Acquired Neurogenic Communication Disorders Flashcards
What do SLPs do?
diagnose and treat communication, swallowing, and related disorders of the oropharyngeal mechanism
SLP settings:
schools
SNF
private practices
hospitals
NICU
acute care
Neurological Processes of Communication:
Cognitive – linguistic processes
Motor speech programming
Neuromuscular execution
Aphasia =
acquired communication disorder caused by brain damage
characterized by an
impairment of language modalities: speaking,
listening, reading and writing
not the result of a
sensory deficit, a general intellectual deficit, or a
psychiatric disorder
Multimodality Deficit
Language is a Central Process
3 levels:
1) word
2) sentence
3) discourse
comprehension:
> listening
> reading
production:
> speaking
> writing
word:
comprehension:
> listening: listen to word & point to object/picture
> reading: read work & point to object/picture
production:
> speaking: name objects/pictures
> writing: write names of objects/pictures
sentence:
comprehension:
> listening: follow command
> reading: follow instruction
production:
> speaking: describe actions
> writing: describe actions
discourse:
comprehension:
> listening: listen to story & answer questions
> reading: read paragraph & answer questions
production:
> speaking: describe complex picture
> writing: write letter/story
Aphasia multimodal language problem
Basic pattern of relative intact function / deficit
listening comprehension is the most preserved function
writing is the most impaired
auditory comprehension (listening) is relatively intact compared to expressive language functions (speaking and writing), especially in cases of more severe impairment
Aphasia is an acquired impairment of the cognitive
system specialized for:
comprehending and formulating
language, leaving other systems relatively intact
Aphasia Symptoms - Expression
anomia
non-fluent aphasia
telegraphic speech
agrammatism
telegraphic speech
paraphasia
neologism
jargon
anomia =
Having difficulty finding words
non-fluent aphasia =
Speaking haltingly or with effort
telegraphic speech =
names of objects
Speaking in single words
agrammatism =
Speaking in short, fragmented phrases
Making grammatical error
telegraphic speech =
Omitting smaller words like the, of, and was
paraphasia =
Substituting sounds or words
semantic word level
paraphasia “table” for bed
phonemic sound level paraphasia
“wishdasher” for dishwasher
neologism =
Making up words
jargon =
Fluently stringing together nonsense words and real words, but leaving
out or including an insufficient amount of relevant content (e.g., fluent
aphasia with empty speech, paucity of content
Aphasia Symptoms - Comprehension
difficulty understanding
spoken utterances
Requiring extra time to
understand spoken messages
Providing unreliable answers to “yes/no” questions
Failing to understand complex grammar
Finding it very hard to follow fast speech (e.g., radio or television news)
Misinterpreting subtleties of
language (e.g., taking the literal meaning of figurative speech such as “It’s raining cats and dogs.”)
Lacking awareness of errors (e.g., anosognosia)
classification of aphasia:
nonfluent = speech production is halting and effortful, grammar is impaired, content words may be preserved
fluent = person is able to produce connected speech, sentence structure is relatively intact but lacks meaning
nonfluent aphasia:
language comprehension relatively intact -> broca’s aphasia & transcortical motor aphasia
language comprehension impaired -> global aphasia
broca’s aphasia =
repetition of words/phrases poor
transcortical motor aphasia =
strong repetition skills
may have difficulty spontaneously answering questions
global aphasia =
severe expressive and receptive language impairment
may be able to communicate using facial expression, intonation, and gestures
fluent aphasia:
language comprehension relatively intact -> conduction aphasia & anomic aphasia
language comprehension impaired -> wernicke’s aphasia & transcortical sensory aphasia
conduction aphasia =
word finding difficulties, difficulty repeating phrases
anomic aphasia =
repetition of words/phrases good
word finding difficulties
uses generic fillers (“thing”) or circumlocution
wernicke’s aphasia =
repetition of words/phrases poor
transcortical sensory aphasia =
repetition of words/phrases good
may repeat questions rather than answering them “echolalia”
Characterize the communication output?
Non-fluent – Speech production is halting and effortful
*grammar is impaired, content words may be relatively preserved
Fluent - produces connected speech
*sentence structure is relatively intact, but lacks meaning
Characterize the auditory comprehension?
Language comprehension relatively intact
Language comprehension relatively impaired
If the repetition abilities were good, what type of aphasia do you think this person has?
a) Broca’s
b) Transcortical motor
c) Conduction
d) Global
b) Transcortical motor
pattern of relatively preserved listening ability, but impaired speaking and writing, along with moderate difficulties in reading, fits with transcortical motor aphasia
anomia (difficulty finding words) and agrammatism (telegraphic speech with missing function words) are common
Paraphasias (word substitutions) might be minimal or absent
argon or neologisms (nonsense words) are typically not prominent
If the repetition abilities were poor, what type of aphasia do you think this person has?
a) Broca’s
b) Transcortical motor
c) Conduction
d) Global
c) Conduction
(listening) is relatively intact
Fluent speech but with frequent phonemic paraphasias (word or sound substitutions)
Anomia (difficulty finding words) is present, but agrammatism is less common compared to Broca’s or transcortical motor aphasia
no jargon or neologisms
Broca’s aphasia also involves poor repetition, but the speech is typically ____
non-fluent, and the graph shows moderate to severe impairments across
Transcortical motor aphasia is characterized by ___
good repetition
Global aphasia involves severe deficits across ____
all modalities, including listening
including listening, speaking, reading, and writing, with very little preserved ability
If the repetition abilities were poor, what type of aphasia do you think this person has?
a) Wernicke’s
b) Transcortical sensory
c) Anomic
d) Global
a) Wernicke’s
Listening comprehension is typically significantly impaired in Wernicke’s aphasia
Fluent speech is common, but it often includes paraphasias (word substitutions), jargon, and neologisms (nonsense words)
Anomia (difficulty finding the right words) is also typica
Transcortical sensory aphasia would involve good ___ despite poor ___
repetition
comprehension
Anomic aphasia is primarily characterized by ____
word-finding difficulties (anomia) but good comprehension and good repetition
If the repetition abilities were good, what type of aphasia do you think this person has?
a) Wernicke’s
b) Transcortical sensory
c) Anomic
d) Global
b) Transcortical sensory
typically have poor comprehension
Fluent speech is common, but often filled with paraphasias (word substitutions) or even neologisms (made-up words)
Anomia (difficulty finding words) is present
Wernicke’s aphasia typically involves:
poor repetition, despite fluent speech and poor comprehension
Anomic aphasia involves:
good comprehension and good repetition, but it is primarily characterized by word-finding difficulties
Screening tool for aphasia
Language Screening Test
Motor Speech Disorders
Dysarthria(s)
Communication through vocal symbols = Speech
Speech =
embodies language into the physical (acoustic)
properties for the purposes of recognition and interpretation
Motor Speech Disorders – Dysarthria(s)
group of neurogenic speech disorders characterized
by “abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for breathing, phonatory, resonatory, articulatory, or prosodic aspects of
speech production
abnormalities are due to one or more sensorimotor problems—
weakness or paralysis
incoordination
involuntary movements
excessive, reduced, or variable muscle tone
predominant framework for differentially diagnosing
dysarthria is based on ___
a perceptual method of classification
perceptual method of classification relies on _____
auditory perceptual
attributes of speech that point to the underlying
pathophysiology
perceptual attributes are used to characterize the dysarthrias and, along with pathophysiological
information, can help identify underlying neurologic illness
Motor Speech Disorders: Dysarthria types
congenital
degenerative diseases
demyelinating and inflammatory diseases
infectious diseases
neoplastic diseases
toxic/metabolic diseases
trauma
vascular diseases
congenital =
cerebral palsy, chiari malformation
degenerative diseases =
demyelinating and inflammatory diseases =
multiple sclerosis, encephalitis
infectious diseases =
acquired immune deficiency syndrome (AIDS), herpes zoster
neoplastic diseases =
CNS tumours, cerebral, cerebellar, or brainstem tumours
toxic/metabolic diseases =
botulism, carbon monoxide posioning
trauma =
traumatic brain injury
chronic traumatic encephalopathy
vascular diseases =
stroke (hemorrhagic or ischemic)
flaccid =
associated with disorders of the lower motor neuron
system and/or muscle
Weakness, flaccidity, atrophy, fasciculations, hypoactive gag reflex, facial myokymia (involuntary, spontaneous, localized
quivering of a few muscles), nasal backflow while swallowing
Spastic =
associated with bilateral disorders of the upper motor
neuron system
Pathologic oral reflexes (sucking reflex; snout reflex; jaw jerk reflex), lability of affect, hypertonia, hyperactive gag reflex
Ataxic =
associated with disorders of the cerebellar control circuit
dysmetric jaw, face, and tongue AMRs, head tremor
Hypokinetic =
associated with disorders of the basal ganglia control
circuit
Masked facial expression, tremulous jaw, lips, tongue, reduced range of motion on AMR tasks, resting tremor, rigidity
Hyperkinetic =
associated with disorders of the basal ganglia
control circuit
Involuntary head, jaw, face, tongue, velar, laryngeal, and
respiratory movements, relatively sustained deviation of head position, multiple motor tics, myoclonus of palate, pharynx, larynx, lips, nares, tongue, or respiratory muscles
Traumatic Brin Injury -
Cognitive-Communicative Disorders
form of nondegenerative acquired brain injury, resulting from an external physical force to the head (e.g., fall) or other mechanisms of displacement of the brain within the
skull (e.g., blast injuries)
Traumatic Brin Injury -
Cognitive-Communicative Disorders: symptoms
Changes in levels of consciousness
Memory disturbances
Changes in cognitive function (e.g., attention,
memory, executive function)
Disturbances of sensory & motor function
Confusion associated with deficits in orientation
Neurological signs, such as brain injury observable
on neuroimaging, new onset or worsening of seizure
disorder, visual field deficits, hemiparesis, etc.
TBIs can result in focal damage =
(e.g., gunshot wound) or be more diffuse in nature (e.g., diffuse axonal injury)
symptoms can vary depending on the site of lesion and extent of damage to the brain
TBI is often associated with polytrauma (injury to the brain in addition to one or more other body systems)
TBI can be categorized as:
mild, moderate, or severe based on the extent and nature of injury, duration of loss of consciousness, post-
traumatic amnesia, and the severity of confusion at initial assessment during the acute phase of the injury
Potential Consequences/Impact of Cognitive-Communication Impairment Can Include:
Reduced ability to effectively communicate needs
Reduced awareness of impairment and its degree
Reduced memory, judgment, and ability to initiate and effectively exchange routine
information
Difficulty performing personal lifestyle management activities (i.e., pay bills)
Reduced ability to anticipate potential consequences, lack of judgment and problem
solving
Reduced social communication skills and/or ability to manage emotions
Cognitive-Communicative Disorders – Potential
Impact on Everyday Function
Difficulty anticipating consequences of own actions
Poor organization, with limited problem solving and judgment
Difficulty with concepts of time and money
Difficulty self-disciplining and self-monitoring to follow rules; exhibits socially inappropriate behavior
Difficulty changing routine or schedule; difficulty learning new rules
Limited communication:
difficulty selecting appropriate words and remembering names
limited memory and/or knowledge of current events and/or personal history
responses in conversation may be verbose, redundant, or tangential
missing or misunderstanding humor
difficulty understanding nonverbal communication (i.e., facial expressions and/or body language)
difficulty understanding abstract information
Difficulty managing home or maintaining a job or business due to:
Difficulty following directions
Difficulty comprehending or applying abstract written information
Difficulty analyzing personal and/or business problems, identifying and applying solutions
Difficulty assessing own strengths and weaknesses, developing effective plans to
improve weaknesses
Difficulty managing multiple responsibilities simultaneously
Difficulty managing emotions (especially anxiety, frustration, or anger) related to performance difficulties
Difficulty making, following, and modifying plans as needed
Difficulty effectively communicating with colleagues and/or customers
Traumatic Brin Injury – Observations: Cognition
Orientation
Attention
Learning & Memory
Recognition, prosopagnosia,
gnosis, etc.
Executive/Goal directed behavior
Self-Awareness
Traumatic Brin Injury – Observations: Language &
Communication
- Verbose
- Tangential
- Paucity of thought
- Slow processing speed
- Word finding
- Expressive impairments
- Receptive impairments
- Dysarthria
Traumatic Brin Injury – Observations: Behavioral
Regulation
- Affect
- Agitation
- Lability
- Sensitivity
- Impulsivity
Traumatic Brin Injury - Neurocognitive Effects
Deficits in shifting attention between tasks
Difficulty with selective attention
Impaired sustained attention (e.g., for task completion)
Increased response latencies
Reduced processing speed
Impaired goal directed behavior
Deficits in short-term memory that negatively affect new learning or planned tasks
Post-traumatic amnesia (retrograde)
Lack of insight for monitoring one’s strengths, weaknesses, functional abilities, problem situations, and so forth
Reduced awareness of deficits (anosagnosia)
Impaired goal directed behavior
Deficits in orientation to self, situation, location, and/or time
Impaired spatial cognition that can affect ability to navigate and ambulate
Traumatic Brin Injury - Language & Communication Effects
- Pragmatic/Social Communication
- Spoken Language
Traumatic Brin Injury - Neurobehavioral Effects
Affective changes, including over-emotional or over-reactive affect or flat (i.e.,
emotionless) affect
Agitation and/or combativeness
Anxiety disorder, depression
Difficulty identifying emotions in others (alexithymia)
Emotional lability and mood changes or mood swings
Excessive drowsiness and changes in sleep patterns, including difficulty falling or
staying asleep (insomnia), excessive sleepiness (hypersomnia)
Feeling of disorientation or fogginess
Increased state of sensory sensitivity accompanied by exaggerated response to
perceived threats (hypervigilance)
Impulsivity, irritability and reduced frustration tolerance
Stress disorders
Pragmatic/Social Communication
Conversational turns marked by verbosity
Difficulty initiating conversation and maintaining topic
Difficulty inhibiting inappropriate language or behavior
Impaired ability to use nonverbal communication effectively (e.g., tone of voice, facial expression, body language)
Impaired social cognition skills (e.g., regulating emotion; expressing emotion and perceiving emotion of others; ability to take the perspective of others and to modify language accordingly)
Tendency to be tangential
Spoken Language =
Anomia or word retrieval deficits
Decreased ability to formulate organized discourse or conversation
Difficulty following directions
Difficulty understanding abstract language/concepts
Difficulty making inferences
Tendency to perseverate in verbal responses
Use of incoherent or confabulatory speech
Difficulty functioning independently due to:
unresponsiveness to all external stimuli
may open eyes, suck, and/or yawn
does not attend to others
no purposeful speech
extremely impaired attention and memory with impulsivity
extremely limited communication:
extremely limited communication:
difficulty responding to and/or saying name
difficulty expressing basic needs to others using simple words and/or gestures (i.e., yes/no
difficulty saying greetings (i.e., “hi” and “bye”) on own
