Classification of Aphasis

Question 1

Prevalence

Answer 1

the total number of disease cases at a given period of time

Question 2

Incidence

Answer 2

the number of new cases during some time period

Question 3

Prevalence of Aphasia

Answer 3

• 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)

Question 4

Fluent vs. Nonfluent Classification (look @ pic)

Answer 4

• 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

Question 5

Receptive Aphasia

Answer 5

• 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

Question 6

Expressive Aphasia

Answer 6

• references deficits in language production

- more anterior cerebral lesions tend to be associated with language production problems

Question 7

Aphasia Symptomatology

Answer 7

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

Question 8

Paraphasias

Answer 8

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)

Question 9

Verbal (Global) Paraphasia

Answer 9

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)

Question 10

Neologistic Paraphasia

Answer 10

references the use of a meaningless, invented word

pts may refer to an object by their invented, nonsensical term
aka: neologism

Question 11

Phonemic (Literal) Paraphasia

Answer 11

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

Question 12

Disorders of Fluency

Answer 12

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

Question 13

Disorders of non-fluency

Answer 13

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

Question 14

Auditory Comprehension

Answer 14

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

Question 15

Repetition

Answer 15

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

Question 16

Paragrammatism

Answer 16

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”

Question 17

Agrammatism

Answer 17

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

Question 18

Anomia

Answer 18

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

Question 19

Grapheme Expression

Answer 19

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

Question 20

Reading Problems

Answer 20

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)

Question 21

Aphasia is NOT

Answer 21

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

Question 22

8 Must Knows

Answer 22

1. site of lesion (can tell if fluent or non-fluent)
2. oral expression (fluency; paraphasia)
3. repetition (can the pt. repeat, how far can they repeat, can they repeat digits, words, phrases, sentences (simple to complex))
4. naming (confrontational (flash card; object), divergent, convergent)
5. auditory comprehension (fluent vs. non-fluent)
6. oral reading (may mirror verbal(oral) expression)
7. reading comprehension
8. grapheme expression (may mirror verbal (oral) expression)