(1) Communication Disorders: Aphasia and Cognition Flashcards
how many adults will have a stroke in their lifetime?
1 in 4
communication disorder resulting from damage to portions of the brain controlling language
- can have difficulty with speaking and writing
- can have difficulty with listening and reading
aphasia
which speech disorder is considered a “language problem”
aphasia
a pt with difficulty with speaking and writing will also be called
expressive
a pt with difficulty listening and reading has issues with?
receptive
difficulty with motor planning (oral, laryngeal, verbal or limb)
apraxia
inability to complete action/mvmt sequence
apraxia
disorder caused by impaired control of m
dysarthria
what condition is often referred to as “garbled speech”
dysarthria
what are the 2 types of aphasia
fluent and non-fluent
what are the 4 types of fluent aphasia
wernicke’s
transcortical sensory
conduction
Anomic
what are the 4 types of non-fluent aphasia
broca’s
transcortical motor
mixed transcortical motor
global
determining the type of aphasia is importanct for determining …
prognosis
what is the most important thing to determin during the eval
strengths and weaknesses to help facilitate communication
for most aphasic pts, how is cognition impacted
usually intact
when determining type of aphasia, what 3 things do we see if the pt can do?
list in order
- fluent
- comprehend
- repeats
what is a hallmark of wernicke’s aphasia
cannot comprehend AND cannot repeat
they ARE fluent
if a pt is:
- not fluent
- non comprehensive
- not able to repeat
global aphasia
if a pt is:
- non-fluent
- non comprehensive
- can repeat
mixed transcortical aphasia
if a pt:
- is non fluent
- can comprehend
- cannot repeat
brocas aphasia
if a pt:
- is non-fluent
- can comprehend
- can repeat
transcortical motor
if a pt is:
- fluent
- non comprehensive
- not able to repeat
wernickes
if a pt is:
- fluent
- non comprehensive
- can repeat
transcortical sensory
if a pt is:
- fluent
- can comprehend
- cannot repeat
conduction aphasia
if a pt is:
- fluent
- can comprehend
- can repeat
anomic aphasia
what is the prominent deficit of wernickes
auditory comprehension
what is the prominent deficit in conduction aphasia
repetition - not able to
what is the prominent deficit in transcortical sensory
auditory comprehension
what is the prominent deficit in pts with anomic aphasia
word finding
what is the most common type of fluent aphasia
wernickes
your pt presents with wernickes aphasia, where is the lesion
posterior aspect of L temporal lobe
your pt presents with:
- poor comprehension and limited awareness of deficits
- sentences full of neologisms, jargon, paraphasic errors
- preserved sentence structure
wernickes
your pt presents with transcortical sensory aphasia, where is the lesion
angular gyrus and posterior aspect of middle temporal gyrus
your pt presents with:
- poor comprehension
- able to repeat words and phrases
- possible echolalia or perseveration
- semantic paraphasias
transcortical sensory aphasia
how can perseveration present?
words, topics, and tasks
your pt presents with conduction aphasia, where is the lesion
arcuate fasciculus and parietal lobe
your pt presents with:
- spared comprehension
- expression characterized by some word retrieval deficit
- repetition becomes worse as length and complexity increases
conduction aphasia
what is one of the biggest ways to differentiate apraxia vs conduction aphasia
fluency vs non-fluency
conduction = fluent
what is the most mild form of aphasia
anomic
your pt has anomic aphasia, where is the lesion
least focal region - peri-sylvian region
your pt presents with:
- spared comprehension with exception of reduced self awareness of word retrieval problem
- pt talks around the word or uses non-specific terminology
- content words replaced with fillers (um, well)
- repetition preserved
anomic aphasia
when does anomic aphasia most likely show up
usually in conversation
what is circumlocution
talking around the word when cannot find the right one
- anomic aphasia
what is the most prominent deficit of brocas aphasia
verbal fluency - stuck all the time
auditory comprehension is intact
what is the prominent deficit of transcortical motor aphasia
spontaneous speech and perseverations in verbal fluency
your pt has broca’s aphasia, where is the lesion
anterior aspect of L hemisphere - posterior inferior frontal gyrus
pt presents with:
- preserved comprehension
- impaired expression
- decreased sentence length and total word count
- telegraphic speech
- content words are present
- pt frustrated
brocas aphasia
your pt has transcortical motor aphasia, where is the lesion
junction of supplementary motor strip of frontal perisylvian area
pt presents with:
- preserved comprehension
- expression markedly impaired with telegraphic speech
- repetition preserved, even for long sentences
transcortical motor aphasia
what is the least common and most severe of the 3 transcortical aphasias
mixed
what is another name for mixed transcortical aphasia
isolation aphasia
your pt has mixed transcortical aphasia, where is the lesion
- usually NOT In brocas or wernickes area
- areas surrounding these areas so there is no connection to other parts of brain
what type of aphasia occurs with a watershed stroke
mixed transcortical
what type of aphasia is rare and often misdx in acute stage
global
your pt has global aphasia, where is the lesion
LARGE L hemisphere lesion in frontal, parietal and temporal lobes
your pt present with:
- severe comprehension and expression deficits
- cannot imitate gestures or makes few attempts
- difficulty following commands related to apraxia
global aphasia
your pt has apraxia, where is the lesion
brocas
your pt presents with:
- difficulty initiating and continuing flow of speech
- speech pattern lacks appropriate prosody and much groping for correct mvmt
apraxia
aphasia or apraxia
- semantic paraphasias or jargon prevalent
- difficulty following commands
- groping or trial and error behaviors NOT seen
aphasia
aphasia or apraxia
- significant effort and struggle to produce intentional speech
- accuracy improved with repetition
- more difficulty with multisyllabic words
- prosody impaired
- large disparity b/w reding comprehension and ability to follow commands
apraxia
inability to control m of speech
dysarthria
what is often referred to as garbled speech that results in poor articulation, decreased breath support and poor intelligibility
dysarthria
pt has flaccid dysarthria, where is the lesion
CN involvement or midbrain
pt has spastic dysarthria, where is the lesion
motor regions of cortex (L or R)
pts with dysarthria most often also have …
dysphagia
dysphagia can present as what 3 deficits?
oral, pharyngeal or esophageal
if a pt has dysphagia with oral deficits, what should you look for? (4 things)
- presence or absence of teeth and condition
- difficulty chewing
- difficulty with bolus formation and cohesion
- pocketing
if a pt has dysphagia with pharyngeal deficits, what should you look for?
- delayed or incomplete swallow leading to penetration or aspiration
pts with dysarthria and esophageal deficits may also have…
GERD
- strictures, webs, or obstruction
- esphageal cancers
- hiatal hernias
- zenker’s diverticulum
what is the premise of water protocol
aspiration of water will NOT lead to adverse outcomes if mouth is clean and void of food particles
who is water protocol used with?
pts receiving thickened liquids
describe how the water protocol is followed
- b/w meals after oral care
- NOT administered 30 min b4 meals or 30 min after
- oral care completed after any food intake PO (including meds)
what are the advantages of water protocol
- pt satisfaction
- better compliance with liquid restrictions during meals
- better hydration and faster swallow recovery
where is the stroke?
- apathy, impulsivity, poor initiation and confabulation, slowed processing and executive dysfunction
ACA
where is the stroke:
- visual field deficits
- visual and auditory inattention
- perceptual deificts
- memory deficits and poor insight
MCA
where is the stroke:
- Homonymous Hemanopsia
PCA
what things do you look for in a clock drawing activity? (4)
- are the #s evenly spaced
- are there 12 #s
- do they know if they are right or wrong and if wrong can they correct it
- do they remember what time you told them to put
the following are ways to facilitate communication for what disorder?
- gain pt visual attention before speaking
- keep commands simple and concrete
- break down complex instructions
- slow speaking rate
- rephrase command if dont understand 1st time
receptive aphasia
the following are ways to facilitate communication for what disorder?
- avoid abrupt topic changes
- verify comprehension by having pt repeat instructions
- DO NOT assume pt understands when they nod yes or no
- have them point to written yes/no
receptive aphasia
the following are ways to facilitate communication for what disorder?
- encourage use of gestures
- ask simple yes/no questions - start broad
- give binary choices
- take cues from pt
- provide single word answer choices
expressive aphasia
the following are ways to facilitate communication for what disorder?
- allow pt to attempt writing
- ask questions regarding pts specific wants/needs
- use pictures and written words to clarify
- be aware of how we facilitate perseveration - give them breaks
- be aware of communication board
expressive aphasia
the following are ways to facilitate communication for what disorder?
- encourage use of gestures and pointing
- use written yes/no or single written words to communicate
- use visual and touch to activate part of body to move
- encourage use of communication book
apraxia
the following are ways to facilitate communication for what disorder?
- encourage slow rate of speech to allow for time for pt to find correct sequence of mvmts
- understand that simple words are easier for pt to say
- accuracy improves with repetition
- take break to avoid frustration
- use “lead ins” –> I need a…
apraxia
the following are ways to facilitate communication for what disorder?
- SLOW
- have pt clue listener to topic and avoid abrupt topic changes or gesture regarding a general area of discussion
- avoid trying to listen with a lot of ambient noise
dysarthria
the following are ways to facilitate communication for what disorder?
- encourage breath support
- try to have pt look at your when talking
- have note pad for pt to write
- model SLOW speech
dysarthria
How can we support pts with dysphagia?
- aware of diet and swallowing strategies
- adhere to safe eating
water protocol - verbally cue pts to swallow before task
- report difficulty with any of these tasks to ST
what is WRAP and what does it stand for
Writing down
Repeating
Associating
Picturing info
- strategy to assist pt with recall
how can we reinforce cognition?
- collaborate with ST on processes and procedures
- be aware of complexity of instructions
- avoid dual task unless specific goal
- give extra time to respond
- be aware that visual-perceptual deficits can impact cognition
what pt population should you make sure you use the SLOW acronym with?
dysarthria
what does SLOW stand for
SLow down rate of speech
Louder
Over-exaggerate mouth mvmts
Wide open mouth
