Language Disorders in Adults Exam 1 (remediation)

neurogenic

caused by or arising in the nervous system (brain)

communication

dynamic process of exchanging thoughts, feelings, and information using a shared system of symbols and signs (verbal and nonverbal)

disorder

disturbance of “normal” functioning (pre-onset)

parts of communication

language, motor, cognition

components of language

form, content, use

components of form

phonology, morphology, syntax

component of content

semantics

component of use

pragmatics

developmental

onset at development, at birth or in utero

acquired

something happened to lead to a sharp onset

progressive

fine at first, but slowly gets worse

aphasia

impairment in comprehension and/or production of language in one or more modalities (spoken, written, gestural), often results in left hemisphere disruption

common etiologies of aphasia

stroke, brain injury, neurodegenerative disease

apragmatism

impairment in conveying and/or comprehending meaning or intent through linguistic, paralinguistic, and/or extralinguistic modes of context-dependent communication, often results from right hemisphere disruption

common etiologies of apragmatism

stroke, brain injury, neurodegenerative disease

cognitive communication disorder

difficulty with any aspect of communication due to disruption of cognition (attention, memory, executive function), variable location of brain, including frontal lobe + left/right hemisphere

common etiologies of cognitive communication disorder

stroke, brain injury, neurodegenerative disease

central nervous system

brain and spinal cord

peripheral nervous system

pairs of cranial and spinal nerves

neurons

receive information (dendrites), process information (nucleus), and transmit information (axon and synapse), about 100 billion in the brain

glia/glial/neuroglia

insulate, support, and nourish neurons, ingest bacteria, clean-up dying cells, about 10x more glial cells than neurons

dendrites

receive information from other neurons, carry information to the nucleus

neurological perspective of aphasia

an acquired language impairment resulting from a focal brain lesion in the absence of other cognitive, motor, or sensory impairments

neurolinguistic perspective of aphasia

breakdown in specific language domains resulting from a focal lesion

cognitive perspective of aphasia

the selective breakdown of language processing itself, of underlying cognitive skills, or of the necessary cognitive resources resulting from focal lesion

functional perspective of aphasia

a communication impairment masking inherent competence

aphasia

a mostly language-level problem, cognitive impairments can be present but are not necessary, impacts receptive and or expressive components, is multimodal in nature (spoken, written, signed), caused by central nervous system dysfunction

aphasia is not attributable to

confusion, sensory loss, motor dysfunction

fluency

quantity of speech (rate, phrase length), thematic elaboration (degree to which individual is inclined to initiate speech or elaborate on themes), articulatory agility (ability and accuracy in producing the motoric aspects of speech), prosody (the melodic line of speech), adequacy and variety of grammatical morphology and syntax

fluent aphasia

grammatically correct, but nonsensical or tangential, word salad, phonemic and semantic paraphasias

nonfluent aphasia

agrammatic, but substantive communication, hesitant, halting, effortful

four parameters in defining aphasia types

fluency, auditory comprehension, repetition, naming

Broca’s aphasia

fluency: nonfluent; short utterances, agrammatic, slow, labored articulation, phonological errors

auditory comprehension: relatively good

naming: impaired

repetition: impaired

transcortical motor

fluency: nonfluent (better than Broca’s); short utterances, agrammatic, slow labored articulation, phonological errors, difficulty initiating speech

auditory comprehension: relatively good

naming: impaired

repetition: relatively good

global aphasia

fluency: nonfluent; limited output; very few words and/or use of stereotype

auditory comprehension: poor; limited to single words and short phrases

naming: poor

repetition: poor

Wernicke’s aphasia

fluency: fluent, but empty speech; neologisms and paraphasias; produce jargon

auditory comprehension: impaired to poor

naming: impaired to poor

repetition: impaired to poor

transcortical sensory

fluency: fluent; relatively good articulation, decent phrase length, some syntax, and adequate prosody

auditory comprehension: impaired to poor

naming: impaired to poor

repetition: relatively intact

conduction aphasia

fluency: fluent; incorrect ordering of sounds (paraphasias) with frequent self-correction attempts

auditory comprehension: relatively good

naming: impaired to mildly impaired

repetition: poor

anomic aphasia

fluency: fluent; spontaneous speech with good articulation, syntax, phrase length, and prosody

auditory comprehension: good to mildly impaired

naming: impaired; prevalent use of circumlocutions

repetition: good

frontotemporal dementia variants

behavioral variant (bvFTD) and language variant primary progressive aphasia (PPA)

PPA variants

nonfluent (nfvPPA), semantic (svPPA), logopenic (lvPPA)

nfvPPA - nonfluent

core features: agrammatism in language production, effortful halting speech with inconsistent errors and distortions (apraxia)

additional features: impaired comprehension of syntactically complex sentences, spared single-word comprehension, spared object knowledge

svPPA - semantic

core features: impaired confrontation naming, impaired single-word comprehension

additional features: impaired object recognition (especially for low frequency items), surface dyslexia or dysgraphia, spared repetition, spared speech production (grammar and motor speech)

lvPPA - logopenic

core features: impaired single word retrieval in spontaneous speech and naming, impaired repetition of sentences and phrases

additional features: phonological speech errors in spontaneous speech and naming, spared single word comprehension and object knowledge, spared motor speech, absence of agrammatism

bilingual aphasia

same principles, must factor in proficiency of languages pre-onset, translation skill ability

Cognitive-Communication Disorder (CCD)

problems with communication that have an underlying cause in a cognitive deficit, rather than a primary language or speech deficit (ex. attention, memory, executive functions, pragmatics)

Right hemisphere disorder (RHD)

impairments in attention, left neglect, memory issues, decreased awareness of deficits, loss of “big picture” thinking, altered creative or music perception, changes in speech

apragmatism

inability to use contextual cues to determine intended meaning, inability to manipulate language to get a desired effect, inability to maintain topic, inability to understand inferences and nonliteral meanings, difficulty with the give and take of conversation

paralinguistic

vocal qualities of speech, like tone, pitch, volume, and intonation

extralinguistic

elements beyond speech signal, such as body language, facial expressions, gestures, and the surrounding environment

aprosodia

impaired ability to discriminate, identify, or classify emotional, grammatical, or pragmatical prosody, and/or impaired production of appropriate prosody, changes in humor and empathy, affective and emotional processing deficits

social cognition

how people perceive, interpret, and remember information about others and social situations

theory of mind

attribute mental states (beliefs, desires, intentions, emotions) to oneself and others, and understand that others’ mental states can differ from oneself

major NCD

significant cognitive decline in one or more areas, someone concerned, impairment is documented, deficits interfere with independences in ADLs and IADLs

mild NCD

modest cognitive decline in one or more areas, someone concerned, impairment is documented, deficits do not interfere with independence in ADLs and IADLs

stroke / CVA

blood supply to part of the brain is blocked or reduced, prevents brain tissue from getting oxygen and nutrients, brain tissue can be permanently destroyed

ischemic stroke

most common type, blockage of blood flow leads to cell death due to deprivation

core

area of brain tissue that has died due to the stroke

penumbra

surrounding areas to the core; disrupted blood flow can lead to further cell loss

diaschisis

additional distant areas of brain tissue can be affected through white matter tracts

transient ischemic attack (TIA)

acute disruption of blood flow to brain without tissue death, often viewed as warning signs for future stroke

hemorrhagic stroke

brain bleed leads to cell death due to deprivation and excess pressure on cells/tissue from leaked blood

aneurysm

weakening and rupture of arterial wall - can be congenital or due to high blood pressure or atherosclerosis

arteriovenous malformation (AVM)

tangled blood vessels that can rupture, can be born with this, but often is the result of trauma, accident, or medical procedure

traumatic brain injury (TBI)

disruption in brain functioning caused by an external and forceful event to the head

closed-head injury

blunt trauma, often diffuse injury (car crash)

open-head injury

penetrating trauma; usually more focal injury (gun shot or sharp object)

non-acceleration injuries

moving object strikes stationary head, tends to be less severe

acceleration injuries

linear acceleration = coup-contrecoup effect, damage at site and damage at opposite site (ex. rear end car accident), rotational acceleration = diffuse axonal injury, brain rotates within skull (ex. football tackle)

chronic traumatic encephalopahty (CTE)

reported head trauma that results in lasting and progressive neural changes, lead to a form of early onset dementia characterized by personality change and aggression

neurodegenerative disease

progressive, continued decline, non-acute, can affect several cognitive abilities