Chapter 8: Neurologically Based Communication Disorders Flashcards
Ishemic Strokes vs Hemorrhagic Stroke
Ischemic: Causes by a blocked or interrupted blood supply to the brain
1. Thrombotic Strokw: A blood clot (thrombus) in an artery
2. Embolic Stroke: A wandering clot (embolus)
Hemorrhagic: Caused by bleeding in the brain due to ruptured blood vessels
1. Intracerebral Hemorrhages (most common type): Blood vessel bleeds or ruptures into the tissue deep witin the brain
2. Extracerebral Hemorrhages: Ruptures within the meninges
- Blood flow is interrupted to the brain
- Blood pools and damange the cells
Major Symtoms of Aphasia
Paraphasia
Repitition
Logorrhea
Empty Speech
Agarmmatic Speech
Anomia
Circumlocution
Others
Paraphasia
An expressive lnaugage eorror unrelated to motor deficits
Semantic: substitution of one word for another; may be related in meaning (marker for pencil)
Phonemic: Errors at the sound level; phonemes may be substitudes, ommited, or transposed (tup for cup)
Neologistic (neologism): nonword a person creates; they are unintelligible, unrelated to the intended word (skeen for pencil)
Logorrhea
Excessive and inappropirate prodution of speech, often tangential and meaningless
Empty Speech
Substitution of such general words as this, that, stuff, and thing in place of more specific words
Agrammatic speech
Omission of grammatic features in speech; speech that consists mostly of content words (nouns, verbs, etc) and lacks function words (articles, conjunctions, prepositions, etc)
Anomia
Naming difficulty or wordfinding deficit with varying severity
Confrontation naming is especially difficult
Circumlocution
Production of nonspecific words and “beating around the bush” often due to word finiding problems
Broca’s Aphasia Language Impairment characteristics
- Non-fluent and effortful speech- frequent pauses, interjected sounds (um, uh), revisions, repetitions, etc.
- Agrammatic, limited speech- “telegraphic speech”
- Impaired repetition (words and sentences)
- Impaired confrontational naming
- Some impairment in auditory comprehension (complex information)
- Alexia (difficulty reading)
- Agraphia (difficulty writing)- slow, agrammatic, many spelling errors
Site of Lesion for Broca’s Aphasia
- Posterior- inferior portion of frontal lobe
- 3rd frontal convolution
- Broca’s area
Blood supply for for Broca’s Aphasia
Middle Cerebral Artery (MCA)
Transcortical Motor Aphasia Language Impairment characteristics
- Muteness- possibly due to akinesia
- Echolalia and perseverative speech
- Reduced spontaneous speech
- Non-fluent, paraphasic, agrammatic, and telegraphic speech
- Confrontational naming deficits
- Intact repetition
- Relatively intact automatic speech (days, months, numbers)
- Intact knowledge of grammar- can correct others
- Limited word fluency
- Use of motor prompts to initiate speech
- Comprehension > Production
- Alexia
- Agraphia
Site of Lesion for Transcortical Motor Aphasia
- Anterior lesions of left frontal lobe
- Subcortical areas of left frontal lobe in the watershed areas
- Below or above Broca’s Area
Blood Supply for Transcortical Motor Aphasia
- ACA
- Watershed region between ACA and MCA
Global Aphasia Language Impairment characteristics
- Globally impaired communication skills- verbal + non-verbal
- Severely reduced fluency
- Extremely limited verbal expression- few recognizable or unrecognizable words
- Impaired Repetition
- Impaired Naming
- Impaired Auditory Comprehension
- Alexia + Agraphia
Site of Lesion for Global Aphasia
- Diffuse left hemispheric damage
- Can have bilateral damage
- Lesion can extend subcortically
Blood Supply for Global Aphasia
Typically MCA but can involve any or all arteries
What is the most severe type of nonfluent Aphasia? and why??
Global Aphasia
Due to extensive lesions that affect all language areas
What are the types of non-fluent aphasia?
Broca’s Aphasia
Transcortical Motor Aphasia
Mixed Transcortical Aphasia
Global Aphasia
Wernicke’s Aphasia Language Impairment characteristics
- Normal or even abnormal speech fluency (logorrhea or press of speech)
- Rapid rate of speech
- Normal prosodic features
- Good articulation
- Normal phrase lengths
- Generally intact grammatical forms
- Severe word-finding problems
- Empty speech
- Poor auditory comprehension
- Impaired conversational skills
- Impaired repetition
- Impaired reading comprehension
- Alexia
Site of Lesion for Wernicke’s Aphasia
Posterior portion of the Superior temporal gyrus in the left
Bloody supply for Wernicke’s Aphasia
MCA
Transcortical Sensory Aphasia Language Impairment characteristics
- Fluent speech- good articulation, normal phrase length
- Good syntactic skills
- Paraphasia- semantic and neologistic
- Empty speech
- Impaired naming
- Good repetition
- Echolalia
- Impaired auditory comprehension
- Once initiated, normal automatic speech
- Sentence completion intact
- Poor reading comprehension
- Relatively preserved oral reading skills
- Agraphia
Site of Lesions for Transcortical Sensory Aphasia
- Inferior left temporoparietal region
- Can be a bilateral lesion
- Middle temporal gyrus
- Occipital lobe could be involved
- Can include angular gyrus, visual and auditory association areas
Bloody supply for Transcortical Sensory Aphasia
PCA
Conduction Aphasia Language Impairment characteristics
- Impaired repetition
- Varied speech fluency
- Paraphasia
- Word finding deficits
- Recognition of errors
- Good syntax and prosodic features
- Normal speech articulation
- Naming deficits (object identification intact)
- Intact auditory comprehension
- Variable alexia
- Agraphia
Site of Lesions for Conduction Aphasia
- The region between Broca’s area and Wernicke’s area
- Supramarginal Gyrus in the inferior parietal lobe and the aecuate fasciculus
- Left parietal or temporal lobe and the insula
Blood supply for conduction Aphasia
MCA
Anomic Aphasia Language Impairment characteristics
- Word finding difficulty- debilitating and pervasive
- Object identification intact (can point to object when named)
- Fluent speech
- Normal syntax
- Verbal paraphasia (word substitutions)
- Intact auditory comprehension
- Intact repetition
- Articulation intact
- Relatively normal oral reading and writing
Site of Lesions for Animic Aphasia
- Varies (causes this to be controversal)
- Many times lesions in parietal-temporal region involving angular gyrus
- Inferior temporal gyrus
Blood supply for Anomic Aphasia
MCA
Types of Fluent Aphasia
Anomic Aphasia
Conduction Aphasia
Transcortical Sensory Aphasia
Wernicke’s Aphasia
Outline of Aphasia Assessment
Assessment of
Repetition Skills
Naming Skills
Sentence Production, narration, and discourse
Speech Fluency
Functional Communcation Skills
Auditory Comprehension
Reading and Writing Skills
Gestures and Pantomime
Automated Speech and Singing
Bilingual Speakers with Aphasia
Alexia vs Dyslexia
Alexia: Loss of previously acquired reading skills due to recent brain damage
Dyslexia: Children’s difficulty learning to read (possibly genentically based)
Agnosia
Impaired understnading of meaing cartain stimuli, without peripheral sensory impairment
4 types
1. auditory agnosia: difficulty in matching objects with their sound, and normal visual recognition of objects
2. auditory verbal agnosia: impaired understanding of spoken words
3. visual agnosia: impaired visual recognition of objects, which may be intermittent
4. tactile agnosia: impaired tactile recognitionof objects when visual feedback is blocked and impaired naming and description of objects clients can feel in their hands
Assessment of Dementia overview
- Case history
- Clinicial examination
- Interview of family and other caregivers
- Neurological assessment
- Communication assessment
- Assessment of intellectual function
What domains or skills should be sampled when assessing dementia?
- Awareness or orientation to surrounding
- Mood and affect
- Speech and language skills
- Storytelling while looking at sequenced pictures
- Storytelling (spontaneous) or retellling the one clinicians tells
- Give a discourse on a current topic
- Abstract language comprehension
- Cognitive tasks (memory and executive function)
- Abnormal thinking (hallucination or delusions)
- Visuospatial skills (replicating a blocked design)
