Chapter 10

o   Aphasia Def:

·       is a language disorder that affects almost all aspects of social communication and participation.

§  possible causes:

·       brain injury resulting in strokes & tumors.

o   Bain Injury:

·       External-> motor vehicle accident.

·       Internal-> stroke

§  High blood pressure

§  High cholesterol

o   Brain tumors:

·       Primary Intracranial tumors: -> those originating in the brain.

·       Migrating tumors: -> originate elsewhere but move into the brain. 

·       Epilepsy/ Seizures

·       Brain infections: Meningitis & Encephalitis

·       Surgical accidents.

§  Impact:

·       language formulation and expression, difficulty remembering words, using the right word, using correct grammar, hard to read and write, difficulty understanding others and using correct grammar. Difficulty understanding or expressing through gestures.

§  Types:

·       Fluent Aphasia:

o   Wernick’s aphasia: fluent, meaningless speech, impaired auditory comprehension, jargon and neologisms, good articulation, and intonation.

o   Conduction aphasia: somewhat fluent speech, minor comprehension problems, significant difficulty imitating words.

o   Anomic aphasia: word finding problems with near normal language and good comprehension.

·       Non-Fluent Aphasia:

o   Broca’s aphasia: effortful, agrammatic speech, short monotone phrases, apraxia, good comprehension, impaired repetition, primary issue is expressive (motor) problems.

o   Transcortical Motor aphasia: similar to Broca’s but with good imitation of speech, even when using long sentences.

o   Global aphasia: language functions impaired across the board, severe issues with comprehension and production, verbal stereotypes, most severe form of aphasia.

o   Motor speech disorders:

§  Apraxia def:

·       Neuromuscular disorder impacting the body’s ability to sequence movements in the absence of muscle weakness or paralysis.

o   Apraxia can impact multiple volitional movements (limb, verbal, and oral apraxia) but automatic and routinized actions are typically not a problem.

o   Apraxia of speech: difficulty initiation the movement patterns needed to talk.

o   Childhood Apraxia of Speech:

§  Neurological problem:

§  Neurobehavioral issues:

§  Idiopathic:

o   Causes

§  Insult/Damage to the left frontal lobe (Broca’s area)

§  The common cause is stroke.

§  Motor vehicle accident.

§  Tumor.

§  Seizure disorder.

§  Dysarthria def:

·       Paralysis, weakness, or incoordination of speech muscles due to central or peripheral nervous system impairments.

o   Causes

§  Vascular & Neurological diseases:

·       Strokes.

·       Traumatic brain injury.

·       Parkinson’s disease.

·       Amyotrophic lateral sclerosis.

o   Dementia Def: Intellectual/behavioral deterioration from degenerative neurological disease.

§  examples of reversible conditions:

·       temporary

o   B12 deficiency, certain prescription meds, drug abuse, lead/mercury toxicity, long-standing anemia, kidney/liver disease, endocrine disorders, brain infections.

§  examples of irreversible conditions:

·       Neurodegenerative

·       Ongoing loss of function resulting in death.

o   Traumatic Brain Injury: two main types

·       Most common in 15-19 year old males.

o   Milder form of TBI= concussion.

§  Penetrating:

·       Open-head injuries-skull is fractured or perforated and meninges are torn.

·       Typically, from piercing of skull by an external object.

·       Death rate is high.

§  Non-Penetrating:

·       Closed-head injuries- indirect damage to the brain with intact meninges.

·       Typically, caused by blunt force trauma with meninges intact.

·       Brain moves in cranium tearing and shearing neurons.

o   Acceleration/ deceleration injuries.

·       Characteristics of Wernicke’s and Broca’s aphasia

o    Werneck’s aphasia consists of individuals who speak fluently, with good articulation, but Meaningless speech.

o   Broca’s Aphasia consists of individuals who speak with interruptions, effortful, agrammatic speech, good comprehension, impaired repetition, and the primary issue is expressive motor problems.  

·       Anomia:

o   Def: Difficulty naming things, objects, and people. May describe the item instead.

o   Ex: Item is shoes. Person will instead say, “it is made of leather, has laces, you wear them on your feet…”

·       Paraphasia:

o   Def: A word substitution problem.

o   Ex: people who talk fluently and grammatically, but they cannot remember words & are substituted with wrong/unusual words.

§  Phonemic paraphasia:

§  Verbal paraphasia:

§  Neologism:

·       Agrammatism:

o   Def: leaving out certain grammatical elements resulting in telegraphic speech.

o   Ex: Use short, non-fluent phrases (filled with pauses, repetitions, revisions, etc.)

§  Speech lacks inflection & intonation.

·       Jargon:

o   Def: fluent but meaningless speech.

o   Ex: normal inflection & intonation. Opposite of Agrammatism. May include Neologistic words.

·       verbal stereotypes:

o   Def: person gets “stuck” and repetitively says common phrases (“I see”, or “Yes”) or a profanity.

§  Neologistic stereotypes: stuck on non-meaningful words.

·       Identify what a family can do to support their loved one.

o   Include the patient in “life” at home and adjust to his/her needs.

·       Match the 7 types of dysarthria with definition.

o   Ataxic:

§  Damage to the cerebellum.

·       Ataxia: balance and sequenced movements are disrupted.

·       Ataxic dysarthria: “drunken sounding” (speech with Ataxia Dysarthria): slow speech, issues with prosody (rate, stress, intonation), voice issues (lack of pitch differentiation, harsh vocal quality).

o   Flaccid:

§  Damage to the cranial nerves involved in speech.

·       Flaccid: flabby

·       Speech with flaccid dysarthria: impact on speech depends on which cranial nerves are damaged.

o   Damage to facial nerve= results in articulation errors, slurring.

o   Damage to vagus nerve results in breathiness, diplophonia, reduced pitch and loudness, and possibly hypernasality.

o   Spastic:       

§  Lesions in the pyramidal and extrapyramidal system cause spastic muscles (stiff and rigid muscles, increased muscle tone) and spastic dysarthria.

·       Speech with Spastic dysarthria:

o   All aspects of speech-> articulation, phonation, & prosodic aspects, may be impaired.

o   Weakness of facial muscles, tongue.

o   May have swallowing disorders.

§  Causes: strokes, traumatic brain injury, & neurological diseases.

o    Hyperkinetic:

§  Damage to the basal ganglia.

·       Hyperkinesia: excessive and involuntary muscle movements (tics, tremors, jerks)- Huntington’s disease (degenerative) is an example.

·       Speech with hyperkinetic Dysarthria:

o   Slow and imprecise articulation

o   Unpredictable speech errors

o   Variable speech rate, pitch, and loudness

o   Harsh voice, with intermittent hypernasality.

o    Hypokinesia:

§  Damage to basal ganglia.

·       Hypokinesia: reduced movement and decreased range of motion due to increased rigidity of muscles- Parkinson’s disease (degenerative) is an example.

·       Speech with Hypokinetic Dysarthria:

o   Tremors of face and/or mouth

o   Hoarse and breathy voice with monopitch and monoloudness

o   Imprecise articulation

o   Mild hypernasality

o   Irregular or fast breathing.

o   UUMN (Unilateral Upper Motion Neuron Dysarthria:

§  Damage to motor neurons in only one hemisphere.

·       Speech with UUMN: milder symptoms with only one side impacted.

o   Phonatory, articulatory, prosodic problems seen in about 20% of patients.

o    Mixed:

§  More than one type of dysarthria is present in the patient.

·       Causes:

o   Multiple strokes, strokes + Parkinson’s disease.

·       Common presentation:

o   Flaccid & Spastic

o   Ataxic & Spastic

·       Be able to identify functions controlled by the right hemisphere.

o    Attention and orientation.

o    Visual perception

o   Spatial awareness

o   Emotional experienced/expressions

o   Other elements:

§  Comprehension & production

§  Understanding implied, ambiguous, or alternative meanings.

§  Understanding speaker’s emotional tone & prosodic features

§  Understanding prosodic features & Pragmatic elements.  

·       Match the type of behavioral deficit seen in right hemisphere disorders with the correct definition.

o    Left neglect & attention deficits:

§  Ignore or neglect the left side of body & left visual field.

o    Disorientation:

§  Spatial or geographic

o   Facial recognition deficits (AKA prosopagnosia):

§  Cannot match faces with names or common tools previously used in their job.

·       Affective Deficits:

o    Difficulty recognizing and/or expressing emotions.

·       Reasoning and planning deficits:

o   Difficulty planning events.

o   Compiling lists for grocery shopping

o   Making inferences based upon current or past events.

·       Communicative deficits

o   Attention deficits and disorientation.

o   Provides inappropriate or incorrect responses.

o   Difficulty distinguishing significant from relevant information.

o   Poor topic maintenance & impulsive responses.

o   Poor eye contact.

o   Unaware that the listener may not be understanding them.

o   Poor auditory comprehension

o   Reading/writing may be impacted by the left neglect.