Chapter 25 Aphasia

Question 1

Aphasia is defined as impairment of _____, _____, _____, and/or _____ secondary to brain insult.

Answer 1

Aphasia is defined as impairment of speaking, listening, reading, and/or writing secondary to brain insult.

Question 2

Name the 3 most common Aphasias.

Answer 2

Broca’s, Wernicke’s, and global aphasias are the most common.

Question 3

It is important to assess patients for ________, a complex sensory and _______ disorder that can often be misdiagnosed as aphasia.

Answer 3

It is important to assess patients for agnosia, a complex sensory and recognition disorder that can often be misdiagnosed as aphasia.

Question 4

The cortical aphasias usually involve the dominant hemisphere and will have anomia. Anomic aphasia (________) is characterized by poor naming skills.

Answer 4

temporal–parietal area and angular gyrus

Question 5

Subcortical aphasias can involve the _______ and _______ and are characterized by _______ and impaired _______.

Answer 5

Subcortical aphasias can involve the internal capsule and putamen and are characterized by sparse output and impaired articulation.

Question 6

Name the vessel that is damaged in Global Aphasia

Answer 6

MCA stem

Question 7

Name the vessel that is damaged in Transcortical mixed Aphasia.

Answer 7

anterior cerebral artery [ACA]/posterior cerebral artery watershed area

Question 8

Name the vessel that is damaged in Broca’s Aphasia

Answer 8

sup. div. of MCA, Brodmann’s area 44 and 45 in prefrontal gyrus

Question 9

Name the vessel that is damaged in Wernicke’s Aphasia

Answer 9

inf. div. of MCA, Brodmann’s area 21 and 42 in the posterior, superior temporal gyrus

Question 10

Name the vessel that is damaged in Transcortical motor Aphasia

Answer 10

ACA, prefrontal lobe near Broca’s area)

Question 11

Patients also demonstrate echolalia in what type of Aphasia?

Answer 11

Transcortical motor Aphasia.

Question 12

Name the vessel that is damaged in Conduction Aphasia

Answer 12

MCA and arcuate fasciculus

Question 13

Name the lobes of the brain that are damaged in Anomic Aphasia

Answer 13

damage to left temporal/parietal lobe[s]

Question 14

Melodic intonation therapy (thought to utilize “musical” areas in the nondominant hemisphere) may be helpful for patients with _______ aphasia.

Answer 14

expressive aphasia.

Question 15

Apraxia of speech is an impairment in the production of syllables and words due to abnormalities in the ______ planning of speech; in the absence of weakness, verbal comprehension is intact.

Answer 15

Apraxia of speech is an impairment in the production of syllables and words due to abnormalities in the motor planning of speech; in the absence of weakness, verbal comprehension is intact.

Question 16

__________ may be helpful for patients with concomitant expressive, but not receptive, aphasia.

Answer 16

Melodic intonation therapy (utilizing nondominant hemispheric musical areas) may be helpful for patients with concomitant expressive, but not receptive, aphasia.

Question 17

Flaccid dysarthria can be the result of weakness of the muscles of articulation (i.e., brain stem or cranial n. pathology). It is characterized by a breathy, ________, weak voice with imprecise consonant formation and ________.

Answer 17

It is characterized by a breathy, hypernasal, weak voice with imprecise consonant formation and monopitch.

Question 18

Ataxic dysarthria is due to ________ disease and is characterized by a ________, slurred, and ________ harsh voice with distorted vowels and irregular articulation.

Answer 18

Ataxic dysarthria is due to cerebellar disease and is characterized by a slow, slurred, and monopitch harsh voice with distorted vowels and irregular articulation.

Question 19

Spastic dysarthria is due to a ________ lesion and is characterized by a voice that is strained, ________, and low in pitch and loudness. Speech is slow and characterized by poor ________. Spastic dysarthria is also associated with ________.

Answer 19

Spastic dysarthria is due to a UMN lesion and is characterized by a voice that is strained, hypernasal, and low in pitch and loudness. Speech is slow and characterized by poor prosody. Spastic dysarthria is also associated with dysphagia.

Question 20

The essentials of a typical dysarthria treatment plan include _______, _______, and _______ interventions. The focus of treatment is to (1) strengthen/coordinate _______; (2) slow down the rate of speech; (3) enunciate clearly or “_______”; and (4) become aware of and practice speech at an appropriate _______.

Answer 20

The essentials of a typical dysarthria treatment plan include medical, prosthetic, and behavioral interventions. The focus of treatment is to (1) strengthen/coordinate orolingual musculature; (2) slow down the rate of speech; (3) enunciate clearly or “overarticulate”; and (4) become aware of and practice speech at an appropriate loudness.

Question 21

Along with modification of food and liquid, the treatment of dysphagia includes both compensatory ________ and ________ to strengthen and increase control of swallowing mechanisms. Other modalities used in the treatment of dysphagia include electrical stimulation, preprandial self-dilation of upper esophageal sphincter (UES) with balloon catheter, preprandial thermal tactile stimulation, surgical UES dilation, and pharyngeal bypass mechanisms when safe oral intake is not possible.

Answer 21

Along with modification of food and liquid, the treatment of dysphagia includes both compensatory swallowing maneuvers and swallowing exercises to strengthen and increase control of swallowing mechanisms. Other modalities used in the treatment of dysphagia include electrical stimulation, preprandial self-dilation of upper esophageal sphincter (UES) with balloon catheter, preprandial thermal tactile stimulation, surgical UES dilation, and pharyngeal bypass mechanisms when safe oral intake is not possible.

Question 22

Suboptimal Cognitive Status – Feedings should be _______. For impulsivity, _______. For poor judgment, use _______, covered cups with small openings, and intermittently pinch straws closed to control drinking rate. For poor attention, a quiet, _______environment should be utilized.

Answer 22

Suboptimal Cognitive Status – Feedings should be supervised. For impulsivity, present foods one at a time. For poor judgment, use small-bowled utensils, covered cups with small openings, and intermittently pinch straws closed to control drinking rate. For poor attention, a quiet, distraction-free environment should be utilized.

Question 23

Oral Phase Dysphagia – For facial weakness, modify food _______ and _______ or on the stronger side (i.e., tilt the head toward the _______ side). EMG biofeedback or sucking/blowing exercises may be helpful. For poor lingual control, _______ and strengthening can be prescribed (precise articulation should be encouraged). Neck _______ may also be used to increase oral transit time.

Answer 23

Oral Phase Dysphagia – For facial weakness, modify food texture and place food at the back of mouth or on the stronger side (i.e., tilt the head toward the stronger side). EMG biofeedback or sucking/blowing exercises may be helpful. For poor lingual control, tongue active ROM and strengthening can be prescribed (precise articulation should be encouraged). Neck extension may also be used to increase oral transit time.

Question 24

______ Dysphagia – This is the most common type and is often accompanied by a ______ voice with coughing.

Answer 24

Pharyngeal Phase Dysphagia – This is the most common type and is often accompanied by a wet, gurgly voice with coughing.
Note that an absent gag reflex does not necessarily connote an unsafe swallow; conversely, those with intact gags may aspirate.

Question 25

Techniques for a delayed swallow reflex include ________, ________, ________, and thickened liquids. The chin tuck maneuver widens the ________ (allowing the bolus to rest there while the reflex is triggered), reduces the airway opening, and reduces the space between tongue base and posterior pharyngeal wall (increasing pharyngeal pressure). In the supraglottic swallow, the patient ________ with a concomitant ________, swallows, clears the throat, then swallows again, before resuming breathing. Chin tuck and supraglottic swallow are also useful for ________.

Answer 25

Techniques for a delayed swallow reflex include chin tuck, rotation of the head to the weaker side, supraglottic swallow, and thickened liquids. The chin tuck maneuver widens the vallecula (allowing the bolus to rest there while the reflex is triggered), reduces the airway opening, and reduces the space between tongue base and posterior pharyngeal wall (increasing pharyngeal pressure). In the supraglottic swallow, the patient holds a deep breath with a concomitant Valsalva, swallows, clears the throat, then swallows again, before resuming breathing. Chin tuck and supraglottic swallow are also useful for reduced laryngeal closure.

Question 26

The ________ maneuver can address incomplete relaxation or premature closing of the ________ . The patient improves pharyngeal clearance by ________ (allowing more complete cricopharyngeal relaxation) before completing the swallow.

Answer 26

The Mendelsohn maneuver can address incomplete relaxation or premature closing of the cricopharyngeus. The patient improves pharyngeal clearance by “holding” a swallow midway for 3 to 5 seconds (allowing more complete cricopharyngeal relaxation) before completing the swallow.