Aphasia Flashcards
<p>a disorder of linguistic processing characterized by a disturbance in the comprehension and formation of language caused by dysfunction in specific brain regions.
</p>
<p>aphasia</p>
<p>multiple aspects of language are comprised of: 3</p>
<p>Syntax – grammatic structure of sentences
Lexicon – collection of words that denote meanings
Morphology of words – combination of individual speech sounds (phonemes) into the smallest meaningful units of words (morphemes).
</p>
<p>1. Anomia is: \_\_\_\_\_\_\_
2. Retrieval of partial information (first letter or sound, word length) can activate phonologically similar words for output. Ex. “kack” for jack
3. incorrect word substituted for an intended or target word
4. substitution, addition, or rearrangement of speech sounds so that the error can be identified as sounding like the target. (more than half of the intended word is preserved.)
5. Activation of semantically related words Ex. “horse” for cow
6. ex. phonemic error on semantic paraphasia (‘miskroscope’ for binoculars)
7. nonsense word-like utterances
</p>
<p>1. impaired word retrieval
2. phonemic paraphasias
3. Paraphasias
4. Phonemic/phonolgic
5. (semantic paraphasia).
6. Mixed error
7. Neologistic paraphasia
Paraphasias - breakdown at a stage of word-retrieval process
Phonemic paraphasia - rearrangement of speech sounds so that the error can be identified as sounding like the target.
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<p>1. lengthy, fluently articulated utterance which makes little or no sense to the listener.
2. string of neologistic paraphasias.
3. consists of unrelated semantic content words.
</p>
<p>1. Jargon
2. neologstic jargon
3. Semantic jargon </p>
<p>1. inability to construct grammatically correct sentences.
2. content words (nouns and verbs) produced, but function words (articles, verb auxiliaries, and prepositions) omitted Ex. “Mother, father...making dogs,...hot dogs; a boy, no two boys...and baseball</p>
<p>1. Agrammatism
2. Telegraphic speech-- </p>
<p>On phonological fluency testing: how do you determine # of words a patient should get?</p>
<p># of years of education = # of words they should be able to get</p>
<p>1. use of an unnecessary large number of words in substitution of the un-retrieved target word. Ex.
2. ex. “noculars’ for binoculars
3. ex. “thunder time” for scissors
4. frequently used over-learned word or phrase
5. related to a recently used word. Ex. “scissors” – “sistle” for whistle
</p>
<p>1. circumlocution - using 5-6 words to describe the 1 word they are unable to bring up
2. part word
3. Unrelated real words
4. Stereotypy
5. Perseveration ex. phonemic paraphasia</p>
<p>1. Broca’s area – lies at the \_\_\_\_\_\_\_\_ of the language network – provides a system for transforming neural word representations into corresponding articulatory sequences.
2. Broca’s area influences
3. Wernicke’s area- lies at the \_\_\_\_of the language network – provides an entry point for the conversion of auditory sequences into neural word representations</p>
<p>1. syntactic-articulatory pole
2. how to order and utter words in the most meaning-appropriate form.
3. semantic-lexical pole </p>
<p>Describe the Naming : schematic representation of distinct cognitive processes underlying naming</p>
<p>1. semantics - see photo of horse
2. amodal general and personal knowledge (say a string of things which remind person of picture - cowboys ride horses, horses can wear saddles, eat hay, like apples, native to US, race, can bite, are large, not eaten in the us, my horse is palomino, John's horse kicks
3. Lexical-semantics (defining features) - mammal, hooves, herbivore, gallops, mane
4. Modality independent lexical access (lemma) Brings above words together
5. Phonological & Orthographic word forms (\h\, \or\, \s\, vs h-o-r-s-e
6. Motor output "horse"</p>
<p>Naming of a visual item:
Step I:
Impairment:</p>
<p>Step 1 – visual recognition
-match to a stored information about the familiar item.
Impairment – apperceptive visual agnosia (can see but not recognize)
</p>
<p>Alzheimers patients have difficulties with \_\_\_\_\_\_\_\_\_ at first</p>
<p>semantics</p>
<p>Step II of naming a visual item:
2 parts
Impairments?</p>
<p>Step 2 Semantics: access meaning
A. Conceptual knowledge re: use and associations
----Impaired conceptual knowledge – inappropriate use of objects (ex. semantic variant of primary progressive aphasia, HSV encephalitis – damage to bilateral anterior temporal lobes)
B. Lexical semantics (specific defining features)
----Incorrect labeling of an item (point to a cow when asked to point to a horse)
- make semantic paraphasic errors
</p>
<p>Naming – Step 3
Impairments?</p>
<p>– Lexical Representation: independent of output modality (i.e., oral or written).
Impairments at this level – ANOMIA
(impaired word retrieval)
- May have partial retrieval (ex. first letter or sound, certain characteristics)
- leading to phonemic or semantic paraphasias
</p>
<p>Naming of a visual item:
Step 4
Impairment?</p>
<p>Lexical representation converted to modality-specific form (phonological representation for spoken word) </p>
<p>Naming of a visual item
Step 5
(two step process)</p>
<p>Phonologic lexical representation must be spoken aloud (motor output)
1. Must maintain the phonologic representation (correct sequence of speech sounds for pronunciation)
- Errors result in substitutions, insertions, and transpositions of phonemes (speech sounds)
2. Motor output – articulation
- requires motor planning/programming of complex movement of lips, tongue, palate, vocal folds, respiratory muscles (speech apraxia)
-Implementation of these movement (dysarthria – motor speech impairment due to impaired strength, range, rate, or timing of movements)
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<p>\_\_\_\_\_\_ is impaired motor planning. AWARENESS OF ERRORS (SO REPEATED ATTEMPTS), MORE IMPAIRMENT WITH POLYSYLLABIC WORDS.
</p>
<p>Speech apraxia</p>
Model of Sentence Production (Garrett)
Series of Cascaded stages:
1. ____ level
2. ___ level
3. ___ level
4. ____ level
- Message level - formulate a concept
- Functional Level: Select particular syntactic structure and modality-independent content words (lemmas)
- Positional Level: Build sentence frame that specifies word order, phonologic lexical representation/words
- Sound Level: Speak – 1)maintain phonologic representations and relationships 2) motor output (articulation)
Model of Sentence production (Garrett)
Series of cascaded stages:
1. Message level - IMPAIRED: ERRORS?
2. Functional Level
3. Positional level
4. Sound level
Impairment at message level – jargon, neologisms
(semantic variant of PPA, Wernicke’s aphasia, transcortical sensory aphasia)
Model of Sentence production (Garrett)
Series of cascaded stages:
1. Message level
2. Functional Level - IMPAIRED - ERRORS?
3. Positional level
4. Sound level
Impairment at functional level of sentence production
-agrammatic speech with incorrect or content words.
Often associated with anomia and working memory deficits
Model of Sentence production (Garrett)
Series of cascaded stages:
1. Message level
2. Functional Level
3. Positional level - IMPAIRED - ERRORS?
4. Sound level
Impairment at POSTIONAL LEVEL of sentence production
Agrammatic spoken output but correct content, but impaired word order or missing determiners, etc.
EX. left posterior, inferior frontal cortex lesions (agrammatic/non-fluent variant of PPA, Broca’s aphasia
Aphasia syndromes:
- Paul Broca (1862)
- Carl Wernicke (1873):
- Lichtheim (1885):
Paul Broca (1862): Damage to dominant (typcially left) posterior frontal lobe – loss of spoken language (expressive aphasia)
Carl Wernicke (1873): Left temporal lobe damage – difficulty understanding speech (receptive aphasia)
Lichtheim (1885): classic description of aphasic syndromes
Aphasia syndromes:
Name: Broca’s aphasia
Symptoms:
Deficit:
Lesion:
- Decreased speech production; sparse, halting speech, missing function words, bound morphemes
- Impaired speech planning and production
- Posterior aspects of 3rd frontal convolution
Aphasia syndromes:
Name: Wernicke’s aphasia
Symptoms:
Deficit:
Lesion:
- Decreased auditory comprehension, fluent speech, paraphasia, poor repetition, and naming
- impaired representation of sound structure of words
- Posterior half of the first temporal gyrus
Aphasia syndromes:
Name: Pure Motor Speech Disorder
Symptoms:
Deficit:
Lesion:
- Disturbance of articulation, apraxia of speech, dysarthria, aphemia
- Disturbance of articulation
- Outflow from motor cortex
Aphasia syndromes:
Name: Pure word deafness
Symptoms:
Deficit:
Lesion:
- Disturbance of spoken word comprehension, repetition also impaired
- Failure to access spoken words
- Input tracts from auditory cortex to Wernickes area
Aphasia syndromes:
Name: Transcortical Motor aphasia
Symptoms:
Deficit:
Lesion:
- Disturbed spontaneous speech similar to BA; relatively preserved repetition, comprehension
- Disconnection between conceptual word/sentence representation and motor speech production
- Deep white matter tracts connecting parietal and temporal lobes
Aphasia syndromes:
Name: Conduction aphasia
Symptoms:
Deficit:
Lesion:
- Disturbances of repetition and spontaneous speech, phonemic paraphasia
- Disconnection between sound patterns and speech production mechanisms
- Arcuate fasciculus
Aphasia syndromes:
Name: Transcortical sensory aphasia
Symptoms:
Deficit:
Lesion:
- disturbance in single word comprehension with relatively intact repetition
- disturbed actvation of word meanings despite normal recognition of auditorily presented words
- white matter tracts connecting parietal lobe and temporal lobe
Aphasia syndromes:
Name: Anomic Aphasia
Symptoms:
Deficit:
Lesion:
- Decreased single word production, marked for common nouns; repetition and comprehension intact
- Impaired storage or access to lexical entries
- Infererior parietal lobe or connections within perisylvian language areas
Aphasia syndromes:
Name: Global aphasia
Symptoms:
Deficit:
Lesion:
- Decreased performance in all language functions
- Disruption of all/most language components
- Multiple perisyvian language components
Name the 3 fluent aphasias
Name the 4 nonfluent aphasias
Fluent Aphasias
Wernicke’s
Conduction
Anomic
Nonfluent Aphasias:
Broca’s
Transcortical motor
Isolation
Global
What are the 6 components of language assessment?
- Spontaneous Speech
- Comprehension of speech -following commands (level of complexity)
-midline
-lateralized
-crossover
-multi-step - Naming
- Repetition
- Reading
- Writing
Besides 6 components of language assessment, what are 5 secondary components?
What also must be checked?
-Inflections
-Intonations
-Tempo
-Rhythm
-Melody
Body language
Name the aphasia:
Effortful speech
Broken, unmusical, telegraphic style
Agrammatic speech
Decreased word output (~
Broca’s (expressive) aphasia
In brocas aphasia _____ is better than _____.
_____ reading
Writing:
Comprehension better than expression (but mild to moderate deficits)
Poor reading
Writing: spelling errors, letter omissions, poor formation of letters
Associated: Buccofacial apraxia, right hemiparesis
Which aphasia?
Fluent, nonsensical (meaningless) speech
Rapid, may be incessant
Intact articulation, grammar, and prosody
Paraphasias, neologisms, jargon
Severe auditory comprehension impairment
Naming deficits (mild to severe)
Impaired repetition
Poor reading comprehension
Copious, errorful writing
May be unaware of deficit (lack of insight)
Paranoia, fear
Can perceive body language
Wernicke’s (receptive) aphasia
Which aphasia?
All modality of language severely impaired
Severe deficits in expression of speech
Severe deficits in auditory comprehension
Marked naming difficulty
Repetition, reading, and writing impaired
Impaired gestural skills
Gradations of severity exist
Involve (typically) large lesions
Poorest prognosis
Global aphasia
Which aphasia?
Markedly impaired repetition
With phonemic paraphasias
Mild to moderate comprehension difficulty
Naming difficulties
Recognition of errors with unsuccessful efforts at self-corrections
Fluent speech
Near-normal syntax and morphology
But hesitations and word-finding pauses
Variable reading skills
Conduction aphasia
Which aphasia?
Intact repetition
Impaired expression/fluency
Good comprehension
Poor naming
Agrammatic, telegraphic speech
Paraphasic errors
Transcortical motor
Which aphasia?
Intact repetition
Fluent speech
Impaired comprehension
Poor naming
Semantic associations poor
Transcortical Sensory
Initial approach to aphasia rehab: 4
- Assessment
2 .Classification of deficits - Point level of impairment
- Utilize retained functions to create goals for functional speech
Approach to treatment in aphasia rehab:
- Find effective ways to communicate
- Importance of education: patient and family regarding deficits, effective communication methods. Family education: allow patient to speak/practice
- Task specific
- Intensity, repetitive practice
- Practice makes perfect
- Sports analogy on practice and recruitment/neuroplasticity
When treating aphasia patients,
It is important to promote:
While avoiding:
- Promote positive reinforcement
Patient - expectations
Provider
Family
2 Avoid Negative reinforcement
Patient - expectations
Three tactics patient’s can use during aphasia therapy
Self correction
Reading aloud
Singing, melody
To be successful in treating aphasia, must remove barriers to recovery/detriments to positive neuroplasticity:
4
depression, pain, sleep hygiene, overall health
What are methods to promote neurolastic changes in aphasia patients?
- Aerobic Exercise Macko, et al: treadmill training Increased production of neurotrophic growth factors
- Melodic intonation therapy
3, Transcranial magnetic stimulation
What are ways to generate prognosis for aphasia patients? 5
MRI indicators (stroke type, stroke burden)
Motivation
Functional capacity
Overall physical health
Neurological health
