5220 Final Exam Study Guide

The World Health Organization's International Classification of Functioning, Disability, and Health (WHO-ICF)

Is a framework for describing and classifying health and health-related states. It provides a standard language and conceptual basis for defining and measuring health and disability, emphasizing the interaction between an individual's health condition and environmental and personal factors.

- Body functions and structures

- Activities and participation

- Environmental and personal factors

What are the three main components for WHO-ICF?

Body functions and structures

This component focuses on the physiological and anatomical aspects of the individual, including speech and language functions that are directly affected by aphasia.

Activities and participation

This component addresses the individual's ability to perform tasks and engage in social roles, which aphasia can significantly impact. It includes communication activities such as speaking, writing, and social interaction.

Environmental and personal factors

This component considers the external and internal factors that influence the individual's functioning, such as social support, access to therapy, and personal attitudes toward the condition.

Aphasia Framework for Outcome Measurement (A-FORM) model

Provide a comprehensive and person-centered framework for managing and measuring outcomes in individuals with aphasia. This model is designed to expand the focus from traditional language impairment-based assessments to a broader consideration of the individual's life participation, personal identity, and environment. The A-FROM model complements the WHO-ICF framework

- Impairment

- Function

- Participation

- Enviornment

A-FORM model four main components?

A-FORM: impairment

This is similar to the "Body Functions and Structures" component of the WHO-ICF model. It focuses on the specific language deficits caused by aphasia, including difficulties in speaking, understanding, reading, and writing. The model emphasizes the importance of assessing and addressing these core language skills.

A-FORM: Function

This component addresses the individual's ability to use language in real-life situations, considering communication effectiveness and efficiency.

A-FORM: Participation

This element mirrors the "Activities and Participation" in the WHO-ICF and focuses on the individual's engagement in life situations. It looks at how aphasia affects the ability to participate in various roles and activities, such as family interactions, social relationships, vocational roles, and recreational activities.

A-FORM: Environment

This includes both the physical and social environments that interact with the individual's aphasia. The environment can either support or hinder communication. Factors such as the presence of supportive communication partners, accessible community resources, and societal attitudes towards disability play a crucial role.

- Respect for people

- Beneficence

- Nonmaleficence

- Justice

What are the four principles of morality that we should abide by?

How do SLPs engage in decisions regarding competence and decision-making?

Comprehension involves understanding written or spoken language; choice entails considering alternatives; appreciation involves evaluating consequences, risks, and benefits; and coercion assessment determines if a person is being forced.

Comprehension is understanding written or spoken communication in the language used.

SLPs assess an individual’s ability to understand spoken and written communication, foundational for making informed decisions. This involves evaluating receptive language skills and ensuring that the individual can process the information provided to them in the language they best understand.

Choice is the ability to deliberate about and logically consider possible alternatives.

SLPs assess the individual’s ability to consider different options and make choices. This involves evaluating cognitive-communication skills, including reasoning, problem-solving, and executive functions crucial for deliberating possible alternatives.

Appreciation

Part of decision-making competence is appreciating the consequences, risks, and benefits of different choices. SLPs evaluate whether the individual can link actions to outcomes and understand the potential impact of decisions.

coercion

Ensuring that decisions are made freely is crucial. SLPs are trained to recognize signs that an individual may be under undue pressure or coercion from others when making decisions.

financial conflicts of interest affect our practice

Continuing treatment beyond expected progress; imposing services on unwilling patients; providing insufficient intervention to low-income patients; treating individuals with limited rehabilitation potential; overstating improvement potential; misrepresenting progress and session time; and avoiding important non-billable activities compromise quality service.

Use It or Lose It

Neural circuits not actively engaged in task performance can degrade over time. Applying this principle, therapists should encourage clients to actively use and practice their impaired skills to prevent further decline.

Use It and Improve It

Engaging in activities that utilize a specific skill can enhance that skill. For clients, this means that targeted and repetitive skill practice can lead to improvements in that area.

Specificity

The nature of the training experience dictates the nature of plasticity. Therefore, therapy should be tailored to the skills that need improvement, ensuring that exercises and activities directly address the client's deficits.

Repetition Matters

Repetitive practice is crucial for inducing lasting neuroplastic changes. Therapists should incorporate high repetition of meaningful tasks into the therapy regimen to promote neural reorganization and skill acquisition.

Intensity Matters

The intensity of the training also influences the degree of plasticity. Intensive, focused therapy sessions yield better neural adaptation and functional improvement outcomes.

Time Matters

The timing of intervention after injury can impact the effectiveness of rehabilitation. Early intervention is often associated with better outcomes, but there are critical periods during which the brain is more receptive to plastic changes.

Salience Matters

The training experience must be salient or meaningful to the individual to drive plasticity. Therapists should ensure that therapy tasks are relevant and engaging to the client, enhancing motivation and participation.

Age Matters

Neuroplasticity occurs throughout the lifespan, but age-related differences exist in the capacity for plastic changes. While younger brains may be more malleable, older individuals can still experience significant neuroplasticity with appropriate training.

Transference

Plasticity in response to one training experience can enhance the acquisition of similar behaviors. Therapists can leverage this by designing therapy activities that have broader applicability to real-world tasks.

Interference

Plasticity in response to one experience can interfere with acquiring other behaviors. Therapists should be mindful of potential adverse interactions between different therapy activities and prioritize the most critical skills for recovery.

Reduction of edema

As the swelling goes down, the compression of surrounding brain tissue is reduced; areas that were temporarily malfunctioning due to increased intracranial pressure begin to function more normally again.

Reperfusion

Blood flow is restored to areas of hypoperfusion (e.g., ischemic penumbrae); with refreshed blood supply to regions surrounding necrotic tissue, surrounding brain tissue becomes more functional.

Resolution of diaschisis

Functions associated with brain structures remote from the area of damage that had been initially impaired improve over time.

Neuronal regeneration

Although necrotic neurons (those whose cell bodies have died) in the brain are typically not considered revivable, components of injured neurons can be restored.

Long-term potentiation (LTP)

It is a long-lasting enhancement in signal transmission between two neurons that results from their simultaneous stimulation. It is one of the primary mechanisms underlying learning and memory.

Unmasking of preexisting pathways

Neural connections that existed before injury but were not active (or previously inhibited) may be activated and thus help compensate for connections lost through injury.

Cortical reorganization

Basic brain-behavior relationships are modified as areas of brain tissue that were not centrally involved in specific functions before injury took over those functions. Examples of this are seen within and between hemispheres.

Main prognostic factors to consider

- Etiology

- Extent of lesions

- Diagnosis

- Severity post onset

- Time post onset

Etiology

Refers to the cause or origin of a disease or condition. In the context of neurological disorders, it might include stroke, traumatic brain injury, infections, congenital anomalies, or degenerative diseases.

Extent of lesions

This refers to the size, location, and number of lesions in the brain or nervous system.

Diagnosis

Identifying a disease or condition based on its signs, symptoms, and results from various diagnostic tests.

Severity post onset

This refers to the intensity of symptoms or the level of functional impairment following the condition's onset.

Time post onset

This indicates the duration that has elapsed since the onset of the disease or injury.

Plan of care components

- Intensity/dose

- Frequency

- Duration

Intensity

Refers to the level of effort or concentration required during therapy sessions. It can be influenced by the complexity of tasks, the level of engagement, and the amount of feedback provided.

Dose

Refers to the therapy provided in each session or over a specific period. It is often measured in terms of the number of repetitions of a task or the total time spent on therapeutic activities.

Frequency

Refers to how often therapy sessions occur. It can range from multiple times a day to once a week, depending on the individual's needs, goals, and the stage of recovery.

Duration

Refers to the length of each therapy session and the overall period of the treatment program.

Supported Communication for Adults (SCA)

It is an approach to enhance communication for individuals with aphasia or other communication disorders resulting from acquired neurogenic conditions. It aims to support the individual's communication abilities and facilitate participation in meaningful interactions (e.g., interacting directly with the patient, talking naturally, avoiding distractions).

SCA key components

- Creating a supportive communication environment

- Using multimodel communication

- Modifying language and communication strategies

- Providing communication aids

- Encouraging active participation

- Training communication partners

- Building confidence and reducing communication anxiety

- Setting realistic goals

Counseling

- Professional, goal-based collaborative process.

- It involves working to help people struggling with mental illness.

- Service provided by a qualified (certified and/or licensed) professional.

- Foster's mental health and wellness can be improved by encouraging changes in thinking, feeling, and behaving.

Life Coaching

- Professional means of helping people develop a clear vision of what is most important to them, empowering them toward wellness, and maximizing their potential.

- More exclusively focused on what can be done in the present and the future.

- More holistically focused.

- Less formal.

How would you assess someone with AOS?

- Sequential Motion Rates (SMR) compared to Alternating Motion Rates (AMR)

- Conversational speech and reading

- Repeating words of increasing length

- Reading or repeating low-frequency, multisyllabic words in isolation or sentences

Assessment tools for AOS

- Apraxia Battery for Adults (ABA-2)

- The Assessment of Intellegibility of Dysarthic Speech (AIDS)

Promoting Aphasics' Communicative Effectiveness (PACE)

Therapy sessions are structured like games, where clients use any communication means necessary to convey a message to the therapist. They aim to promote natural communication strategies, such as gesture, writing, drawing, and verbal expression. Compensatory

Target: Encourages functional communication and conversational skills.

Communication Drawing Program (CDP)

It teaches clients to use drawings to represent various concepts and actions. This approach can facilitate communication when speech is limited and can serve as a bridge to more verbal communication. Compensatory

Target: Utilizes drawing to compensate for impaired language production.

Back to the Drawing Board (BDB)

This approach expands on CDP by including a more structured set of drawing exercises designed to represent more complex ideas and actions, fostering the development of communication strategies beyond single-word exchanges. Compensatory

Target: Enhances non-verbal communication through drawing.

Visual Action Therapy (VAT)

Specifically designed for individuals with global aphasia and apraxia, it involves training the patient to use hand gestures to indicate the use of objects that cannot be named verbally. The eventual goal is to generalize these gestures to other communicative contexts. Both

Target: Facilitates gestural communication for individuals with severe aphasia.

Constraint Induced Language Therapy (CILT)

This approach is intensive and typically delivered in a clinical setting, where clients must use verbal language exclusively for several hours a day for several weeks to promote language recovery. Restorative

Target: Improves spoken language abilities.

Script Training

Involves repetitive practice of specific, individualized scripts (e.g., ordering food at a restaurant) to promote automaticity in verbal production, which can improve functional communication in particular situations. Restorative

Target: Functional communication and automatic speech production.

Melodic Intonation Therapy (MIT)

Harnesses the melody and rhythm of speech, areas often preserved in those with non-fluent aphasia. It intones simple phrases in a singing-like manner, with the support of left-hand tapping to emphasize syllable production. Both

Target: Addresses severely impaired speech output and non-fluent aphasia.

Voluntary Control of Involuntary Utterances (VCIU)

It takes advantage of automatic speech (e.g., greetings, counting) often preserved in people with aphasia, using it as a foundation to expand into more deliberate, purposeful speech. Restorative

Target: Converts involuntary vocalizations into voluntary speech.

Response Elaboration Training (RET)

Uses a picture or a question to elicit a response from the client, then the therapist models an elaborated version of that response, encouraging the client to increase the complexity and length of their responses over time. Restorative

Target: Enhances the length and information content of utterances.

Treatment for Aphasic Perseveration (TAP)

Offers strategies such as semantic blocking or phonemic cueing to help clients break out of perseverative loops during conversation, enhancing the flow and relevancy of communication. Restorative

Target: Reduces repeated and unwanted word utterances.

Computer-Based Treatment (APPS)

Treatment extenders such as technology tools can be used as part of a home program to practice in the home and in the community. Compensatory

Semantic Feature Analysis (SFA)

It teaches clients to generate a set of semantic features (like category, function, and attributes) related to target words to improve their ability to develop words when needed. Both

Target: Enhances word retrieval through semantic networks.

Phonological Components Analysis (PCA)

It is similar to SFA but focuses on word sound structure. It encourages clients to think about word sounds, which can help them retrieve the correct word. Both

Target: Focuses on phonological aspects of word retrieval.

Verb Network Strengthening Treatment (VNeST)

Strengthening the network of associations between verbs and their typical subjects and objects, helping improve the ability to construct sentences around specific verbs. Restorative

Target: Improves verb usage and sentence production.

Verb as Core (VAC)

Focuses on building sentences by starting with a verb and systematically adding elements (subjects, objects) to increase sentence complexity. Restorative

Target: Emphasizes verb retrieval and sentence construction.

Gestural Facilitation of Naming

Uses intact gesture abilities to facilitate activation of word retrieval by taking advantage of the interactive nature of language and action. Compensatory

Word Retrieval Cueing Strategies (Cueing Hierarchies)

Starts with the strongest cues (e.g., providing the first letter of a word) and progressively weakens them (e.g., giving a synonym) to assist clients in retrieving words independently. Both

Target: Improves word-finding and retrieval difficulties.

Treatment of Underlying Forms (TUF)

Addresses deficits in syntactic production by practicing the formation of sentences that require specific syntactic structures, like passive voice or embedded clauses. Restorative

Target: Aim to improve complex syntax and sentence structure.

Mapping Therapy

This method targets the connection between thematic roles in a sentence and syntactical structures, using a variety of activities to improve the comprehension and production of complex sentences. Restorative

Target: Enhances the ability to understand and produce sentences.

Sentence Production Program for Aphasia (SPPA)

A structured program that involves the construction of sentences of increasing complexity, aimed at improving syntactic processing in spoken and written language. Restorative

Target: Addresses sentence production deficits.

Copy and Recall Treatment (CART)

Involves copying sentences and then recalling and writing them from memory to improve written language abilities, particularly in aphasic patients who have retained the ability to read. Restorative

Target: Improves written expression and spelling.

Restorative

Anagram and Copy Treatment (ACT)

Clients create words and sentences from provided letters (anagrams) and then copy them to improve spelling and sentence construction skills. Restorative

Target: Targets spelling and sentence construction in writing.

The Problem-Solving Approach

Clients engage in activities that require problem-solving, reasoning, and language processing, such as planning an event or resolving a hypothetical problem, to improve high-level language and cognitive skills. Both

Target: Cognitive communication skills in everyday situations.

Multiple Oral Rereading (MOR)

This involves the repeated reading of a single text to improve reading speed, accuracy, and fluency, which can have a generalized impact on language processing. Restorative

Target: Improves reading comprehension and fluency.

Oral Reading for Language in Aphasia (ORLA)

Involves reading aloud with the support of a clinician, focusing on the accurate production of each word to improve language processing in reading and spoken language. Restorative

Target: Targets reading and speech production.

Compensatory approach

- PACE

- CDP

- BDB

- VAT

To improve overall language

- CLIT

- Script training

- MIT

- VCIU

- RET

- TAP

- AAPS

To improve word-finding

- SFA

- PCA

- VNeST

- VAC

- Gestural Facilitation of Naming

- Cueing Hierarchies

To improve syntax

- TUF

- Mapping therapy

- SPPA

To Improve reading and writing

- CART

- ACT

- Problem-Solving approach

- MOR

- ORLA

Global aphasia

Lesion site: Perisylvian region, left hemisphere (including Broca's and Wernicke's areas).

Blood supply: Middle cerebral artery (MCA).

Naming: Severely impaired.

Spontaneous speech: Non-fluent, limited to a few words or stereotyped expressions.

Sentence production/grammar: Severely affected, lacking proper structure.

Comprehension: Severely impaired.

Repetition: Severely impaired.

Reading: Significantly compromised.

Writing: Severely affected.

Broca's aphasia

Lesion site: Posterior inferior frontal gyrus, left hemisphere (Broca's area).

Blood supply: Middle cerebral artery (MCA).

Naming: Impaired (anomia).

Spontaneous speech: Non-fluent, with agrammatism and telegraphic speech.

Sentence production/grammar: Simplified structures, difficulty with complex grammar.

Comprehension: Relatively preserved.

Repetition: Variably affected, better with short phrases.

Reading: Better than writing, difficulty with complex syntax.

Writing: Effortful and agrammatic, similar to speech patterns.

Wernicke's aphasia

Lesion site: Posterior superior temporal gyrus, left hemisphere (Wernicke's area).

Blood supply: Middle cerebral artery (MCA).

Naming: Impaired; often produces incorrect or nonsensical words (paraphasias).

Spontaneous speech: Fluent but often lacks meaning, with neologisms and paraphasias (word salad).

Sentence production/grammar: Superficially intact but often nonsensical or irrelevant.

Comprehension: Severely impaired.

Repetition: Impaired.

Reading: Affected; difficulty understanding written text and errors when reading aloud.

Writing: Often meaningless, mirroring speech with neologisms and paraphasias.

Conduction aphasia

Lesion site: Arcuate fasciculus and/or supramarginal gyrus, left hemisphere.

Blood supply: Middle cerebral artery (MCA), branches to parietal lobe and perisylvian region.

Naming: Moderately impaired; word-finding difficulties (anomia) and paraphasias.

Spontaneous speech: Fluent, with normal grammar but phonemic paraphasias.

Sentence production/grammar: Intact but disrupted by pauses and revisions.

Comprehension: Usually preserved.

Repetition: Significantly impaired.

Reading: Preserved.

Writing: May be affected similarly to speech.

Transcortical sensory aphasia

Lesion site: Posterior regions of the left hemisphere, surrounding Wernicke's area (angular gyrus, posterior middle temporal gyrus).

Blood supply: Middle cerebral artery (MCA) and anterior branches of the posterior cerebral artery (PCA).

Naming: Impaired; word-finding difficulties (anomia) and paraphasias.

Spontaneous speech: Fluent but lacking meaning, with grammatically correct but semantically inappropriate sentences.

Sentence production/grammar: Intact, but content may be irrelevant or tangential.

Comprehension: Severely impaired.

Repetition: Relatively preserved.

Reading: Affected; struggles with comprehension but can read aloud accurately.

Writing: Fluent but may lack meaning.

Transcortical motor aphasia

Lesion site: Anterior superior frontal lobe, surrounding Broca's area (supplementary motor area, prefrontal cortex).

Blood supply: Anterior cerebral artery (ACA) and superior branch of the middle cerebral artery (MCA).

Naming: Impaired, with some word-finding difficulties (anomia).

Spontaneous speech: Non-fluent and effortful, with reduced output and simple sentences.

Sentence production/grammar: Simplified, with short sentences and reduced grammatical complexity.

Comprehension: Preserved.

Repetition: Preserved.

Reading: Preserved, but reading aloud may be difficult due to non-fluent speech.

Writing: Non-fluent, mirroring speech with simple structures and reduced output.

Anomic aphasia

Lesion site: Damage to various regions associated with language processing, including the left temporal lobe, parietal lobe, and angular gyrus.

Blood supply: Middle cerebral artery (MCA), but varies based on lesion location.

Naming: Primary impairment in both spoken and written modalities.

Spontaneous speech: Fluent and grammatically correct, but with frequent pauses, circumlocutions, and use of nonspecific words due to word-finding difficulties.

Sentence production/grammar: Intact, though sentences may be incomplete or lack specific content due to naming difficulties.

Comprehension: Preserved.

Repetition: Preserved.

Reading: Preserved.

Writing: Fluent and grammatically correct.

Comparing/Contrasting Language and Signs/Symptoms (Aphasia language sample)

To compare and contrast language abilities in individuals with aphasia, you would analyze aspects such as fluency, comprehension, repetition, naming, and reading/writing abilities. For instance, one individual might have fluent speech but poor comprehension, suggesting Wernicke's aphasia. In contrast, another might have a non-fluent, effortful speech but relatively good comprehension, indicative of Broca's aphasia.

Determining Probable Lesion Site and Aphasia Subtype (Aphasia language sample)

Based on language profiles, you can hypothesize lesion sites:

Wernicke's Aphasia: Lesion in the posterior region of the superior temporal gyrus.

Broca's Aphasia: Lesion in the posterior inferior frontal gyrus.

Selecting a Type of Treatment and Identifying the Treatment Rationale (Aphasia language sample)

Choose treatments that target deficits. For non-fluent aphasia, you might select Melodic Intonation Therapy because it uses intact melodic/prosodic processing to facilitate speech. Semantic Feature Analysis might be chosen for fluent aphasia to improve word retrieval by strengthening semantic networks.

Deciding How Long to Treat (Aphasia language sample)

Duration is based on several factors, including severity, progress rate, patient goals, and practical considerations like insurance coverage. Regular reassessment is necessary to determine whether to continue, modify, or terminate therapy.

Components of a Measurable Treatment Goal (Aphasia language sample)

A measurable goal should include:

- Who: The patient (e.g., 'The patient will...')

- Do What: The specific action or behavior (e.g., 'name objects...')

- Under What Conditions: The context in which the behavior occurs (e.g., '...in a structured therapy activity...')

- How Well: The criterion for success (e.g., '...with 80% accuracy...')

- By When: The time frame (e.g., '...across three consecutive sessions.')

Proper Roles of Care Partners in Supporting Communication (Aphasia language sample)

Care partners can:

- Facilitate practice of strategies learned in therapy.

- Provide emotional support and encouragement.

- Help establish communication-friendly environments.

- Act as advocates for the patient’s communication needs.

Role of AAC and When It May or May Not Be Used (Aphasia language sample)

AAC (Augmentative and Alternative Communication) devices can be beneficial when speech is severely impaired or ineffective. They can support communication in individuals with aphasia, often those with non-fluent or global aphasia. However, they might not be used if the individual has adequate verbal skills for functional communication or if cognitive deficits preclude effective use of AAC.

Example case 1 for aphasia language sample

Patient A exhibits fluent speech, poor comprehension, and difficulty in repeating phrases, suggesting a lesion in the posterior superior temporal gyrus (Wernicke's aphasia). You might implement Semantic Feature Analysis to help Patient A improve word retrieval, working on goals like "Patient A will name pictured objects with 75% accuracy during therapy sessions".

Example case 2 for aphasia language sample

Patient B has non-fluent, telegraphic speech but understands spoken language well, indicating a lesion in the posterior inferior frontal gyrus (Broca's aphasia). A suitable therapy might be melodic intonation therapy to leverage their good auditory comprehension and improve verbal output, with goals such as "Patient B will use melodic intonation to produce bi-syllabic words in 4/5 opportunities."

Sequential Motion Rates (SMR)

(e.g., "pataka"): This task involves producing a sequence of different sounds. It requires the speaker to change articulatory positions rapidly and precisely. In AOS, SMRs can be particularly challenging due to difficulties in transitioning between distinct phonetic positions.

Alternating Motion Rates (AMR)

(e.g., "papapa"): This involves repeating the same sound. It's generally easier than SMRs because it requires less motor planning for transitions between different sounds.