612 Aphasia and Neurogenic Communication Disorders Test 1

what is the Aphasia top 10

basic facts

“classic types”/ W-L model

spontaneous recovery/plateau myth

neuroplasticity

not a loss of language

does aphasia therapy work

functional/compensatory, restorative/impairment-based interventions

interactive activation model

FRAME supportive communication strategies

is there a lot of community knowledge of aphasia?

no— in fact about 85% haven’t heard of it

how many americans does aphasia affect?

approximately 2 million (180,00 acquire every year)

Aphasia is more common than …

Parkinson’s

what is aphasia?

an acquired selective impairment of language modalities resulting from focal lesion in language dominant hemisphere

a linguistic performance disorder, processing disorder

is aphasia a disorder of linguistic knowledge?

no

(chronic) aphasia’s onset is …?

sudden

what is the most common etiology of aphasia?

stroke (20-40% result in aphasia)

what is primary progressive aphasia (PPA)?

a gradual onset, related to mild cognitive impairment/dementia

word finding difficulties, object naming difficulties, word comprehension impairments in spontaneous convo or on formal language measures

does aphasia only involve one language modality?

no it involves multiple

aphasia results from damage to the … which means it may co-exist with motor, cognitive, or sensory impairment(s)

CNS

what is aphasia NOT?

MSD

loss of language

loss of intelligence

dementia (with the exception of PPA)

psychological/psychiatric impairment

what are the brain basis of stroke outcomes?

size and location of lesion and “spared tissue”

factors contributing to biological resilience

changes related to recovery (bio and behavior driven)

experience-dependent neuroplasticity is possible for how long?

across the lifespan, extends beyond the spontaneous recovery period for years

evidence to site that aphasia therapy works

Robey 1994

Robey 1998

Holland, Fromm, DeRuyter, Stein 1996

Brady, Kelly, Godwin, Enderbery, & Campbell June, 1, 1996

WHO international classification of functioning, disability, and health (ICF)

how does impairment affect body structures, body functions, activities and participation, contextual factors 

allows for holistic service delivery

what is the purpose of treatment according to the biopsycholsocial approach

improve language, communication, quality of life

take biological-impairment based factors, psycholinguistics, and cognitive processes within social context

what are the two types of treatment?

impairment-based or restorative

compensatory or functional communication

what is the target and goal for impairment-based or restorative treatment?

target: specific language impairment

goal: generalization to new items and environments

reducing impairment > improving success of communication

what is the target and goal for compensatory or functional communication treatment?

target: individual communication abilities with relevance —> eliminating barriers

goal: improving successful communication and quality of life

quality of life > reducing impairment

what does impairment-based treatment requires knowledge of?

models of aphasia in order to help interpret assessment and treatment plans

What are the modular models/theories?

language is stored in whole parts in specific locations

processed/put together unit by unit step by step

what are the distributed models (aka connectionist)?

many tiny language units put together via activation in the moment 

processed simultaneously (not sequentially)

what does the Wernicke-Lichtheim model try to show?

where the lesion is and what theoretically happens

aka the house

is a PWA his/her impairment?

NO —> they have unique abilities, needs, goals, strengths, personal identities, attitudes, quality participation

what is EBP?

best available external evidence, clinical expertise, and patient preferences/values

aphasia is a … disorder that causes a variety of impairments that cannot be explained by dementia, sensory loss, motor issues

multimodality

what is the aphasia continuum?

anyone can appear like they have aphasia given the right factors

everyone can present differently

what are the main linguistic features of aphasia?

anomia

circumlocution

agrammatism/telegraphic speech

auitory comprehension

phonological errors

phonemic paraphasias

semantic errors

semantic/verbal paraphasias

perseverations

neologisms/jargon

stereotypy

alexia

agraphia 

what is one of the main ways aphasia is described?

fluent/non-fleunt dichotomy

the Wernicke-Lichtheim has … parameters that leads to … types

4, 8

parameters of the wernicke-lichtheim model

fluency

auditory comprehension

repetition

naming

how is fluency multidimensional?

can de defined by length, pauses, prosody, rate, effort, intonation, and/or elaboration

what are the 8 classic aphasia types (w-l model)?

Broca’s: NF

Wernicke’s: F

Conduction: F

Transcortical Motor: NF

Transcortical Sensory: F

Mixed Transcortical: NF

Global: NF

Anomic: F

should you always describe apahsia using the types?

no, it is best that you attend to features and describe the deficits instead of attending to labels 

why are the classic types classification still useful, even though not as clinically useful now?

many medical professionals and clinicians use this to describe

starting point to understand the patient

is there a 1 to 1 correlation with the language symptoms/types of aphasia and the site of lesion?

no

do people always have a classified aphasia?

many have “unclassified”

if classified, may no longer be accurate or reflect current abilities/deficits

does language processing only rest on Broca’s and Wernicke’s areas?

no language processing is a network which is unique and overlapping

large scale language architecture  

what should you always follow when addressing aphasia?

a descriptive, deficit-based assessment and treatment approach

what are the main classification systems for aphasia?

fluent/nonfluent

wernicke-lichtheim model

does fluency provide sufficient information alone?

no, it is a bit relative actually 

when you describe aphasia through linguistic impairment features, it leads to ….

a more specified description of the impairment that is helpful for all aspects of clinical decision making

what is preferred to identify and describe impairment and abilities

linguistic features/errors

what is the hallmark of aphasia (all types)?

anomia

what is anomia?

a word finding difficulty 

what is circumlocution?

description of the target

what is agrammatism/telegraphic speech?

omission of function words, content words used only

what are phonemic paraphasias?

phonological errors (substitutions, additions, anticipatory, perseverative) that are less than 50% of all the phonemes in the target word 

what are semantic/verbal paraphasias?

semantically related errors

what are semantic errors?

an unrelated real word is produced

what are mixed paraphasias?

both phonological and semantic 

what is a neologism?

nonword (over 50% of phonemes in target are errored)

what is jargon?

utterance comprised of neologisms

what are perseverations?

recurring responses (usually a response produced eralier)

what is stereotypy?

a frequently used word/phrase in place of a target

what doe most people with aphasia have?

alexia and agraphia

what is agraphia?

writing impairment

what is alexia?

reading impairment

will people with aphasia only have one type of error?

no, typically have a mix and typically requires many trials/assessments to see this

which lobes are most important for speech and language?

frontal and temporal

where is the insula?

if you part the sylvian fissure, it is between the frontal and temporal lobes

what does the insula do?

self-awareness

consciousness

cognitive functions

motor planning and control

Wernicke-Lichtheim house diagram

early neuroanatomically based model of language and its impairment 

what is the most common/general aphasia type?

Broca’s

is Broca’s fluent or nonfluent?

nonfluent

speech behavior seen in Broca’s aphasia

anomia

short phrase length

agrammatism

phonemic paraphasias

intact comprehension

impaired repetition

writing may also be impaired

what is Broca’s aphasia also known as?

expressive aphasia

where is damage associated with Broca’s aphasia?

left inferior frontal gyrus (IFG) aka Broca’s area

BA 44, 45

what are some associated signs with Broca’s aphasia?

right hemiparesis/hemiplegia

right hemisensory loss

what vascular distribution is associated with Broca’s aphasia?

anterior branches of the MCA

if someone has a lesion in the left IFG, does that always mean they present with Broca’s aphasia?

no, they may have lesion in another area and present with Broca’s or present with another type of lesion is in left IFG

which aphasia most commonly co-occurs with apraxia of speech (AOS)?

Broca’s-like

what is apraxia of speech?

an impairment of articulation and prosody

deficit in motor planning

what is AOS not?

an impairment of language or musculature

sequence of motor movements

motor planning → motor programming → execution

what are the 3 necessary features for diagnosing apraxia of speech?

sound errors, especially distortions and distorted substitutions

slowed rate

prosodic abnormalities

slowed rate characteristics AOS

slowed interval between words, syllables to produce sounds, and/or sound transitions

prosodic abnormalities in AOS

syllable segregation and equalized stressed

what are non-discriminatory characteristics of AOS and therefore cannot be used to base diagnosis off of?

articulatory groping

increasing error with increasing word length

phonemic substituions

cluster reduction

speech initiation difficulties

awareness of errors → self-correction

automatic speech > propositional speech

islands of error free speech

what are characteristics that can NOT be used to diagnose apraxia of speech?

limb or oral apraxia

expressive-receptive speech/language gap

what are the exclusionary characteristics for AOS?

fast rate, normal rate, normal prosody

is wernicke’s aphasia fluent or nonfluent?

fluent

what are notable speech behaviors seen in wernicke’s aphasia?

empty speech

press of speech (rapid)

notable anomia

jargon with neologisms and verbal paraphasias 

not always aware of deficits/errors

reading is often quite challenging

impaired auditory comprehension and repetition 

what is wernicke’s aphasia also known as?

receptive aphasia

where is damage associated with wernicke’s aphasia?

left superior temporal gyrus aka primary auditory cortex

BA 22, may involve 39, 40

what are some associated signs with wernicke’s aphasia?

possible right hemianopia

what is the vascular distribution associated with wernicke’s aphasia?

MCA and PCA

is werncike’s as common as broca’s like?

no

what would some spared tissue in wernicke’s area potentially resolve into? (what kind of aphasia)

conduction or anomic

is conduction aphasia fluent or nonfluent?

fluent

what are the notable speech behaviors of conduction aphasia?

anomia

speech may be interrupted by word-finding pauses or attempts to self-correct

difficulty with repetition (conduit d’approache= closer, conduit d’ecart= farther)

aware of deficits

good auditory comprehension

where is damage associated with conduction aphasia?

arcuate fasciculus

may extend to areas such as inferior parietal region, supramarginal gyrus (BA 40) with or without extension to subcortical areas, the insula, left primary auditory cortices, or underlying white matter

what are some associated signs with conduction aphasia?

right hemiparesis

right hemisensory loss

right hemianopia 

what is the vascular distribution associated with conduction aphasia?

MCA, parietal branches of PCA

lesion information is only …..

a hint/starting place

the descriptive approach to classifying aphasia is…

more informative

is the wernicke-lichteim model the best to use?

no, it is a good starting point and some terminology is still used

what is the most detrimental/profound aphasia?

global

what are defining characteristics of global aphasia?

profound anomia

little to no verbal output

poor external auditory comprehension

stereotypy (do not fit context)

can affect all language modalities (tho maybe not all equally)