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Aphasia > Aphasia Assessments > Flashcards

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
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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)

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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)
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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?
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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
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6
Q

Oral Expression- Grammar

A
  • examine linguistic level of syntax and morphology
  • prime importance as to aphasia classification
  • agrammatism
  • paragrammatism
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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
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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
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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?

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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
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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
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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
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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 __”

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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
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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?
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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

  1. Auditory/verbal comprehension
  2. Repetition
  3. Naming
  4. Reading
  5. 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
Q

Pure Alexia (signs and symptoms)

A
  • 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
Q

Alexia with agraphia

A
  • 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
Q

Alexia with agraphia signs and symptoms 1

A
  • 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
Q

Alexia with agraphia signs and symptoms 2

A
  • 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
Q

Frontal Alexia

A
  • 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
Q

Frontal Alexia (signs and symptoms) 1

A
  • 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
Q

Frontal Alexia (signs and symptoms) 2

A
  • demonstrate morphological errors when reading
  • writing difficulties may also be present
  • differential impairment in comprehending spoken versus written language
  • limited verbal output
32
Q

Agraphia 1

A
  • 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
Q

Agraphia 2

A
  • 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
Q

Pure Agraphia

A
  • 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
Q

Apraxia Agraphia

A
  • 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
Q

Motor Agraphia

A
  • 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

Aphasia (13 decks)

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