CSD 146 Unit 4 Test

What are the two types of strokes?

Ischemic and Hemorrhagic

What are Ischmeic Strokes?

Occur due to an occlusion in an artery

blockage can be thrombosis or embolism

make up 80% of strokes

What are Hemorrhagic strokes?

Occur due to bleeding in the brain from rupture of an artery

makes up 20% of strokes

Ischemic strokes occur when __________________

an artery to the brain is occluded (blocked)

Thrombosis blockage

• Stationary ischemic occlusion

• Formation of a blood clot (thrombus) within a blood vessel, potentially obstructing blood flow

Embolism blockage

• Traveling ischemic occlusion

• occurs when a thrombus, or other material, travels through the bloodstream and blocks a vessel, often leading to serious complications

Broca’s area is repsonsible for ______________

language production

Wernicke’s area is responsible for _________________

language comprehension

The _________ connects Broca’s area to Wernicke’s area

Arcuate Fasciculus

What is the Arcuate Fasciculus

fiber tract that connects and allows for communication between Broca and Wernicke’s areas

whast is aphasia?

a language disorder that makes it difficult to express yourself (speak or write) and understand language (read or understand what others say)

What is the most common cause of aphasia?

strokes

Aphasia is…

• An acquired disorder

• Not a psychiatric problem

• Not a motor speech disorder

What parts of the brain does aphasia damage?

the lanuage areas

Anterior lesions case _____ aphasias

nonfluent

Posterior lesions cause ________ aphasias

fluent

Aphasia can affect language ________, ________, and/or ________

production, comprehension, and/or repetition

Production

may be fluent or nonfluent and may have difficulty with naming

Comprehension

may have difficulty understanding language

repetition

may have difficulty repeating words

Common Problems in Aphasia: Agrammatism

Leaving out grammatical markers in sentences and phrases

Common Problems in Aphasia: Word-finding problems “anomia”

Difficulty thinking of words or names of items

Common Problems in Aphasia: Telegraphic speech

Phrases and sentences with content words, but no function words

Common Problems in Aphasia: Paraphasias

Substitution of one words for another

Common Problems in Aphasia: Jargon

Language that has no meaning

Common Problems in Aphasia: Neologisms

Making up a new word (e.g., the whozit over there")

Common Problems in Aphasia: Effortful Articulation

Labored speech

Common Problems in Aphasia: Initiation Difficulty

Difficulty or inability to initiate speech

Common Problems in Aphasia: Comprehension deficits

Difficulty or inability to understand language

Common Problems in Aphasia: Impaired repetition

Inability to repeat sounds, words, or phrases

What are the eight classic aphasia syndromes?

• Broca's aphasia

• Transcortical motor aphasia

• Wernicke's aphasia

• Transcortical sensory aphasia

• Global aphasia

• Mixed transcortical aphasia

• Conduction aphasia

• Anomic aphasia

Broca’s aphasia is caused by damage to _______

Broca’s area

Broca’s aphasia

• Production- impaired

  • Nonfluent

    • Slow, telegraphic speech

  • Naming

    • Mild to severe anomia

  • Comprehension- preserved

    • Relatively preserved

      • Mild to moderate difficulties

  • Repetition- impaired

Transcortical motor aphasia is caused by damage to the ________

prefrontal cortex (i.e., “watershed area” around broca’s area)

transcortical motor aphasia

• Similar to Broca's aphasia except that individuals have strong repetition skills

• Production- impaired

• Comprehension- preserved

• Repetition- preserved

Wernicke’s aphasia is caused by damage to _________

Wernicke’s area

Wernicke’s aphasia

• Production- preserved (fluent)

  • Normal prosody and sentence length, though little meaningful content

  • Neologisms, jargon present

  • Naming impaired, with frequent paraphasias and circumlocutions

• Comprehension- impaired

  • Difficulty understanding spoken and written language

  • Poor awareness

Transcortical sensory aphasia is caused by damage to the ________ and __________

temporal and occipital lobes (i.e., “watershed area” around wernicke’s area)

transcortical sesnory aphasia

• Similar to Wernicke's aphasia except that patients have strong repetition skills

• Production- preserved (fluent)

• Comprehension- impaired

• Repetition- preserved

Global aphasia is caused by damge to ________________________

multiple areas of the brain

global aphasia

• Patients with global aphasia have extensive deficits across domains

• Production, comprehension, repetition all severely impaired

Mixed transcortical aphasia is caused by damage to _______________________________

“watershed areas” around broca’s area, wernicke’s area, and the arcuate fascicules

mixed transcortical aphasia

• Similar to global aphasia except that patients have strong repetition skills

• Production- impaired

• Comprehension- impaired

• Repetition- preserved

conduction aphasia is caused by damage to the __________

arcuate fasciculus

conduction aphasia

• Production- preserved (mostly fluent)

  • Fluent with only mild to moderate deficits in output

  • Mild to moderate naming difficulties

• Comprehension- preserved

  • Understanding is fair to good

• Repetition- impaired

  • Impairment in repetition is the hallmark characteristic of conduction aphasia

  • Difficulty repeating because they cannot transfer input from Wernicke's area to Broca's area

Anomic aphasia is not associated with damge to ___________

any specific brain region

Anomic aphasia

• This is the most mild classic aphasia syndrome

• Production- preserved (fluent)

  • Deficits in naming/word-finding

• Comprehension- preserved

• Repetition- preserved

• Anomic aphasia is the most pervasive type of chronic aphasia, after treatment

Primary Progressive Aphasia (PPA) is aphasia due to ______________

neurodegenerative disease

Primary Progressive Aphasia

• Not a classic aphasia syndrome

• Acquired language deficit (i.e., progressive)

• Language deficit is the most prominent aspect of the clinical picture (i.e., primary)

SLPs assess ______, ______, and ______ to characterize aphasia

production, comprehension, and repetition

what is the goal of aphasia treatment?

• Remediation

  • E.g., speech-language therapy to improve skills

• Compensation

  • E.g., implementing multimodal communication, using strategies such a circumlocution, caregiver strategies

SLPs encourage communication through…

• Spoken and written keywords

• Body language and gestures

• Hand drawings

• Pictures/photographs

Which brain hemispherebis responsible form many nonverbal functions

the right hemisphere

nonverbal functions that the right brain hemisphere is responsible for

comprehending visuospatial information, emotional expression

when the right hemisphre is damaged…

it can lead to disruptions in cognition, perception, and behavior

What are characteristics of Right Hemisphere Dysfunction (RHD)

1. Unawareness, or even denial, of cognitive-linguistic deficits

2. Unawareness, or even neglect, of the left side of the body and external stimuli

3. Difficulty recognizing faces

4. Poor pragmatic skills

5. Wordy or tangential language

6. Difficulty understanding or using higher-level cognitive-linguistic skills, such as problem solving or abstract thought

Treatment for RHD as aphasia treatment

Not much is known about treatment

Therapies may include

• Improved attention to stimuli across visual fields

• High level cognitive linguistic tasks

  • E.g., solving functional problems, understanding and using figurative language

• Pragmatics

  • E.g., turn taking, topic maintenance, eye contact

What are Traumatic Brain Injuries (TBI)?

damage to the brain from external forces

What is the difference between diffuse and focal injuries?

• Diffuse: affects large area of brain

• Focal: affects only one specific region

Where does damage occur with a closed-head injury

both sides of the brain

What is a coup injury?

an injury that occurs on the side of impact

What is a countercoup injury?

an injury that occurs on the side opposite the impact

How are TBIs characterized

By level of consciusness after the injury and over time (Glasgow Coma Scale and Rancho Los Amigos Scale)

Glasgow Coma Scale

• Scores selected to describe an individual's

  • Eye responses

  • Motor responses

  • Verbal responses

• Lowest scores indicate serious comatose state

Ranchos Los Amigos Scale

Scores individual to a level 1-10 based on level of responsiveness

Resulting disorders vary with severity of injury, site of lesion, characteristics of the individual before the injury

• More severe injuries = less chance of full recovery

• May have delayed onset of impairment

Treatment for TBIs

• Initially, treatment may involve trying to get a response (i.e., reaction to stimuli)

• Later, treatment may involve helping people return to home, school, or work

Dementia is a general term to descrive chronic and progressive decline in…

• Memory

• Cognition

• Language

• Personality

what causes dementia?

central nervous system dysfunction

Most dementia is chronic and progressive, but some reversible conditions cause dementia

• Metabolic disturbances ("metabolic encephalopathy")

• Infections (e.g., UTI)

• Drug Toxicity

• Vitamin deficiency

• Thyroid

• Because depression can sometimes affect memory and cognition, it is often difficult to clearly differentiate depression from dementia

What might an individual with dementia experience?

• Memory impairment

• Impairment in cognitive skills

• Aphasia, apraxia, and/or agnosia (i.e., inability to recognize objects, words, sounds)

Mild dementia

Forgetfulness, decreased vocabulary, decreased length of utterances in conversation, misplaces things

Moderate dementia

Disoriented to time and place, poor attention and memory, significant anomia, empty conversations, tend to roam

Severe Dementia

extreme disorientation, profound lnaguage deficits

Dementia treatment depends on

 the individual's level of function, family support, living situations, priorities, etc.

Therapy for dementia usually focuses on compensation instead of remediation

• Compensatory strategies

• Environmental modifications

• Family education and training

• Long-term care and support

What are motor speech disorders impairments of?

speech production

What causes Motor Speech Disorders?

Defects of the neuromuscular system, the motor control system, or both

Motor planning

Processes that define/sequence articulatory goals (e.g., lip closure, onset of voice) prior to their occurrence

Motor Programming

Processes that establish/prepare the flow of motor information across muscles for speech production, and specify the timing and force required for the movements

Motor Execution

Processes that activate relevant muscles during the movements used in speech production

Motor Planning and Programming characteristics

• Plan/Program correct sequence of motions with correct timing and force

• Occurs BEFORE a motor act

Motor Execution characteristics

• execute motions

• IS the motor act

What are the two categories of Motor Speech Disorders

Disorders of Motor Planning and Programming and Disorders of Motor Execution

Disorders of motor planning and programming

• Disorders of motor planning and programming

  • Inability to group and sequence muscles in order to plan or program a movement

    • Muscle physiology and movement are intact coordination

    • Coordination is disrupted

    • Apraxia of Speech

Disorder of Motor Execution

• Deficits or inefficiencies in basic physiological or movement characteristics of the musculature

  • Planning/programming intact

  • Muscle physiology and movement are disrupted

  • Dysarthria

Motor speech disorders can be _________ or _________

developmental or acquired

Developmental Motor Speech Disorders

• Caused by abnormal development or early damage to the nervous system

• E.g., cerebral palsy, fragile X syndrome, Down syndrome, early TBI/brain tumors/CVAs

Acquired Motor Speech Disorders

• Caused by (later) damage to the nervous system

• E.g., strokes, degenerative diseases (such as Parkinson's, ALS), brain tumors, TBI

How is the severity of Motor Speech Disorders determined

By the symptoms and how the disorder affects the person’s participation in life

What is Apraxia of Speech?

•  an impairment of motor programming and planning

• Inability to transform a linguistic representation into the appropriate coordinated movements

What are the two types of apraxia of speech?

• Childhood apraxia of speech (CAS)

  • Developmental

• Acquired apraxia of speech (AOS)

  • Acquired

Childhood Apraxia of Speech

• Developmental

• Causes are not well understood

• May be a hereditary component for some individuals

• May be due to genetic disorders (Fragile X)

• May be from neurological damage, but for others no specific evidence of neurological changes

Adult Apraxia of Speech

• Acquired

• Due to neurological changes/damage

• Usually acute onset (such as from a stroke), though less commonly can be progressive (Primary Progressive Apraxia of Speech)

What are early indicators of Childhood Apraxia of Speech in younger children?

• Does not coo or babble as an infant

• First words are late, and they may be missing sounds

• Only a few different consonant and vowel sounds

• Problems combining sounds, may show long pauses between sounds

• Simplify words by replacing difficult sounds with easier ones or by deleting difficult sounds

• May have problems eating

As children with Childhood Apraxia of Speech get older, characteristics include

• Inconsistent sound errors

• Understands language better than they can talk

  • Decreased intelligibility

• Difficulty imitating speech

• “Groping” when attempting to produce sounds or coordinate the lips, tongue, jaw for purposeful movement

• More difficulty saying longer words or phrases

• Speech may sound choppy, monotonous, or have abnormal stress patterns

Shared common characteristics between Acquired Apraxia of Speech and Childhood Apraxia of Speech

• Difficulty imitating speech sounds

• Difficulty imitating non-speech movements, such as sticking out tongue

• Groping when trying to produce sounds and in severe cases, an inability to produce sound at all

•  Inconsistent errors from attempt to attempt

•  Slow rate of speech

• Somewhat preserved ability to produce rote or automatic speech

• Decreased intelligibility

What causes Dysarthria?

damage somewhere in the neurological motor system (underlying neuromuscular disturbances in muscle tone, reflexes, and aspects of movement)

For Dysarthria, damage may occur in…

• The parts of the brain that control muscle movement,

  • “Motor strip” of the frontal lobe

• The Cerebellum that coordinates movements, or

• The Cranial nerves that exit the CNS to tell muscles how to move

Dysarthria is an impairment of ________________

motor execution