chapter 6 Communication Disorders and Related Symptoms

Question 1

Brain insults

Answer 1

are seldom clean
rarely does an insult fit perfectly into a category of Brocas aphasia or Wernickes aphasia
slp’s job to describe the symptoms/characteristics of the communication deficit

Question 2

Aphasia

Answer 2

• acquired language disorder redulting from damage to the language centers
• may affect auditory comprehension, reading, verbal expression, writing
• often grouped into categories of fluent aphasia vs. non-fluent aphasias

Question 3

what is fluent aphasia

Answer 3

good pragmatics, intonation eye contact etc, rambling wernicke’s

Question 4

what is non fluent aphasia

Answer 4

broken, halting, labored, filled with pauses -mostly broken

Question 5

Cognitive-Communication Disorders

Answer 5

• Dementia/Disease Patients (PArkinson’s, Alzheimers, Picts, Creutz)
• cognitive disorders affect the executive center, resulting in problems with conversation, attention, abstraction, decision-making, inhibition, pragmatics
• typically result from diffuse damage, not necessarily a focal lesion
• Injury may be from a single incident or from a progression of lesions/disease
• Injury may disconnect the executive center from the limbic system (and may result in mood changes, depression)

Question 6

Language/Linguistic Symptoms (terms you can use to describe; regardless of cause)

Answer 6

1. Auditory comprehension problems
2. Visual comprehension problems
3. Paraphasias
4. Nonfluent aphasia
5. Fluent aphasia
6. Anomia
7. Confabulation
8. Jargon
9. Agraphia

Question 7

1. Auditory comprehension problems

Answer 7

(damage/stroke to area 22/Wernicke’s)

Question 8

2. Visual comprehension problems

Answer 8

(damage/stroke areas 18/19 (agnosia) or areas 39/40 (dyslexia))

Question 9

3. Paraphasias

Answer 9

are word errors: phonemic-SODA, Neologistic-nonsense utterance/word (Wernickes), Semntic (verbal)-word substitutionm using a related word knife/spoon Wernickes

Question 10

4. Nonfluent aphasia

Answer 10

results from damage to area 44/45 Broca’s area characteristics are: limited length of utterance, agrammatic, telegraphic (content words), more content words than substantive (function) words, morphological markers often missing (prefixes/suffixes) [Aphasic/Language Deficits]; groping, effortful, halting, trial-and-error speaking pattern, frequent pausing (phoneme sequence area 44, not an artic or motor problem [Apraxia of Speech problems] somewhat monotone

Question 11

5.Fluent aphasia

Answer 11

results from damage to area 22, Wernickes area characteristics are
-speech is grammatically correct for the most part, lengthy but has no meaning
-grammatical errors may be present, fast speaking rate is not unusual
-normal intonation and pausing for the most part
there are other types of fluent aphasias beside wernickes

Question 12

6. Anomia

Answer 12

is the inability to retrieve a word (also known as word-finding/retrival)
-results from any damage to the brain, but in particular areas 39/40
-semantic paraphasias are a common substitution for the intended word( closely related word)
anaphors is the use of indefinite pronouns to replace the intended word (it)
circumlocution is using a description of the intended word

Question 13

7. Confabulation

Answer 13

responding with unrelated information

Question 14

8. Jargon

Answer 14

is the use of nonsense productions (neologisms) or sometimes the use of real words (which do not make any sense), called semantic jargon
in many cases there is a combinationof neologisms and semantic jargon within a single utterance .
Wernickes

Question 15

9. Agraphia

Answer 15

is the inability to write

errors(paragraph) include spelling errors, grammatical errors, or incorrect word usage, (39/40 areas)

Question 16

Sensory and Perceptual Symptoms

Answer 16

1. Sensory

2. Perceptual

Question 17

sensory

Answer 17

involve the outer receptors of the body (eyes, ears, and brain stem) brain damage typically does not result in sensory issues (unless you count brain stem lesions)

1. Central/retrocochlear hearing loss- generally from damage to the auditory nerve/ brain stem neuronal system, possible reaching area 41 (Heschl’s gyrus) primary auditory cortex
2. Diplopia (double vision) results from damage in brainstem area- cranial nerve IV and III could also be optic nerve II
3. Nystagmus (oscillations of the eyeball) results from vestibular or cerebellar lesions

Question 18

Perceptual

Answer 18

disorders from damage to association or tertiary areas of the brain

1. auditory agnosia- results from damage to area 42, just anterior to area 22 Wernickes area. In this disorderm non-speech signals cannot be identified (music, motorcycle, birds)
2. auditory verbal agnosia-results from damage to Wernickes area, in this disorder words (language) comprehension is impaired
3. Amusia is the inability to distinguish between subtle musical notes/pitch. in this disorder the lesion is typically in the right hemisphere
4. Hemianopsia- is the inability to see items in a particular quadrant of a visual field. Figure 6-1
5. visual agnosia- is the inability to name a seen object resulting from damage to areas to 18/19
6. Autopagnosia is the inability to recognize ones own body parts ( left side neglect)-usually right side lesion
7. Prosopagnosia is the inability to recognize faces or expressions from right side lesion
8. Anosgnosia (visual neglect) typically occurs on the left side from right hemisphere damage.
9. Sensory agnosia is the inability to name an object from touch (damage is areas 5/7

Question 19

Behavioral and cognitive symptoms

Answer 19

behaviors can change as the result of prefrontal cortex damage or from any diffuse brain injury.
behavioral changes are considered abnormal if they are excessive, inappropriate, inconsistent with the persons premobid personality or if they interfere with social communications
1. Euphoria-constant state of joyousness or denial of a negative situation
2. Increased egocentricity-usual self centeredness or refusal to cooperate with others
3. Excessive affective behavior- outbursts/swearing or odd self stimulating behaviors
4. emotional lability- unexpected/uncontrollable crying/laughter
5. Inconsistent/fluctuating responses-very commonly observed part of pregress or lack of
6. Stimulus boundness-fixating on specific aspects of a stimulus, refusal to enlarge situation
7. Increased Frustration-very common immediately after the injury, fatigue difficulty of task
8. Reduced attention span-due to drugs, slowness of recovery, fatigue, interest, memory, etc
9. increased concretism-reducd ability for abstraction, decision making, executive functions
10. social withdrawal-reduce contact with certain people, situations, entertainment etc.
11. depression-up to 50%, slower/longer the recovery the greater the chance of occurrence
12. Catastrophic reaction- verbal outburst, seizure, temper-tantrum, aggression, rage .#3
13. Increased dependency-caregivers often enable the patient, slowing down recovery
14. Perseveration-repeated response to a changing stimulus (especially verbal repetition)
15. Disorientation-inability to recall place/time/purpose. always check before starting TX
16. Acalculia-math disability
Amnesia-anterograde is inability to form new memories; retrograde cannot recall past

Question 20

Motor symptoms

Answer 20

depend on site of lesion
left side damage of the frontal lobe (broca’s area) typically results in visible motor deficits
right hemisphere damage also produces some unusual motor complications
1. Hemiplegia-refers to paralysis of the arms and legs. sometimes damage to Broca’s area in the left hemisphere results in contralateral hemiplegia of the tight lower quadrant of the face, right arm and right leg. damage to the brain stem can produce quadriplegia or even locked in ipsilateral hemiplegia of arms and/or legs
2. Hemiparesis-refers to weak muscle function. Generally a frontal lobe stroke produces hemiparesis rather than a full blown hemiplegia
3. Ataxia-results typically from cerebellar damage symptoms are a lack of balance or coordination of fine motor skills resembling a drunken state including slurred speech with variable rate of speech and variable pitch/ loudness control
4. Contractures- result from spasticity(damage to UMN) as seen in spastic cerebral palsy
5. Seizures-can resultfrom previous brain damage, fatigue, or from unknown reasons. generally stroke patients do not suffer from ongoing seizures
6. Limb/motor apraxia-inappropriate use of an object typically upon command
7. Constructional apraxia- difficulty reproducing 3-D configurations or copying a design, resulting typically from right hemisphere damage
8. Oral apraxia-inability to follow oral-periphery commands
9. Apraxia of Speech-inability to sequence phoneme correctlywhe n producing a word upon command (all apraxias result from damage to area 6(premotor strip) or area 44 in the case of AOS. in apraxia there is no paralysis/paresis. it is a disorder of programming upon command. the same action typically can be performed spontaneously.)
10. Dysarthria- damage to the motor strip results in at least paresis, if not paralysis of the contralateral muscles that are involved. this damage is typically diagnosed as flaccid dysarthria, resulting in slurred speech(if the articulators are involved) damage of the upper motor neurons descending away from the motor strip results in spastic dysarthria.

Question 21

Other Symptoms

Answer 21

with any other damage to the brain other symptoms may resultsuch as lack of bladder/bowel control. remember however that any new or change of behavior ( compared to premorbid state) may or may not be disruptive to communication or a particular lifestyle.