Communication

Question 1

what portion of stroke survivors will have communication disorders?

Answer 1

1/3

Question 2

how can we classify communication disorders?

Answer 2

speech or language problem

Question 3

differentiate language v speech

Answer 3

language: use of symbols (print, pics, spoken words) that make up our messages
speech: mechanics of talking - vocal production including multiple components

Question 4

what are the five components of speech

Answer 4

1. respiration (breath support)
2. phonation (vocal tracts to modify acoustics)
3. articulation (use of tongue, teeth, and lips to produce sounds
4. resonance (quality of voice)
5. prosody (rhythm, fluency, and patterns of speech)

Question 5

expressive and receptive language disorders consistently seen with ____ brain damage

Answer 5

left

Question 6

Left sided (dominant) language centers confirmed by left-sided damage resulting in…. (2)

Answer 6

1. acquired dyslexia

2. deaf aphasia

Question 7

what is deaf aphasia

Answer 7

a consequence of left brain damage in hearing impaired individuals where the individual loses the ability to sign, akin to verbal aphasia

Question 8

what are the right brain pragmatic aspects to language?

Answer 8

1. context
2. metaphors
3. inflection
4. jokes

Question 9

how is language affected following R brain injury?

Answer 9

patients may lose the ability to understand context, they will consider things literally, will not be able to understand inflection, and may not understand jokes

Question 10

give an example of how a patient with R sided brain injury might have difficulty in communication

Answer 10

“heavy heart” can be taken literally

Question 11

Five types of communcation disorders

Answer 11

1. dysarthria
2. dysphagia
3. apraxia
4. aphasia
5. cognitive-communcation

Question 12

define dysarthria

Answer 12

motor SPEECH disorder caused by weakness/paresis/paralysis of muscles involved in speech

Question 13

T/F: Dysarthria on affects the phonation (motor) component of speech

Answer 13

false: dysarthria can affect ALL components of speech

Question 14

what causes dysarthria

Answer 14

unilateral, bilateral, or brainstem involvement (a UMN OR LMN issue)

Question 15

what is the chief patient complaint with dysarthria

Answer 15

“people don’t understand me… they think I’m drunk”

Question 16

what does dysarthria sound/look like (4)

Answer 16

1. facial muscle visible weakness/asymmetry
2. slurring
3. complex sounds are shortened (street = reet)
4. wet/breathy/strained

Question 17

what are four strategies to use with dysarthria patients?

Answer 17

1. eliminate environmental variables
2. ask patient to slow down/space out each word
3. yes/no questions or options
4. letter boards/writing/etc (alt communication)

Question 18

what is apraxia

Answer 18

a motor SPEECH disorder caused by motor planning problems related to muscles of speech production

Question 19

T/F: those with speech apraxia are able to respond “hi,” “how are you,” and “stop it.”

Answer 19

true! automatic speech may be intact in those with apraxia

Question 20

what is a typical patient complaint with apraxia

Answer 20

“i know what I want to say but I can’t say it”

Question 21

What does apraxia sound/look like?

Answer 21

1. errors - inconsistent and unpredictable
2. automatic speech > volitional speech
3. awareness of errors, but unable to correct
4. may be accompanied by limb apraxia

Question 22

what are three apraxia strategies to be used by the PT

Answer 22

1. limit burden by asking yes/no or give options
2. alt communication
3. speak slowly and let the patient watch your mouth

Question 23

what is aphasia

Answer 23

LANGUAGE disorder due to (usu) LEFT hemisphere damage

Question 24

what does aphasia look/sound like

Answer 24

1. impaired auditory comprehension/retention
2. impaired accuracy of speech
3. impaired reading comprehension
4. impaired writing

Question 25

What is a common patient complaint of aphasia

Answer 25

"i can't... understand you, find the word I want, make myself understood" - like being in a foreign country!!!

Question 26

T/F: aphasia is a speech disorder

Answer 26

false - it is a language disorder

Question 27

T/F: aphasia is a cognitive disorder

Answer 27

false - a patient's cognitive ability may be masked by aphasia

Question 28

what is the APHASIA strategy to communicate with aphasic patients

Answer 28

``` A - ask simple questions P - provide choices H - help communicate if asked A - acknowledge frustration S - slow... speak slowly and clearly I - if you don't understand, say so! A - allow extra time ```

Question 29

what are the two major categories of aphasia

Answer 29

1. nonfluent (Broca's) global transcortical motor aphasia | 2. fluent (Wernicke's) conduction anomic transcortical sensory aphasia

Question 30

what does nonfluent aphasia sound/look like

Answer 30

1. slow, laborious, halting 2. telegraphic (high content but absent little words) 3. words may be wrong, but related to the right word 4. apraxia 5. comprehension > expression 6. good error awareness

Question 31

what are four nonfluent aphasia strategies

Answer 31

1. establish yes/no strategy 2. simplify language (only give back what the patient gives you) 3. give single written word cues/choices 4. use gestures, objects, pictures, facial expressions

Question 32

what does fluent aphasia sound/look like

Answer 32

1. fluent, copious, effortless expression 2. normal intonation 3. decreased auditory comprehension 4. poor error awareness

Question 33

what are 2 fluent aphasia strategies

Answer 33

1. stop them from talking when you are | 2. use all previously described strategies

Question 34

what is the best position to swallow

Answer 34

"chin tuck facilitates swallow"