Day 5 Flashcards
In the 18th century it was
believed that aphasia was caused by a ________________ (Johann Gesner 1738-1801)
congestion of the nerve ducts
__________ was practiced in the 19th century
Phrenology
20th century –___________ believed language is localized to specific areas in the brain.
localizationists
Define: aphasia
impairment of language affecting the production or comprehension of speech and the ability to read or write
(More, less) people have aphasia than other common conditions, including cerebral palsy, multiple sclerosis, Parkinson’s disease, or muscular
dystrophy.
More
_________ is a leading cause of long-term disability.
Stroke
There are at least __________ people in the USA with aphasia.
1,000,000
2 fathers of aphasia
Paul Broca and Carl Wernicke
Paul Broca
French neurologist who, worked with a patient with limited speech and impaired language due to
brain damage to a specific area. These clinical features are now identified with Broca’s aphasia.
Carl Wernicke
Such as Broca’s area and Wernicke’s area
2 structures in the specific :eloquent cortex”
Broca’s area and Wernicke’s area
Many now believe (mostly from fMRI and PET data) that language should be viewed as __________. Why?
Neural networks. During imaging studies, many areas light up when
performing language tasks
White matter pathways carry information to/from ____________.
the “eloquent” cortex
Cognitive areas impact what 4 cognitive-linguistic functions?
attention, memory, impulse control, initiation
Blue lobe (largest) at forehead/front region
frontal
Pink lobe at bottom middle region
temporal
Green lobe at top middle region
parietal
Orange/red small lobe in back
occipital
10 primary structures of the cerebral cortex
- Central sulcus (Fissure of Rolando)
- Lateral sulcus (Sylvian fissure)
- Primary Motor cortex • Primary Sensory Cortex • Broca’s area • Wernicke’s area • Supramarginal gyrus • Angular gyrus • Primary visual cortex • Primary auditory cortex
Central Sulcus (Fissure of Rolando)
divides frontal and parietal lobes.
Lateral Sulcus (Sylvian Fissure)
divides frontal and temporal
lobes.
Primary Motor Cortex- define and location
AKA precentral gyrus Sends motor information to contralateral body (in frontal lobe)
Primary Sensory Cortex - define and location
AKA postcentral gyrus Receives sensory information from contralateral body (in parietal lobe)
Broca’s Area- define and location
Motor programming for speech production (in frontal lobe)
Wernicke’s Area- define and location
Comprehension of oral
language (in temporal lobe)
Supramarginal gyrus- define and location
Symbolic integration for writing (in parietal lobe)
Angular gyrus- define and location
Symbolic integration for reading (in
parietal lobe)
Primary visual cortex (define and location)
Receives visual information for seeing (in occipital lobe)
Primary auditory cortex (define and location)
Receives auditory information for hearing (in temporal lobe)
Perisylvian Zone- aka, lesion implications
aka Lateral fissure, lesions in this area can result in language disturbances
Largest cortical vascular territory- most important implications for speech/language
Middle cerebral artery
Wernicke-Geschwind process of reading aloud
Primary visual cortex –> angular gyrus –> Wernicke’s area –> Broca’s area –> Primary motor cortex
Wernicke-Geschwind process of Verbal repetition
Primary auditory cortex –> Wernicke’s area –> Broca’s Area –> Primary motor cortex
What stroke location/cerebrovascular artery has most implies aphasia
Left hemisphere, MCA
Define: White matter
bundles of myelinated axons that are interconnected
Define: Arcuate fasciculus
white matter pathway that connects Broca and Wernicke’s areas
Clinical features of Broca’s aphasia
Relatively good auditory comprehension ▫ Nonfluent speech with short sentence length ▫ Increased effort in speaking ▫ Agrammatism (lack of “little words”) ▫ Poor repetition and naming
Neurological location often associated with Broca’s aphasia
Broca’s area AND surrounding white/gray matter
Clinical features of Wernicke’s aphasia
Poor auditory comprehension ▫ Fluent speech/normal sentence length ▫ Lack of meaning in speech ▫ Paraphasias (jargon) ▫ Poor repetition and naming
Neurological location often associated with Wernicke’s aphasia
Wernicke’s area in the temporal lobe
Clinical features of global aphasia
▫ Poor auditory comprehension ▫ Nonfluent/limited speech
▫ Poor naming and repetition
▫ Comprehension of pictures and gestures are typically better than auditory comprehension
Neurological location often associated with global aphasia
Larger area of damage including both Broca and Wernicke areas
Which types of aphasia have poor auditory comprehension?
Wernicke’s and Global
Which types of aphasia have non-fluent speech?
Broca’s and Global
Commonality between Global, Wernicke, and Broca
Poor naming and repetition
Which type of aphasia involves more awareness of their deficits?
Broca’s aphasia
Which type of aphasia is the most severe in characteristics and implications?
Global aphasia
Are lesion sizes/locations variable between patients?
YES!
Define: Conduction aphasia
repetition is primary impairment
Define: transcortical aphasia
repetition is intact
Define: subcortical aphasia
damage is in subcortical structures such as thalamus, internal capsule, basal ganglia
Define: crossed aphasia
Right handed with right hemisphere stroke
resulting in aphasia
Define: primary progressive aphasia
Focal dementia impacting language functions first
2 important aphasia clinical resources
Aphasia simulation, ASHA practice portal
Movement over the past decade to focus on the ______, or _____ model.
Person, social.
4 considerations of social model
Life participation is the ultimate goal
▫ Important to assure treatment generalizes to real life
▫ Social supports are important
▫ Communication partner training is included in treatment
6 communication tips for clinicians
• Minimize background noise when speaking • Make sure you have the person’s full attention
before you start
• Get on the person’s level and communicate face to face
• Acknowledge that this person is smart and has something to contribute to the conversation
• Speak slower but in a natural way
• Give the person time to speak
4 cognitive constructs
speed of processing, memory, executive functions, attention
2 types of memory- define each
Episodic memory (long-term, autobiographical) Working memory (simultaneous storage and manipulation)
3 types of executive functions
Resistance to interference, Inhibition of distractions
Manipulating information, Planning & strategizing
Multi-‐tasking
2 types of attention- define
Sustained- focus on one activity for a long period of time
Selective- ability to focus on one thing when other distractions are present
Impacts of speed and memory on assessment and treatment
Introduce yourself and tell them why you are there every single time. make a lot of lists, be direct of split into 2 sentences
Function of hippocampus
central switchboard where all aspects (taste, smell, sight, sounds, etc). come together and are integrated into one mental representation.
Speed relationship with pathology and age
Speed much worse with pathology and worse with age
Episodic memory- details vs. larger picture, locations that cause worse damage to episodic memory
Gist memory is good, details may be hazy
– VERY impaired if damage to hippocampus or white matter leading to hippocampus
Working memory- aging, locations that cause worse damage to working memory
Somewhat limited in healthy aging – Even worse if significant frontal lobe damage
Executive function- aging, locations that cause worse damage to executive function
Somewhat impaired in aging
• Active inhibition of distractions
• Multi-‐tasking • Much worse with frontal & parietal lobe damage
– Mostly intact in aging: Planning & strategizing, understanding cause & effect
2 other disorders that cause impaired executive function in at least some patients- explain
ALL get impaired with TBI
• Diffuse damage to white matter, especially connections within frontal lobe and to/from frontal lobe
– Impaired in dementia (but different types of dementia will affect different abilities at different times)
Attention relies on integrity of _______________ that go from frontal lobes to parietal lobes to basal ganglia
(bidirectionally)
large cortical networks (loops)
Aging has minor effects on sustained attention, but may impact __________ a bit more . Why?
selective attention. Related to inhibition, but inhibition is active suppression of distraction, selective attention is more basic FOCUSing ability.
Attention is Seriously impaired in ______, with any kind of _______ or ________ damage.
TBI, frontal lobe or basal ganglia
Impacts of attention on assessment and treatment
Make sure TV is off and no other distractions before you ask them to concentrate. Make a lot of lists. Shorter more varied assessment. More frequent breaks. Positive reinforcement. Physical activity.
3 mitigating factors
education, pain and infection, sensory impairment
Education effects, considerations
Education & learning experiences build neural connections, give a buffer so that normal function can be maintained .
• Every day performance used to be much higher, but can still perform “within normal limits” even with age-‐related changes • Greater education has been found to predict better recovery (and sometimes amount of functional deficits) in some studies.
Hard to see if highly educated have memory issues because were so incredibly well-performing before that they still may perform normally on memory tests.
Pain and infection effects
Can magnify apparent cognitive impairment. – Normal function returns when condition is resolved
Visual impairment effects, considerations, solutions
Considerations: glass, macular degeneration; do as many auditory tasks as possible, has effects on written or picture-based assessment
Define- cognitive reserve
how much more you have beyond the required functioning for everyday tasks
Hearing impairment effects, considerations, solutions
Hearing aids on, and batteries properly installed/functioning? Use written or picture based communication.
Hypothesis about visual and hearing impairments
Long-term uncorrected visual and hearing impairments may have effects on cognition- less input to that cortex, those parts of the brain get taken over by other functions
6 parts of a bedside exam or general assessment
Introductions Item naming Orientation questions Multi-‐step Commands Oral-‐Mech exam Swallowing Exam
10 primary considerations in thinking about changes in neural bases of communication throughout the lifespan
- Speed of processing • Episodic memory
- Working Memory • Inhibition • Multi-‐‐tasking • Attention • Education
- Pain • Visual impairment • Hearing impairment
6 populations that demonstrate possible cognitive impairment as compared to normal adults
Mild Cognitive Impairment Alzheimer & other dementias Parkinson’s disease Following Stroke Young Adult with TBI Children
6 things that individual differences in cognitive abilities and history
(education, sensory impairments, pain levels) can impact
Cognition at assessment
Ability to understand instructions Response to treatment
Probability of completing “homework” Expectations of improvement
Awareness of their own deficits