SLP 5220 Study Guide for Midterm Exam

Primary etiologies of aphasia

- Stroke

- Head Injury

- Brain Tumor

- Disease

- Toxicity

Cerebrovascular accidents (CVA)

Stroke is a leading cause of aphasia, resulting from a disruption in the blood supply to the brain.

Traumatic brain injury (TBI)

Head injuries can lead to aphasia depending on the area of the brain affected.

Degenerative diseases

Conditions like Alzheimer's and Parkinson's disease can also cause aphasia.

Tumors

Brain tumors, especially those in language areas, can cause aphasia.

What are the signs of a stroke (CVA)?

Numbness, asymmetric muscle control, loss of balance, dizziness, falling, sudden speaking, word-finding difficulties, blurred vision, trouble swallowing, slurred speech, and comprehension difficulty.

Fast acronym

Face drooping

Arm weakness

Speech difficulty

Time to call emergency services

What are the different types of CVA?

- Ischemic (occlusive) stroke

- Hemorrhagic stroke

- Transient Ischemic Attack (TIA)

Ischemic (occlusive) stroke

Caused by a blockage or clot in a blood vessel supplying blood to the brain.

Thrombotic

Blockage build-up in the same area where the blockage becomes a problem (most common).

Embolic

Blockage travels elsewhere via the bloodstream.

Hemorrhagic stroke

Caused by bleeding into the brain due to a ruptured blood vessel (intracerebral, subarachnoid, and subdural).

Transient Ischemic Attack (TIA)

"Mini stroke," where neurological function is regained quickly with time.

Endarterectomy stroke

Caused by an artery in the brain becoming blocked during the early postoperative period or because of bleeding into the brain tissue.

CVA impact aphasia

A temporary/permanent disruption of blood supply to the brain.

What is happening in the brain/body to cause a CVA?

A temporary/permanent disruption of blood supply to the brain.

Structural changes

Edema, electrochemical changes, function changes, infarct.

Arteriosclerosis

Buildup of lipids and cellular debris within the arteries that narrow the channels restricts flow and causes loss of arterial elasticity.

Lifestyle factors

- Diet

- Exercise

- Stress

- Smoking.

Genetic factors

Structural abnormalities, aka AVM hematological pathologies.

How do we treat CVAs?

Tissue Plasminogen Activator

Tissue Plasminogen Activator (tPA)

Breaks up the blood clots that block blood flow to your brain. A healthcare provider will inject tPA into a vein in your arm. This type of medicine must be given within 3 hours after stroke symptoms start.

The first 8-16 seconds during CVA

May result in loss of consciousness

After 20-25 seconds during CVA

Changes to electrical activity in neurons

After 3-5 minutes during CVA

May result in irreversible damage

Pharmacological intervention

- Hypertension medications

- Anticoagulants

- Antiplatelets

- Vasodilators

Surgical intervention

- Endarterectomy

- Angioplasty

Four core elements for aphasia

- Acquired

- Language (not a sensory, motor, psychiatry, or intellectual disorder)

- Neurological

- Multimodal, affecting reception and production

What is not an element of aphasia?

It is NOT progressive or degenerative or an intellectual, sensory, motor, or psychiatric disorder.

Modalities impaired by aphasia

- Expressive language (word finding)

- Auditory comprehension

- Reading

- Writing

Broca's Aphasia

Site: Lesion in posterior inferior frontal gyrus (Broca's area) BA 44 and 45

Blood Supply: MCA

Characteristics: Non-fluent speech, intact comprehension, poor repetition

Error Patterns: Agrammatism, effortful speech

Strengths: Good comprehension

Wernicke's Aphasia

Site: Lesion in posterior superior temporal gyrus (Wernicke's area) BA 22

Blood Supply: MCA

Characteristics: Fluent speech, poor comprehension and repetition

Error Patterns: Semantic paraphasias, neologisms

Strengths: Fluent speech, articulation

Global Aphasia

Site: Extensive lesion involving Broca's and Wernicke's areas

Blood Supply: MCA

Characteristics: Severe impairment in all language modalities

Error Patterns: Profound deficits in comprehension and production

Strengths: Difficult to identify due to widespread impairment

Conduction Aphasia

Site: Lesion in arcuate fasciculus (BA 44, 45, and 22)

Blood Supply: MCA

Characteristics: Fluent speech, good comprehension, poor repetition

Error Patterns: Phonemic paraphasias, poor repetition

Strengths: Intact comprehension, fluent speech

Transcortical Motor Aphasia

Site: Lesion anterior superior frontal lobe (BA 6, 8, 9, 10, and 46)

Blood Supply: ACA branches of MCA

Characteristics: Non-fluent speech with intact repetition and comprehension (similar to BA)

Error Patterns: Agrammatism, effortful articulation

Strengths: Intact repetition and comprehension

Transcortical Sensory Aphasia

Site: Lesion angular gyrus and posterior temporal gyrus (BA 39 and 37)

Blood Supply: PCA branches of MCA

Characteristics: Fluent, nonsensical speech with intact repetition, poor comprehension (similar to WA)

Error Patterns: Semantic paraphasias, jargon

Strengths: Intact repetition

Mixed Transcortical Aphasia

Site: Lesion sparing inferior frontal and temporal lobe

Blood Supply: Watershed areas between MCA branches

Characteristics: Severe impairment in all language modalities with intact repetition

Error Patterns: Profound deficits in production and comprehension

Strengths: Intact repetition

Anomic Aphasia

Site: Lesion in the angular gyrus (BA 39)

Blood Supply: Branches of MCA

Characteristics: Fluent speech with word-finding difficulties, intact comprehension and repetition

Error Patterns: Difficulty in word retrieval

Strengths: Relatively preserved comprehension and repetition

Non-fluent aphasia list

- Transcortical motor (good comprehension, good repetition)

- Broca’s (good comprehension, poor repetition)

- Global (poor comprehension, poor repetition)

- Mixed (poor comprehension, good repetition)

Fluent aphasia list

- Anomic (good comprehension, good repetition)

- Conduction (good comprehension, poor repetition)

- Transcortical sensory (poor comprehension, good repetition)

- Wernicke’s (poor comprehension, poor repetition)

How do we assess aphasia?

Using a screening and/or comprehension assessment.

What tools do we use to assess aphasia?

Screeners, impairment-based batteries, participation-based assessments, patient-reported outcome measures, and caregiver reports.

What is a screener?

Typically a brief evaluation of whether a person has a problem that may benefit from further professional attention

Screening tools examples

Bedside screener:

The MS aphasia screening test (MAST) - expressive/receptive language.

Screen cognition:

The Montreal cognitive assessment (MoCA) - cognition.

A screener cannot do what?

It cannot determine a diagnosis, and they indicate if a full assessment is needed.

Standardized assessment

Include data from healthy individuals and those with the disorder being assessed. This allows for comparing individual scores to group averages.

Non-standardized assessment

It involves subjective observations, qualitative data collection, and tailored interactions to assess an individual's abilities, behaviors, or skills.

Standardized assessment pro and con

Pro:

- Provides us with a "ceiling" and "basal (floor)" for the client.

- Can compare client's scoring/samples to normative values.

Con:

- Fail to meet a wide range of criteria for test design, psychometric properties, and means of controlling for confounding factors.

Non-standardized assessment pro and con

Pro:

- Allow greater flexibility regarding how much any particular domain is sampled, what cues are given, and how relevant the type of ability is being assessed.

Con:

- Does not enable comparison of the individual tested to a normative sample.

Norm-referenced

Indices in which results are compared to a sample of a population with similar traits.

Criterion-referenced

Used to gauge a person's own ability without direct comparison to others.

When to use NR?

Use this to see how the individual is doing compared to others.

When to use CR?

Use this when the individual has specific goals or standards.

NR advantages/disadvantages

Advantages: Useful for identifying relative strengths and weaknesses compared with peers. Also, identify who may need additional support.

Disadvantages: Does not provide information about whether an individual has achieved specific skills or objectives.

CR advantages/disadvantages

Advantages: Provides clear information about whether an individual has met specific criteria or objectives.

Disadvantages: Does not provide information about how an individual’s performance compares to that of others.

Examples of screening tools

- Aphasia Screening Test, 2nd Ed (AST)

- Bedside Evaluation Screening Test, 2nd Edition (BEST-2)

Aphasia Screening Test, 2nd Ed (AST)

Target clinical population: People with aphasia

Constructs assessed: Auditory and reading comprehension, oral and written language production, calculation

Bedside Evaluation Screening Test, 2nd Edition (BEST-2)

Target clinical population: People with aphasia

Constructs assessed: Conversational expression, object naming, object description, sentence repetition, single-word comprehension, reading

Examples of assessment tools

- Boston Naming Test (BNT)

- Aphasia Diagnostic Profiles (ADP)

- Western Aphasia Battery (WAB)

Western Aphasia Battery (WAB)

The WAB is a comprehensive assessment battery used to evaluate aphasia and related language impairments. It consists of subtests covering different aspects of language, including fluency, comprehension, repetition, and naming. The WAB provides a detailed profile of language abilities and helps classify aphasia types.

Boston Naming Test (BNT)

The BNT is a widely used assessment tool for evaluating word retrieval and naming abilities in individuals with aphasia. It presents line drawings of objects; the individual is asked to name each object aloud. The number of correctly named items measures naming ability, often impaired in aphasia.

Aphasia Diagnostic Profiles (ADP)

ADP is a comprehensive assessment tool designed to evaluate various aspects of language and communication in individuals with aphasia. It includes subtests to assess auditory comprehension, verbal expression, reading, and writing skills. ADP provides a detailed profile of language impairments, helping clinicians tailor treatment plans to individual needs.

Functional Independence Measure (FIM) scores

Used to assess an individual's level of independence in activities of daily living and mobility. It also evaluates functional status and tracks changes over time.

FIM scores pro

The instrument can allow clinicians to check the patient's comprehension, expression, social interactions, and memory abilities.

FIM scores con

It is difficult because language has so many components. The scaling measures too wide and can not be precise on the individual's communication ability.

WHO ICF

World Health Organization International Classification of Functioning, Disability, and Health

What is WHO ICF?

Provides a comprehensive understanding of health and disability, guiding assessment and treatment planning for SLPs.

What factors do we use when determining/thinking about prognosis?

- Etiology

- Diagnosis

- Severity

- Time post onset

How do we assess a bilingual speaker?

- Use questionnaires like the LEAP-Q to obtain information about their pre-morbid proficiency and linguistic characteristics.

- You can use informal measures such as language samples in both languages.

What factors or issues do we need to keep in mind?

Cultural/linguistic differences can impact outcomes. Know which errors are appropriate for that culture.

How is an assessment for a bilingual speaker the same/different from a monolingual speaker?

- Disorders are similar

- Obtain linguistic information.

- Modify assessment administration and/or data collection to prevent bias.

Anomia

Difficulty in recalling or finding words.

Ex: Difficulty in naming common objects such as “pen” or “chair.”

Anomic aphasia

Circumlocution

Using indirect or roundabout language to describe something when unable to recall the precise word.

Ex: Describing a “watch” as “something you wear on your wrist that tells time.”

Anomic aphasia

Semantic paraphasia

Substituting a word with one that is semantically related.

Ex: Saying “dog” instead of “cat.”

Wernicke's and TSA

Phonemic paraphasia

Substituting a word with one that sounds similar but has a different meaning.

Ex: Saying “tat” instead of “cat.”

Wernicke’s aphasia

Agrammatism

Difficulty in producing grammatically correct sentences.

Ex: “Me go store” instead of “ I’m going to the store.”

Broca's and TSA

Paragrammatism

Production of syntactically complex and grammatically incorrect sentences.

Ex: “Yesterday go store me” instead of “Yesterday, I went to the store.”

Wernicke's and TMA

Echolalia

Repeating words or phrases spoken by others.

Ex: If asked, “How are you?”, the person responds, “How are you?”.

Transcortical motor and TSA

Telegraphic speech

Speech that lacks grammatical structure and includes only essential words.

Ex: “Dog chase ball” instead of “The dog is chasing the ball.”

Braoca’s and transcortical aphasia

Conduit d'approche

Repeated attempts at a word, getting closer to the target with each attempt.

Ex: Trying to say “elephant” and saying “e…ele…eleph…elephant.”

Conduction aphasia

Logorrhea/ press of speech

Excessive, rapidly, and continuously, with minimal pause for breath or interaction.

Ex: Speaking rapidly and continuously, without regard for turn-taking or listener comprehension.

Wernicke’s aphasia

Fillers

Insertion of non-meaningful wounds or words into speech.

Ex: Using “uh”, “um”, or “you know” excessively.

Stereotypy

Repetitive or fixed patterns of speech or behavior.

Ex: Repeating the same phrase or actin multiple times without variation.

Global aphasia

Acquired neurogenic cognitive-linguistic disorders

- Aphasia

- Dyslexia

- Dysgraphia

- TBI

- RHS

Acquired neurogenic speech disorders

- Apraxia of speech

- Dysarthria

Aphasia

Impairment of language, usually caused by left hemisphere damage either to Broca's area (impairing speaking) or to Wernicke's area (impairing understanding).

Dyslexia

Impairment of the ability to read.

Dysgraphia

Difficulty in handwriting.

Right hemisphere syndrome (RHS)

Attentional deficits, affective deficits, and communicative deficits in the right side of the brain.

Apraxia of speech

A problem of motor programming for speech articulation.

Dysarthria

A problem of innervation of the speech mechanism for articulation.

What are acquired neurogenic disorder?

A wide array of disorders of language or speech caused by problems in the brain of a person who had previously acquired language and speech.

Incidence

The likely number of newly diagnosed cases per specified unit of time.

Prevalence

The proportion of specified populations that had or have the disorder at a particular time.

What are the primary frameworks for conceptualizing aphasia?

- Medical

- Multidimensional

- Unidimensional

- Cognitive neuropsychological

- Social

- Biophyschosocial

What is the best framework for conceptualizing aphasia?

A clinical should grasps and appreciates multiple viewpoints.

What is a leading cause of a stroke?

Atherosclerosis

Hypoperfusion

An insufficiency in blood supply to the brain due to heart problems or hemorrhaging elsewhere in the body.

Neoplasm

New growth (tumor)

Toxemia

The poisoning, irritation, or inflammation of nervous system tissue through exposure to harmful substances