Language Disorders E3

TBI

blow from an external force to the head

CHI

skull is not penetrated

OHI

skull is penetrated, skull fracture

Nontraumatic Brain Injury

caused by strokes, encephalopathies (lack of oxygen in the brain), toxins or tumors. similar to injuries by a blow from an external force

TBI Causes

largest single injury comes from FALLS in children and adults older than 65

vehicle accidents combined account for 46% of injuries

drugs and alcohol

Focal Brain Damage

local; one specific area

primary impact - brain hits skull

skull is thrown front to back

Diffuse Brain Damage

widespread damage; often seen in CHIs where brain moves inside the skull

Shearing/Twisting

axonal damage/diffuse axonal injury (DAI)

results in diffuse damage at the cellular level

MRI/CT scans will not show the potential damage

Mild TBI

aka concussion; mild blow to head

no LOC (or unconsciousness for <30 mins)

nausea, headaches, confusion, learning problems

10% have lifelong problems; problems w employment and social interaction

Moderate TBI

unconsciousness (>30 mins - 24 hours)

motor problems

33% have lifelong problems, difficulty w cognitive communicative impairments

Severe TBI

coma (>6 hours)

severe motor problems

75% (3/4) have lifelong impairments

Medical Problems Associated with TBI

seizures

bowel/bladder incontinence

orthopedic problems

sensory problems (hearing, vision, any sensory area)

Physical Problems Associated with TBI

mild (paresis) to severe (paralyzed/plegia)

Perceptual-Motor Problems Associated with TBI

visual neglect (brain fails to pay attention to one half of the visual space)

motor apraxia (the person knows what they want to do but cannot make their body perform the action)

Cognitive-Communication Problems Associated with TBI

dysarthria/apraxia of speech (slurred speech)

tangential speech (getting off-topic),

confabulations (can't separate truth & fiction)

hyperverbosity (talking too much)

anomia/dysnomia (difficulty with word retrieval)

memory/attention/concentration

poor problem-solving

problems in executive functioning

egocentric thinking

Behavioral Problems Associated with TBI

impulsivity

emotional liability

disinhibition, anger outbursts

poor judgment/motivation

apathy, lethargy (fatigue)

Social Problems Associated with TBI

biggest concern

withdraw

easily distracted/influenced

bossy/argumentative

misperceive social actions/events

poor responsibility/dependency

loneliness/stubbornness

mood changes

perseveration (stuck on an idea/motor movement)

sexually inappropriate behavior

reluctance to seek assistance

Proactive Intervention Associated with TBI

look at what is ahead of the individual

determine obstacles they’ll confront

plan viable solution

exercise creativity, ingenuity, and flexibility

involve key people

use many of the strategies we use for LBLD/DLD and ADHD

Stroke

not degenerative

“brain attack”

can occur anywhere within the brain or skull

Ischemic Stroke

aka occlusive

deficiency of blood, caused by blockage or contraction usually within an artery

thrombus is a blood clot that attaches to the wall of the carotid artery, or above the carotid bifurcation

embolas is bateria, tumor, debris

Hemorrhagic Stroke

blood escaping into brain tissue

blood is out of artery and spills over brain tissue due to aneurysms

Stroke in LEFT hemisphere/cortex

for more people 95%

results in aphasia

Stroke in RIGHT hemisphere/cortex

results in right hemisphere syndrome/disorder (RHD/RHS) (apragmatism)

Stroke in FRONT - FRONTAL LOBE

results in motor (output, expressive) problems

Stroke in BACK - TEMPORAL/PARIETAL/OCCIPITAL LOBE

results in sensory (input, receptive) problems

Fluent Aphasia

aka receptive aphasia aka sensory aphasia

Wernicke’s

Transcortial Sensory

Conduction

Anomic

F - Wernicke’s

lesions in POSTERIOR portions of the left hemisphere (temporal/parietal)

✔ FLUENT speech,

✕ POOR auditory comprehension

✕ POOR repetition

F - Transcortical Sensory

lesions in POSTERIOR portions of the left hemisphere (temporal/parietal)

✔ FLUENT speech,

✕ POOR auditory comprehension

✔ GOOD repetition

F - Conduction

lesion in areas that connect the anterior and posterior portions of the cortex

✔ FLUENT speech,

✔ GOOD auditory comprehension

✕ POOR repetition

F - Anomic

occur in various portions of the cortex (no specific site of lesion)

word-retrieval problems

✔ FLUENT speech

✔ GOOD auditory comprehension

✔ GOOD repetition

Non-Fluent Aphasia

aka expressive aphasia aka motor aphasia

Broca’s

Transcortical Motor

Global

Transcortical Mixed

NF - Broca’s

lesions in the ANTERIOR portions of the left hemisphere

✕ NONFLUENT speech

✔ GOOD auditory comprehension

✕ POOR repetition

NF - Transcortical Motor

lesions in the ANTERIOR portions of the left hemisphere

✕ NONFLUENT speech

✔ GOOD auditory comprehension

✔ GOOD repetition

NF - Global Aphasia

most severe

lesion covers both ANTERIOR and POSTERIOR portions of the left hemisphere

✕ NONFLUENT speech

✕ POOR auditory comprehension

✕ POOR repetition

NF - Transcortical Mixed

rare type; similar to global expect repetition is slightly better than speech and auditory comprehension

Classifying Aphasia Types - 1. Conversation Abilities

does the patient use paraphasia?

• semantic: “sleep” for bed

• phonemic: flipped syllables

• neologistic: nonsense

is patient’s speech fluent?

• anomia?

• coherent speech?

Classifying Aphasia Types - 2. Naming Abilities

checks expressive language/output

• confrontational naming

• free recall aka word fluency

• recognition naming

Classifying Aphasia Types - 3. Auditory Comprehension

checks receptive language/input

• ask patient to point to objects and/or pictures

• ask patient to follow commands

• ask patient to respond yes/no questions

Classifying Aphasia Types - 4. Repetition

checks connection between input and output languages

• ask patient to repeat words which increasingly become difficult

• consider low/high probability of words being used

SCA w Aphasia

communicative success results from

• skill of person with aphasia

• skill of conversational partner

• availability of appropriate resources

SCA Techniques - Spoken Utterances

• natural tone and prosody

• slightly slower rate

• simple statements/questions

• chunk information into phrases

• emphasize keywords with loudness and pitch

SCA Techniques - Gestural Supports

• “layer” gestures on top of spoken utt.

• use appropriate gaze direction

• orient body toward person w aphasia

• point to graphic/objects for support

• use symbolic gestures

SCA Techniques - Graphic Supports

• written keywords

• bold font w white background

• avoid clutter

• simple syntax for sentences

SCA Techniques - Pictographic Supports

• line drawings representing key concepts

• grouping of pictographs within “topics”

SCA Techniques - Verification

• check to make sure YOU understood the intention of the person with aphasia

SCA Techniques - Physical Materials

• always have paper and bold-colored marker

• use marker to print keywords or draw

• person with aphasia may prefer a pen/pencil to write/draw

Working Memory

short-term

temporary storage place

affected early in the disease

“what did you have for breakfast yesterday?”

Declarative Memory - Semantic

facts you just know

affected later in the disease

“mother’s maiden name”

Declarative Memory - Episodic

memory for events; scene for a movie

affected early in the disease

“what was your prom night like?”

Declarative Memory - Lexical

memory for words; signage and simple words

able to identify nonsense words

affected later in the disease

Procedural Memory - Motor

motor memory

affected later in the disease

“driving a car, writing, dressing yourself”

Procedural Memory - Cognitive

automatic thinking

“adding in your head, how to read”

Strategies for Improving Communication for Persons with Dementia - Goals

• reduce demands on episodic memory

• support working memory

• provide stimuli

Reduce Demands on Episodic Memory

• avoid recall memory situations and instead use recognition memory situations

  • yes/no questions

• use recognition questions

• provide permanent cues for location of important things

  • labels, schedules, instructions

• recreate conditions that existed at the time the memory was made

Support Working Memory

• reduce distractions

• highlight important cues; keep info short and visible

• work within patient’s memory span

• chunk info into smaller units

• write instructions

• use multi-sensory stimulation

Provide Stimuli to Evoke Fast Memory, Emotion, and Action

• manipulate environments

• modify clinicians language