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PRAXIS > 8a. Neurologically Based Communication Disorders and Dysphagia -- APHASIA > Flashcards

8a. Neurologically Based Communication Disorders and Dysphagia -- APHASIA Flashcards

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1
Q

Types of Neuropathologies/Brain Trauma (6)

A 
Aphasia
AoS
Dysarthrias
Dementia
Right hemisphere syndrome
TBI
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2
Q

Aphasia: Foundational Concepts

A

*A neurologically based language disorder
(distinct from neurologically based speech disorders such as AoS and dysarthria)
*Caused by various types of neuropathologies (usually strokes aka cerebrovascular accidents (CVA)); More than 50% of people w/ strokes have aphasia
*Strokes may be ischemic or hemorrhagic
*Other causes of aphasia: brain trauma, intracranial tumors, and infections

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3
Q

Ischemic vs Hemorrhagic Strokes

A

Ischemic: caused by blocked or interrupted blood supply to brain caused by either thrombosis (blood blockage) or embolism (traveling clot)

Hemorrhagic: caused by bleeding in brain due to ruptured blood vessels; Ruptures may be intracerebral (w/in brain) or extracerebral (w/in meninges)

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4
Q

Aphasia: Definition and Classification

A
  • Numerous definitions exist; Some are non-typological (suggest a single disorder) and others are typological (classify aphasia into types); Other definitions are based on cognitive functions
  • General definition: A loss or impairment of language caused by a recent brain injury. Comprehension and expression of language, along with reading and writing, may be impaired
  • Most contemporary experts classify aphasia into types: fluent, nonfluent, or subcortical
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5
Q

Types of NONFLUENT APHASIA (4)

[Characterized by limited, agrammatic, effortful, halting, and slow speech w/ impaired prosody; Generally caused by lesions in the anterior brain structures]

A
  • Broca’s Aphasia
  • Transcortical Motor Aphasia
  • Mixed Transcortical Aphasia
  • Global Aphasia
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6
Q

Broca’s Aphasia

A
  • Caused by damage to Broca’s area (Brodmann’s area 44 and 45) in posterior inferior frontal gyrus of the L hemisphere of brain
  • Broca’s area is supplied by the upper div. of the middle cerebral artery
  • Damage to Broca’s area is not always necessary to produce this type of aphasia…
  • Patients may have 1+ independent speech disorders (Aos, dysarthria)
  • May have R-sided paralysis or paresis
  • Some pts may be depressed or react emotionally when confronted w/ difficult assessment tasks
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7
Q

Broca’s Aphasia: General Characteristics

A
  • Nonfluent, effortful, slow, halting, and uneven speech
  • Limited word output; short phrases and sentences
  • Misarticulated or distorted sounds
  • Agrammatic or telegraphic speech
  • Impaired repetition or words and sentences, esp. grammatical elements of a sentence
  • Impaired naming, esp. confrontation naming
  • Rarely normal but better auditory comprehension of spoken language vs production
  • Diff. understanding syntactic structures
  • Poor oral reading and comprehension of read material
  • Writing problems (slow/laborious + sp. errors; possibly due to having to use nonpreferred L hand)
  • Monotonous speech
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8
Q

Transcortical Motor Aphasia

A
  • Caused by lesions in the anterior superior frontal lobe, often below/above Broca’s area, which is not affected
  • The areas supplied by anterior cerebral artery and ant. branch of middle cerebral artery are affected in TMA
  • Pts tend to exhibit such motor disorders as rigidity of upper extremities, absence or poverty of movement (akinesia), lowness of movement (bradykinesia), buccofacial apraxia, and weakness of legs
  • Apathy, withdrawal, and little interest in comm. may be additional behavioral characteristics of some pts
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9
Q

Transcortical Motor Aphasia: General Characteristics

A
  • Speechlessness
  • Echolalia and perseveration
  • Absent or reduced spontaneous speech
  • Nonfluent, paraphasic, agrammatic, telegraphic speech
  • *Intact repetition (distinguishing characteristic of TMA)
  • Awareness of grammaticality
  • Refusal to repeat nonsense syllables
  • Unfinished sentences
  • Limited word fluency
  • Simple and imprecise syntactic structures
  • Attempts to initiate speech w/ help of motor activities
  • Usu. good comprehension of simple conversation
  • Slow and difficult reading aloud
  • Seriouly impaired writing
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10
Q

Mixed Transcortical Aphasia

A
  • Somewhat rare variety of nonfluent aphasia
  • Caused by lesions in the watershed area or the arterial border zone of the brain (between the areas supplied by the middle cerebral arteries and the anterior and posterior arteries)
  • Varied neurologic symptoms are seen in pts; these may include: bilateral UMN paralysis (spastic paralysis that affects the volitional movements), weakness of all limbs (quadriparesis) and visusal field defects
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11
Q

Mixed Transcortical Aphasia: General Characteristics

A
  • Limited spontaneous speech
  • Automatic, unintentional and involuntary nature of comm.
  • Severe echolalia
  • Repetition of an examiner’s statement
  • Severely impaired fluency
  • Severely impaired auditory comprehension for even simple conversation
  • Marked naming difficulty and neologism; impaired confrontation naming
  • Mostly unimpaired automatic speech (e.g., reciting months in a year) if initiated and not interrupted
  • Severely impaired reading, reading comprehension, and writing
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12
Q

Global Aphasia

A
  • Most severe form of nonfluent aphasia
  • Caused by extensive lesions affecting all language areas (the perisylvian region)
  • Widespread destruction of fronto-temporoparietal regions of brain is common
  • The more common sites of damage are supplied by the middle cerebral artery
  • Verbal and nonverbal apraxia, although technically not part of aphasia, may be present
  • Strong neurological symptoms, incl. R-sided paresis or paralysis, R-sided sensory loss, and neglect of L side of body may be observed in many pts
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13
Q

Global Aphasia: General Characteristics

A
  • Profound impaired language skills and no significant profile of differential skills
  • Greatly reduced fluency
  • Expressions limited to a few words, exclamations, and serial utterances
  • Impaired repetition
  • Impaired naming
  • Auditory comprehension limited to single words at best
  • Perseveration (repetition of short utterances)
  • Impaired reading and writing
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14
Q

Types of FLUENT APHASIA (4)

[Characterized by relatively intact fluency but generally less meaningful, or even meaningless, speech; Generally caused by lesions in the posterior brain structures]

A
  • Wernicke’s Aphasia
  • Transcortical Sensory Aphasia
  • Conduction Aphasia
  • Anomic Aphasia
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15
Q

Wernicke’s Aphasia

A
  • Caused by lesions in Wernicke’s area (the posterior portion of the superior temporal gyrus in the L hemisphere of the brain)
  • Wernicke’s area is supplied by the posterior branch of the left middle cerebral artery
  • Pts may sound confused
  • B/c of lack of insight into their lang. probs, pts are less frustrated w/ their failed attempts at comm.
  • Pts may also be paranoid, homicidal, suicidal, and depressed; Therefore, they may be confused with psychiatric patients
  • Pts are generally free from obvious neurological symptoms; Paresis and paralysis are uncommon
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16
Q

Wernicke’s Aphasia: General Characteristics

A
  • Incessant, effortlessly produced, flowing speech with normal, or even abnormal, fluency (logorhea, or press of speech) with normal phrase length
  • Rapid rate of speech w/ normal prosodic features and good articulation
  • Intact grammatical structures
  • Severe word-finding problems
  • Paraphasic speech containing semantic and literal paraphasias, extra syllables in words, and creation of meaningless words (neologisms)
  • Circumlocution (talking around words that can’t be recalled)
  • Empty speech (freq. use of this, that, thing, stuff, etc)
  • Poor auditory comprehension, esp. with b/g noise
  • Impaired conversational turn-taking
  • Impaired repetition skill
  • Reading comprehension probs (word sounds/meaning)
  • Writing probs (meaningless, misspellings, neologistic)
  • Generally poor comm. in spite of fluent speech
17
Q

Transcortical Sensory Aphasia

A
  • Caused by lesions in the temporoparietal region of brain, esp. in posterior portion of middle temporal gyrus
  • This region is supplied by the posterior branches of the left middle cerebral artery
  • A hemiparesis associated w/ onset of TSA may disappear, leaving pt w/ no obvious neurologic impairment; Neglect of one side of body is common
  • Pts w/ TSA sound similar to those with Wernicke’s BUT repetition is intact in pts with TSA
18
Q

Transcortical Sensory Aphasia: General Characteristics

A
  • Fluent speech w/ normal phrase length, good prosody, normal articulation, and appropriate grammar and syntax
  • Paraphasic and empty speech
  • Severe naming problems and accompanying pauses
  • Good repetition but poor comprehension of repeated words
  • Echolalia of grammatically incorrect forms, nonsense syllables and words from foreign langs (unlike TMA pts)
  • Impaired auditory comprehension of spoken lang
  • Difficulty in pointing, obeying commands, answering simple yes/no questions
  • Normal automatic speech (E.g., counting)
  • Tendency to sentences started by clinician
  • Good reading (aloud) but poor comprehension
  • Generally better oral reading vs other lang. skills
  • Writing probs that parallel those in expressive speech
19
Q

Conduction Aphasia

A
  • Rare variety of fluent aphasia
  • Caused by lesions in the region between Broca’s and Wernicke’s area, esp. in the supramarginal gyrus and the arcuate fasciculus
  • Lesion sites of conduction aphasia are controversial, as is this aphasia type
  • Symptoms are similar to those of Wernicke’s aphasia but a main difference is that pts with conduction aphasia have good to normal auditory comprehension
  • While some pts may have no neurological symptoms, others may have paresis of the R side of face, limb, or oral apraxia and R sensory impairment; Pts may recover from most of these impairments
20
Q

Conduction Aphasia: General Characteristics

A
  • *Disproportionate impairment in repetition (a distinguishing characteristic)
  • Variable speech fluency across pts; usu. less fluent than pts w/ Wernicke’s aphasia
  • Paraphasic speech
  • Marked word-finding problems, esp. for content words
  • Empty speech b/c of omitted content words
  • Efforts to correct speech errors (not always successful)
  • Good syntax, prosody, and articulation
  • Severe to mild naming problems
  • Near-normal auditory comprehension
  • Pointing to named stimulus>Confrontation naming
  • Highly variable reading probs; better comprehension of silently read material
  • Writing problems in most cases
  • Buccofacial apraxia (difficulty performing buccofacial movements when requested) in most pts
21
Q

Anomic Aphasia

A
  • Controversial; May be caused by lesions in different regions of brain, incl. angular gyrus, the 2nd temporal gyrus, and juncture of temporoparietal lobes
  • Anomic aphasia is a syndrome, whereas anomia is a naming difficulty (a symptom) common to most aphasias
  • The distinguishing feature of anomic aphasia is that, generally, most language functions, except for naming, are relatively unimpaired
  • A residual symptom may be a persistent naming probs in most pts who recover from any type of aphasia
22
Q

Anomic Aphasia: General Characteristics

A
  • *A most debilitating and pervasive word-finding difficulty, which is the distinguishing feature; however, pointing to named objects is unimpaired
  • Generally fluent speech
  • Normal syntax except for pauses (b/c word-finding?)
  • Use of vague/non-specific words–> empty speech
  • Verbal paraphasia (word substitutions)
  • Circumlocution (beating around bush b/c lack of access to precise words)
  • Good auditory comprehension of spoken lang
  • Intact repetition
  • Unimpaired articulation
  • Normal oral reading and good reading comprehension
  • Normal writing skills
23
Q

SUBCORTICAL APHASIA

[Caused by lesions in the BG and surrounding structures and the thalamus]

A
  • Aphasia is typically produced by cortical damage; however, aphasia due to subcortical injury has been reported in recent years
  • Extensive subcortical damage, with possible involvement of the L cortical areas of the brain, may underlie this type of aphasia
  • Lesions in the areas of the brain surrounding the BG and thalamus have been linked to subcortical aphasia
24
Q

Subcortical aphasia caused by lesions in the BG and surrounding structures in the L hemisphere is characterized by:

A
  • Fluent speech, which may incl. pauses and hesitations
  • Intact repetition skills
  • Normal aud. comprehension for routine conversation
  • Articulation probs (similar to those in Broca’s aphasia)
  • Prosodic problems
  • Word-finding problems
  • Semantic paraphasia in some cases
  • Relatively preserved writing skills
  • Limb apraxia if the lesions extend posteriorly to deep white matter in the parietal area
25
Q

Subcortical aphasia caused by lesions or hemorrhages in the L thalamus is characterized by:

A
  • Hemiplegia, hemisensory loss, R-visual field probs, and in some cases, coma
  • Initial mutism, which may improve to paraphasic speech
  • Severe naming problems
  • Good auditory comprehension of simple material and poor comprehension of complex material
  • Good repetition skills
  • Impaired reading and writing skills
26
Q

Aphasia in Bilingual Populations

A
  • Patterns of recovery from aphasia vary; Some may recover both languages, some only one lang, and some only the dom. lang; Some pts may recover one lang first and the other after months; Some pts may lose the first recovered lang as they begin to recover the other lang
  • Some pts may mix langs or automatically translate their/others utterances into one of their langs
  • Clinicians should analyze individual patterns, not just known patterns, in person who are bilingual and have aphasia
27
Q

Aphasia in L-Handed Individuals

A
  • Little research due to limited incidence
  • Of the 4% of the pop. that is L-handed, 1/2 have lang represented in L hemisphere (other 1/2 in R); In essence, only 2% have R-dominance for lang
  • Symptom complex and recovery patterns of aphasia in L-handed individuals (either w/ R or L hemisphere damage) are comparable to those found in typical pts
28
Q

Standardized Aphasia Tests: Screening Tests (6)

A
  • Aphasia Language Performance Scale (ALPS)
  • Sklar Aphasia Scale (SAS)
  • Children’s Acquired Aphasia Screening Test (CAAST)
  • Bedside Evaluation and Screening Test (BEST-2)
  • Aphasia Screening Test (AST)
  • Quick Assessment for Aphasia
29
Q

Standardized Aphasia Tests: Diagnostic Tests (8)

A
  • Boston Diagnostic Aphasia Examination (BDAE-3): Tries to classify aphasia into types
  • Western Aphasia Battery (WAP): Tries to classify aphasia into types
  • Minnesota Test for Differential Diagnosis of Aphasia (MTDDA): Evas 5 areas of performance/”disturbances”
  • Neurosensory Center Comprehensive Examination for Aphasia (NCCEA)
  • Multilingual Aphasia Examination (MAE): Comes in English, French, German, Italian, and Spanish
  • Bilingual Aphasia Test (BAT): Evals skills in 40 langs
  • Porch Index of Communicative Ability (PICA): Reqs intensive training to administer and score
  • Aphasia Diagnostic Profiles (ADP): Evals overall severity w/ specific skills; Helps classify aphasia
30
Q

Functional Assessment Tools (5)

[Targets daily communication skills in everyday settings]

A
  • Functional Communication Profile (FCP): Evals 45 behaviors in 5 categories using 9 point rating scale
  • Communicative Abilities in Daily Living (CADL-2)
  • Communicative Effectiveness Index (CETI): Evals 4 domains of functional comm. skills incl. social needs, basic needs, life skills, and health threats
  • ASHA Functional Assessment of Communication Skills for Adults (ASHA-FACS): Helps rate social comm.
  • Amsterdam-Nijmegan Everyday Language Test (ANELT): 2 forms w/ 10 items each to assess pragmatic skills of daily life
31
Q

Auditory Comprehension and Reading Tests (3 each)

[In addition to diagnostic aphasia tests, clinicians may use independent tests of specific skills such as auditory comprehension and reading]

A

Auditory Comprehension Tests: Token Test, Auditory Comprehension Test for Sentences (ACTS), and Functional Auditory Comprehension Task (FACT)

Reading Tests: Reading Comprehension Battery for Aphasia (RCBA-2), the Nelson Reading Skills Test (NRST), and the Gates-MacGinitie Reading Test (GMRT)

32
Q

Outline of Aphasia Assessment

A
  • Detailed case hx
  • Orofacial exam
  • Hearing Screening
  • Assessment of the following (9) speech and language skills that affect diagnosis of aphasia:
    1. repetition
    2. naming (responsive, confrontation, word fluency)
    3. auditory comprehension of spoken lang (hearing and visual eval; comprehension of commands)
    4. comprehension of single words (single items and semantic groups of items; words that vary semantically/phonetically)
    5. comprehension of sentences and paragraphs (stories)
    6. reading (silent, oral; matching words w/ pics; completion of printed sentences)
    7. writing (general, automatic, prepositional, confrontation, narrative, writing to dictation, graphomotor skills (letter formation))
    8. gestures/pantomime (expression/comprehension)
    9. automated speech and singing (recitation of ABC’s, days of week, months, #s; prayers, poems, nursery rhymes; humming in tune)
33
Q

Aphasia Treatment: Skill areas (5)

A

Generally involves the following skill areas: auditory comprehension, verbal expression (naming), verbal expression (expanded utterances), reading, and writing

34
Q

Alexia, Agraphia, and Agnosia

[All may be seen in patients with aphasia]

A
  • Alexia: Loss of previously acquired READING skills due to recent brain damage (Dyslexia is difficulty in learning to read); Due to cortical damage
  • Agraphia: Loss or impairment of normally acquired WRITING skills due to lesions in the foot of the second frontal gyrus of the brain (aka Exner’s writing area); Due to cortical damage
  • Agnosia: Sensory disorder; impaired understanding of the meaning of certain stimuli even though there is no peripheral sensory impairment. Pts can see, feel, and hear stimuli but cannot understand their meaning; Impairment often limited to one sensory modality and meaning may be grasped in another modality; There are 4 forms of agnosia: Auditory, Auditory-verbal, Visual, and Tactile
35
Q

Forms of Agnosia (4)

A

Auditory: Associated w/ bilateral damage to auditory association area; Characterized by impaired understanding of meaning of auditory stimuli, normal hearing, difficulty matching objects w/ their sound

Auditory-verbal (pure word deafness): Associated w/ bilateral temporal lobe lesions that isolate Wernicke’s area; Characterized by impaired understanding of spoken words and normal hearing

Visual (rare): Associated w/ bilateral occipital lobe damage or posterior parietal lobe damage; Characterized by impaired visual recognition of objects and normal auditory or tactile recognition of objects

Tactile: Associated w/ lesions in parietal lobe; Characterized by impaired tactile recognition of objects when visual feedback is blocked, impaired naming and describing of objects clients can feel in their hand

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