Aphasia Flashcards
causes of aphasia
- stroke
- TBI
- infections (meningitis)
- tumors
- neurotoxicity (drugs, chemicals)
most common cause of aphasia
stroke
stroke cause
insufficient blood flow to the brain
brain receives ?% of cardiac output and ?% of O2
15% cardiac output
20& O2
lack of blood flow after ? seconds leads to dysfunction
8-10 seconds
lack of blood flow after ? minutes leads to irreversable damage
5 minutes
types of stroke
- ischemic
- hemorrhagic
ischemic stroke
blockage (clot, thrombus, or embolism)
hemorrhagic stroke
rupture (aneurysm)
transient ischemic attack (TIA)
- mini stroke
- brief, lasts only a few minutes
- no permanent damage
FAST
- face
- arms
- speech
- time
TBI cause
- falls
- accidents
- attacks
TBIs can cause what injury types
- focal injury
- diffuse injury
focal injury (TBI)
- caused by a hit
- brain bruise or bleed
- injury to one, specific area
diffuse injury (TBI)
- caused by a car accident
- brain moves and rotates inside the skull
- tearing of axons in the brain
infections (TBI)
- encephalitis (inflammation caused by an infection or autoimmune response)
- injury is typically more diffuse
tumors (TBI)
- typically more focal (area of difficulty is in line with the area of the tumor)
- with metastasis (spread) there can be more area affected
what types of damage can occur in a TBI
- primary injuries
- secondary injuries
primary injuries (TBI)
- localized
- tissue necrosis and apoptosis (cell death) occur in response to a clot, hemorrhage, or hit
- in stroke there is a core area where cell death has occurred and the ischemic penumbra
ischemic penumbra meaning
region around the damaged area that is at risk of dying but can be salvaged with timely treatment and restoring blood-flow
secondary injuries (TBI)
- diffuse, can be acute and chronic
- linked to neurodegenerative disease
ABI associated communication disorders
- aphasia
- apraxia of speech
- dysarthria
- dysphonia
- cognitive communication disorders
- pragmatic/social communication disorders
what is A-FROM
- Living with Aphasia - A Framework for Outcome Measurement
- adaptation of the WHO’s ICF
- provides a framework for thinking about aphasia
- assess and treat all parts of aphasia
what is recovery in aphasia
- many understandings
- guided by A-FROM, recovery should include a focus on impairment, participation, and quality of life
language includes
- concepts/semantic knowledge (red, juicy)
- phonology (apple v. grapple)
- vocabulary (apple)
- morphology (apple-s)
- syntax (I ate the apple.)
- pragmatics (He’s a bad apple)
characteristics of aphasia
- ranges from mild to severe
- affect any language modality (speaking, writing, reading)
- heterogeneous
- can have fully intact cognition (insight, attention, memory, problem solving)
- can co-occur with other communication disorders (dysarthria, apraxia)
- can co-occur with motor, emotional, sensory difficulties that can impact communication and therapy
motor changes in aphasia
- weakness (hemiparesis, paralysis)
- postural stability and head control
sensory changes in aphasia
- deafness
- visual changes
- hypothesia (reduced feeling)
- pain
- agnosia
cognitive changes in aphasia
- reduced insight
- fatigue
- memory
- attention
- executive function
- orientation
- arousal levels
- awareness
emotional changes in aphasia
- depression
- agitation
- anxiety
- lability (emotional switching)
semantic paraphasia definition
- a word that is conceptually/meaningfully related to the target
- fork and knife
phonemic paraphasia definition
- a word that is phonologically similar to the target
- fork and cork
anomia definition
difficulty naming
word finding definition
- difficulty finding the particular word
- pauses, filler words/phrases, circumlocution
neologism definition
- making new words (no phonemic or semantic connection)
- mation
circumlocution definition
- talking about a word
- mango = the sweet yellow fruit
jargon definition
- output which is not comprehensible to a listener (can be semantic)
- the dinner platomin pice
agrammatism definition
- difficulty with grammatical morphemes (free or bound), word order
- tomorrow, I walked shop to
telegrammatic definition
- a term to describe halting output with omission of free or bound morphemes
- walk shop
perseveration definition
- an unintentional production of a unit of information that has been previously produced or head
- can be continuous, stuck-in-set, or recurrent
- can operate at different levels (word, syntactic, etc.(
- wa wa walk walk walk
aphasia classifications
- dichotomous
- anatomical
- symptom-based
dichotomous aphasia classification
- receptive (understanding) versus expressive (output)
- fluent versus non-fluent
anatomical aphasia classification
- Broca’s
- Wernicke’s
- conduction
symptom-based aphasia classification
- anomic
- global
receptive language and aphasia classifications associated with it
- affecting understanding or input (listening, reading)
- global, wernicke’s, transcortical sensory
expressive language and aphasia classifications associated with it
- affecting output (talking, writing)
- conduction, transcortical motor, anomic, broca’s, global
pros and cons of associating receptive and expressive language with specific aphasia classifications
pros:
- provides brief description of primary nature of difficulty
cons:
- doesn’t tell us anything about what is actually affected (semantics, syntax)
- doesn’t tell us about level of ability (word level)
- heterogeneous
fluent aphasia and aphasia classifications associated with it
- able to produce fluent speech, grammar relatively intact
- conduction, anomic, transcortical sensory, wernicke’s
non-fluent aphasia and aphasia classifications associated with it
- output halting and effortful, grammar impacted, content words might be preserved
- broca’s, transcortical motor, global
pros and cons of associating fluent and non-fluent aphasia with specific aphasia classifications
pros:
- non-specific description of primary nature of difficulty
cons:
- doesn’t tell us what is affected or level of ability
- doesn’t tell us about language modality affected
- heterogeneous
boston classification system
use language profiles and localization to classify into classic syndromes
pros and cons of boston classification system
- pros: more specific, slightly more homogeneous
- cons: doesn’t inform therapy
aphasia syndromes
- Broca’s aphasia
- Wernicke’s aphasia
- Conduction aphasia
- Global aphasia
- transcortical sensory aphasia
- transcortical motor aphasia
Broca’s aphasia
- left inferior frontal lobe (Broca’s area)
- non-fluent
- lack of grammatical structure and content
- comprehension stronger than expression
- words produced contextually correct
- ex: “want coffee”
Wernicke’s aphasia
- posterior superior temporal gyrus (Wernicke’s area)
- impaired understanding with fluent speech
- syntax (grammat) preserved but full of paraphasias (word errors)
- ex: “I walked the dog in the poll under the saw.”
Conduction aphasia
- arcuate fasciculus damage
- fluent
- cannot repeat, better spontaneous speech
- generally good comprehension
- phonological issues
- ex: “Where is my hat”, correct
What’s this? (hat) “bat, bat, mat, hat”, wrong (cannot perceive difference)
Global aphasia
- large lesion in frontal/parietal/temporal lobe
- severe aphasia
- involves expression and comprehension in all modalities
- little output except automatic phrases
- severe comprehension difficulties
Transcortical sensory aphasia
- associated with infarcts of posterior cerebral artery
- fluent with normal repetition
- speech filled with paraphasias and sometimes echolalia
- impaired auditory comprehension
- ex: can repeat a long sentence, cannot understand it
Transcortical motor aphasia
- lesions of left supplementary motor cortex (initiation)
- Broca’s aphasia can evolve to transcortical during recovery
- non-fluent
- similar to Broca’s however able to repeat (repeat > spontaneous speech)
- good comprehension
- word finding difficulties and tip of tongue phenomenom characteristic
full ability profile is built on:
- theory based on area of infarct
- discrete impairment-based assessment results (psychometric testing)
- information on functional ability in context
how are models useful
- conceptualize abstract, complex, and confusing processes
- inform specific targets
Cognitive Neuropsychological Model of Language Processing
- cognitive neuropsychology aims to understand how the brain’s structure and function relates to psychological processes (language, memory)
- describes word level only (not sentences)
- helps identify highly specific therapy targets
Garrett’s Model of Speech Production
- can hear a word and then say it (repeat) without knowing the meaning
- can read and then write a word without knowing the meaning
Garrett’s Model of Sentence Production
- conceptual level: message
- formulation level: functional, positional
- formulation and articulation level: phonetic and articulatory
conceptual level: message (Garrett’s Model of Sentence Production)
- objective and subjective
- ideas about people, places, and things
formulation level: functional (Garrett’s Model of Sentence Production)
- content words: lexical-semantic concepts (word meanings) are selected to represent the message
- verb, noun, adjective: lexical-semantic concepts are assigned syntactic functions
- predicate argument structure (PAS) is created, meaning only words not arranged yet
formulation level: positional (Garrett’s Model of Sentence Production)
- word selected at the functional level are slotted into order (syntactic form)
- retrieval of lexical phonological representations (i.e. k - a - t = cat)
formulation and articulation level: phonetic and articulatory (Garrett’s Model of Sentence Production)
phonetic
- motor planning and programming
- plan: structure specific (tongue)
- program: muscle specific (genioglossus)
articulation
- execution and adaptation
- completing movement and changing it to suit the environment
- involves pyramidal system, cranial nerves, basal ganglia, and cerebellum
how might difficulties with sentence production present in aphasia? (Garrett’s Model of Sentence Production)
sentence comprehension model
- psycholinguistics steps in reverse to decode messages
- complex networks
discourse definition
- connected language, beyond the sentence level used for a specific function
- does not have a strict set of rules
- has a communicative function (commenting, directing, attention, requesting, showing)
- involves complex interplay between cognitive and linguistic elements
primary progressive aphasia (PPA)
- neurodegenerative disorder (Parkinsons, MS, dementia)
- gradual emergence of language difficulties
- complete diagnosis requires language difficulties for >2 years
- cognitive decline emerges as the disease progresses
- onset of symptoms between 50 and 70
PPA causes
- degeneration of the frontotemporal brain region (usually left)
- often have a build up of protein tau and TDP-43
PPA types
- logopenic
- non-fluent agrammatic
- semantic
logopenic PPA
- impaired word finding, naming, repetition
- left temporoparietal region affected
- ex: telling story about their dog, cannot retrieve the word “ball”
non-fluent agrammatic PPA
- non-fluent, effortful speech
- lacking in grammatical structures
- inferior frontal gyrus and premotor regions affected
- ex: “Restaurant…dinner…pasta…good”
semantic PPA
- impaired object knowledge
- anomia
- comprehension difficulties with single words (lacking context to take clues from)
- atrophy in anterior parts of temporal lobe
- ex: show them an apple, doesn’t recognize it and can’t name it. person wants an apple - asks “can I have an apple?”
childhood aphasia considerations
- must be considered in a developmental context
- more varied presentation
- more plasticity
what does observation include
- extended factual notes (after observation, note what is seen, heard, smelled in detail and factually)
- interpretative notes (interpret notes as an SLT)
- personal notes (record your thoughts and feelings)
