Aphasia Final Flashcards
Treatment of and for PWA
A-FROM model
Living with Aphasia: Framework for Outcome Measurement
What are the domains of the A-FROM model?
participation in life situations
personal identity, attitudes, and feelings
severity of aphasia
communication and language environment
what domain would activities, communication and conversation, roles and responsibilities, and relationships be part of?
participation in life situations
what domain would future, view of yourself, aphasia and who you are, and feelings?
personal identity
what domain would understanding other people, speaking, reading, and writing part of?
severity of aphasia
what domain would services, systems, and policies; attitudes of others to you and the aphasia; help with communication and conversation?
communication and language environment
what should the clinician primarily address in the personal domain of the A-FROM model?
psychosocial sphere
what are the two types of causes that affect emotions in the personal domain of the A-FROM model?
Organic and reactive. The diagnosis from the brain damage that is organic affects emotional/psychological behavior while people react to the newly acquired disorder usually during acute onset of illness
identify two major regions of lesions in the left hemisphere and describe the results of each.
Frontal: depression, catastrophic reactions, indifference/apathy (w/prefrontal damage)
Posterior: unawareness, agitation, sometimes paranoia, rarely euphoria
how is a catastrophic reaction different from typical ones and why is it so rare?
person is not making decisions under voluntary control and it does not last longer than a few days; few people have catastrophic reactions with left frontal regions
what challenge is there when assessing people with aphasia? what has been done to address this?
it is problematic to assess psychiatric disturbances in people with significant communication disorders; visual analog mood scale
explain the visual analog mood scale
vertical scale of 100 mm with polar moods at top and bottom
PWA can quantify mark by measuring mm
Make the scale vertical instead of horizontal to be aware of visual field dominance/field of vision of the PWA
What emotional areas should be addressed for the PWA?
reduced concern for others w/ increased egocentrism
need for routine (concretism)
social isolation from w/drawl from social contact
not truly reactive emotional lability; bilateral brain damage leads to extreme emotional lability
anxiety and fear about another stroke
frustration and anger
embarrassment
guilt because of life role changes
emotional lability
rapid, often exaggerated changes in mood, where strong emotions or feelings (uncontrollable laughing/crying, or heightened irritability or temper) occur
how odes stroke and aphasia affect the family of the PWA?
involuntary removal of work can be devastating
familial roles shift (financial, care taking, cooking, driving, etc)
loss of conversational partner to talk other events of the day
changes in parent-child relationships: who is the caregiver now?
how can the affects of aphasia be related to the stages of grieving?
Denial Anger Bargaining Depression Acceptance
aspects of grieving
may take a long time
unique to individual
referral to trained counselor
SLP is important part of support to help patient and family reach acceptance stage
what are some of the effective actionable steps for SLPs to take when treating a PWAA at the emotional level?
listen; empathize acknowledge reality of the loss show unconditional positive regard give PWA control over treatment decisions provide perspective and key information
Geschwind model
- command understood in Wernicke’s area
- Info sent to premotor on left
- Info sent to premotor area on right via corpus callosum
- Info sent to right Primary Motor Area
- Person salutes w/ left arm
maximize communication for PWA by
preserved and impaired abilities
linguistic and nonverbal cognition
treatment plan has variety of output modalities
A-FROM Aphasia: Framework for Outcome Measurement
impaired-best treatment
fix-it, restorative
compensate-for-it
both
diaschisis
PWA appears worse than they will be
areas of brain not actually damaged, but temporarily dysfunctional
early loss of function and electrical activity in brain regions remote from lesion but connected via neural networks
spontaneous recovery
diaschisis fades after a few weeks and PWAA show natural recovery up to at least 6 months
“harness” spontaneous recovery by treating vigorously in this period
HOWEVER, much evidence shows people will respond to treatment no matter what the time post onset is
schuell brookshire facilitation - stimulation approach
I 80% REAM for sure for sure very easy intensive elicit performance to 80% repetitive accurate elicited max feedback systematic familiar success varied extensions
amount for treatment to be effective
frequency: at least 2 hours/week
multi-modality stimulation and response
multimodality input by SLP
multimodality output by PWA
and vice versa
intersystemic reorganization
luria
impaired function, intact function, operation
scaffold with function you wouldn’t ordinarily do so in activity
divergent therapy
Kearns (IHP Chair before Dr Lof)
response elaboration training (RET)
no specific target, GERNERALIZE
response elaboration training (RET)
Kearns’ RET
divergent mindset
best for MILD Broca’s aphasia
utilize output patient is already producing, elicit more language
PACE principles
Promoting Aphasics’ Communicative Effectiveness
- clinician and PWA senders and messages
- exchange new, previously unknown info
- multiple modalities
- clinician and PWA act as receivers to know whether message was adequately conveyed
long term goal
describes cognitive process you are targeting
short term goal
describes stimulus you give and response you expect from patient
writing goals and keeping data
LTG and STG need to be…
operational
have accuracy measurements (criterion)
language of goal writing
use active verbs to describe behavior say read point produce
assessing outcomes
Bad Ass Resist Push baselines advance retest powerful
subarachnoid hemorrhage
bleed in one of meningeal layers
embolic infarct
lesion caused by clot in vessel, clot originated somewhere else (usually the heart)
intracerebral hemorrhage
bleeding within neural tissue of brain
primary progressive aphasia
neurodegenerative disorder that affects only language at onset
transient ischemic attack
TIA
mini-stroke
temporary interruption of function
nonfluent aphasias
Broca’s
Global
Transcortical Motor
ruptured aneurysm
ballooned out area of blood vessel that has broken
left temporal meningioma
tumor arising from one of protective layers on outside of brain
traumatic brain injury
coup and contre coup injury may be seen in this
posterior capsular-putaminal aphasia
subcortical aphasia syndrome with fluent type of aphasia but also with hemiparesis
thrombotic infarct
lesion caused by clot in vessel; clot forms right at spot in brain
fluent aphasias
wernicke’s
transcortical sensory
anomic
conduction
middle cerebral artery
artery occluded in PWA
artery occluded in hemiparesis
posterior cerebral artery
visual field cut
inferior temporal lobe regions
anterior cerebral artery
anterior frontal lobe regions
conduction aphasia
closer and closer to target phonemic paraphasias, poor repetition
transcortical sensory aphasia
fluent, empty verbal output with impaired auditory comprehension and surprisingly good repetition
Broca’s aphasia
good auditory comprehension, short phrase lengths, agrammatism, poor repetition
anomic aphasia
significant word finding difficulty with preserved auditory comprehension and good repetition
transcortical motor aphasia
nonfluent, poor spontaneous initiation, good repetition
global aphasia
verbal stereotypy only, impaired auditory comprehension, poor repetition
mixed-nonfluent aphasia
nonfluent with better auditory comprehension than global but not as good as Broca
Wernicke’s aphasia
fluent verbal output with poor auditory comprehension and sometimes see presence of speech
