ECU aphasia Flashcards
which area or the brain contains Wernickes
area 22
which functions are affected by damage to the angular gyrus
acalculia
agraphia
which area of the brain is indicated in apraxia
insula
what is ischemia
physiological tissue change
what is infaction
tissue death
what is the physiologic response to an ischemic stroke
edema transneural degeneration denervation hypersensitivity diaschisis (distal loss of function) collateral sprouting(neighboring neurons take over)
what is the penumbra
area around a stroke that could either die or survive
what are medical treatments for ischemic stroke
- carotid endarterectomy
- carotid stenting
- tPA
what are the 3 types of hemorrhagic strokes
- epidural
- subdural
- intracerebral
what are medical treatments for hemorrhagic stroke
- clipping
2. cerebral stent
what is hypoperfusion
reduction of blood flow to all parts of the body
watershed areas affected
what are the Brodmann’s area for speech and language
44 Pars Opercularis: brocas area
Broca’s aphasia and apraxia
45 Pars Triangularis: Brocas
22 Superior Temporal Gyrus: Wernickes aphasia
40 Supramarginal Gyris” Wernickes aphasia
41,42 Primary Auditory Association Cortex: Wernickes
39 Angluar Gyrus: Acalculia, agraphia, alexia
what are the patterns of impairment with aphasia
- speech fluency
- paraphasia (word, sound errors, semantic errors)
- repetition
- language comprehension
what are the characteristics of nonfluent aphasia
- slow halting speech
- great effort
- speech has diminished or absent intonation or emphatic stress
- function words omitted
- rely a lot on nouns
- 3-4 words per breath
- associated with agrammatism
what are the characteristics of fluent aphasia
- speech smooth and effortless
- rate and intonation similar to normal speaker
- function words present
- syntax appropriate
- variety of grammatical constructions
- 5-6 words per breath
- associated with paragrammatism or grammatically incorrect sentences
what are the types of nonfluent aphasia
broca’s
global
what are the types of fluent aphasia
wernickes
conduction
anomic
transcortical sensory
what are the characteristics of Brocas
poor fluency
good content
comprehend intact words and simple sentences
poor repetition
poor naming of verbs
poor reading and spelling
associated with right arm weakness and apraxia
preserved self monitoring
writing large, absent of function words(macrographia)
what are the characteristics of wernickes
good fluency poor content and comprehension poor repetition poor naming, worse for nouns poor spelling and reading associated with superior visual field cut jargon poor self monitoring anosognosia micrographia
what are the characteristics of conduction aphasia
fair-good fluency good content comprehension of intact words and simple sentences poor repetition fair-good naming spelling and reading may be spared associated with poor working memory lesions in upper temporal, lower parietal or insula
what are the characteristics of transcortical motor aphasia
poor fluency good content comprehension of intact words and simple sentences good repetition fair-good naming spelling and reading may be spared associated with abulia damage to watershed areas that spare brocas
what are the characteristics of transcortical sensory
good fluency poor content and comprehension good repetition poor naming, spelling, and writing asociated with right field cut damage to watershed areas that spare wernickes
which artery is responsible for thalamic aphasia
posterior cerebral artery
what is alexia without agraphia
pure word blindness
can write complex sentences but cant read what they wrote
difficulty copying
what is ideational apraxia
inability to conceptualize, plan, and execute the complex sequence of motor actions involving the use of tools or objects
what is ideomotor apraxia
inability to imitate hand gestures
what is intentional aphasia
intent to speak
anterior
impaired expressive language and motor speech
what is attentional aphasia
sensory
impaired attention to comprehension
posterior
what is the NIH stroke scal
clinical assessment tool to evaluate and document neurological status in acute stroke patients
what are some functional outcome assessment measures of stroke
- functional independence measure
- stroke impact scale
- burden of stroke scale
what are some aphasia screening tools
- language screening test (naming, repetition, automatic speech)
- aphasia rapid test: beside assessment to rate aphasia severity in acute stroke patients
what are components of comprehensive aphasia test batteries
- comprehension
- expression(repetition)
- motor skills
- reading/writing
- memory
- voice/swallowing
what are some tests of sentence comprehension
- token test
2. northwestern syntax screening test
what are assessments for single word comprehension
- select from an array procedure
2. test of single word comprehension (PPVT)
what variables influence single word comprehension
frequency
semantic or acoustic relationship to foil
part of speech
ambiguity
what variables influence sentence comprehension
length and syntactic comprehension
reversibiity and plausability
predictability
personal reference ( using pronouns, who is “he”)
what variables influence discourse comprehension
salience directness redundancy cohesion and coherence rate and emphatic stress
what is cohesion
how sentences are held together by conjunctions or pronouns
what is coherence
topic maintenance
what are some assessments of verbal expression
- simple speech production: repetitions, sentence completion, automatized sequences
- confrontational and responsive naming
what variables affect naming accuracy
frequency of occurrence
length and phonologic omplexity
semantic categories
context
what areas should be assessed for aphasia
comprehension expression reading writing cognition pragmatics
what are the predictors of aphasia recovery
age handedness education intelligence size, location, and number of lesions type of aphasia biggest predictor is initial aphasia severity
during what part of recovery is there the most improvement
first 3 months
what is the stimulation-facilitation model of treatment
- aphasia is an auditory processing deficit
- make the stimulus adequate
- bombard with stimuli
- elicit accurate responses
- use cueing and cueing hierarchies
what is the modality model of treatment
- aphasia is a uni or multi-modality deficit
- remediate input and output modalities, singly or in combination
- pair weak with strong modalities
what is the linguistic model of treatment
- aphasia is a selective deficit in language system or subsystems
- restore language performance by organizing stimuli according to linguistic system and complexity
what is the processing model of treatment
- aphasia reflects the product of spared language in response to impaired modules
- an impairment in the “executor” that allocates attentional resources to modules and processes
- restore or compensate for language specific processing deficit
what is the minor hemisphere mediation model of treatment
use minor hemisphere abiities to mediate communication through use of imagery, drawing, melody, contextually rich stimuli, novel stimuli, and humor
what is the functional communication model of treatment
emphasize pragmatic function over linguistic form
- enhance intermodality flexibiity
- establish strategies for communication repair
what is Response Elaboration Training
- increases MLU in nonfluent patient by capitalizing on preserved oral repetition
- designed to enhance initiation ability
- elaboration on patients phrase
- targets expressive language
what is Promoting Aphasics Communicative Effectiveness
- use all channels of communication (verbal, gestural, writing)
- emphasize content over form
- patient and clinicians simulate conversation
- free choice of communication mode
- targets communication
what is the Life Participation Approach
- focus is on re-engagement in life and real life goal
- social approach vs a medical model
- problems emerge from interaction between individual and environment
- targets communication
what is the social approach to treatment
- enhance communication by expanding skill in coversation, compensatory-strategies, scaffolding and supported conversations and partner training
- increase participation in events
- provide support systems
- increae confidence and positive identity
- promoting advocacy
what is language oriented treatment
- fits into linguistic model
- highly structured
- receptive targets include improving discrimination of speech sounds, improving access to word meanings, and changing the environment to support auditory comprehension
- expressive targets include semantic cueing, categorization, word to picture matching, phonemic cueing, cueing spoken output with written letters, repetition, and reading aloud
- targets all language domains
what is constraint induced language therapy
individuals with aphasia use the communication channel that is accessible with the least amount of effort
strategies suppress these in favor of verbal communication
2. avoid compensation by not allowing non verbal communication
3. targets expressive language
what is communicative speech therapy
- emphasizes interaction between patient and clinician in natural communication
- foals include topic maintenance, discourse management
- pragmatic treatment goals addressed along with linguistic therapy
what is the Bottom up model of auditory comprehension treatment
- start with physical characteristics of message
2. work way through series of levels until the message is comprehended
what is the Top down model of auditory comprehension treatment
- begin with general expectations about what a speaker is likely to say
- use general knowledge to prove or disprove their expectations
what are treatment techniques for sentence comprehension
- answering questions (yes/no and open ended)
- follw spoken directions
- sentence verification (sentence to picture match or multiple choice responses)
what is the heirarchy of reading comprehension tasks
- functional reading (survival skills)
- single word
- sentence reading
- paragraph and text
how do you facilitate expressive language
- phrase and sentence completion
- word and phrase repetition
- confrontation naming
- responsive naming
how do you facilitate word retrieval
- delay
- semantic association
- phonetic association
- description
- generalization
what are characteristics of right hemisphere syndrome
- left visual neglect
- difficulty with facial recognition
- poor awareness of deficits
- poor self monitoring
- impulsive behavior
- poor initiation and motivation
- disorientation
8 impaired attention/memory - difficulty with organization and problem solving
- difficulty with social aspects of language
what are task oriented approaches
improve performance on specific activities specialized to the patient. Considered functional therapy approach
what are process oriented approaches
- addresses processes and mechanisms underlying observed disabilities
- includes compensation techniques and facilitation techniques
how do you treat left neglect through compensation
verbal cues
visual and tactile cues
anchors
restructuring the enviornment
how do you treat left neglect through facilitation
pharmocological
vestibular stimulation
behavioral treatments
left limb stimulation
what is edgeness
- patient becomes familiar with spatial boundaries by tracing the perimeter with one finger
- colored cubes are placed on work space
- patient instructed to find and remove cubes
what is bookness
patient opens a book and traces perimeter
2.patient matches stimuli on right and left side
how do you treat sustained attention
- yes/no questions
- simple math
- sorting
- letter cancellation
- solving mazes
