After the stroke-Brancamp Flashcards
What is cerebral plasticity?
the ability of the brain to rewire when a particular part of a brain is damaged and not functioning
THe brains ability to reassign functions served by damaged tissue diminishes with (blank)
age
The (blank) a person is at the time of brain injury, the more severe the persisting consequences of the injury are likely to be.
older
What is aphasia?
loss of ability to understand or express speech, caused by brain damage.
What are the four primary facts of aphasia?
- Aphasia is neurogenic
- Aphasia is acquired
- Aphasia involves language problems
- Aphasia is not a problem of sensation, motor function or intellect
(blank) is a multimodality disorder represented by a variety of impairments in auditory comprehension, visual and reading comprehension, oral-expressive language and writing
Aphasia
Aphasia (is/is not) a disturbance of articulation
IS NOT
Are patients with mutism aphasic?
not necessarily
(blank) is the loss of ability to speak through disease of or damage to the larynx or mouth.
Aphonia
Are patients with aphonia aphasic?
NO they are not
Is a language disorder experienced in altered states of awareness aphasic?
no
What is dysarthria?
neurological problems transmitting information to cause musculature control of speech
(difficult or unclear articulation of speech that is otherwise linguistically normal)
Dysarthria designates problems in oral communication due to inability to TRANSMIT commands causing (blank), (blank) or (blank) caused by neurological damage
paralysis, weakness, or incoordination of speech musculature
(blank) is the inability to GENERATE commands to cause particular purposive actions, as a result of brain damage (neurogenic) ie. you cannot program commands for muscle movement for speech sounds
apraxia
Can you get apraxia w/out signif weakness or neuromuscular slowness? Can you get apraxia in the absence of disturbances of conscious thought or language?
Yes
Yes
What is the difference between aphasia and apraxia and dysarthria?
Aphasia you have problems generating or understanding speech.
Apraxia you have problems generating speech motor commands.
Dysarthia you have a problem transmitting the signal from you brain to your muscles to execute speech commands.
What are disorders that accompany neurogenic speech disorders?
- agnosia (cant recognize things)
- acalculia (dyscalculia)
- alexia/dyslexia (deep and surface)
- agraphia (dysgraphia)
- constructional disturbance
What is alexia?
What is agraphia?
What is a constitutional disturbance?
Alexia->cant see words
Agraphia-> cant write meaningul words but can write normal letters
constitutional disturbance-> is characterized by an inability or difficulty to build, assemble, or draw objects.
Approx. (blank) percent of aphasia syndromes conform to a classical anatomo-clinical scheme;
80%
Where will your lesion be located if you have Broca’s aphasia?
- lateral frontal
- suprasylvian
- pre-Rolandic
- extending into adjacent subcortical periventricular white matter
Where will your lesion be located if you have wernickes aphasia?
posterior 1/3rd of superior temporal gyrus
Where will your lesion be located if you have conduction aphasia?
superior marginal gyrus and underlying white matter pathways, wernickes area, left insula and auditory cortex
Where will your lesion be located if you have an anomic aphasia?
Angular gyrus and second temporal gyrus
Where will your lesion be located if you have trancortical motor aphasia?
Anterior frontal paramedian; anterior and superior to brocas area
Where will your lesion be located if you have transcortical sensory aphasia?
Posterior parieto-temporal, sparing Wernicke’s area
Where will your lesion be located if you have a global aphasia?
large perisylvian, extending deep into subadjacent white matter
Where will your lesion be located if you have subcortical aphasia?
thalamus head of caudate nucleus putamen and/or internal capsule
(blank) is a bundle of axons that forms part of the superior longitudinal fasciculus. The arcuate bidirectionally connects caudal temporal cortex and inferior parietal cortex to locations in the frontal lobe.
arcuate fasciculus
What is thought to be the function of the arcuate fasciculus?
connects two important areas for language use, Broca’s area in the inferior frontal gyrus and Wernicke’s area in the posterior superior temporal gyrus.
(blank) allows for communcation between the components of the limbic system. It wraps around the frontal lobe to the temporal lobe and is involved in apathy and depression. THe posterior portion is related to cognition
cingulum
its location allows for the intergration of information
Explain what the posterior component of the cingulum regulates?
attention, visual and spatial skills, working memory, and general memory
What part of the brain does this:
motor programming for articulation (anterior language zone)
Broca’s area
What part of the brain does this:
activation of muscles for articulation
precentral gyrus
What part of the brain does this:
transmision of linguistic info to anterior areas from posterior areas
arcuate fasciculus
What part of the brain does this:
comprehension of oral language (posterior language zone)
Wernicke’s area
What part of the brain does this:
integrate visual, auditory and tactile info and carries out symbolic integration for reading (L parietal thought to be one of two areas associated with alexia-also L occipital)
angular gyrus
What part of the brain does this:
symbolic integration for writing
supramarginal gyrus
What part of the brain does this:
transmission of info b/w hemispheres
corpus callosum
What are the dichotomous classifications of aphasia?
- receptive vs. expressive aphasia
- motor vs. sensory aphasia
- fluent vs. nonfluent aphasia
What are all the cortical aphasia syndromes?
- brocas aphasia
- wernickes aphasia
- conduction aphasia
- anomic aphasia
- transcortical motor aphasia
- transcortical sensory aphasia
- global aphasia
- mixed nonfluent aphasia
What are all the subcortical aphasia syndromes?
- anterior capsular-putaminal aphasia
- posterior capsuar-putaminal aphasia
- global capsular-putaminal aphasia
- thalamic aphasia
Whats up with a persons speech who has aphasia?
they can produce it but it wont conform to grammatical rules of the language being used
What are the grammatical errors like in pnts who have aphasia?
- omission of words
- erroneous choice of words
- errors in word order
During the first hours or days of aphasia onset, the aphasic person may not produce (Blank) but most will attempt to do what?
speech
communicate by gesture or facial expression
A patient with aphasia often has difficulty comprehending a purely (blank) command
Verbal
i.e verbal messages through auditory or visual means w/out gestures, facial expressions or emotional intonation
Patients with aphasia have errors ranging from almost complete inability to comprehend a (blank) to mild deficits with (Blank)
single world
complex sentences
What is a Patient with aphasias awareness level?
So what are they intent on?
complete normal (is aware of self and environment) -intent on communicating thoughts regarding his/her condition and environment
When will aphasic patients not try to communicate?
during the first few hours after acute infarcts and late chronic stages for a few
General characteristics of speech fall into one of two categories, what are they?
fluent
nonfluent
What is this:
approximates normal speech in terms of the rate of word production, length of sentences, melodic intonation, and ease in speaking (9+ words/utterance)
Fluent
What is this:
rate is slow, sentence length is short, melodic contour is lost, production is effortful, may be more pauses than actual words {0-5 words/utterance}
non-fluent
What are disturbances of repetition?
failure to repeat words or sentences is a hallmark of aphasia ; ability may be completely lost or characterized by phonemic paraphasias or omissions of sounds/words
What are phonemic paraphasias?
cant repeat back a word but isntead repeat something sort of similiar that isnt a real word
If you patient has impaired repetition where do you think the problem is?
perisylvian region of the dominant hemisphere
People with aphasia often have distrurbance of auditory comprehension… these deficits can range from inability to understand what?
- single words
- sentences
- multiple step commands
- narrative discourse
What is agrammatism?
difficulty ordering words and putting them together in a sentence
(blank) patients have difficulty producing function words and bound
agrammatic
Patients with auditory comprehension deficits usually have some (Blank) impairment
reading
Reading impairment can appear in a pure form without (blank or blank) impairment
auditory comprehension or writing impairment
In most cases of aphasia, (blank, blank and blank) comprehension are impaired together, but not to the same degree.
reading, writing and auditory
WHat are the signs of aphasia?
- disturbances of reading and writing
- disturbances of grammatical processing
- disturbances of auditory comprehension
- disturbances of repetition
- disturbances of fluency
What are the characteristics of broca’s aphasia?
- dysfluent
- increased effort in speaking
- speech is agrammatic, telegraphic, groping
- often accompanied dysarthria and/or apraxia of speech
- comprehension better than expressive
- repetition abnormal
- naming is poor
- writing reflects spoken output
Patients with brocas aphasia are usually (aware/unaware) of their communication and physical impairments. Are they cooperative?
aware
yes and task oriented but get upset by failed communication attempts
What are the characteristics of wernickes aphasia?
- pt usually appears normal with no dysarthria or limb weakness/paralysis
- speech is fluent but often presents with paraphasias and jargon
- syntax is normal
- comprehension is poor
- reading is poor
- repetition is poor
- word-salad
What is paraphasia?
production of unintended syllables, words, or phrases during the effort to speak.
What is the general appearance of a patient with wernicke’s aphasia?
-alert, attentive and task oriented
A patient with mild wernickes are (unaware/aware) of errors and generally follow conversational turn taking
aware
How does a moderate wernickes patient present?
-rarely notice errors or attempt repairs; attentive and cooperative but get off topic easily (verbal tangents)
How does a severe wernickes patient present?
attentive, but severe comprehension deficits interfere with all communication tasks
What is global aphasia?
severe impairment in both comprehension and expression
What can someone with global aphasia understand?
symbols, icons, picture
What cant someone with global aphasia understand?
- abstract or inferential info
- simple words
How can you enhance the performance of someone with global aphasia?
w/ materials or activities that are automatic or emotionally laden
What are some speech characteristics of pnts with global aphasia?
-speech is severely limited and often characterized by stereotypical utterances (whatawhy), overlearned phrases (how-de-do) or expletives
What is the demeanor of pnts with global aphasia?
-attentive, task oriented, socially appropriate
Can global aphasia patients comprehend personally relevant questions? What about reliably answer yes/no questions?
fairly well
some can
What is the site of lesion for conduction aphasia?
arcuate fasciculus or temporal lobe
What is speech and audition like in a pnt with conduction aphasia?
fluent speech; auditory comprehension deficits range from moderate to mild
What is the hallmark of conduction aphasia?
inability to repeat long sentences- grossly impaired repetition and relatively preserved language comprehension and prosody may be affected
What is the general appearance of conduction aphasia?
-alert, attentive, task oriented, aware of errors in speech and writing; attempts repairs (“why cant i say that?)
(blank) is defining characteristic of the transcortial aphasias (wernickes, brocas, and arcuate fasciculus are spared)
preserved repetition
In transcortical aphasias, lesions are outside of the (Blank) zone
perisylvian (transcortical motor aphasia, transcortical sensory aphasia, mixed transcortical aphasia)
(blank) is word finding difficulties; is common in aphasia and other neurologic disorders (dementia, encephalopathy)
anomia
Anomic aphasia is usually a (blank) impairment of a more severe aphasia
residual
In anomic aphasia how is speech affected?
spontaneous speech is fluent and grammatically correct, but marred with frequent word-retrieval failures. Average phrase length is within normal limits
What is comprehension and repetition like in anomic aphasia?
auditory comprehension and repetition are relatively intact
How can you obtain a discourse sample?
“What happened to you?”
“What problems are you having now?”
“What do you do for a living?”
How can you assess auditory comprehension skills?
“Sit up straight…close your eyes…open them…look all around the room…point to the door…point to the ceiling… point to the source of illumination…point to the floor and exit.”
How can you assess auditory comprehension?
transition to body parts.
-point to your noise, point to yoru cheek, point to your elbow
How can you assess naming skills?
What do you call this/these?
watch, band, numbers etc
How can you asses repetition skills?
“repeat after me”
-bed, pizza, money, i love you, happy hippopotamus
How can you assess reading and writing?
Asking pt to read aloud is not reading comprehension. Some are unable to read aloud, but may comprehend silent reading. Others may read words aloud, but not comprehend
(blank) results from similiar etiologies that underlie left hemisphere damage
Right hemisphere damage
(blank) are the leading cause of RHD
CVAs
What is prosopagnosia?
cant recognize faces
WHat are the 5 communication deficits associated with right hemisphere damage?
- facial recognition
- comprehending facial expressions and expressing usial facial expressions
- prosodic deficits
- inferencing deficits
- discourse deficit
What are the 2 visuoperceptual deficits associated with right hemisphere damage?
simultagnosia
cerebral achromatopsia
What are the attentional deficits associated with right hemisphere damage?
neglect
sustained and selective attention deficits
What are the neuropsychiatric disorders associated with right hemisphere damage?
- anosognosia
- depression
- capgras delusion
- visual hallucinations
- paranoid hallucinations
What is anosognosia?
an inability or refusal to recognize a defect or disorder that is clinically evident
Does a person with RHD have problems with comprehension and expression of languange?
no, they have few if any problems in comprehending or expressing language syntax (grammar), morphology (eg, word endings), and/or phonology (speech sounds)
-have normal lexical retrieval
Does a person with RHD have classical aphasia?
no
What is lexical retrieval?
coming up with words they want to say
Why do some RHD patients have trouble naming pictures/objects?
due to visual-perceptual or visuospatial difficultures
What is hemispatial (hemineglect, left or visuospatial neglect)?
How common is this?
Where is the lesion located to cause this?
inattention to left side
13-80% of patients with RHD
-Inferior parietal lobe; parieto-temporal juction
I-nferior frontal, underlying white matter, thalamus, basal ganglia
What is motor neglect?
reduced use of left side of body (less than capable)
What is tactile neglect?
reduced response/recognition of tactile stimulation (greater than sensory deficit)
What is auditory neglect?
reduced processing of auditory stimuli from left-poorer localization of sounds
What are the three attention neglect problems?
- motor neglect
- tactile neglect
- auditory neglect
What are the three neglect subtypes?
- personal space
- peri-personal space
- extra-personal speace
What is personal space neglect?
neglect on ones body-Neglect to shave, comb, dress on L side
What is peri-personal space neglect?
neglect within reaching distance-
Neglect of items scanning/drawing/copying; L placed item on food tray
What is extra-personal neglect?
–neglect beyond arm’s reach-
Neglect of people on left side of room, items on L of room
How long does neglect last?
What is it usually accompanied by?
often resolves within first few weeks
-anosognosia (unaware of their issue) and other cognitive/communicative deficits
What is neglect dyslexia?
Omit, substitute letters, parts of words, words on a line
ex.Painting ->thing
Looking ->king
What is neglect dysgraphia?
Write on Right side of page
Letter perseverations
What is hemispatial neglect?
Why dont you get right sided neglect?
results from brain injury to right cerebral hemisphere resulting in loss of left hand side of space.
-becuase you have redudant processing of the right space by both the left and right cerebral hemispheres.
What is aprosodia and how is RHD associated with it?
- Production: flat, monotone speech, rate sounds fast
- RHD onts have problems with Comprehension: problems interpreting prosody
RHD possibly effects (blank) prosody more than linguistic prosody
emotional
People with RHD have affective disorders and prosody disorders… what does emotional speech production look like? What doe emotional comprehension look like?
-emotional and nonverbal communication is altered.
Production
- Use fewer emotionally-charged words
- Reduced facial expressions
- Reduced animation
- Flat affect – reduced animation, reduced prosody/intonation
Comprehension
-Misinterpretation of emotional cues (e.g., facial expression, body language, intonation)
What are the themes in RHD communication disorders?
- pragmatics
- multiple meanings, distantly related meaning
- using context
