Aphasia Assessments Flashcards
1
Q
Foundational Concepts of Aphasia Assessment
A
- assessment of aphasia involves evaluation of speech, language, reading, and writing skills
- related cognitive functions may also be addressed
- dysarthria, dysphagia, and/or voice related issues may also coexist
- may involve standardized and client-specific procedures
- think about the 8-must knows
2
Q
Oral Expression- Aphasia Assessment
A
- expressive output or oral expression
- begins with free conversation as able
- oral expression involves seven characteristics
— articulatory agility
— prosody
— phonation
— grammar
— fluency
— word finding
— paraphasia(s)
3
Q
Oral Expression- Articulatory Agility
A
- speech is abnormal if:
- there is any deviation from normal ease and/or accuracy
- b/d in automaticity
- output may be labored, awkward, or not at all
- can involve simplifications, omissions, substitutions, distortions
- think about motor speech disorder(s)
4
Q
Oral Expression- Prosody
A
- rate, rhythm, melodic intonation patterns per single words, phrases, sentences, and conversation
- are syllable stress patterns lost with equal stress applied to every syllable?
- is range of intonation compressed?
- is speech monotone?
5
Q
Oral Expression- Phonation
A
- is pt hypophonic?
- abnormally weak voice?
- indicative of the extent of the lesion to the deeper subcortical areas of the brain
- seen also in hypokinetic dysarthria (PD)
- referral to ENT; possible vocal fold pathology
6
Q
Oral Expression- Grammar
A
- examine linguistic level of syntax and morphology
- prime importance as to aphasia classification
- agrammatism
- paragrammatism
7
Q
Oral Expression- Fluency
A
- fundamental and vital in differential diagnosis
- fluent versus nonfluent
- evaluated in terms of number of words per uninterrupted group that the pt may produce
- Pts who produce 5+ connected words may be judged fluent
- When word output is less than 50 words a minute in conversation, fluency is significantly impaired
8
Q
Oral Expression- Word Retrieval
A
- based on pt’s level of fluency; is there a dearth (lack) of correctly chosen nouns and verbs
- if so, pt’s speech could be classified as anomic
- fluent, anomic speech may take many forms
may be vague and circumlocutory - may be marked by overt blocking at key words with self-critical comments by the pt
- may be paraphasic so much so that the key informational words cannot be detected
9
Q
Naming
A
- may reveal anomic tendencies not present in running speech
- note different modes of stimulation:
- naming to visual confrontation
- naming to tactile presentation
- naming to definition or cloze prompt
- probe for clues as to how close pt is to succeeding at retrieval
- does pt respond to phonemic cues?
- can pt recognize the first correct sound of the word?
can pt indicate word length?
10
Q
Repetition
A
- repetition is of diagnostic significance
- can present in various forms:
- specific preservation: ability to repeat is preserved or markedly better from other symptoms of aphasia
- selective disorder:
— repetition is vulnerable to words containing a succession of syllables starting with plosives (basketball player)
—- pts may also have difficulty with unusual sentences composed of small grammaical words such as “no, ifs, ands, or buts.”
- be sure to assess numbers and nouns of varying lengths
11
Q
Repetition
A
- it is common for single word numbers to be repeated perfectly whereas multi-digit numbers elicit verbal paraphasias; non-number words elicit phonemic paraphasias
- asses a pt’s ability to repeat multisyllabic words, nonsensical words, or even foreign-language phrases
- does the pt have parrot-like speech
12
Q
Automatics
A
- memorized sequences
- may be retained and performance may be essentially intact even with severe forms of aphasia
- counting, MOY, DOW, nursery rhymes, alphabet, etc
13
Q
Auditory Comprehension
A
- free conversation: will pt respond to questions of personal or timely relevance?
- do not forget the power of y/n questions for pts with limited speech output
- phonological discrimination: discrimination of minimal pairs
- lexical comprehension: examine words out of context; have pt select items from a visual multiple choice display
—- “point to the cup” versus “pour some water into the cup”
—- use phrases such as “from a field of __”
14
Q
Reading
A
- letter recognition
- word recognition (multiple choice, matching, oral)
- complete tasks targeting both oral reading & reading comprehension
- compare site reading for sound and site reading for meaning
- paralexias: disturbance in reading ability marked by the transposition of words or syllables
- reading without knowledge or meaning is possible
- various forms of alexia
15
Q
Graphemic Expression
A
- evaluate letters, short words, written syntax, recall of lexical items
- evaluate channels that go together for writing
— sound-to-motor associations
— visual imagery of word shapes
— orthographical skills
— phoneme-to-grapheme conversion
- paragraphia: words or letters other than those intended are written (“dead” in lieu of “kill”)
- does graphemic expressions parallel oral expression?
16
Q
Aphasia Assessments
A
- assimilate the 8-must knows with the information presented in the previous slides
- we can discuss assessment in terms of formal and informal evaluation as well as broad-based and specific-based means
- common batteries:
— Western Aphasia Battery (WAB)
— Porch Index of Communication Ability (PICA)
— Minnesota Test for Differential Diagnosis of Aphasia (MTDDA)
— Boston Diagnostic Aphasia Examination (BDAE)
17
Q
Western Aphasia Battery
A
- first published in 1982; revised/enhanced in 2006
- provides a numerical (quotient) classification of aphasia; often used in research studies
18
Q
Western Aphasia Battery
A
Auditory-oral section:
1. Spontaneous speech
- Auditory/verbal comprehension
- Repetition
- Naming
- Reading
- Writing
19
Q
Western Aphasia Battery Scoring
A
Nonfluent Aphasias -0-4
Less comprehension- Global or Mixed
Poor Repetition- Global
Good Repetition- Mixed
More comprehension- Broca’s or TCM
Poor Rep- Broca’s
Good Rep- TCM
Fluent Aphasias- 5-10
Less comp. Wernickes, TCS
Poor Rep.- Wernickes
Good Rep.- TCS
More comp. Anomic, Conduction
Poor Rep. Conduction
Good Rep- Anomic
20
Q
Porch index of communication ability (PICA)
A
- first published in 1967
- contains 18 subtests of the four language modalities (audition, reading, speech, writing)
- very complex scoring mechanism (known as a multidimensional scale)
21
Q
Minnesota Test for Differential Diagnosis of Aphasia
A
- widely used in the 1960s and 1970s; developed by Hildred Schuell
- first published in 1948; eighth version was released to the public in 1965
22
Q
Boston Diagnostic Aphasia Examination
A
- first published in 1972, revised in 1983, and then again in 2001
- BDAE-3 contains the following salient features:
—- classification of aphasia into syndromes according to symptom patterns
—- analysis of spontaneous verbalizations
—- a short form
—- extended testing
23
Q
Alexia
A
- loss of reading proficiency or impaired reading proficiency secondary to recent brain damage (three significant types)
- dyslexia: difficulty learning to read with adequate instruction
- alexia without agraphia (pure alexia)
- alexia with agraphia
- frontal alexia
24
Q
Pure Alexia- Alexia without agraphia
A
- reading problems due to recent brain damage w/intact writing skills
- damage to the left visual cortex & to the posterior corpus callosum fibers that connect the left hemisphere with the right visual cortex
- occlusion of the posterior cerebral artery is frequently implicated in damage to the left visual cortex
25
Pure Alexia (signs and symptoms)
- inability to read normally; may read letter-by-letter
- normal recognition of words orally spelled and traced in palm
- near-normal writing (may deteriorate)
- difficulty copying written words
- near-normal oral language skills; possible anomia
- possible color id issues; even questions about colors of objects
- hemianopia may occur without other neurological symptomatology
26
Alexia with agraphia
- writing and reading problems secondary to neurological impairment
- difficulties are equal between writing and reading skills
- reading of musical notes & mathematical symbols may be impacted
- occurs secondary to lesions in the angular gyrus
- common etiologies involve CVA pathology per the MCA
- tumors, metastatic tumors, trauma, and GSW are also included
- problems isolate the visual cortex from Wernicke and Broca’s areas
27
Alexia with agraphia signs and symptoms 1
- dominant characteristics include: reading and writing difficulty with some symptoms of aphasia
- possible initial paresis of the UE and right-side sensory deficits
- loss or serious impairment in reading/writing
- difficulty with oral reading extending to letters and word (different than individuals with pure alexia as they can recognize alphabet
28
Alexia with agraphia signs and symptoms 2
- difficulty in comprehending what has been read or spelled aloud
- writing difficulties mirror reading problems (appear nonsensical)
- letter/word copying skills are better than spontaneous writing
- no cursive writing from printed words
- possible acalculia
29
Frontal Alexia
- poor reading skills in pts with damage to the frontal cortex
- some pts refuse to read or are unable to read upon command
- often associated with Broca’s type aphasia
- pts may also present with right hemiplegia
- most frequent site of lesion is the posterior portion of the inferior frontal gyrus (may extend into the anterior insula)
- most frequent cause of the lesion is CVA; tumors and trauma are also implicated
- note: alexia is not a diagnostic feature of Broca’s type aphasia
30
Frontal Alexia (signs and symptoms) 1
- significant reading problems; may only read substantive words
- limited comprehension
- difficulty with relational words (adjectives, conjunctions, prepositions)
- refusal to read; insist they have lost the capacity to read
- failure to read upon command
31
Frontal Alexia (signs and symptoms) 2
- demonstrate morphological errors when reading
- writing difficulties may also be present
- differential impairment in comprehending spoken versus written language
- limited verbal output
32
Agraphia 1
- writing disorders associated with recent cerebral pathology
- term implies loss of or impairment of previously acquired writing skills
- lesions in the left hemisphere tend to produce more pronounced structural and syntactic writing problems than in the right hemisphere
- left hemisphere lesions: agrammatic, syntactic, neologistic errors
33
Agraphia 2
- anterior lesions: misspellings, poor letter formation
- posterior lesions: cause problems in word order and word omissions; letters may be formed well
- right hemisphere lesions affect certain spatial aspects of writing
- left neglect may be noted in reading and drawing
34
Pure Agraphia
- isolated writing problems with all other language skills functioning as normal
- pts are unable to write anything; no aphasia or motor involvement
- damage is thought to be in the premotor cortex
- lesions in the left superior parietal lobe have also been suggested
- auditory comprehension and expressive language skills are normal to near-normal
35
Apraxia Agraphia
- references writing problems associated with apraxia
- serious problems in letter formation (some may only scribble)
- others may write in only capital letters
- spontaneous writing, copying, and writing to dictation may all be equally affected
- may spell words correctly; even say the words they were asked to write but produce only scribbles
- focal brain lesions in the parietal lobe cause apraxic agraphia
36
Motor Agraphia
- group of writing disorders due to neuromuscular problems
- hypokinetic agraphia: writing with small letters or letters that get progressively smaller in a writing sample; often associated with PD
- hyperkinetic agraphia: writing associated with tremors, tics, chorea, dystonia; when UEs have involuntary hyperkinetic movements writing is extremely disturbed or impossible
