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Organic Disorders > Chapter 2 Aphasia > Flashcards

Chapter 2 Aphasia Flashcards

1
Q

Adult language impairment include

A

 Language Development Through the Lifespan
 Aphasia
 Right Hemisphere Damage
 Traumatic Brain Injury
 Dementia

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2
Q

Language impairment through life span

A

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

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3
Q

Aphasia

A

*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

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4
Q

Expressive language Aphasia
Impairments characteristics

A

*Reduced vocabulary
 *Omission/addition of words
 *Stereotypic Speech
 *Delayed or reduced output of speech
 *Hyperfluent speech
 * Word Substitutions

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5
Q

Language Comprehension deficits Aphasia

A

*Impaired interpretation of linguistic deficits

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6
Q

Concomitant Deficts

A

*Hemiparesis *Agraphia
 *Hemiplegia *Alexia
 *Hemisensory *Anomia
 Impairment *Jargon
 *Hemianopsia *Neologism
 *Dysphagia *Paraphasia
 *Agrammatism *Verbal Stereotype

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7
Q

Sensory Involvement Aphasia

A

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.

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8
Q

 Damage from a CVA

A

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.

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9
Q

DYSPHAGIA-

A

Swallowing Disorder

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10
Q

Cognition Aphasia

A

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)

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11
Q

ANOMIA

A

-Difficulty in naming things, objects
and people.

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12
Q

 PARAPHASIA

A

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”)

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13
Q

*NEOLOGISM

A

creation of a new word often
meaningless. (ie “ponty” for “chair”)

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14
Q

AGRAMMATISM-

A

-omission of certain grammatical elements

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15
Q

JARGON

A

-relatively fluent but irrelevant or meaningless speech

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16
Q

VERBAL STEREOYPES-

A

expression is repeated over and over.

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17
Q

AGRAPHIA

A

writing problems

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18
Q

ALEXIA

A

-reading problems

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19
Q

AGNOSIA

A

difficulty in understanding sensory information
 *Auditory Verbal Agnosia
 *Visual Agnosia

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20
Q

Causes of Aphasia
CEREBRAL VASCULAR ACCIDENT (CVA)

A

ISCHEMIC- are caused by a blocked or
interrupted blood supply to the brain.
 –Cerebral arteriosclerosis(hardening of
the arteries.
 –Embolism
 –Thrombosis

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21
Q

Causes of Aphasia
HEMORRHAGIC

A

-are caused by bleeding in
the brain due to ruptured vessels
 –Intercerebral (within the brain)
 –Extracerebral (within the meninges)
 *Aneurysm
 *Arteriovenous Malformations

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22
Q

Causes of Aphasia
TRANSIENT ISCHEMIC ATTACK (TIA)

A
  • 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.
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23
Q

Causes of Aphasia
Lesion

A

 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

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24
Q

Causes of Aphasia
NEOPLASM-

A

NEOPLASM-tumor
 *Intercranial (within the brain)
 *Metastic (grown elsewhere but migrated and
attached to the brain tissue and still growing)

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25
Q

Stroke causes

A

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

26
Q

 FLUENT APHASIAS

A

*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

27
Q

Wernicke’s Aphasia

A

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

28
Q

Anomic Aphasia (fluent)

A

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

29
Q

Conduction aphasia (fluent)

A

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

30
Q

Transcortical sensory aphasia (fluent) TSA

A

 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

31
Q

Subcortical Aphasia (fluent)

A

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

32
Q

Broca’s aphasia (nonfluent)

A

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

33
Q

Transcortical Motor aphasia TMA (nonfluent)

A

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

34
Q

Global Aphasia (nonfluent)

A

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

35
Q

Additional types of aphasia

A

 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.

36
Q

Lifespan issue of aphasia

A

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.

37
Q

Aphasia Assessment

A

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.

38
Q

Aphasia screening

A

 Aphasia Language Performance Scales (ALPS)
 Sklar Aphasia Scale (SAS)
 Bedside Evaluation and Screening TestSecond Edition (BEST-2)

39
Q

Standardize test for aphasia

A

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

40
Q

Functional assessment tools for aphasia

A

Functional Communication Profile
 Communicative Abilities in Daily Living
 The Communicative Effectiveness Index
 Functional Assessment of Communication
Skills for Adults
 Reading Comprehension Battery for Aphasia

41
Q

what do test for aphasia do and evaluate?

A

 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

42
Q

specific speech and language skills to be assessed

A

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

43
Q

Aphasia intervantion

A

 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

44
Q

Right hemisphere disorder

A

 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

45
Q

Right Hemisphere damege

A

 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

46
Q

assessment for RHD

A

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.

47
Q

Intervention for RHD

A

 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.

48
Q

Traumatic Brain Injury

A

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

49
Q

Lifespan issues with TBI

A

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

50
Q

Assessment for TBI

A

SLP
 *Cognitive-communication abilities
 *Swallowing
 *Assessment varies with stages of recovery
 *Few comprehensive tools
 *Sampling essential for pragmatics

51
Q

Intervantion for TBI

A

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

52
Q

Dementia

A

 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

53
Q

Types of dementia

A

CORTICAL DEMENTIA and SUBCORTICAL DEMENTIA

54
Q

CORTICAL DEMENTIA

A

Visuospatial deficits,
memory problems,
judgment and abstract
thinking disturbances,
and language deficits
in naming, reading and
writing and auditory
comprehension
 *ALZHEIMER’S
 *PICK’S

55
Q

SUBCORTICAL DEMENTIA

A

Deficits in memory,
problem solving,
language,
neuromuscular control
 *Multiple sclerosis
 *AIDS-related
encephalopathy
 *Parkinson’s
 *Huntington’s

56
Q

Alzheimer’s dISEASE

A

 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

57
Q

Alzheimer’s severity

A

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

58
Q

Lifespan issues with Alzheimer’s

A

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

59
Q

Assessment for Alzheimer’s

A

 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

60
Q

Intervention for Alzheimer’s

A

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

Organic Disorders (6 decks)

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