Aphasia, Dysarthria, & Dysphagia Flashcards
Scope of Practice
Eval/Diagnose/Treat: communication & swallowing delays and disorders
What do SLPs Do?
- Expressive/receptive language
- cognitive linguistic skills (attn, memory, processing, visuo-spatial, executive functioning)
- Speech (dysarthria, apraxia)
- Voice
- Fluency (stuttering, cluttering)
- Swallowing
- Pragmatics
- MORE
Aphasia
- loss or impairment of language skills in adults who have a history of normal language skills.
- impairment associated with recent cerebral pathology or trauma (mostly left side of brain)
Anomic
trouble naming/finding words
Modalities of Communication with Aphasic pts
Input: reading, writing
Output: speaking, writing, gesturing
When does aphasia occur?
- Immediately post CVA
- Gradual with degenerative disease (MS, Parkinson’s, Dementia)
Aphasia can occur with:
- Dysarthria
- Apraxia of speech
- Cognitive disorders
- Dysphagia
Classifications of Aphasia
Expressive vs Receptive
-OR-
Fluent vs Nonfluent
Expressive Aphasia
- difficulty communicating message (verbal, written, gestural)
- Associated with lesions in Broca’s Area
- AKA Nonfluent Aphasia
- Can understand
Receptive Aphasia
- Problem understanding Communication (auditory, gestural, reading)
- Associate with lesion to fissure of rolando
- AKA Fluent Aphasia
Fluent Aphasia
Mimics actual language even if you can’t understand the words
Nonfluent Aphasia
Break down of flow, ineffective communication
Fluency
- Refers to flow of speech (flows, not hesitant, no repetitions)
- Not stuttering
- Prosodic and Melodic features of speech
Types of aphasia
- Broca’s
- Wernicke’s
- Transcortical Motor
- Transcortical Sensory
- Mixed Transcortical
- Conduction
- Anomia
- Global
Characteristics of Fluent Aphasia
- Deficits in: auditory/reading comprehension
- Speaking rate of 100-200 words per min (normal)
- Syntactic errors
- Normal articulation, prosodic features and fluency
- Omission of content words (“bbe boop AND oop dopp but um oo bee doo”)
- Circumlocutions
- Paraphasias (“gat” instead of “Cat”)
Types of Fluent Aphasia
- Wernicke’s
- Anomic
- Conduction
- Transcortical Sensory
- Mixed Transcortical
Associated Lesion Sites of Fluent Aphasia
- Fissure of Rolando (post to central sulcus)
- Temporal lobe of left hemisphere
- Temporal-parietal
Impaired Auditory Comprehension
- Impaired comprehension of:
- -Single words, sentences, simple directions/commands, conversations
Alexia
Disorder of Reading
Agraphia
Disorder of writing
Acalculia
Disorder of math
Paraphasias
- literal/phonemic
- Verbal/semantic
- neologisms
- jargon
Literal/phonemic paraphasia
substitute unintended sounds for intended sounds of words
verbal/semantic paraphasia
word errors in which error is semantically related to correct word
neologisms
combo of consanants and vowels with appropriate syllable structure and inflection to create new words
Jargon
pt is unaware he is speaking in paraphasisias and believes everyone understands him
Propositional Language
- Novel language
- pts have difficulty with this
- conversation
Nonpropositional language
-autonomic/overlearned language
Rule of 5s
- keep it simple
- 5 letter words
- 5 words per sentence
Keep the language similar
- “point to the apple”
- “point to the apple”
- Not: point, then touch then where is it, then point
Nonfluent Aphasia Types
- Broca’s
- Transcortical Motor
- Global
Associated Lesion Sites of Nonfluent Aphasia
- Central Sulcus–ant to fissure of rolando
- Broca’s Area
- Motor strip
Characteristics of Nonfluent Aphasia
- Good auditory comprehension
- difficulty initiating speech
- reduced speech rate
- effortful speech
- Abnormal intonation and prosody
- increase of content words
- deletion of gramatical morphemes
- uses short phrases/sentences
- reluctance to speak (know they’re having troubles)
Broca’s Aphasia
- right-sided weakness/paralysis
- deficits in auditory comprehension
- difficulty understanding syntactical morphemes
- Agrammatic speech
- Telegraphic speech (like Sarah from video)
- slow effortful speech
- difficulty reading/writing
- oral reading effortful and nonfluent
- writing difficulties mirror verbal expression
- can occur with motor speech disorders
Global Aphasia
- combo of fluent and nonfluent aphasia
- more severe
- Cause: occlusion of L MCA
- Severe impairments of comprehension, integration and formulation of language in ALL modalities
- hard talking, reading, writing etc
Dysphagia
- Swallowing disorder
- difficulty swallowing that occurs when impairments affect any of the 4 phases of swallowing and put an individual at risk for aspiration of food and liquid and potential aspiration pneumonia
4 Phases of Swallowing
- Oral preparatory
- oral
- pharyngeal
- esophageal
Modified Barium Swallow Study
- Gold standard
- dynamic imaging of bolus from entering mouth to entering stomach
- AKA: MBS (modified barium swallow), VFSS (video fluoroscopic swallow study)
Fibro Endoscopic Eval of Swallowing
- (FEES)
- info about pharyngeal phase
- endoscope passed through nose into nasopharynx
- laryngopharynx can be viewed while pt eats
- black out when pt swallows (not visible)
Penetration
-Material enters larynx and remains above vocal folds
Aspiration
material goes beyond vocal folds
Aspiration Pneumonia
- acute inflam caused by material entering lungs
- symptoms: spiked temp, myalgia, productive cough
Silent Aspiration
- aspiration without productive cough or choking because of a lack of sensation in larynx
- no sensation=no protective maneuvers (cough, choke)
Treatments for Dysphagia
- Vital stim (NMES for swallowing)
- traditional dysphagia exercises
- Different postures/positions/techniques
- diet modifications
Diet Modifications
Liquid consistencies (thin, nectar-like, honey-like, spoon thick/pudding thick)
Solid Consistencies: (National Dysphagia Diet: NDD1, NDD2, NDD3, Regular)
Swallow Precautions Seen
- diet modification (or NPO)
- chin tuck
- chin tilt (L, R)
- head turn (L, R)
- Double swallow
- alternate solids and liquids
- small bites/sips
- 24/7 supervision
