Aphasia Flashcards

1
Q

<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>

A

<p>aphasia</p>

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2
Q

<p>multiple aspects of language are comprised of: 3</p>

A

<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>

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3
Q

<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>

A

<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.
</p>

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4
Q

<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>

A

<p>1. Jargon
2. neologstic jargon
3. Semantic jargon </p>

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5
Q

<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>

A

<p>1. Agrammatism
2. Telegraphic speech-- </p>

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6
Q

<p>On phonological fluency testing: how do you determine # of words a patient should get?</p>

A

<p># of years of education = # of words they should be able to get</p>

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7
Q

<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>

A

<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>

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8
Q

<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>

A

<p>1. syntactic-articulatory pole
2. how to order and utter words in the most meaning-appropriate form.
3. semantic-lexical pole </p>

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9
Q

<p>Describe the Naming : schematic representation of distinct cognitive processes underlying naming</p>

A

<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>

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10
Q

<p>Naming of a visual item:
Step I:
Impairment:</p>

A

<p>Step 1 – visual recognition
-match to a stored information about the familiar item.


Impairment – apperceptive visual agnosia (can see but not recognize)
</p>

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11
Q

<p>Alzheimers patients have difficulties with \_\_\_\_\_\_\_\_\_ at first</p>

A

<p>semantics</p>

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12
Q

<p>Step II of naming a visual item:
2 parts

Impairments?</p>

A

<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>

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13
Q

<p>Naming – Step 3
Impairments?</p>

A

<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>

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14
Q

<p>Naming of a visual item:
Step 4
Impairment?</p>

A

<p>Lexical representation converted to modality-specific form (phonological representation for spoken word) </p>

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15
Q

<p>Naming of a visual item
Step 5
(two step process)</p>

A

<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)
</p>

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16
Q

<p>\_\_\_\_\_\_ is impaired motor planning. AWARENESS OF ERRORS (SO REPEATED ATTEMPTS), MORE IMPAIRMENT WITH POLYSYLLABIC WORDS.
</p>

A

<p>Speech apraxia</p>

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17
Q

Model of Sentence Production (Garrett)
Series of Cascaded stages:
1. ____ level
2. ___ level
3. ___ level
4. ____ level

A
  1. Message level - formulate a concept
  2. Functional Level: Select particular syntactic structure and modality-independent content words (lemmas)
  3. Positional Level: Build sentence frame that specifies word order, phonologic lexical representation/words
  4. Sound Level: Speak – 1)maintain phonologic representations and relationships 2) motor output (articulation)
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18
Q

Model of Sentence production (Garrett)
Series of cascaded stages:
1. Message level - IMPAIRED: ERRORS?
2. Functional Level
3. Positional level
4. Sound level

A

Impairment at message level – jargon, neologisms
(semantic variant of PPA, Wernicke’s aphasia, transcortical sensory aphasia)

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19
Q

Model of Sentence production (Garrett)
Series of cascaded stages:
1. Message level
2. Functional Level - IMPAIRED - ERRORS?
3. Positional level
4. Sound level

A

Impairment at functional level of sentence production
-agrammatic speech with incorrect or content words.
Often associated with anomia and working memory deficits

20
Q

Model of Sentence production (Garrett)
Series of cascaded stages:
1. Message level
2. Functional Level
3. Positional level - IMPAIRED - ERRORS?
4. Sound level

A

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

21
Q

Aphasia syndromes:
- Paul Broca (1862)
- Carl Wernicke (1873):
- Lichtheim (1885):

A

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

22
Q

Aphasia syndromes:
Name: Broca’s aphasia
Symptoms:
Deficit:
Lesion:

A
  1. Decreased speech production; sparse, halting speech, missing function words, bound morphemes
  2. Impaired speech planning and production
  3. Posterior aspects of 3rd frontal convolution
23
Q

Aphasia syndromes:
Name: Wernicke’s aphasia
Symptoms:
Deficit:
Lesion:

A
  1. Decreased auditory comprehension, fluent speech, paraphasia, poor repetition, and naming
  2. impaired representation of sound structure of words
  3. Posterior half of the first temporal gyrus
24
Q

Aphasia syndromes:
Name: Pure Motor Speech Disorder
Symptoms:
Deficit:
Lesion:

A
  1. Disturbance of articulation, apraxia of speech, dysarthria, aphemia
  2. Disturbance of articulation
  3. Outflow from motor cortex
25
Aphasia syndromes: Name: Pure word deafness Symptoms: Deficit: Lesion:
1. Disturbance of spoken word comprehension, repetition also impaired 2. Failure to access spoken words 3. Input tracts from auditory cortex to Wernickes area
26
Aphasia syndromes: Name: Transcortical Motor aphasia Symptoms: Deficit: Lesion:
1. Disturbed spontaneous speech similar to BA; relatively preserved repetition, comprehension 2. Disconnection between conceptual word/sentence representation and motor speech production 3. Deep white matter tracts connecting parietal and temporal lobes
27
Aphasia syndromes: Name: Conduction aphasia Symptoms: Deficit: Lesion:
1. Disturbances of repetition and spontaneous speech, phonemic paraphasia 2. Disconnection between sound patterns and speech production mechanisms 3. Arcuate fasciculus
28
Aphasia syndromes: Name: Transcortical sensory aphasia Symptoms: Deficit: Lesion:
1. disturbance in single word comprehension with relatively intact repetition 2. disturbed actvation of word meanings despite normal recognition of auditorily presented words 3. white matter tracts connecting parietal lobe and temporal lobe
29
Aphasia syndromes: Name: Anomic Aphasia Symptoms: Deficit: Lesion:
1. Decreased single word production, marked for common nouns; repetition and comprehension intact 2. Impaired storage or access to lexical entries 3. Infererior parietal lobe or connections within perisylvian language areas
30
Aphasia syndromes: Name: Global aphasia Symptoms: Deficit: Lesion:
1. Decreased performance in all language functions 2. Disruption of all/most language components 3. Multiple perisyvian language components
31
Name the 3 fluent aphasias Name the 4 nonfluent aphasias
Fluent Aphasias Wernicke’s Conduction Anomic Nonfluent Aphasias: Broca’s Transcortical motor Isolation Global
32
What are the 6 components of language assessment?
1. Spontaneous Speech 2. Comprehension of speech -following commands (level of complexity) -midline -lateralized -crossover -multi-step 3. Naming 4. Repetition 5. Reading 6. Writing
33
Besides 6 components of language assessment, what are 5 secondary components? What also must be checked?
-Inflections -Intonations -Tempo -Rhythm -Melody Body language
34
Name the aphasia: Effortful speech Broken, unmusical, telegraphic style Agrammatic speech Decreased word output (~
Broca's (expressive) aphasia
35
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
36
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
37
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
38
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
39
Which aphasia? Intact repetition Impaired expression/fluency Good comprehension Poor naming Agrammatic, telegraphic speech Paraphasic errors
Transcortical motor
40
Which aphasia? Intact repetition Fluent speech Impaired comprehension Poor naming Semantic associations poor
Transcortical Sensory
41
Initial approach to aphasia rehab: 4
1. Assessment 2 .Classification of deficits 3. Point level of impairment 4. Utilize retained functions to create goals for functional speech
42
Approach to treatment in aphasia rehab:
1. Find effective ways to communicate 2. Importance of education: patient and family regarding deficits, effective communication methods. Family education: allow patient to speak/practice 3. Task specific 4. Intensity, repetitive practice - Practice makes perfect - Sports analogy on practice and recruitment/neuroplasticity
43
When treating aphasia patients, It is important to promote: While avoiding:
1. Promote positive reinforcement Patient - expectations Provider Family 2 Avoid Negative reinforcement Patient - expectations
44
Three tactics patient's can use during aphasia therapy
Self correction Reading aloud Singing, melody
45
To be successful in treating aphasia, must remove barriers to recovery/detriments to positive neuroplasticity: 4
depression, pain, sleep hygiene, overall health
46
What are methods to promote neurolastic changes in aphasia patients?
1. Aerobic Exercise Macko, et al: treadmill training Increased production of neurotrophic growth factors 2. Melodic intonation therapy 3, Transcranial magnetic stimulation
47
What are ways to generate prognosis for aphasia patients? 5
MRI indicators (stroke type, stroke burden) Motivation Functional capacity Overall physical health Neurological health