Adult Neurogenic Communication Disorders II Exam 1

symptoms

aphasia is not a disease; it’s a set of ______

etiologies of aphasia

• stroke

• tumor

• TBI

• degenerative diseases

• infection

• seizures

• PPA

• etc.

cognitive communication disorders

refer to difficulties with communication that arise from impairments in the cognitive processes that support language use

treatment

theories are important for ______ in clinical practice

different

two patients with the same lesion will show ________ symptoms

yes

people with aphasia will or will not show aided recovery after 1 year post-stroke?

types of aphasia

• Broca’s

• Wernicke’s

• Global

• Conduction

• Anomic

• Transcortical Motor

• Transcortical Sensory

aphasia assessment

should result in the following:

• diagnosis of a language disorder

• description of the characteristics, severity, and functional impact of the language disorder

• prognosis for change (in the individual or in relevant contexts)

• recommendations for intervention, support, and community resources

• referral for other assessments or services

outline of aphasia assessment

• spontaneous recovery

• assessment in general

• evaluation of perceptual and motor skills

• in-depth communication evaluation

• differential diagnosis

• test confounds

• prognostic factors

mechanisms and bilingual aphasia

what is included in spontaneous recovery assessment?

mechanisms of language recovery

• RH reorganization

• there is an implication of residual LH language areas

• recruitment of LH regions is not typically involved in language

• reorientation of domain general networks not specifically dedicated to language

assessment in general

• WHO ICF model

• goals and general principles

• flow

in-depth communication evaluation

includes comprehensive test batteries, tests of specific functions, and tests for other cognitive abilities

types of spontaneous recovery

• acute

• subacute

• chronic

the first month

when is spontaneous recovery the greatest after a stroke?

spontaneous recovery

remission of language dysfunction without formal therapy

aided recovery

refers to the process of using external tools or support systems to help an individual recover or manage a condition, especially in the context of neurological or cognitive impairments

recovery in the acute phase

• during the first 3 weeks

• restoration of perfusion (normal glucose metabolism)

• decrease of cerebral edema & disappearance of local inflammations

• penumbra recovers over time

penumbra

• zone around an irreversibly damaged core infarction

• predictor of clinical progress

• salvageable brain area

ischemic core

• brain tissue destined to die

• located within the penumbra

recovery in subacute phase

• recovery that occurs up to 6 months after a stroke

• neural plasticity

• restoration of diaschisis

neural plasticity

• ability of neural networks in the brain to change through growth and reorganization

• includes sprouting and activation of silent synapses

sprouting

the growth of new dendrites at the level of the axons

diaschisis

• a sudden change of function in a portion connected to a distant but damaged brain area

• positive correlation between the decrease in ______ and recovery

• the breaking up of a pattern of brain activity by a localized injury that temporarily throws the whole activity out of function though destroying only part of a structure

chronic phase of recovery

• after 6 months post-stroke

• mainly therapy related

spontaneous recovery

• steepest during the first month post onset

• flattens out during 2nd and 3rd months but is still rising at 6 months (sometimes even longer)

• typically a period of 6 months

types of insult

• ischemic/occlusive stroke

• hemorrhagic stroke

• TBI

ischemic/occlusive stroke

greatest change occurs during 4-6 weeks post-stroke in an _______ stroke

hemorrhagic stroke

• most difficult type of stroke to detect

• most dangerous

• little change initially (first month) but then recovery occurs quickly

TBI

stepwise improvement

reading

after a stroke, which comes back first?

reading or writing

listening

after a stroke, does listening or reading comprehension come back first?

comprehension

after a stroke, __________ comes back before expression does

patterns of recovery in bilingual aphasia

• parallel

• selective

• successive

• differential

• antagonistic

• etc.

parallel recovery

both languages recover at the same time

selective recovery

only one language recovers

successive recovery

one language comes back first, and the other comes back later

differential recovery

both languages comes back but to different degrees

antagonistic recovery

as one language recovers, the other worsens

selective aphasia

aphasia in only one language

WHO ICF model

• Health Condition (disorder or disease)

• Activities

• Body Functions and Structures

• Participation

• Environmental Factors

• Personal Factors

health condition

diagnosis, lesion location, and extent

body functions and structures

• anatomical parts of the body such as organs, limbs, and their components

• physiological functions of the body systems (including psychological functions)

• examples include memory deficits, type and degree of impairment, neglect syndromes, rigidity, spasticity, weakness, etc.

activities

• the execution of a task or action by an individual

• examples include reading, writing, comprehension, following directions, talking on the phone, following a recipe, reading a newspaper, making appointments, etc.

participation

• involvement of people in all areas of life

• examples include working, going to church, leisure activities, occupation, family gatherings, going to the bank, etc.

environmental factors

• physical, social, and attitudinal environment in which people live and conduct their lives

• examples include who the patient lives with (home life), type of support they have, familial expectations, technology, societal awareness, social norms, etc.

personal factors

• the particular background of an individual that are not part of a health condition or health states

• examples include how many family members one has, methods of transportation, job, intelligence, cultural background, coping styles, socioeconomic status, etc.

formal assessment

any published quantification tool (psychometric properties such as standardization, reliability, validity)

informal assessment

• process of creating and manipulating stimuli for making clinical decisions

• gathering background information through record review, family interview, etc.

concomitant disorders with aphasia

• anomia

• agrammatism

• auditory/visual deficits

• motor speech disorders

• depression

• anxiety

goals

assessments should establish _____, and all domains of functioning/disability should be considered

assessment procedures

1. Case history

2. Observation

3. Screening

4. Formal tests

5. Qualitative and informal assessment

6. Caregiver assessment

screening

________ comes before the assessment tests

case history

• contains information about health status and premorbid condition

• includes medications, family history, goals, age, gender, education level, hobbies, cultural background, etc.

neurological exam

• neck flexion

• auscultation

• palpation

• neuro-ophthalmologic

• assesses motor and sensory fx

• cranial nerve fx

• reflexes

• higher cognitive fx (MMSE)

assessing structural level

1. angiography

2. computed tomography (CT)/CAT scan

3. MRI

assessing functional level

1. PET scan

2. fMRI

invasive assessments

1. angiography

2. CT

3. PET scan

noninvasive assessments

• MRI

• fMRI

bedside communication evaluation

• provide nursing staff, physician, and family ways to enhance communication with the patient

• better to use due to decreased attention and increased fatigue

• highlight strengths and weaknesses during this period

• less than 30 min.

• guidelines for counseling and education

• mini version of assessment batteries

screening tools

• Aphasia Screening Test - 3

• Quick Assessment for Aphasia

• Inpatient Functional Comm. Interview

• Shortened versions of WAB-R and BDAE-3

purpose of in-depth communication evaluation

• obtains differential diagnosis

• helps plan Tx

• tests level of response, coping styles, motivation, etc.

• serves as baseline data for Tx planning

background

consider educational, socio-economic, dialect/language, and cultural ________ when selecting a test

comprehensive batteries

• assesses the number of linguistic skills and communication modalities

• identifies the presence and type of aphasia

tests used to assess linguistic skills

• Boston Naming Test

• Northwestern Assessment of Verb and Sentences

aphasia

• sudden onset

• spontaneous recovery

• may have hemiparesis

• focal lesion

TBI

• problems with orientation and memory

• syntax, word finding, auditory comprehension, repetition

• making up confabulatory stories

apraxia

effortful, trial/error, groping, dysprosody, articulatory inconsistency, difficulty initiating

psychiatric illnesses

• disorientation, confabulation

• gradual of symptoms in late adolescence

• absence of observable brain damage

• language problems such as excessive output, simplified syntax, decreased informativeness

pragmatic

age/education and ethnocultural background are important to take note of, especially when testing ______ skills

specific

prognosis should be for the improvement of ________ functions

biographical factors

1. Age

2. Gender

3. Education

4. Premorbid intelligence

5. Personality

6. Level of social support

most important determinants in prognostic factors for language recovery *

• initial severity

• etiology

• site and extent of brain damage

superior temporal gyrus

problems with auditory comprehension = damage to the _____ ______ ____

standardized testing batteries

• Boston Diagnostic Aphasia Examination

• Western Aphasia Battery

• Communication Activities of Daily Living

• Assessment of Language-Related Functional Activities

• Porch Index of Communicative Abilities