Aphasia Test 2

Methods of Assessment - Aphasia

traditional testing
-standard general language tests
-special tests

authentic assessment
-functional communication (fairly unstructured)

General/Comprehensive Aphasia tests

Boston Diagnostic Aphasia Examination (BDAE)
Western Aphasia Battery (WAB)
Comprehensive Aphasia Test (CAT)
Aphasia Diagnostic Profile
Quick Aphasia Battery
Porch Index of Communicative Ability (PICA)
Minnesota Test for Differential Diagnosis (MTDD)

Boston Diagnostic Aphasia Examination (BDAE)

-profile that helps determine the severity and type of aphasia
-measure reading, writing, verbal output, auditory comprehension

Western Aphasia Battery (WAB)

-AQ (aphasia quotient) and type of aphasia
-BDAE and WAB measure reading, writing, verbal output, auditory comprehension
-can take 1-4 hours depending on the severity of aphasia/fatigue

Comprehensive Aphasia Test (CAT)

-includes psychological implication of aphasia
-gives you a profile of the aphasia to guide you in treatment

Aphasia Diagnostic Profile

-9 different subtests
-40 to 45 mins to administer
-provides information on aphasia type
-assesses/considers emotional state during testing

Quick Aphasia Battery

-free online test
-fairly new
-bridge between long extensive test and short quick test

Porch Index of Communicative Ability (PICA)

Gives a qualitative aspect of scoring (delayed response, needed to repeat a question, etc)

Minnesota Test for Differential Diagnosis (MTDDA)

assessment of aphasia in terms of modalities instead of types

Special Tests of Specific Linguistic Skills - Aphasia

Revised Token Test
Reading Comprehension Battery for Aphasia
Boston Naming Test
Word Fluency Measure
Discourse Sampling and Analyses

benefits of special tests of aphasia

-captures mild impairments that other comprehensive tests may not pick up on
-picks up on subtle deficits
-tests areas not touched on fully from one of the comprehensive tests

Revised Token Test

auditory comprehension test

Reading Comprehension Battery for Aphasia

subtle issues in reading

Boston Naming Test

word recall in conversation

Word Fluency Measure

asking someone to say as many “animals” they can in the next minute, category and time frame

Discourse Sampling and Analyses

-looks at word productivity: number of productive words that have meaning
-count pauses, filled pauses (errr, ummmm)
-story retell

Screening tests -aphasia

Aphasia Language Performance Scale
Aphasia Rapid Test
Frenchay Aphasia Screening Test III

Benefits of screening tests for aphasia

-short duration/quick
-beneficial for someone who just had a stroke who may not be able to sit through a long test
-will contain different modalities with fewer questions/tasks under each

Tests of cognition

Cognitive Linguistic Quick Test
Scales of Cognitive and Communicative Ability for Neurorehabilitation
Colored Progress Matrices

Cognitive Linguistic Quick Test

-good for people with language problems
-15 to 30 minutes to administer

Scales of Cognitive and Communicative Ability for Neurorehabilitation

-tests attention, memory, orientation, language
-linguistic load is very light
-multiple choice, non-verbal, assessment of reasoning

Colored Progressive Matrices

test for people with aphasia who may have subtle cognitive issues affecting language (ex: trouble switching attention)

Authentic Assessments - functional communication/participation

-ASHA FACS (Functional Assessment of Communication Skills)
-Functional Independence Measure
-Communicative Abilities in Daily Living

ASHA FACS (Functional Assessment of Communication Skills)

-quick and easy to administer
-functional communication based on observation
-7 point scale

Functional Independence Measure

-used by other professions/fields as well
-7 point scale
-portions related to PT/OT

Communicative Abilities in Daily Living

-functional communication tasks
-ex: using a phone, ordering from a menu, looking at a map

informal assessment - aphasia

-what is the extent of the problem?
(in loud environments do they have more problems with language, etc)

-where does the behavior break down?
(auditory comp - break down at the one-step to 2? etc)

-what helps the behavior?
(how do they compensate?)

-what are the underlying mechanisms for behavior?
(are there other things contributing? apraxia, dysarthria, etc)

impairment based approach - aphasia treatment

-about performance not competence
-language is dynamic
-schuell's stimulation approach

biopsychosocial approach (theory)

therapy should take into account the biological impairment-based factors and the psycholinguistic and cognitive processes of language and communication within the social context of the person with aphasia and his or her family

schuell's stimulation approach

-general language deficit across all language modalities
-the language system is working with reduced efficiency
-aphasia is one
-ex: having people follow directions, yes/no questions, finish the sentence
-auditory processing is at the center of this approach to therapy

localization

based on the classification/type of aphasia

participation focused

-pragmatic/functional:
partner training to give them tools for better communication

-social:
acknowledging environmental factors (aphasia groups, organizations, etc)

different types of Alexias

-peripheral Alexias (pure, neglect, attentional, visual)
-central Alexia (surface, deep, phonological)

peripheral alexias

most lesions have been identified in areas of the brain associated with visual processing

-pure Alexia
-neglect Alexia
-attentional Alexia
-visual Alexia

central alexias

typically co-occur with aphasia
-surface Alexia
-deep Alexia
-phonological Alexia

Pure Alexia

-impairment in the simultaneous, parallel identification and processing of letters in a written word
-damage to the visual word processing area
-letter by letter reading

Neglect Alexia

-impairment in correctly identifying initial or final letters in words (left side/beginning of words most likely to be neglected)
-issues typically occur in parietal lobe
-often cooccurs with other attentional disorders

Attentional Alexia

-incorrect productions of letters in word as the result of interference from other letters in word

Visual Alexia

-production of a word that is visually similar to the target word

Surface Alexia

-often occurs with fluent aphasia
-left temporal or temporoparietal lesions
-damage between occipital and temporal lobe
-impaired reading of irregularly spelled words
-relatively intact reading of regularly spelled real words and pseudowords
-visual errors, regularization errors, and errors with visual and semantic overlap with the target

Deep Alexia

-often occurs with non-fluent aphasia
-extensive left hemisphere lesions
-impaired pseudoword reading
-production of semantic and visual errors in oral reading
-severely impaired pseudoword reading
-semantic errors in oral reading
-visual errors in oral reading
-morphological errors in oral reading
-imageability effect
-part-of-speech effect

Phonological Alexia

-often occurs with mild aphasia or none
-left perisylvian or left superior temporal gyrus lesions
-impaired pseudoword reading
-absence of semantic reading errors
-visual errors
-imageability effects

treatments for alexia

-Oral Reading Techniques
-Supported Reading Comprehension
-Phonologically Based Interventions
-Externally Driven Techniques

Oral Reading Techniques (Alexia)

-very functional, diagnosis must be very moderate to mild severity for success
-most appropriate for surface Alexia
-Oral Reading for Language in Aphasia (ORLA)
-Modified Multiple Oral Reading (MMOR)

Oral Reading for Language in Aphasia (ORLA)

-SLP-led, intensive, multi-phase treatment where participants read sentences aloud with varying levels of clinician support
-8 to 16 weeks
-working up through stages to be able to produce a read sentence, increases in sentence complexity

Modified Multiple Oral Reading (MMOR)

-SLP-led, regimented, individualized technique involving reading aloud a passage to criterion
-varied level of support until you can hit an accuracy level, mostly computerized

Supported Reading Comprehension (Alexia)

-Strategy-based treatment
-Aphasia-friendly reading modifications
-Aphasia book clubs

strategy based treatment (aphasia)

SLP-led training in the use of reading strategies (reducing visible text, summarizing main points, reading comprehension guides, etc)

Aphasia-friendly reading modifications

-incorporation of aphasia-friendly text supports such as reader-friendly formatting (large, sans serif font), relevant pictures and icons, and large amounts of white space
-kindles are good technology options to offer helpful format

Aphasia book clubs (Alexia)

SLP-led book clubs that include reading ramps (summaries, keywords, character guides, etc)

Phonologically Based Interventions (Alexia)

-phonomotor treatment
-Lindamood Phoneme Sequencing Program (LIPS)

Phonomotor treatment

SLP-led, explicit, multi-sensory treatment that presents phonemes multimodally and gradually increases length of phoneme presentations

Lindamood Phoneme Sequencing Program (LIPS)

-SLP-led, explicit, multi-sensory instruction of the oral-motor movements of phonemes initially validated on children (based on program for kids with dyslexia)
-6 to 18 week
-not semantic at all, phonologically based, good for dorsal route stroke

Externally Driven Techniques

cognitive based treatment:

-SLP-led, explicit training in cognition (working memory, attention) to indirectly target reading
-more for peripheral alexias, also a treatment for aphasia

different types of agraphia

-pure agraphia
-agraphia with Alexia
-aphasic agraphia
-apraxic agraphia
-spatial agraphia

pure agraphia

no other language problems present, lesion sites vary

agraphia with alexia

-no spoken language problems, difficulty reading and writing, may have mild anomia
-lesions in the parietal lobe

aphasic agraphia

-Broca's: telegraphic speech and writing, poor/lack of grammar, difficulty with grapheme finding; lesion in Broca’s area

-Conduction: poor repetition, poor spelling, spelling real words is easier for them than nonwords

-Wernicke's: jargon, not a lot of substance in their writing, does not make sense, lots of misspellings

apraxic agraphia

motor control/programming difficulty, hard time holding writing utensil

spatial agraphia

-hard time with line direction, margins, may add extra letters
-lesions in non-dominant parietal lobe

different types of dysgraphia

-central dysgraphias
-peripheral dysgraphias

central dysgraphias

-lexical/surface dysgraphia
-phonological dysgraphia
-deep dysgraphia
-semantic dysgraphia

peripheral dysgraphias

-allographic dysgraphia
-apraxic dysgraphia
-motor nonapraxic dysgraphia
-spatial/afferent dysgraphia

allographic dysgraphia

-bad letter shape selection, difficulties with cursive or print, uppercase vs lowercase, hard time with oral spelling, selecting correct letters to write down
-lesion in left parieto-occipital lobe

apraxic dysgraphia

-motor issues with letter formation, motor programing for letter formation, difficulties holding writing utensil
-lesions in pre-motor cortex, superior parietal lobe, supplementary motor area

motor nonapraxic dysgraphia

micrographia, other motor issues like writing with the right amount of force on the paper, may write too fast or too slow, may see this in Parkinson's disease

spatial/afferent dysgraphia

-difficult writing on the lines, possible spatial neglect, may duplicate or omit words or letters
-lesions in the right hemisphere (non-language)

auditory comprehension disorders

-Wernicke's
-Conduction
-Transcortical Sensory

(rare types)
-Pure Word Deafness/Word Sound Deafness
-Word Form Deafness
-Word Meaning Deafness

wernicke's auditory comp disorder

Impaired naming and comprehension at the single word level or complications at higher level language

conduction auditory comp disorder

Repetition issues

transcortical sensory auditory comp disorder

comprehension is poor at the single word level or higher level language levels

rare types of auditory comp disorders

pure word deafness:
-inability to repeat, write to dictation
-word level comprehension problems only
-lipreading can be helpful

word form deafness:
-can make minimal pair discriminations but problem identifying a certain word

word meaning deafness:
-unable to understand word meaning but are able to repeat words

types of intervention for auditory comprehension disorders

-impairment based
-AFROM and ICF Frameworks (support)
-stimulation approach
-PACE
-self directed strategies

level of analysis (auditory comp disorders)

-auditory analyis
-phonological input
-semantic access
-sentence and discourse
-participation
-communication
-language environment
-personal factors

intervention for writing disorders

-Strengthening Lexical Route:
recognizing the whole word, semantic meaning focus on specific words, make sure it is augmenting speech (ex: copy target words)

-Graphemic Buffer Impairment:
working on actual path from grapheme to phoneme focusing on self-corrections and evaluating accuracy on their own, teaching ways to self-correct

-Peripheral Dysgraphias:
focusing on improving letter and word production, writing letters bigger/smaller, spatial - give them margins and paper with lines to write on, make sure they are using the whole page, etc

assessment of writing disorders

traditional tests
-writing subtest in most general aphasia tests

spontaneous writing
-ask client to write down a story or describe a picture
-quick way to assess writing ability

single-word writing
-ask client to copy down a word spoken or shown
-good place to start with a client so as not to overwhelm them and lessen the frustration level

investigating/assessing word production

everyday speech errors (slip of the tongue):
-typically our speech errors follow a rule, either semantic or phonological relation
-shows activation in some area of the brain when producing an error, it is not completely random

tip of the tongue:
-typical of anomic aphasia
-cant get the right word out or find the right word

Anomia types

-semantic: difficulty accessing and retrieving word meanings

-phonological: difficulty accessing and retrieving words

-phonemic: difficulty accessing and retrieving phonemes; retrieving sounds and attaching them to words

assessment/diagnosis of anomia

interactive model (impairment based approach)

2 stages of word production:

1. retrieval of the word
-can be problems with picking from lexical or semantic levels (wrong word or word meaning

2. phonological encoding
-putting sounds onto the word (ex: 'bat' for cat)

treatment approaches for anomia

-impairment based:
focus on the severity of impairment or deficit

-participation:
how is their inability to produce the correct word affecting their engagement in life

treatments for anomia

-Semantic Feature Analysis
-Verb Network Strengthening Treatment
-Cueing Hierarchies
-Contextual Repetition and Production Priming
-Phonological Priming
-Phonomotor Treatment

Semantic Feature Analysis

-developing a chart listing all of the semantic features of a word
-tends to have a good generalization

Verb Network Strengthening Treatment

-focused on the verb
-targets the semantic lexical retrieval
-uses utterances followed after a wh question

Cueing Hierarchies

-very helpful for anomia
-when someone is having trouble retrieving a word give them a semantic clue (something to drink out of) then a phonemic cue (mmmm) if they still struggle
-sentence completion cue (ex: I put tea in a ....)

Contextual Repetition and Production Priming

-mass repetition in order to prime a target word
-something related to target word is used to prime for that target word
-say "bake" or show a picture of baking cookies

Phonological Priming

-use rhyming words to reach target word

Phonomotor Treatment

-working at a phonological level
1. sounds in isolation
2. sounds in sequence

sentence processing disorders

-agrammatism:
characterized by lots of syntactic errors
difficulty using basic grammar and syntax (word order, sentence structure)
typically associated with Broca's aphasia
can be associated with expressive language or auditory comprehension problems

-paragrammatism:
makes more morphological errors (substitutions, reversals, or omissions of sounds/syllables)

-sentence complexity:
ability to process complex sentences (ex: passive vs active sentences)

Lexical/Surface Dysgraphia

-poor spelling in irregular words and words with multiple meanings
-ability to spell phonemic words is intact
-might see a lesion in orthographic output lexicon (posterior temporal-parietal lobe junction)

Phonological Dysgraphia

-hard time sounding things out phonetically
-lesion in left supramarginal gyrus

Deep Dysgraphia

-deep issue with semantics
-semantic paraphasias
-phonological errors
-may also have moderate to severe non-fluent aphasia
-lesion in the direct lexical semantic route

Semantic Dysgraphia

-problems with spontaneous writing and written naming
-writing to dictation is preserved/intact