Exam 2 - Adult Acquired Speech Disorders

Aphasia

Inability to produce or understand speech due to a stroke

What organ are the cranial nerves attached to?

brain stem

What are the main functions of the frontal lobe?

Decision-making and motor control

Which structures in the FRONTAL lobe are responsible for speech/lang?

• Broca’s Area

• Motor Strip

• Prefrontal Cortex

What are the main functions of the temporal lobe?

inputting and outputting language

What structure in the temporal lobe is responsible for speech/lang?

Wernicke’s Area

What are the main functions of the parietal lobe? 

• Memory

• Language

• Reading, Writing (in left lobe)

• Visual Spatial Constructional (in right lobe)

What structure in the parietal lobe is responsible for speech/lang?

Sensory Strip

What is the main function of the occipital lobe?

visual processing

What structure in the occipital lobe is responsible for speech/lang?

visual cortex

What does the dominant side (in 98% of people, the left hemisphere) of the brain refer to?

Primary Language Centers

What does the non-dominant side (in 98% of people, the right hemisphere) of the brain refer to?

Non-primary Language Centers

How do the L and R hemispheres of the brain communicate to one another?

Through the corpus callosum

If there is an error with your cognition, what neurological condition would you have?

Dementia

If there is an error with your language, what neurological condition would you have?

Aphasia

If there is an error with your motor planning, what neurological condition would you have?

Apraxia of speech

If there is an error with your motor execution, what neurological condition would you have?

Dysarthria

What do receptive forms of aphasia include difficulties with?

• auditory comprehension

• reading comprehension

What effects does fluent receptive (wernicke’s) aphasia have on an individual?

• Wernicke’s area is damaged

• Individual can speak fluently, but there are issues with morphosyntax and understanding speech

What do expressive forms of aphasia include difficulties with?

• verbal expression

• graphic (writing) expression

What effects does non-fluent expressive (broca’s) aphasia have on an individual?

• Broca’s area is damaged 

• Understanding is good, but using correct words when speaking is difficult (weak speech production)

Paraphasia

A symptom of aphasia where you substitute certain words for others

Global Aphasia

Form of aphasia where affected patient can speak correctly with automatic processing, but cannot really use manual processing with speech (can’t answer questions past kindergarten-level)

• Stronger expressive than receptive communication

• location of problem is within frontal + temporal lobe

What are the most common causes of aphasia?

• Trauma

• Tumor

• Progressive Disease

  • Primary Progressive Aphasia

• Stroke

• Cerebral Vascular Accident (CVA)

Hemorrhagic Stroke

Ruptured (burst) artery

Ischemic Stroke

Clogged Artery

More common

What are interventions used for treating ischemic strokes?

• TPA=Tissue Plasminogen Activator=Can break up blockage within specific time window

• Clot retrieval=can remove blockage if done in time window

What are two types of assessments used for aphasia?

• Boston Diagnostic Aphasia Exam

• Western Aphasia Battery

What are the functions of the R hemisphere?

slower synthesis, context oriented, great at understanding the whole, not just the ingredients

What are the functions of the L hemisphere?

Fast analysis, detail oriented, great at understanding + producing speech + language

Where is Wernicke’s area located?

Temporal lobe

Where is Broca’s area located?

bottom of frontal lobe

Neuroplasticity 

The brain’s ability to change, adapt, and regenerate following a neural injury

Salience

In terms of therapy, prompting exercises that are motivating and important to a patient

Right Hemisphere Disorder (RHD)

Unilateral Neglect

an attention disorder where a person is aware of all their surroundings, but pays attention to only one side of their body or space due to brain damage, most often from a stroke

Unilateral Spatial Neglect (Hemi-neglect)

an attention disorder where a person ignores one side of their body or space, typically following a brain injury like a stroke (usually the left side)

What are 3 different types of TBI?

1. Internal Hemorrhage (bleeding skull fracture)

2. Acceleration injury (going too fast then slamming head)

3. Radiation waves from explosion

What are the three domains of cognition?

• Memory

• Attention

• Executive Functioning

Attention

• directed towards internal + external stimuli

• memory, executive function, and lang/communication depend on this

• weakness: it has a limited capacity

• strength: selects wisely

What does your Executive Function do?

it engages in goal-directed behavior (planning)

Working Memory system components

• visuo-spatial sketchpad: hold and manipulates VS information

• phonological loop: holds + processes words/sounds

• central executive: processes info to make decisions + problem-solve

4 stages of memory

1. encoding -front part of brainstem, picks out details

2. consolidation - memory filing clerk, hippocampus

3. storage - unlimited amount, temporal lobe

4. retrieval - hippocampus, find memory again

Voice

vibration caused by VF

Resonance

The routing of speech sounds out the mouth or into the nasal cavity

VF Adduction

VF are TOGETHER

happens when vocalizing or coughing

VF Abduction

VF are APART

happens when breathing (resting)

Which phonemes are the only ones that vibrate in our nasal cavity?

/m/ /n/ /ng/

What does the soft palate serve as in terms of speech?

a mechanism to route sounds—can lower to produce oral sounds, and lower to produce nasal sounds

The tighter your VF…

The louder your volume is

Immature larynges are…

• smaller

• more compact

• higher (compared to spinal cord)

Mature larynges are…

• larger

• longer

• lower (compared to spinal cord)

Hypernasality

oral sounds are being allowed into the nasal cavity

Hyponasality

nasal sounds are not being allowed into the nasal cavity 

Resonance

ability to route voice out of mouth or nose

What are the two types of organic voice disorders?

1. structural-based

2. neurogenic-based

Organic voice disorder

voice disorder caused by physical changes or underlying medical conditions that affect the vocal cords or the muscles and nerves that control them

Functional voice disorder

voice disorder that occurs in normal structures and with normal neurology, caused by an inefficient use of phonation system 

Structural-based vocal nodules 

callous-like thickening of VF tissues from increased usage

Neurology-based Parkinson’s Disease

Bowing of the VF resulting in decreasing vocal loudness

Muscle Tension Dysphonia (Functional Voice Disorder)

Alter vocalization due to abnormally high degree of vocal tone

Tracheostomy

placement of a tube below the VF to assist with severe pulmonary problems

Laryngectomy

removal of larynx due to laryngeal cancer

Tracheal-Esophageal Prothesis 

a potential option to restore speech after having a laryngectomy

A motor speech is classified as having:

• deficits in CNS or PNS

• sensorimotor planning + programming of speech movement

• processes that execute, control, + regulate that movement

Dysarthria

a motor speech disorder that has problems specifically with executing, controlling, + regulating speech movements

Apraxia of speech

a motor speech disorder that involves issues with planning + programming speech movements

Normal Swallowing contains

volitional + reflexive systems

to safely swallow, we need to…

1. prepare bolus

2. protect airway

3. move bolus

What are the 4 stages of swallowing?

1. oral prep

2. oral propulsion

3. pharyngeal 

4. esophageal