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Neuro > 8. Aphasia and Acquired Communication Disorders > Flashcards

8. Aphasia and Acquired Communication Disorders Flashcards

1
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A
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2
Q

What is aphasia?

A

An acquired, selective impairment of language processing caused by brain damage, resulting in a multimodal communication disability affecting everday life.

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3
Q

Why might the term ‘aphasic’ be problematic

A

It is an acquired condition
unreasonable to assume that this is something encompassing their identity

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4
Q

Diagnostic process and practice parameters

A

Diagnostic process involves:
- aetiology of condition
- expertise about the condition
- their presentation / behaviour

This diagnostic conclusion is constrained by practice parameters:
- clinical purpose
- practice scope
- service context (community setting / hospital / etc)

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5
Q

We can differentiate aphasias through:

A

Onset (persisting/progressive/sudden)
Impacts (speech / language / cognition / communication)
Context (community/hospital/longterm residential)

we then present proximal explanations and distal explanations

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6
Q

Primary progressive aphasia =

A

a form of language-led dementia

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7
Q

Dysarthria =

A

affects the motor function of speech

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8
Q

How many people who experience a stroke will develop aphasia?

A

around 1/3

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9
Q

Outline aphasia:

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  • associated with increased mortality, higher rehab costs, more freq depression, poorer functional outcomes
  • severity decreases over time for most people (most severe at onset)
  • aphasia will persist for 50-60% of people who present with it at onset (the remainder will see substantial recovery)
  • 25% will see complete recovery
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10
Q

How many new strokes per year? How many people with Aphasia in Australia?

A

50 000 new strokes per year

80 000 people with aphasia in Australia

We expect this to increased due to increased stroke survival and aging population

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11
Q

What is aphasia caused by?

A

Damage to the areas of the brain supporting language processing:
- strongly lateralised to the left hemisphere of the cerebral cortex (L handers are more likely to have right-lateralized or more bilaterally represented language but still uncommon - if they develop aphasia, its called cross aphasia)

Stroke is most common cause of aphasia as it disrupts blood supply to cells in the brain: ischaemic (blockages) vs haemorrhagic (bleeds)

Can be caused by traumatic injuries, tumours, infections, degenerative conditions

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12
Q

What is a perilesional area?

A

Areas around the parts of the brain that have been lesioned by destruction of blood supply

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13
Q

What is hemiplegia and hemiparesis

A

Hemiplegia; motor disruption (paralysis of lower and upper limbs)

Hemiparesis: motor effects on lower and upper limbs (jerking)

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14
Q

What are the perisylvian regions:

A

Regions of cortex around the sylvian fissure

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15
Q

Broca’s area is

A

Inferior Frontal Gyrus of LH
45 and 44

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16
Q

Wernicke’s area is

A

Superior Temporal Gyrus of LH
22 and 42

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17
Q

Broca and Wernicke’s area are important…

A

encoding areas
damage to them won’t necessarily result in severe impairment
it is more damage to the inferior frontal region and superior temporal region, and around the sylvian fissure (lateral sulcus)

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18
Q

What are the 4 pathways?

A

Fibre tracts (white matter tracts) connect regions by the dorsal pathway (sound and motor) and ventral pathway (sound and meaning).

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19
Q

What is the important of the middle cerebral artery?

A

It provides blood supply to the lateral surface of the brain - many who have a stroke will be a result of disruption to this blood supply

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20
Q

What are the highly specialized intraconnected regions that support these language functions?

A
  • language network
  • multiple demand network (exec functions, novel problem solving, mathematics, reasoning)
  • theory of mind network (social reasoning and mentalizing)

These activate regardless of modality of language

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21
Q

As tasks become slightly less linguistic we get…

A

weaker elicitation of activation in the brain:

responses in language areas are highest for understanding or producing sentences, compared to processing or producing lists of nonwords (across modalities)

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22
Q

What is phonology?

A

Sound of language

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23
Q

Mortality of haemorrhagic vs ischaemic strokes:

A

haemorrhagic strokes are more likely to cause death than ischaemic strokes

but those who survive haemorrhagic strokes (bleeds) have better outcomes than survivors of ischaemic strokes (blockages)

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24
Q

Severity of symptoms

A

More than 50% of people with aphasia will have milder symptoms

–> around 20% will be younger than 65

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25
Q

Motor impairments and aphasia

A

More likely to occur alongside aphasia
- particularly for ischaemic strokes
- less likely when aphasia symptoms are more receptive and lesions are posterior

26
Q

around __% of people experiencing stroke will present with aphasia, dysarthria, and/or dysphagia

A

60%
dysarthria (motor speech disorder) and dysphagia (swallowing disorder) are more common following stroke than aphasia, and often co-occur

Around 10% will have ALL 3 conditions

20-30% of people with communication impairments following stroke will experience both aphasia and dysarthria (more common than aphasia or dysarthria alone)

27
Q

What is the primary mechanism for recovery in days and weeks post-onset?

A

Tissue re-profusion: getting blood back to the effected parts through natural brain internal process or facilitative medical intervention (drug / surgery).

28
Q

What is spontaneous recovery?

A

Natural improvement (in language functions) in aphasia symptoms without intervention

May persist for many months post-onset (3-6 months) but seems to be greatest around 1 month

29
Q

What are the strongest predictors of recovery from aphasia?

A

Lesion volume and integrity of perilesional areas (i.e. how well the surrounding areas take up those functions)

Successful recruitment of right hemisphere homologue regions may be important for recovery - particularly in sub acute phase.

Factors that have NOT comprehensively demonstrated an influence in degree of recovery: age, gender, handedness, stroke type, aphasia type

30
Q

What is the efficacy of instrumental interventions for aphasia recovery?

A

i.e. different kinds of noninvasive brain stimulation

people try to pitch these as instruments to cure, but they don’t to anything without behavioural interventions

31
Q

What is the recovery timeline?

A

Hours and days: tissue reperfusion

Days - weeks - months: Reorganisation of structure-function relationships in the brain

Months-years: establishing new pathways and compensatory mechanism

32
Q

What are the lifelong effects of aphasia?

A

Impacts on identity, life, overall health, personal relationships, participation in society.

  • more likely to experience depression (which can have substantial impacts on success of rehabilitation)
  • working age people w aphasia are less likely to return to paid employment (28% of people w/ aphasia return to work vs 45% of those who have stroke and no aphasia)

Fewer social contacts, reduced social networks, and increases dependence ony others

Evidence that among health conditions: largest negative impact on quality of life

33
Q

Depression after stroke for people with aphasia

A

Major depression is much higher with people with aphasia - compared to stroke victims without aphasia - 12 months after onset

34
Q

How did we come about to characterising aphasia syndromes?

A
  • Wernicke came up with the Wernicke-Lictheim model of aphasia (Classical Connectionist Model)
  • Broca came up with Broca’s aphasia
  • conceptualising aphasia fell out of favour, and was later revived by Geschwind as The Boston Diagnostic Aphasia Examination (BDAE)

Medically oriented model: clusters of symptoms grouped to form various syndromes
Uses people’s aphasia presentations to make inferences about the brain structures that they expected should be present.

35
Q

What are the categories of aphasia?

A

Non-fluent types: anterior lesions and motor impairments are likely

Fluent types: posterior lesions, motor impairments less likely

36
Q

Key Term: anomia

A

problem with word production

37
Q

Paraphasia is

A

distortion of a targeted word, may be phonemic (literal) and semantic (verbal)

38
Q

Neologism is

A

production of non-words, may fill much of a person’s utterances

39
Q

Agrammatism is

A

morphosyntactic problems associated with non-fluent aphasia

40
Q

Paragrammatism is

A

morphosyntactic problems associated with fluent aphasia

41
Q

automatic speech =

A

well learned language patterns (counting, idioms, responsive talk)

42
Q

Transcortical refers to

A

relatively intact repetition - some white matters tracts that connected distal parts are intact

43
Q

Outline the non-fluent types:

A
  • global
  • mixed transcortical (isolation)
  • broca’s
  • transcortical motor
44
Q

Outline the fluent types:

A
  • wernicke’s
  • transcortical sensory
  • conduction
  • anomic
45
Q

What is the limitation of the categorising of non-fluent and fluent types

A

very focused on cortical lesions (no reference to subcortical lesions)

46
Q

What is the most severe form of aphasia

A

Global aphasia (impaired fluency, comprehension, repetition)

47
Q

What are the various critiques directed at the syndrome approach of categorising aphaisa?

A
  • have little basis in theories of language processing
  • in this approach: underlying causes are not differentiated
  • predictions about lesion location are inconsistent
  • does not deal well with the heterogeneity of aphasia
  • people w the same classification have different clinical presentations
  • classification does not offer specific direction for intervention
48
Q

What is the conclusive statement on aphasia syndromes?

A
  • syndromes can be useful shorthand / heuristic for communicating between professionals
  • but the categories are not particularly informative outcomes of assessment and provide limited specific direction for intervention

-some of the underlying premises of the system (relationship between lesion location and language abilities) are questionable

49
Q

Explain ‘IFC’ as a scheme to classify health conditions

A

Classifying health conditions top to bottom –> looking at body functions & structures, participation, environmental and personal factors

The result of the disease disrupt for their overall health is a complex interaction between the things they are doing, involvement in life situations they want to achieve, and other contextual factors.

50
Q

What is A-FROM

A

It is a framework for successful living with Aphasia as a function of a range of different factors (not just impairment).

Includes:
- communication and language environment
- participation in life situations
- personal, identity, attitudes and feelings
- language and related impairments

51
Q

What practices are involved in acute recovery for speech pathologists?

A
  • working alongside medical teams
  • screen for, monitor and diagnose aphasia
  • assess and support communication needs
  • counsel and educate clients
  • advocate
52
Q

Rehabilitation phase, speech pathologists:

A
  • diagnose and describe aphasia
  • provide intervention
  • support needs for discharge
  • counsel and educate
  • case management
  • discharge and refer to other services
53
Q

In the community, speech pathologists:

A

Shift in the way speech paths start to work with people with aphasia:
- support self-management
- refer to other services
- everything we do for our clients should be oriented towards getting them out of needing this service –> how can we help them be independent

54
Q

What is the medical approach to aphasia management at the acute stage:

A
  • direct assessment activities tend to be more individualised (and flexibly monitoring recovery, establishing baseline information)
  • engage in consultative activities that speech pathologists undertake (receiving counselling about condition and what to expect, and team members receive information and training
  • establish robust communication for people with aphasia (like alternative communication systems)
55
Q

What is the medical approach to aphasia in the rehabilitation phase?

A
  • direct assessment activities tend to draw on structured strategies (more extensive language assessment, monitoring change, goal setting for intervention) –> in contexts that are most relevant to them
  • team based management to suit multiple needs: speech paths, medical doctors, occupational therapists, physios, neuropsychologists, social workers
  • impairment focused intervention is high priority, and interventions focused on discrete activities of daily living (ADL)

Stage can be brief - if they don’t present with motor impairments and they have a supportive family, often medical teams are hoping to push them out of hospital.

56
Q

Community recovery - switching from a medical model care to a socially oriented model of care

A

Direct assessment mixes structured and individualised strategies: assessment of communications begins to take precedence

Speech pathologists often become a primary source of healthcare for people with aphasia (interdisciplinary health falls away - bad problem as 12 month depression period)

Intervention approaches employed are increasingly heterogenous to meet life demands

57
Q

What do people with aphasia want?

A
  • speech path services that foster hope
  • earlier stages of recovery: active engagement in rehab, positivity, accepting need for adaptation, support
  • late stages: emphasis on engagement in meaningful social activities and communication

Tend to frame objectives for rehab in terms of specific aspects of their lives (activities and practical outcomes)

desire to return to pre-injury lifestyle, gain more information about their condition, help others

58
Q

What are some of the constraints / realities for practice? - acute stage

A

Early in recovery - very few people with aphasia are being seen 7% (instead focusing on dysphagia 89%)

Lack of space, lack of privacy, dynamic and changing nature of work - make it difficult to work with people with aphasia

Professionals find aphasia challenging and confronting, reporting negative experiences

While medically unwell and distressed, people with aphasia may have limited ability to engage with speech path tasks (including impairment focused intervention)

Early psychosocial support offers the best, most applicable approach to aphasia care (environments that are communicatively enriching and accessible)

59
Q

Constraints and influences on practice in the rehabilitation stage

A
  • challenging to implement multifaceted, high dosage speech path intervention (so people tend to get lower doses of behavioural intervention)
  • under-resourced
  • engaging patients in demanding interventions may not be feasible at this time
60
Q

Constraints and influences on practice in the community stage

A
  • chronicity and complexity of aphasia is not well recognised by healthcare systems (don’t attend to the lifelong nature of the disease)
  • strong risk of isolation and disengagement with healthcare and society (needs in the community are likely underestimated)
  • multifaceted life enablement approaches that are promoted for this stage of recovery are principle heavy and theory/evidence light

Neuro (7 decks)

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