SW

Assessment of Acquired Language Disorders 3/19/25

Assessment of Acquired Language Disorders

  • Focus on diagnostics and evaluations for language disorders in adults.

Types of Adult Language Disorders

  • Aphasia: Language impairment usually due to brain injury (most common).

  • Psychosis: Network of mental health issues that can affect language.

  • Language of Confusion: Disordered thinking impacting verbal communication.

  • Generalized Intellectual Deterioration: Cognitive decline affecting language abilities.

  • Right Hemisphere Impairment: Affecting comprehension and expression of language.

Aphasia

  • Characteristics: Varies based on type (e.g., expressive, receptive, global).

  • Etiology: Often the result of strokes, traumatic brain injuries, or tumors.

  • Onset: Can be sudden or progressive over time.

  • Presentation and Progress: Varies at individual levels; assessment necessary for prognosis.

  • Severity: Assessed using various metrics and scales.

  • do not forget gestural communication in our definition of aphasia

  • classifications: fluent or nonfluent (Brocas (NF) vs Wernickes (F) )

  • when the aphasia comes on due to a tumor or something degenerative, it can also be sudden due to TBI. tumors can present with variable differences between modalities like writing is better than verbal. strokes lead to more predictable patterns of behavior

  • severity can be venerable or almost total

Aphasia Assessment

  • Focus Areas to Assess:

  • Speech fluency and output.

  • Auditory comprehension.

  • Repetition and naming abilities.

  • Language-specific deficits.

  • page 254-255 in book= review of different kinds of aphasia

  • special consideration of cognition. waking up in the hospital like that can be confusing and disorienting at first. do not confuse this disorientation with a true permanent cognitive disability

  • we will look at word retrieval, labeling, memory, naming things, reading, auditory comprehension, writing, cognition, functional communication/pragmatics

  • hospital stuff like can we use the call button, can they read the board, can they pick out a menu, can they make sense of pamphlets

  • can they make sense out of bills, emails, prescriptions

Purpose of Assessment

  • Screening for presence/absence of aphasia.

  • Characterizing the type of aphasia.

  • Identify any compensatory strategies the patient may use.

  • Offer recommendations for treatment and estimate prognosis.

Determining Presence/Absence of Aphasia: Standardized test vs informal assessment

you as the SLP are building knowledge as to how everything works and presents

informal= not as rigid like a formal assessment. probes, discourse analysis

  • Utilize screening charts and patient interaction.

  • Conduct interviews with caregivers for comprehensive case history.

  • Challenges in assessment may arise from dysphagia and other comorbidities.

  • SLIDE 6: screening!! to ID need for a more formal or more detailed assessment.

  • interview notes: sometimes people will say he forgets things. we write things down to remember things, but people who cannot write cannot do this. this does not mean that their memory is gone, but that their strategies to remember are harder to come by!!!

  • they also may say they are stubborn, but this can just mean they are struggling. he won’t eat may mean he can’t eat!

  • page 257: table 8.2 in book= list of formal screenings

  • what can you do in a screening of aphasia that can also screen speech= ask them questions and see how they respond.

  • when is further assessment not needed? if you do not see any signs or symptoms of aphasia! you can just rescreen later especially if they are too medically fragile

Sample Questionnaire Topics for a Case History- slide 7

  • Personal Information: Marital status, education, hobbies, changes in personality post-injury, etc.

  • Medical Details: Date and cause of injury, unconsciousness duration, presence of paralysis, etc.

  • Communicative Information: Initial symptoms of speech changes post-injury and current struggles.

Characterization of Aphasia

  • Types of Aphasia:

  • Broca's Aphasia: Non-fluent speech, good comprehension.

  • Wernicke's Aphasia: Fluent but nonsensical speech, poor comprehension.

  • Global Aphasia: Severe deficits in both expression and comprehension.

  • Anomic Aphasia: Difficulty with word retrieval, otherwise fluent speech.

  • Evaluation Techniques: Video resources for visual understanding of different aphasia types.

  • ex: Nonfluent aphasia characterized by severe disfluencies in expressive language

  • you dont always have to say that it is brocas or wernickes unless you are absolutely sure

  • neologisms= more in line with Wernickes bc fluent

  • tono tono guy= hard to know his comprehension bc he recognizes his intonation. just says tono tono over and over.

  • anyone who has had a stroke can always have another one so be on lookout!!!

Potential Compensatory/Facilitative Strategies-11

  • Use of multiple modalities to enhance understanding during treatment.

  • Establishing cueing hierarchies for word retrieval.

  • Incorporating clear, concise language in communication.

  • pg 272 in book cueing heirarchy, start at the max amount of cues and use less and less if they need it, or vice versa start at less and work your way up

  • always write down that you used cues if they got 50% accuracy for example

  • scrabble tiles and whiteboard can also be helpful for cues

Aphasia Assessment Practices

Communicative Activities of Daily Living = CADL

  • CADL-2 designed specifically for adults with brain damage; employs a Life Participation Model.

  • Assessment covers a variety of skills in diverse contexts, standardized for neurogenic disorders.

  • visual and auditory processing, expressive and receptive communication

Other Language-Related Disorders- slide 17

  • Psychosis/Delirium: Distinguishing aphasia from psychiatric conditions. this is due to emotional libility like inappropriate laughing. psychosis is associated with frustration, withdrawal, etc. think of the yellow wallpaper

  • psychosis is associated with a known mental health condition, but delirium is associated with confiusion due to wrong meds or anesthesia from surgery, substance withdrawal, kidney disease.

  • Mild Cognitive Impairment: Recognition of cognitive deficits using tools like the MoCA.

  • Dementia: Communication deficits enhance understanding of cognitive decline.

  • Psueodementia= loss of appetite, trouble sleeping. looks like dementia but it is not

  • Right Hemisphere Impairment: Attention, cognition, and nonverbal communications affected.

  • aphasia is not a mental health disorder

  • Languge of Confusion= associated with osmething like TBI not like a tumor. less predictable. harder to interpret reality and signals around them

  • TBI can cause anything from coma to just a mild impairment. range of severity levels and impairment

  • post-concussive syndrome

  • mild cognitive impairment= step between dementia and normal functioning

  • language of generalized intellectual deterioration- to have dementia someone needs to have deterioration of memory + 3 (on slide), but memory + 2 is also sufficient

Conclusion

  • Comprehensive assessments are crucial in identifying the nature of acquired language disorders.

  • Tailored approaches based on individual circumstances and difficulties provide better treatment outcomes.