. to acknowledge the competence of the PWA

2. To help the PWA reveal his/her competence

What is the IN part for communication partners?

• short, simple sentences

• write keywords/topics

• eliminate distractions

• observe PWAs physical gestures

What is the OUT part of communication partners?

• yes/no questions

• one thing at a time

• fixed choices

• ask for help/cues

What is the VERIFY part of communication partners?

• summarize

• add gestures/keywords

• repeat PWA message

• expand thoughts

• recapping conversation

• reflect-expand-summarize

What are the hallmarks of Aphasia?

• language disorder

• resulting from an ABI

• Left sided CVA in adults

• leading cause is stroke

• intelligence remains intact, speech output is affected

• chronic

General strategies for SPEAKING to a PWA?

• Face to face

• natural voice and loudness

• clearly and slow

• allow for listener process time

• 5-10 second wait time

What are word finding strategies?

• cueing approaches (phonemic & semantic)

• visual and verbal prompts

What is Semantic Feature Analysis (SFA)?

A type of treatment used to improve word-finding skills by implementing target pictures for patients to point to the accurate name. Uses the following order to elicit:

• action

• use

• location

• association

• super

What is Semantic Priming to Improve Comprehension and Expression of Sentences (SPICES)?

involves exposing the brain to related words or concepts before encountering the target sentence. Priming your brain with semantically related information, you're essentially creating a cognitive pathway that facilitates the processing of specific concepts or words.

WHO, WHAT, ACTION

What is Visual Scene Display?

A scene that depicts a situation, place, or experience in ways that clearly communicate a message

What is augmentative and alternative communication?

All forms of communication other than oral speech that are used to express thoughts, ideas, wants and needs.

• writing communication boards, eye gaze boards, speech generation devices

What is copy and recall treatment (CART)

Targets writing and spelling

• During the copying phase, the individual is asked to reproduce or write down the given language stimuli. This can include words, phrases, or sentences.

• In the recalling phase, the individual is asked to remember and verbally express or write down the language stimuli without the aid of the original text.

What is Oral reading for Language in Aphasia (ORLA)

It is a repetitive reading practice treatment targeting reading comprehension and speech Fluency

• Level 1: simple 3-5 word sentences at a first-grade reading level

• Level 2: 8 to 12 words that may be single sentences or two short sentences, at a third- grade level

• Level 3: 15 to 30 words, divided into two to three sentences, at a sixth-grade level

• Level 4: 50 to 100 words compromising a four to six simple paragraph

What are scripts?

Allows PWA to tell their stories in detail and perform other communication tasks.

• personal stories

• visual supports

What are Afferent Neurons?

Sensory Neurons

What are Efferent Neurons?

Motor neurons

What is the Longitudinal Cerebral Fissure?

Separate the left and right hemispheres of the cerebrum

What is the Central Sulcus (Fissure of Rolando)?

Divides the anterior half of the brain from the posterior half

What is the Sylvian Fissure (Lateral Fissure)?

Runs from lower frontal lobe at the base of the brain and moves upward

What does the Slyvian fissure do?

Separates nonfluent and fluent

What regions surround the sylvian fissure?

speech, language, hearing

Describe the frontal lobe

The largest of the lobes contains the precentral gyrus (motor strip) which is the major portion of the primary motor cortex, critical for speech and language, houses BROCAS area

Describe the temporal lobe

Holds receptive language functions, primary auditory cortex and WERNICKES area

What is Wernickes area?

house of comprehension of spoken and written language

Left temporal lobe = ?

Significant for language comprehension

Right temporal lobe = ?

May be involved in nonverbal memory, music, and rhythm

Hippocampus = ?

medial part of temporal lobe (memory & learning)

Describe the parietal lobe

Houses the post central Gyrus (sensory strip/sensory cortex)

known for: perception, sensation, integration of sensory experiences

holds the supramarginal gyrus & angular gyrus

What happens if the supramarginal gyrus gets damaged?

damage result in agraphia

What happens if the angular gyrus gets damaged?

Causes naming, reading, and writing difficulties

Describe the occipital lobe

It is the smallest lobe, responsible for processing VISUAL information

• boundaries are arbitrary, no sulci to seperate from other lobes

What is the brainstem?

Region of the brain essential to life functioning

• location of most cranial nerve cell bodies

What are the 3 primary structures of the Brainstem, superior to inferior?

Midbrain

pons

medulla

What does the Medulla control?

Heart rate

Blood Pressure

What is the midbrain?

controls some sensory & motor functions

• eye movement

• coordination of visual & auditory processing

  • motivation, reward, movement

What is the Pons?

the “bridge” to the cerebellum & movement info of hearing, balance, head & face sensation, and saliva production

What is the Medulla Oblongata?

• Passes through the foramen magnum and transitions to the spinal cord,

• autonomic functions like digestion, respiration, blood pressure & heart rate

What are the motor pathways?

A pyramidal system that is a direct pathway to corticobulbar & corticospinal tracts that control voluntary movement

• monosynaptic: two neurons

What do the corticobulbar and corticospinal connect to?

Bulbar: surface to the brainstem

Spinal: surface to the spinal cord

What is contained in the Pyramidal System?

• Cell bodies located in cerebral cortex (bilateral)

• long axons down to brainstem or spinal cord

• synapse at brainstem/spinal cord

What is the corticobulbar tract?

Originates in cortex, connects to motor neurons (cranial nerves) in the brainstem which are responsible for volitonal movement of head/neck, oral structure

Describe the corticobulbar tract pathway

Starts in the UMN and goes through the midbrain into the pons, then goes to the nerve and synapses to the physical capability.

What are the signs of damage to the UMN?

• spasticity

• increased tone

• hyperflexia

• paralysis/paresis

• clonus

Describe the role of the UMN to the LMN

UMN serves as the brakes for the LMN, if the UMN is damaged it cannot send signals to the LMN and in result, spasticity occurs

Describe Lower Motor Neuron (LMN)

They consist of both cortico tracts and the cell bodies are located in the brainstem or anterior horns of the spinal cord and the axons travel to the muscles

• Innervate the skeletal muscle AKA FINAL COMMON PATHWAY

How many pairs of cranial nerves are there?

12

What system are the cranial nerves apart of?

The peripheral nervous system (PNS)

Describe the pathway of the cranial nerves

Exit the CNS & synapses onto the muscles at the neuromuscular junction

How are cranial nerves categorized?

Primarily sensory

primarily motor

mixed sensory & motor

What are the cranial nerves involved in speech and communication?

• Vagus (CN X)

• Hypoglossal (CN XII)

• Facial (CN VII)

• Glossopharyngeal (CN IX)

• Accessory (CN XI)

• Trigeminal (CN V)

What does the cerebrovascular system control?

Blood supply

What does the vascular network contain?

Arteries & veins

What is the role of the arteries?

carry oxygenated blood AWAY from the heart and to the body

& the brain

What are the two main things the brain needs?

glucose & oxygen

What is the role of blood in the brain?

To remove CO2

What is the definition and function of the aorta?

It is the main artery of the heart and carries blood from the left ventricle to all parts of the body EXCEPT the lungs

The brain is % of our body weight but needs __% of our blood supply

2% & 25%

What is the role of the veins?

They carry deoxygenated blood TO the heart and away from the body and brain

Describe the pathway of the carotid & vertebrals

The carotid (anterior) & vertebral (posterior) pathways go from the heart to the brain

Aorta to carotid arteries (L & R neck), then to the __________

circle of willis

Circle of willis to the _________

Cerebral arteries (anterior/middle/posterior)

What is the blood supply called?

Circle of Willis

Describe the Circle of Willis

It is a series of anastomeses connecting carotid and vertebral systems.

• promotes equal distribution of blood

• located at base of the brain

• blood supply: cerebral arteries

What are the Anterior Cerebral Arteries (ACA)?

They supply the upper/anterior regions of the frontal lobes & anterior corpus callosum

What are the Middle Cerebral Arteries (MCA)

They supply the lateral surfaces of brains hemispheres

Why are the MCA important for SLPs?

They surround the perisylvian fissure which is the role of language and speech

What are the Posterior Cerebral Arteries (PCA)?

They are the basilar (left & right vertebral) supply of the occipital and the lower parts of the temporal lobe

Describe the functionality of the Circle of Willis

One big roundabout at the base of the brain, all arteries circle together

• the cerebral arteries will go off into the surface of the brain

What happens if there is a blockage in one area below the circle of willis?

That part of the brain loses oxygen and the COW helps by providing equal distribution of blood

What are the meninges & their purpose?

Membranes that cover the brain and spinal cord

to protect, hold structures in place during movement, provide support

How many layers does the meninges have?

3

What are the layers of the meninges?

• Dura mater: most superficial “tough mother”

• arachnoid: web-like, separates dura & pia mater, lots of vasculature

• Pia mater: Innermost layer, thin, following the contour of the brain; contains vasculature that serves as the surface of the brain (covers bumps, gyrus)

What is the subarachnoid mater?

The layer between pia and arachnoid mater, holds the cerebrospinal fluid (CSF)

What is a subdural hematoma?

A brain bleed between the dura & arachnoid mater

An acute SDH develops within hours to days of injury

• chronic in elderly/alcoholic population

How is a SDH drained?

Via catheter

Describe what CSF is

A clear lymph-like fluid that circulates in the subarachnoid space that surrounds the brain and spinal cord

• used to protect the CNS

• manufactured in the ventricles

  • produce new fluid every 7 hours & reabsorbs the old fluid

The role of CSF

Cushions the brain and spinal cord during trauma caused by rapid acceleration (i.e TBI, car crash)

How many ventricles are in the brain?

4: a pair in each left and right side and then a 3rd & 4th on their own

What do ALL ventricles contain?

Choroid Plexus

What is the choroid plexus?

the tissue that produces CSF

What is the pathway of the basal Ganglia?

Cortical to subcortical

What are the 5 interconnected nuclei, from the cerebrum to the upper brain stem of the basal ganglia?

Caudate nucleus (cerebrum)

putamen (cerebrum)

globus pallidus (cerebrum)

subthalamic nucleus (below thalamus)

substantia nigra (midbrain)

What is the motor control of the Basal Ganglia?

Neurotransmitter behavior is important in the regulation of movement (i.e dopamine), posture, tone, voluntary movement, & automatic movement

What are signs of damage to the Basal Ganglia?

Too much or too little movement (i.e huntington’s or Parkinsons disease)

What is the Thalamus?

the motor and sensory relay station (shipping and receiving center)

What is the role of the thalamus?

receives information from the spinal cord, basal ganglia & brainstem and sends the info to the cortex for processing

• maintains consciousness, alertness & attention

Describe the cerebellum

• “little brain”

• found posteriorly, under the occipital lobe

• 2 hemispheres, 3 lobes

Role of the cerebellum

contributes to smooth, coordinated movement, balance, motor learning, cognition & memory

What are the 3 types of strokes?

CVA

TIA

Ischemic

What is a Cerebral Vascular Accident (CVA)?

It is an acute sudden onset resulting is focal brain damage caused by disrupted cerebral blood circulation (blockage)

What is a Transient Ischemic Attack (TIA)?

Transient = brief blockage of blood supply to brain (not permanent)

• lasts long enough to be noticed

• resolves on its own, no permanent damage

• “mini stroke” OR “warning stroke”

What are the symptoms of a stroke?

• severe headache

• impaired speech

• impaired comprehension

• dizziness

• sudden falls

• paresis

• vomiting

• seizures

  • symptoms lasting 24 hours or more

What is a Ischemic stroke (Hedge)?

• occlusion

• ischemia = interrupted blood supply to brain

  • lack of glucose & oxygen can cause death of neural tissue (infarction)

Describe an Ischemic: Thrombosis

thrombus = collection of blood materials that gets trapped with cell material and blocks circulation

• caused by atherosclerosis

• hereditary

• found in large arteries

  • tend to occur when the person is asleep or low activity

What are antiplatelet agents?

drugs that prevent formation of blood clots

What is a carotid endarterectomy?

a surgical procedure to remove a thrombus

There are two types of hemorrhagic strokes, what are they?

intracerebral & extracerebral