Aphasia and Right Hemisphere Disorder

Aphasia

-neurologically based language disorder caused by various types of neuropathies
-may or may not be accompanied by alexia, agraphia, or agnosia
-tx is concerned with verbal expression, auditory comprehension, reading, writing, and nonverbal modalities
-may be fluent, nonfluent, or subcortical

Nofluent Aphasias

-Broca's
-Transcortical Motor
-Global

Broca's aphasia

-lesion in the posterior inferior gyrus of the left hemisphere
-nonfluent/effortful
-limited word output
-distorted speech sounds
agrammatic/
telegraphic speech
-impaired repetition and naming
-poor reading/reading comp/writing
-monotnous speech
-relatively preserved comprehension

Transcortical Motor Aphasia

-lesion in the anterior frontal lobe of the language domain hemisphere; often above/below broca's area
-absent/reduced spontaneous speech
-nonfluent
-paraphasic, agrammatism, telegraphic speech
-echolalia/ perseveration
-intact repetition skills
-limited fluency
-use of simple and imprecise syntactic structures
-attempts to initiate speech associated with motor movements
-slow and difficult reading/ writing

Global aphasia

-lesions affecting all areas
-profoundly impaired language skills
-reduced speech output and fluency
-impaired repetition, naming, and comprehension
-perseveration
-impaired reading + writing

Fluent Aphasias

-Wernicke's
-Transcortical sensory
-conduction
-anomic
-subcortical

Wernicke's Aphasia

-lesion in posterior portion of the superior temporal gyrus in the left hemisphere
-incessant, effortless, flowing speech with normal fluency
-rapid rate
-intact grammatical structures
-severe word finding
-circumlocution
-paraphasic speech with semantic + literal paraphasias
-empty speech
-poor auditory comprehension
-poor repetition
-poor turn taking
-reading + writing deficits

Transcortical Sensory Aphasia

-lesion in tempoparietal region
-fluent with normal phrase length, prosody, articulation, and morphosyntax
-paraphasic + empty speech
-severe naming problems
-good repetition
-echolalia with grammatically incorrect forms
-impaired auditory comprehension
-difficulty following commands
-intact automatic speech
-good reading
-poor comprehehnsion

Conduction aphasia

-lesion between broca's and wernicke's areas; especially in the arcuate fasciculus
-debilitating and pervasive word finding difficulties
-generally fluent
-verbal paraphasia
-circumlocution
-good auditory comprehension
-intact repetition and articulation
-normal writing
-use of vague/non-specific words (empty speech)

Anomic aphasia

-lesions in various parts of the brain
-debilitating and pervasive word-finding difficulties
-generally fluent speech, normal syntax
-verbal paraphasia
-circumlocution
-good aud. comprehension
-intact repetition and articulation
-normal reading and writing

Subcortical aphasia

-extensive subcortical damage, w/ possible involvement of the left cortical/basal ganglia
-fluent speech
-intact repetition
-intact comprehension
-articulation difficulties
-prosody difficulties
-word finding difficulties
-semantic paraphasias
-possible limb apraxia
-possible initial mutism

Prognostic factors of aphasia

-younger/ healthier
-higher education
-smaller lesions
-no pre-existing conditions
-good hearing
-normal vision
-better motor skills
-better preserved language
-immediate tx.
-good health during course of tx
-family involvement

Right Hemisphere Functions

-understanding holistic gestalt stimuli, visual perception, geometric and spatial information
-facial recognition, attention, and orientation
-emotional experience and expression
-language comprehension in general and meanings of words
-prosodic features of communication
-understanding ambiguous language
-expressing and understanding emotion of speech
-understanding discourse
-pragmatics

Sytmptoms of RHD

-prosodic deficits
-impaired/ disorganized discourse and narrative skills
-confabulation and excessive speech
-difficulty understanding implied, alternate or abstract meanings
-pragmatic deficits

Assessment of RHD

-RIC eval of communication problems in RHD
-mini inventory of right brain injury
-the RHL battery
-test of visual neglect
-bells test
-behavioral inattention test

Denials and indifferences management

immediate feedback to increase awareness

Impaired attention management

-drawing attention to treatment stimuli
-giving specific directions
-repeating direction
-reinforcing attention and stopping pt when attention diverts

Impulsive behavior management

utilizing nonverbal sounds to wait before giving an impulsive response

Discourse problem management

utilize story retelling and generation with hierarchial cues

Pragmatic impairment management

-utilizing visual feedback to show appropriate and inapproiate behaviors to increase awareness

WHO Framework

-Body structure and functioning (impairments of brain and function)
-Activity and participation (speaking, listening, reading, and writing)
-Environment (assistive tech, attitudes of PWA)

Etiologies of aphasia

-stroke
-TBI
-brain surgery
-infections
-tumors
-degenerative disease
-exposure to chemical

Choroid plexus

manufactures cerebrospinal fluid

Blood brain barrier

-dynamic interface that separates the brain from the circulatory system and protects CNS from harmful chemicals
-some substances are allowed past the barrier

Meningeal linings

-provide CSF protection
-dura mater
-arachnoid mater
-pia mater
-tentorium cerebelli
-falx cerebri

Embolism

-floating clot or obstruction
-blood moves the obstruction to another point where it then restricts flow
-bowling ball rolling through your veins

Thrombosis

-obstruction of a blood vessel
-air bubble or clot
-a TIA is a warning sign for this

Hemorrhage

-blood from an artery begins bleeding into the brain
-weakened blood vessels burst and bleed into surrounding brain
-sudden onset of severe intractable headache followed by alterations of consciousness

FAST

-face
-arm
-speech
-time

Penumbra

-area surrounding an ischemic even such as a thrombotic or embolic stroke
-brain tissue that is potentially salvageable

Locationist view of language functions

-old view
-region A controls function B
-example: the inferior motor strip in the parietal lobe controls voluntary movement

Network view of language function

-newer view
-a network of brain areas work together to support a function
-example: broca's area, wernicke's area, auditory nerve, motor stip, etc. control speech
-multi-component systems

Most common cause of aphasia

stroke

Ischemic stroke

thrombotic and embolic

Hemorrhagic stroke

occurs when a blood vessel in the brain leaks or ruptures; also known as a bleed

Transient ischemic attack

temporary interruption in the blood supply to the brain; "mini stroke"

MCA damage

-hemiplegia/paresis
-hemisensory loss
-homonymous hemianopsia
-perceptual dysfunction
-aphasia

ACA damage

-hemiparesis of legs more than arms
-mutism
-decreased sponenaeity
-bradyphrenia
-apraxia
-abulia (decreased initiation)

PCA damage

-coma
-hemiplegia
-ataxia
-tremor
-hemiballismus
-sensory loss
-intractable pain
-vision loss
-prosopagnosia

Vertebral-basilar artery damage

-paresis
-sensory loss
-cranial nerve
-ataxia
-diplopia
-vertigo
-coma

Tissue plasminogen agent

-tPA
-important drug that can be effective in restoring blood flow to the affected area
-only for thrombotic clots
-patient receives a CT head scan ASAP to determine type of stroke prior to administering drug

Treatment of aphasia focus

Improving ADLs and IADLs

Assessment of aphasia hallmarks

-consider restrictions to personal activities and participation in life
-collect several language samples
-observe communicative behavior
-formal assessment tools
-respect patient wishes and previous abilities

5 broad domains of cognitive function

1. attention
2. memory
3. language
4. executive function
5. visuospatial skills

Confrontation naming

-verbal and written naming in response to stimuli
-boston naming
-cookie theft picture
-generative naming
-describe multi-step activivity
be cautious of cultural and age factors when providing naming stimuli

Automatic closure naming

-complete an open ended sentence or phrase
"it's raining cats and___"

Automatic serial naming

-ability to produce rote or learned material
-"count to 20"

Semantic paraphasia error

fork for spoon

random paraphasic error

tractor for spoon

Neologism

target word: spoon
Production: sklervick

Perseveration

repetition of a particular word, phrase, or gesture

Impairment based intervention to aphasia

-schuell's
-MIT
-constraint-induced
-lexical retrieval

Social intervention to aphasia

-life participation approach to aphasia
-conversation training
-functional communication

How to assess visuospatial neglect

-complex cancellation task
-line bisection
-scanning
-drawing
-clock drawing

True or false, RHD may impact a person's ability to recognize faces

True

Promoting Aphasics' Communicative Effectiveness (PACE)

A therapy approach that targets using any means of communication (verbal, written, gestures, pointing, vocalizations, drawing, etc.)

Verb Network Strengthening Treatment (VNeST)

-an aphasia treatment to promote lexical retrieval in sentence context
-targets verbs and their roles to activate semantic networks and to improve the production of basic syntactic structures (e.g., subject-verb-object).
-For example, the person with aphasia is given a verb (e.g., paint) and is asked to retrieve related agents and objects (e.g., artist-paints-picture and painter-paints-house

Treatment of Transcortical Motor Aphasia

-improving word finding
-increasing sentence length/structure and syntactic complexity
-improving naturalness of prosody/rhythm
-speech initiation
-improving writing skills