Classification of Aphasis Flashcards
Prevalence
the total number of disease cases at a given period of time
Incidence
the number of new cases during some time period
Prevalence of Aphasia
- CVA: 3rd leading cause of death in US
- mortality rates differ across strokes; 8-12% of ischemic strokes and 37-38% of hemorrhagic strokes result in death
- leading cause of disability
- ischemic strokes are more common than hemorrhagic
- Broca’s aphasia is more common in younger pts
- Wernicke’s aphasia is more common in older pts
read over pp98-99 of text (ethnocultural groups)
Fluent vs. Nonfluent Classification (look @ pic)
- pts w/aphasia are grouped according to their fluency of speech
- we are not speaking of fluency (necessarily) as it relates to the presence or absence of stuttering
- some pts have relatively preserved fluency of speech while others have marked difficulty in producing and sustaining fluent speech
- hence our classifications are either fluent or nonfluent
- this classification is based on both deficiencies of language but also on anatomical considerations
Receptive Aphasia
- references deficits in language comprehension
- lesions more posteriorly located in the cerebrum tend to produce more comprehension related issues
- fluent aphasias are considered receptive aphasias
Expressive Aphasia
- references deficits in language production
- more anterior cerebral lesions tend to be associated with language production problems
Aphasia Symptomatology
patients will demonstrate a set of common symptoms:
- paraphasia (various types)
- disorders of fluency (not stuttering per se)
- auditory comprehension
- repetition
- agrammatism vs. paragrammatism
- anomia (word finding difficulties)
- writing problems (agraphia)
- reading problems (alexia)
- visual (gestures)
- apraxia vs. dysarthria or both
Paraphasias
errors in speech consisting of unintended words or sound substitutions
-often considered a central sign of aphasia
most are present in all types of aphasia, as such, (not a significant factor in identification of specific types of aphasia)
3 primary types of paraphasia: verbal (global) paraphasias (unintended word) neologistic paraphasias (made up word) phonemic (literal) paraphasias (sound level)
Verbal (Global) Paraphasia
entire word is substituted
2 types:
[1] semantic paraphasia: substituted word is semantically related to the one intended (e.g., pt says son for daughter) (in same category as intended word)
[2] random paraphasia: substituted and intended words are not semantically related (e.g., window for banana) (no relation to the word intended)
Neologistic Paraphasia
references the use of a meaningless, invented word
pts may refer to an object by their invented, nonsensical term
aka: neologism
Phonemic (Literal) Paraphasia
substitution of one phoneme for another (loman for woman) or the addition of a phoneme (wolman for woman)
different diagnosis than apraxia of speech or speech sound disorder
Disorders of Fluency
aspect of language production; fluent speech flows and is produced with less effort
it is smooth and devoid of too many interruptions
fluency: speech that approximates the normal rate, typical word output, length of sentences and the melodic contour
pts who produce 5+ connected words may be judged fluent
when word output is less than 50 words a minute in conversation, fluency is significantly impaired
Disorders of non-fluency
pts who are nonfluent, tend to speak with a degree of muscular effort not seen in normally fluent speakers.
speech may be slow, deliberate, or limited
utterances may contain fewer words than normal
speech is usually hesitant
Auditory Comprehension
most pts w/aphasia have some degree of difficulty w/auditory comprehension
not dependent necessarily upon fluent or nonfluent status
it is the degree of severity that varies
assessed from simple tasks to more complex multi-steps
Repetition
pts imitation of single words, phrases and sentences
usually more frequently present in cases of impaired auditory comprehension; not always the case though
must rule out true deficit versus inability to repeat secondary to apraxia, etc
Paragrammatism
seen in fluent aphasias
substitution/addition of inappropriate sequences (verb tense confusions, gender case issues, incorrect choice of prepositions, misuse of inflections, juxtaposition issues
think “cocktail party speech”
Agrammatism
seen in nonfluent aphasias
simplification/reduction of grammatical construction
omission of articles, connected words, auxilary verbs, inflectional morphemes
pt’s will use only content words
think telegraphic speech
Anomia
word finding difficulty usually persists for those that recover
present in confrontational naming:
- divergent: (name 3 fruits)
- convergent: (apple, pear and orange are all _____)
word frequency and semantic categories
-words that are less frequent in everyday language
anomia is not particularly useful when differentiating types of aphasia (it’s more of a general problem)
persistent and severe word-finding and naming difficulties are dominant, pt may have anomic aphasia
Grapheme Expression
agraphia: writing problems associated w/cerebral lesions
most all pts will demonstrate some difficulty w/writing
problems will generally reflect problems seen in verbal expression
-agrammatic, effortful, sparse speech seen in pts w/Broca’s aphasia will demonstrate agrammatic, effortful, sparse writing
may exhibit poor letter and/or word formation
may reverse, confuse or substitute letters
self-correction may be poor; nonsensical words and poor orthographic skills
may be totally unreadable
Reading Problems
again, variety is noted in pts w/aphasia
some have difficulty reading secondary to verbal expressive problems
others may demonstrate poor comprehension of what is read silently or orally
alexia (loss of or inability to comprehend written language)
Aphasia is NOT
dementia: progressive neurological disease in which communicative and cognitive skills, along with social and personal behaviors continue to deteriorate
- Alzheimer’s disease
- Pick’s and Parkinson’s diseases also can cause dementia
schizophrenia: psychiatric d/o characterized by d/o’d thought, affect and behavior
- pts exhibit irrelevant speech and disturbed thinking
- disassociation from reality with hallucinogenic qualities
- typically dx’d earlier in life than aphasia
- onset is usually more gradual
8 Must Knows
- site of lesion (can tell if fluent or non-fluent)
- oral expression (fluency; paraphasia)
- repetition (can the pt. repeat, how far can they repeat, can they repeat digits, words, phrases, sentences (simple to complex))
- naming (confrontational (flash card; object), divergent, convergent)
- auditory comprehension (fluent vs. non-fluent)
- oral reading (may mirror verbal(oral) expression)
- reading comprehension
- grapheme expression (may mirror verbal (oral) expression)
