Chapter 2 Aphasia Flashcards
Adult language impairment include
Language Development Through the Lifespan
Aphasia
Right Hemisphere Damage
Traumatic Brain Injury
Dementia
Language impairment through life span
Unless there is neuropathy, adults continue to
refine communication skills.
Use
*Adults are skilled conversationalists
*Narratives improve until the seventies
Content
*Some words fade and others are added
* Deficits in accuracy and the speed of word
retrieval/naming
Form
*Continue to acquire some aspects of syntax
*Complex sentence construction declines with
advanced ag
Aphasia
*Literally “without language”
Affects over 1 million people in the U.S
My affect listening, speaking, reading, writing
Range In Severity
*Related to cause, location/extent/age of
brain injury, age/general health of patient
Patterns of behavior can be used to
categorize by type/symptom
Expressive language Aphasia
Impairments characteristics
*Reduced vocabulary
*Omission/addition of words
*Stereotypic Speech
*Delayed or reduced output of speech
*Hyperfluent speech
* Word Substitutions
Language Comprehension deficits Aphasia
*Impaired interpretation of linguistic deficits
Concomitant Deficts
*Hemiparesis *Agraphia
*Hemiplegia *Alexia
*Hemisensory *Anomia
Impairment *Jargon
*Hemianopsia *Neologism
*Dysphagia *Paraphasia
*Agrammatism *Verbal Stereotype
Sensory Involvement Aphasia
Touch, Vision and Auditory Comprehension
can be affected after a CVA.
Hemisensory Impairment-inability to sense
pain or touch on one side of the body
Loss of Vision can also occur after a CVA
Damage to either the optic nerve/tract or
damage to the Occipital Lobe is called
HEMIANOPSIA.
Damage from a CVA
HEARING ACUITY is NOT affected by a CVA.
Damage from a CVA occurs in the TEMPORAL
LOBE OF THE CORTEX which serves to
interpret auditory signals and make sense out
of them, therefore, it’s Auditory
Comprehension that is affected.
DYSPHAGIA-
Swallowing Disorder
Cognition Aphasia
The cognitive function of the two halves of
the brain is responsible for integrating,
processing and computing information.
Could affect behaviors such as problem
solving, memory, judgment, reasoning,
perception and imagination.
fMRI (functional magnetic resonance imaging)
PET scan (Position Emission Tomography)
ANOMIA
-Difficulty in naming things, objects
and people.
PARAPHASIA
word substitution problem
*Phonemic Paraphasia-word substitution
based on phonemic similarity (ie “tar” for
“car” or “hiss” for “kiss”)
*Verbal paraphasia-substituted words have
similar meanings similar to correct words (ie
A woman referred to her husband as “wife”)
*NEOLOGISM
creation of a new word often
meaningless. (ie “ponty” for “chair”)
AGRAMMATISM-
-omission of certain grammatical elements
JARGON
-relatively fluent but irrelevant or meaningless speech
VERBAL STEREOYPES-
expression is repeated over and over.
AGRAPHIA
writing problems
ALEXIA
-reading problems
AGNOSIA
difficulty in understanding sensory information
*Auditory Verbal Agnosia
*Visual Agnosia
Causes of Aphasia
CEREBRAL VASCULAR ACCIDENT (CVA)
ISCHEMIC- are caused by a blocked or
interrupted blood supply to the brain.
–Cerebral arteriosclerosis(hardening of
the arteries.
–Embolism
–Thrombosis
Causes of Aphasia
HEMORRHAGIC
-are caused by bleeding in
the brain due to ruptured vessels
–Intercerebral (within the brain)
–Extracerebral (within the meninges)
*Aneurysm
*Arteriovenous Malformations
Causes of Aphasia
TRANSIENT ISCHEMIC ATTACK (TIA)
- mini stroke
* warning sign that the person is at
increased risk of a future stroke
* symptoms usually disappear completely
within 24 hours
* 30% of people have damage evident on
sensitive brain imaging techniques such as
MRI after a TIA.
Causes of Aphasia
Lesion
Lesion-an injury that leaves an area of
cortical tissue incapable of functioning in a
normal way.
How can you get brain damage
1. CLOSED HEAD INJURY
2. OPEN HEAD INJURY
3. CONTRECOUP INJURY
Causes of Aphasia
NEOPLASM-
NEOPLASM-tumor
*Intercranial (within the brain)
*Metastic (grown elsewhere but migrated and
attached to the brain tissue and still growing)
Stroke causes
Most victims of a stroke are middle age and
beyond
Risk of stroke increases with:
*Smoking, alcohol use, poor diet, lack of
exercise, high blood pressure, high cholesterol,
diabetes, obesity, previous strokes
First signs
*Loss of consciousness, headache,
weak/immobile limbs, slurred speech
One third will die from a stroke or soon after
Those that survive may need services after acute
care stay
FLUENT APHASIAS
*Word substitutions, neologisms, and often
verbose verbal output
*Often posterior lesions in the left
hemisphere
*Wernicke’s Aphasia
*Anomic Aphasia
*Conduction Aphasia
*Transcortical Sensory Aphasia
*Subcortical Aphasia
Wernicke’s Aphasia
Poor Auditory Comprehension
Impaired repetition skill
Intact grammatical structures
Severe word finding problems
Poor visual comprehension
Seldom are paralyzed because damage is not in motor area
Rapid rate of speech with normal prosodic features and good articulation
Incessant, effortlessly produced, flowing speech with normal phrase length
Empty speech
Writing problems
Verbal paraphasias and neologisms
Reading comprehension problems
Circumlocutions
Reduced ability to comprehend the speech of others
Speech often lacks content
Have a hard time monitoring themselves
Generally poor communication in spite of fluent speech
Good articulation
Anomic Aphasia (fluent)
Damage at the convergence of the parietal- temporal-occipital cortex
Fluent spontaneous speech marred by word
retrieval difficulties
Mild to moderate auditory comprehension
problems
Severe anomia in both speech and writing
When a word is furnished-patient usually recognizes it immediately
Intact repetition
Normal oral reading skills and good reading
comprehension
Unimpaired articulation
Conduction aphasia (fluent)
Caused by lesions in the region between the
Broca’s and Wernicke’s area.
Disproportionate impairment in repetition
Paraphasic speech
Marked word-finding difficulties
Empty speech
Reading and Writing are usually good
Good syntax, prosody, and articulation
Auditory comprehension ranges from mild to
moderate
Naming deficits ranges from mild to severe
Transcortical sensory aphasia (fluent) TSA
Lesion in the temporo-parietal region
Rarest of the fluent aphasias
Good repetition skills but poor comprehension of repeated
words
Normal automatic speech (counting)
Paraphasic and empty speech
Echolalia of grammatically incorrect forms
Difficulty in pointing, obeying commands, or answering
yes/no questions
Good reading outloud but poor comprehension of material read
Writing problems that parallel those in expressive speech.
Impaired auditory comprehension of spoken language
Severe naming problems
Subcortical Aphasia (fluent)
Caused by lesions in the basal ganglia and
surrounding structures
Intact repetition skills
Word-finding problems
Articulation problems
Semantic paraphasia
Normal comprehension for routine conversation;
may be defective for complex material
Fluent speech, which may include some pauses
and hesitations
Prosodic problems
Relatively preserved writing skills
Broca’s aphasia (nonfluent)
Damage in the Posterior-Inferior Frontal Gyrus of the Left
Hemisphere
Nonfluent, effortful, slow, halting and uneven speech
Misarticulated or distorted sounds
Agrammatic or telegraphic speech
Impaired repetition of words and sentences
Impaired naming
Better auditory comprehension of spoken language
Poor oral reading and poor comprehension of material read
Monotonous speech
Apraxia of speech
Dysarthria
Writing Problems
Limited word output, short phrases and sentences
Telegraphic speech
Transcortical Motor aphasia TMA (nonfluent)
Lesions in the anterior superior or frontal lobe
Initial speechlessness
Echolalia and Perseveration
Absent or reduced spontaneous speech
Nonfluent, paraphasic, agrammatic, and
telegraphic speech
Intact repetition skill
Slow difficult reading outloud
Good comprehension of simple conversations
Seriously disturbed writing
Unfinished sentences
Global Aphasia (nonfluent)
Extensive lesions affecting all language areas
Most severe form of nonfluent aphasia
Profound impaired language skills
Greatly reduced fluency
Impaired repetition
Impaired reading and writing
Auditory comprehension limited to single
words
Impaired naming
Perseveration
Additional types of aphasia
Some aphasias may affect primarily one
modality
Alexia with Agraphia-Reading with writing
impairment
Alexia without Agraphia-Reading impairment
Pure Agraphia- Severe writing disorder
Pure Word deafness-Lack of auditory
comprehension with error free spontaneous
speech
Crossed Aphasis-Aphasia accompanying right
hemisphere damage.
Lifespan issue of aphasia
May receive services for at least the first few
months
Families are often frightened and confused
May exhibit perserveration, disinhibition,
emotional problems
Course/extent of recovery difficult to predict
Spontaneous recovery
The earlier the treatment, the better the
recovery
Loss of Language ability can lead to social
isolation.
Aphasia Assessment
Assessment occurs in multiple phases as
client recovers
Medical History
Interview with client and family
Oral Peripheral Examination
Hearing Testing
Direct Speech and Language Testing
Counseling is ongoing
Formal testing postponed until patient is
stable
Address
*Overall communication skills
*Expressive language
*Receptive language
*All modalities across all aspects of
language
Standardized tests are available
Observation/interpretation of client behavior
Definitive diagnosis difficult early on
SLP
*Identifies changes in language
performance and behavior
*Genetic history and health information
*Observation in different environments
*A few language tests exist
* Scales can be used for rating loss
*Aphasia assessments can be used.
Aphasia screening
Aphasia Language Performance Scales (ALPS)
Sklar Aphasia Scale (SAS)
Bedside Evaluation and Screening TestSecond Edition (BEST-2)
Standardize test for aphasia
The Boston Diagnostic Aphasia Examination
The Western Aphasia Battery
The Minnesota Test for Differential Diagnosis
of Aphasia
The PORCH Index of Communicative Ability
Bilingual Aphasia Test
Functional assessment tools for aphasia
Functional Communication Profile
Communicative Abilities in Daily Living
The Communicative Effectiveness Index
Functional Assessment of Communication
Skills for Adults
Reading Comprehension Battery for Aphasia
what do test for aphasia do and evaluate?
1. Severity of disorder
2. Classification
3. Strengths and Weaknesses
4. Competence of test- accountability
5. #’s to tell other professionals-data to report
6. Changes-want to show if patient gets better
7. Watch patient take test-what strategies are
they using
8. To plan treatment
9. We use tests because they are there.
10. Provide Information and Answer Questions
specific speech and language skills to be assessed
Assessment of:
*Repetition Skills
*Naming Skills
*Auditory Comprehension of Spoken Language
*Comprehension of single words
*Comprehension of sentences and paragraphs
*Reading Skills
*Writing Skills
*Gestures and Pantomime
*Automated Speech and Singing
Aphasia intervantion
A GOOD ASSESSMENT LEADS TO GOOD
THERAPY!!!!
THE OVERALL GOAL OF INTERVENTION IS TO
AID IN THE RECOVERY OF LANGUAGE AND TO
PROVIDE STRATEGIES TO COMPENSATE OF
PERSISTENT LANGUAGE DEFICITS.
Determine by assessment and client/family
needs
Cross Modality generalization
Conversational techniques
“Bridging” between hemispheres
Multimodality stimulation
AAC
Neural plasticity
Involve family members
Right hemisphere disorder
Group of deficits resulting from right cerebral
hemisphere injury
Characteristics
*Neglect information from left side
Unrealistic denial
Impaired judgment and self-monitoring
Lack of motivation
Inattention
Right Hemisphere damege
Cognitive deficits result in communication problems
Linguistic deficits
*Pragmatics most impaired
*Incorrect Interpretations
*Misinterpret contextual information
*Understanding may be concrete
*Difficulty with naming, writing, repetition
Paralinguistic deficits
*Aprosodia
assessment for RHD
Visual scanning and tracking
Auditory and visual comprehension
Direction following
Response to Emotion
Naming and Describing
Writing
Observation is essential for pragmatics
Portions of aphasia batteries, standardized
measures for RHD, and nonstandardized
measures.
Intervention for RHD
Visual and auditory recognition
Respond appropriately in conversation
Track increasingly complex information
Use time restraints
Sequencing and explaining actions
Synthesize skills within conversation
Target nonlinguistic markers.
Traumatic Brain Injury
Disruption in normal functioning caused by a
blow or jolt to the head or penetrating injury
Leading Causes
*Falls (28%)
*Motor Vehicle Accidents(20%)
*Blows to the Head (19%)
*Assaults (11%)
1.4 million people sustain TBI annually
*Males sustain TBI more often than females.
Affects orientation, memory, attention,
reasoning/problem solving, executive
function
Most disturbed language area is pragmatics
Deficits may also include
**Speech
**Voice
**Swallowing
**Psychosocial/personality changes
Severity related to initial levels of
consciousness and post-traumatic amnesia
Lifespan issues with TBI
Most are young, results of vehicular accident
Several Stages of recovery
Initially, nonresponsive and requires full
assistance
Gradually respond to stimuli and recognize
some individuals
Confusion and Agitation
Inappropriate, incoherent, emotional
language
Later, can remain alert and hold short
conversation
Oriented to person and place, not time
Inappropriate, unaware, unrealistic, and
uncooperative
In later stages of recovery, can initiate and
carry out tasks
May consistently behave in a socially
appropriate manner.
Periodic depression and irritability
Most will have lingering deficits, especially
pragmatics
Assessment for TBI
SLP
*Cognitive-communication abilities
*Swallowing
*Assessment varies with stages of recovery
*Few comprehensive tools
*Sampling essential for pragmatics
Intervantion for TBI
Cognitive Rehabilitation
*Restorative Approach
*Compensatory Approach
Early Stages
*Orientation, sensorimotor stimulation,
recognition
Middle Stages
*Reduce confusion, improve memory and goal
directed behavior
Late Stages
*Comprehension of complex information and
directions, conversational and social skills
Dementia
Intellectual Decline due to neurological
causes
*Additional deficits
*Poor reasoning/judgment, impaired
abstract thinking, inability to attend to
relevant information, personality changes
*Language functions most dependent on
memory are affected
*Fewer than 15% of elderly experience
dementia
*20% respond to treatment
Types of dementia
CORTICAL DEMENTIA and SUBCORTICAL DEMENTIA
CORTICAL DEMENTIA
Visuospatial deficits,
memory problems,
judgment and abstract
thinking disturbances,
and language deficits
in naming, reading and
writing and auditory
comprehension
*ALZHEIMER’S
*PICK’S
SUBCORTICAL DEMENTIA
Deficits in memory,
problem solving,
language,
neuromuscular control
*Multiple sclerosis
*AIDS-related
encephalopathy
*Parkinson’s
*Huntington’s
Alzheimer’s dISEASE
Cortical pathology
Affects 13% of those over 65
50% of those over 85
Affects primarily memory, language, or
visuospatial skills
Cause unknown
Genetic and environmental
Presence of neurofilaments and plaques
Extensive damage to hippocampus and cortex
Alzheimer’s severity
Mild dementia
Name recall difficulty, occasional disorientation, memory
loss
Later stages
Paraphasia, delayed responding, reduced vocabulary and
syntactic structure, pronoun confusion, topic digression,
inability to shift/return to topic, reading/writing errors
Most severe form
Naming errors, generic terms, syntactic errors, minimal
comprehension, jargon, echolalia, mutism
Lifespan issues with Alzheimer’s
Often unaware or ignores early signs
No cures
Drug therapy may help
Early stages
Memory loss
As disease progresses, memory loss increases and
vocabulary decreases
Most advanced stages
All intellectual functions are severely impaired
Almost all reside in nursing homes
Assessment for Alzheimer’s
Definitive diagnosis difficult early on
SLP
Identifies changes in language performance and behavior
Genetic history and health information
Observation in different environments
A few language tests exist
Scales can be used for rating loss
Aphasia assessments can be used
Intervention for Alzheimer’s
Goal
Maintain client at highest level of functioning and help
others maximize client’s participation
Emphasize intact abilities
Compensate for deficient abilities
Target memory or word retrieval
Coherent verbal responses
Longer, more complex utterances with memory aids
Stimulating cognitive processes plus pharmacological
treatment is best
