Aphasia

Question 1

During group therapy, having one or more members who are positive role models of recovery can strengthen which of the following motivational factors. All of the choices are true to some degree but one choice is most directly affected by role models.

Select one:

a. They can help to support the need for autonomy in other members
b. They can help to support the need for relatedness in other members
c. They can promote hope in other members
d. They can help build self-efficacy in other members

Answer 1

d. They can help build self-efficacy in other members

Question 2

You have a patient who suffered RHD and has left visuospatial neglect. Your CFY supervisor recommends that you focus on compensatory techniques during visual scanning tasks with these patients. She also stated that this is usually enough to improve a patient’s functional performance on a variety of real world tasks. Which of the following statements is consistent with the Cicerone et al (2011) review?

Select one:

a. The supervisor is right. Simple visual scanning tasks are effective and often generalize to other functional tasks
b. Simple visual scanning tasks are not effective - you need to practice solely on more complex, real-world tasks.
c. The supervisor is right. Simple visual scanning tasks have been shown to generalize but better generalization is seen if more complex visuospatial tasks are included in treatment.
d. Compensatory approaches, are not appropriate since there are different restorative approaches to treatment the work better.

Answer 2

c. The supervisor is right. Simple visual scanning tasks have been shown to generalize but better generalization is seen if more complex visuospatial tasks are included in treatment.

Question 3

Based on the following results from testing, which of the following naming treatments makes the most sense for your client with aphasia?

30/60 correct on the Boston Naming Test
Errors were a combination of “don’t know” responses and semantic paraphasias
Most errors were on uncommon vs common objects
Repetition was moderately impaired. More errors on low imageability vs high imageability words. There was no significant frequency or length effect.
Performance on the Pyramids and Palm Trees Test was impaired.
Select one:
a. Phonological Component Analysis by Leonard, Rochon, & Laird, 2008
b. Semantic Feature Analysis by Boyle and colleagues
c. Melodic Intonation Therapy by Sparks and colleagues
d. None of the above
Feedback

Answer 3

b. Semantic Feature Analysis by Boyle and colleagues

Question 4

Your post-stroke patient has the following findings after testing. Which focus of treatment is the most rational?

No significant difficulty matching lower to upper case letters
No significant difference in the ability to read regularly vs irregularly spelled words
Much greater difficulty reading non-words vs real words
No significant imageability or frequency effects
Select one:
a. Treatment should focus on letter identification
b. Treatment should focus on grapheme to phoneme conversion and blending
c. Treatment should focus on whole word identification/comprehension
d. None of the above

Answer 4

b. Treatment should focus on grapheme to phoneme conversion and blending

Question 5

Your post-stroke patient has the following findings after testing. Which focus of treatment is the most rational?

Significant difficulty matching lower to upper case letters
Equal difficulty reading regularly vs irregularly spelled words
Equal difficulty reading non-words vs real words
No significant imageability or frequency effects
Select one:
a. Treatment should focus on letter identification
b. Treatment should focus on grapheme to phoneme conversion and blending
c. Treatment should focus on whole word identification/comprehension
d. None of the above

Answer 5

a. Treatment should focus on letter identification

Question 6

During an assessment of a person with aphasia, you find a striking difference between real word and non-word repetition (non-word is much worse). Based on this finding, what factor should you pay particular attention to when choosing words to target during naming treatments.

Select one:

a. length
b. frequency
c. imageability
d. none of the above

Answer 6

A. length

Question 7

You gave the CAT to one of your patients. She did poorly on the spoken word to picture matching task. Most of her errors were choosing phonological distractors. She did not display any phonological errors during naming. You have time to give only one extra test/subtest after completing the CAT. Given the results mentioned above, which task would you give to confirm the kind of processing difficulty suggested by your patient’s performance.

Select one:

a. Pyramids and Palm Trees test
b. Repetition of real words vs. nonwords
c. Repetition of words of increasing length
d. Auditory minimal pairs discrimination task
e. None of the above are appropriate

Answer 7

d. Auditory minimal pairs discrimination task

Question 8

You are administering semantic feature analysis training to one of your clients. Which of the following statements is most accurate about what to expect from this treatment approach?

Select one:

a. The patient will improve on trained items but the treatment is not designed to encourage generalization to untreated items.
b. The patient will improve on trained items and show some generalization to untrained words. Generalization is expected occur on words both within and outside the category being trained.
c. The patient will improve on trained items and show some generalization to untrained words. Generalization will tend to occur on words within the category being trained.
d. None of the above

Answer 8

c. The patient will improve on trained items and show some generalization to untrained words. Generalization will tend to occur on words within the category being trained.

Question 9

Your patient is 8 years post-stroke. Her main goal is to improve her reading so she can participate in a book club. You only have time to administer one of the following assessments. Which one would you administer?

Select one:

a. Reading subtests from the PALPA
b. Western Aphasia Battery
c. Cognitive Linguistic Quick Test

Answer 9

a. Reading subtests from the PALPA

Question 10

Monopitch and monoloudness in persons with dysarthria may not represent an underlying aprosodia.

Select one:
True
False

Answer 10

True

Question 11

You receive a consult for a patient. The consult says: 67 y/o female s/p L MCA CVA. MRI shows an inferior posterior frontal lobe lesion. What type of aphasia are they most likely to have?

Select one:

a. Transcortical motor
b. Broca’s
c. Conduction
d. Wernicke’s
e. None of the above

Answer 11

b. Broca’s

Question 12

What is the advantage of the most recent version of the BDAE vs the most recent version of the WAB?

Select one:

a. The BDAE is used in research more often so it’s easier to compare clinical findings with research findings
b. The BDAE has a shortened form
c. The BDAE provides a more in-depth psycholinguistic assessment if using the extended version
d. None of the above

Answer 12

c. The BDAE provides a more in-depth psycholinguistic assessment if using the extended version

Question 13

You gave the CAT to one of your patients. She did poorly on the spoken word to picture matching task. Most of her errors were choosing phonological distractors. She did not display any phonological errors during naming. You have time to give only one extra test/subtest after completing the CAT. Given the results mentioned above, which task would you give to confirm the kind of processing difficulty suggested by your patient’s performance.

Select one:
a. Pyramids and Palm Trees test
b. Repetition of real words vs. nonwords
c. Repetition of words of increasing length
d. Auditory minimal pairs discrimination task
e. None of the above are appropriate
Feedback

Answer 13

d. Auditory minimal pairs discrimination task

Question 14

You have a patient with severe, global aphasia. This patient did very poorly on the Pyramids and Palm Trees (PPT) test. You want to test single spoken word comprehension but you think the spoken word to picture matching subtest from the CAT will be too difficult for him (the CAT has 4 items to choose from - one close semantic distractor, one distant semantic distractor, a phonological distractor, and an unrelated distractor). Given his performance on the PPT, how would you modify the a spoken word to picture matching task so that your patient is likely to get some right (i.e. which is the best approach)?

Select one:

a. Reduce the array of choice of pictures from 4 to 2
b. Reduce the array of choices from 4 to 2 and make stimuli very different phonologically
c. Reduce the array of choices from 4 to 2 and make the stimuli very different semantically
d. None of the above

Answer 14

c. Reduce the array of choices from 4 to 2 and make the stimuli very different semantically

Question 15

You have a patient who has significant difficulty reading. They are able to write, and they show no overt signs of anomia or other language impairments. When you verbally ask them to tell you what sound different letters make (e.g. What sound does the letter “b” make), they are able to do this. But, when you provide them with a printed letter they can’t tell you what sound it makes. Additionally, they have difficulty matching letters of different case (e.g. matching g to G or r to R). They can copy letters. At what stage of reading are they having difficulty?

Select one:
a. Abstract visual letter identification
b. grapheme to phoneme conversion
c. poor visual acuity
d. none of the above
e. all of the above
Feedback

Answer 15

a. Abstract visual letter identification

Question 16

Based on your understanding of neuroanatomy, where would you expect the lesion to be in question previously?

Select one:

a. Anterior frontal lobe
b. Anterior parietal lobe
c. Anterior temporal lobe
d. Anterior occipital lobe
e. none of the above

Answer 16

d. Anterior occipital lobe

Question 17

A lexical decision making task focuses on assessing..

Select one:

a. speech sound processing
b. lexical recognition
c. lexical meaning
d. none of the above
e. all of the above

Answer 17

b. lexical recognition

Question 18

You have a patient that makes semantic errors across all modalities of language (auditory comprehension, written language, verbal expression) on the CAT. You can give one more test. Which test should you give?

Select one:

a. Philadelphia Naming Test
b. Auditory and written lexical decision making task from the PALPA
c. Repetition task that is controlled for length
d. Pyramids and Palm Trees test
e. None of the above

Answer 18

d. Pyramids and Palm Trees test

Question 19

You’ve received a consult to evaluate a patient. The neurologist has diagnosed the person with Broca’s aphasia. During the interview, the patient sounds as if they may have a Broca’s aphasia. Assuming that the patient does have a Broca’s aphasia, which of the following sentences would you expect them to have the most difficulty understanding?

Select one:

a. The farmer is painted by the policeman
b. The woman is eating an ice-cream
c. She is laughing
d. The policeman paints the old farmer

Answer 19

a. The farmer is painted by the policeman

Question 20

Language impairments in PWA can make assessment of executive function difficult. Which of the following tasks might be appropriate to assess executive function in PWA?

Select one:

a. Design fluency tasks
b. Mazes
c. Trail making tasks
d. None of the above
e. All of the above

Answer 20

e. All of the above

Question 21

What is the benefit of having a test that has parallel versions (e.g. you can give the same test with different stimuli - form a, form b, etc)

Select one:
a. One version of the test may be more appropriate for a patient than another version
b. It is a more objective measure of change over time (e.g. pre and post treatment)
c. It reduces clinician boredom
d. None of the above
Feedback

Answer 21

b. It is a more objective measure of change over time (e.g. pre and post treatment)

Question 22

Some cognitive or language tests include verbal fluency tasks. If you ask a patient to name as many words that begin with a letter (phonemic/letter fluency) and name as many items in a category (semantic/category fluency), they may do poorly for which of the following reasons?

Select one:

a. Anomia
b. Executive dysfunction
c. Self-monitoring deficits
d. None of the above
e. All of the above

Answer 22

e. All of the above

Question 23

Before testing executive functioning, or at least before making a judgment of executive function ability, we should test and understand which of the following cognitive processes?

Select one:

a. Attention
b. Memory
c. Language ability
d. None of the above
e. All of the above

Answer 23

e. All of the above

Question 24

According to social cognitive theory, which factor is strongest when it comes to using group therapy to promote patients’ motivation

Select one:

a. It can increase self-efficacy by allowing patients to observe the successes of others
b. It can increase self-efficacy through verbal encouragement
c. It can increase self-efficacy by reducing social isolation
d. None of the above

Answer 24

a. It can increase self-efficacy by allowing patients to observe the successes of others

Question 25

Autonomous forms of motivation are promoted via…

Select one:

a. supporting the feeling of autonomy
b. supporting the feeling of competence
c. supporting the feeling of relatedness
d. None of the above
e. All of the above

Answer 25

e. All of the above

Question 26

Assessments of drawing ability are usually reserved for patients who have severe verbal expression difficulty.

Select one:
True
False

Answer 26

True

Question 27

You ask your patient what “the squeaky wheel gets the grease” means and the patient says “when you hear your wheels squeak you need to grease them up.” In the context of executive function, this is a sign of impaired generative thinking.

Select one:
True
False

Answer 27

False

Concrete interpretations of proverbs is a sign of difficulty with abstract reasoning and concept formation.

Question 28

If you ask a patient to repeat the following numbers “9 5 4 8 2 7” this is an example of a working memory task

Select one:
True
False

Answer 28

False

A digit span forward task is a test of immediate memory. Working memory tasks require some kind of mental manipulation of the information in memory (e.g. mental math or repeat digit spans backwards).

Question 29

Mr. X is a 61 yo right-handed veteran seen for a speech-language
evaluation. He suffered a stroke in 2000. His primary complaint is word finding difficulty. Mr. X continues to act as a minister in his church but would like to improve his ability to perform a sermon.

EXAM

Administered the Comprehensive Aphasia Test (CAT), which includes subtests
assessing auditory comprehension, reading comprehension, oral reading, writing,
oral and written picture description, naming, and repetition. Nonverbal semantic processing and nonverbal memory were screened.

There was no evidence of dysarthria or apraxia of speech. Prosody,
articulation, resonance, voice, and breath support for speech were all WNL.

Mr. X’s average T-score across CAT subtests was 65.4, placing him in the 94th
percentile of the aphasic distribution. Six of his 8 modality scores were
close to, but below, the normal cutoff.

Mr. X’s poorest performance across subtests was, interestingly, on a nonverbal semantic association task and a nonverbal memory task (testing picture recognition for items presented during the semantic association task). He score slightly below average for aphasic individuals on both tests.

Repetition of words, nonwords, and sentences was without error.
Digit span was 7 forward and 4 backwards, both WNL and in the above average to
superior range for aphasic individuals.

Mr. X’s confrontation naming of objects was characterized by one frank error
(“tent..sand dune” for pyramid) and one self correction (“sh-..ski” for ski) on
24 items. Naming of verbs was poorer at 3/5 correct, with a tendency to give object
names instead of verbs. On a verbal fluency task his performance was within normal limits for semantic/category naming (i.e. 17 animals); his performance was below normal for phonemic/letter fluency as he only named 6 items in one minute. No overt naming strategy was noted during the phonemic verbal fluency task but was observed during the semantic verbal fluency task (i.e. he named animals in clusters by setting → farm animals then zoo animals).

His spoken picture description contained an adequate number of appropriate
content words. There were no frank word finding blocks or paraphasias. Occasional pauses/hesitations of 1-2+ seconds were noted. One mildly inappropriate sentence construction was noted (“His feet are resting up” to describe a man with his feet up on a
coffee table). The range of grammatical structures and grammatical well-
formedness were essentially within normal limits, perhaps with some mild simplification.

Written picture naming, copying, and writing to dictation were done without error. Written picture description was better than spoken picture description. The only error noted was one lack of capitalization for the initial word in a sentence. Sentences were grammatically well formed and included an adequate range of syntactic complexity.

Auditory comprehension performance was within normal limits for matching spoken words to
pictures with four choices. He was 13/15 correct, with some delayed responses, for
matching of written words to pictures. Erred responses were choosing semantically
related foils. Auditory sentence comprehension testing showed inconsistent errors on
reversible sentences, especially those with post-modifying phrases.

Oral reading of words and nonwords was without error. Written sentence comprehension showed no frank errors, but delayed responses for the same types of sentences that gave Mr. X difficulty during auditory testing.

Also, began administration of the CAT disability questionaire, will complete at
next session. X indicated during this portion of the testing that he has the most difficulty when he is required to speak when stressed or under pressure.

Answer 29

Patient X displays to have an Anomic aphasia. The patient demonstrates naming problems, within normal limits fluency, good auditory comprehension, and good repetition, thus according to the connectionist classification system leading to the conclusion of Anomic aphasia. Also, the patient’s primary complaint was word finding difficulty, which is the key sole characteristic of Anomic aphasia. Patient X’s repetition task was completed without error, auditory comprehension was noted to be within normal limits, and oral reading of words and non-words was without error. A mild error of occasional pauses and were noted, which is also in conjunction with characteristics of Anomic aphasia. Patient X’s test scores also support the mildness of Anomic aphasia, by performing better than 94% of others in relation to the aphasic distribution and were in proximity to the normal cutoff.

Question 30

Briefly describe two non-language impairments in RHD that could affect assessment of reading ability. For each impairment, what type of reading errors would you expect to see and why?

Answer 30

The two non-language impairments presented in Right Hemisphere Disorder (RHD) that could affect assessment of reading ability would be visuospatial neglect and attention difficulties. We would expect to see neglect dyslexia from the visuospatial neglect, and attention dyslexia from the attention difficulties. Neglect dyslexia may be characterized by the patient ignoring half of the page, or half side of the book and attention dyslexia will present with difficulty comprehending what they are reading or maintaining their place on a page.