Exam 1 Study Guide Flashcards
Aphasia
Language disorder resulting from brain damage to brain areas that subserve the formulation and comprehension of language and its components (semantic, phonological, morphological, and syntactic knowledge)
A multimodality language disorder due to brain damage; modalities involved are auditory comprehension, reading comprehension, oral expression, and written expression
Agnosia
Impairment of the ability to comprehend the meaning of a perceived stimulus;
-the inability to recognize people or objects, sounds, or voices, even when basic sensory modalities, such as vision and hearing, are intact
Echolalia
Involuntary repetition of someone else’s words
Logorrhea
Excessive speech output
Fasciculus
A bundle of nerve fibers
Neologisms
new words, phrases or sentences only understood by the speaker
new word formations that can render language unintelligible
Jargon
meaningless and unintelligible speech
can be unintelligible words that usually follow the phonological rules of our language (e.g., freach) or unintelligible words that bear no relationship to the stimulus
Semantic/Verbal paraphasias
the substituted word is related to the target word (i.e. fork for knife)
also called verbal paraphasia; confusion with closely associated words (e.g., driving range for parking lot)
Phonemic/literal paraphasias
the substituted word differs from the target word by a phoneme (i.e. ped for bed)
also called literal paraphasia (e.g., saying corned beef and garbage, or saying fable, sable, or cable for table);
typically found in patients with conduction or Wernicke’s aphasia
Circumlocutions:
talking around a topic; being able to describe but not name
can be empty speech, a description of the use or function of the item to be named, or use of a word that is correct semantically and syntactically but is not in common usage
Hemorrhage:
the rupture of a blood vessel with subsequent bleeding into or around the brain
Ischemia:
deficient circulation in the brain
reduction of oxygen due to an occluded vessel
Thrombosis
an occlusion of an artery to the brain by a clot
plaque and fat build up at the site of blockage
Embolism
Blood clot that breaks off and travels through the blood stream until it can no longer pass, occluding the vessel
AVM
Arteriovenous malformation; webbing of capillaries than can cause a hemorrhage
congenital communication between arteries and veins which tend to bleed and cause subarachnoid hemorrhage
TIA:
Transient Ischemic Attack; an acute neurological deficit of vascular cause that lasts less than 24 hours
While transient ischemic attack (TIA) is often labeled “mini-stroke,” it is more accurately characterized as a “warning stroke,” a warning you should take very seriously.
TIA is caused by a clot; the only difference between a stroke and TIA is that with TIA the blockage is transient (temporary). TIA symptoms occur rapidly and last a relatively short time. Most TIAs last less than five minutes; the average is about a minute. When a TIA is over, it usually causes no permanent injury to the brain.
Aneurysm
ballooning or weakening of a vessel wall
Give an example of a “neurotransmitter”.
Dopamine, PI (phosphatidyl-inositol), acytylcholine, serotonin, norepinephrine
What disorders can be traced to neurotransmitters?
- Parkinson’s disease- Substantia Nigra; insufficient dopamine production
- Bipolar: neurotransmitter called PI (phosphatidyl-inositol)
- Alzheimer’s: neurofibrillary tangles
What is the homunculus? What does it represent? Be able to sketch the distribution of different areas of the body as represented on the motor strip.
“Little man” that represents the areas of the body controlled on the motor strip. Size of the features relates to the number of neural connections
Basal Ganglia
– responsible for motor control and motor integration
i. Caudate nucleus
ii. Putamen
iii. Globus pallidus
iv. Amygdala
- Consists of Caudate Nucleus, Putamen, and Globus Pallidus.
- Caudate Nucleus + Putamen – Striatum
- Basal Ganglia- acts as a filter to prevent unwanted movements
- Substantia Nigra – Lowered dopmaine levels lead to Parkinson’s disease
• Diencephalon
Thalamus:
attention, memory
•Relay for sensory information toward the cerebral cortex
• Primary bridge for information from the cerebellum and globus pallidus to the cerebral cortex
– Important subcortical gray matter structure
– Doorway through which subcortical systems of nervous system communicate with cerebral cortex
– Receives neural inputs of planned motor movements from basal ganglia and cerebellum
– Sensory impulses from the body pass through thalamus on way to cortex
– Believed to use sensory information to further refine motor impulses
What structures make up the (functional) limbic system (sometimes called the “limbic lobe”)?
- Uncus (on top of amygdala)
- Parahippocapal gyrus
- Cingulate gyrus
- Olfactory bulb and tract
- Hippocampal formation
- Dentate gyrus
What areas are connected by the following fibers:
a. Corona Radiata: Cortex to the brainstem and spinal cord
b. Arcuate fasciculus: Broca’s area to Wernicke’s area
c. Corpus Callosum: Left and Right Hemispheres
The Circle of Willis is made up of what arteries?
a. Anterior Cerebral
b. Anterior Communicating Artery
c. Middle Cerebral Artery
d. Posterior Cerebral
e. Posterior Communicating
f. Sometimes: Basilar and carotid are included
A stroke in the superior division of the MCA could lead to what types of aphasia?
Hemisensory loss, hemineglect, weakness in the upper/lower extremities.
Could lead to Broca’s, Wernicke’s or Global, it depends where the infarct occurs
A stroke of the posterior division of the MCA would result in what types of deficits?
•Fluent aphasia (Wernicke’s)- inability to repeat
Limb apraxia, visual loss → Fluent aphasias
A stroke of the anterior division of the MCA would result in what deficits?
•Non-Fluent Aphasias (Broca’s)- inability to repeat
What is meant by the “watershed effect” of the cerebral blood supply? How does that relate to our topic of aphasia?
•When there is a clot in an artery -blood flow is interrupted for any part beyond the clot
All the areas that relate to speech production are supplied blood from the MCA. Vessels branching out from this will be affected if a clot/hemorrhage occurs in certain areas. Knowing the areas of the brain that control which types of functions is necessary when determining which parts of the brain were deprived of blood.
How does the Blood-Brain Barrier impact our study of CVA, particularly hemorrhages?
•The Blood-Brain Barrier is responsible for preventing harmful substances from damaging our brain while allowing the good parts (i.e., nutrients, oxygen, certain medications) in.
•Blood itself is toxic to the brain
•Hemorrhages violate the blood brain barrier
oDue to AVM or aneurysm
The Blood-Brain Barrier prevents cerebral penetration of harmful toxins, substances, etc. This also prevents the penetration of helpful items from crossing which could interfere with medicines stopping a hemorrhagic bleed. Hemorrhages also interfere with the BBB.
Broca’s aphasia:
-Physical: Dysarthria/apraxia, monotone speech, hemiplegia, right facial weakness, poor walking, emotionally liable
-Site of lesion: left lateral frontal, pre-Rolandic, suprasylvian region
• Brodmann’s Areas 44 and 45
• Superior division of the MCA
-Language: o Good auditory comprehension → the BEST of all aphasics o Short phrase length o Poor repetition ability o Telegraphic speech o Impaired reading and writing o Distorted sounds o Slow rate and uneven flow
-Broca’s Aphasics can:
o Communicate, even if little information is given
o Not irrelevant in their responses
o Can produce meaningful speech
o Aware of speech difficulties
o Try to repeat or attempt to correct mistakes
o Frustrated when they fail-try hard!
o Can recite automatic information better than spontaneous (counting, Pledge of Allegiance)
Transcortical Motor Aphasia:
-Site of Lesion: Anterior frontal perisylvian (association pathways connecting perisylvian region with other regions)-supplementary motor areas involved
o Outside of Broca’s Area
o Looks a lot like Broca’s
-Characterized by:
o Impaired initiation of verbal output- possibly mute
o Echolalia and perseveration are common
o Little spontaneous speech
o Speech recovered is: nonfluent, paraphasic, agrammatic & telegraphic. Initiate but not finish
o Short phrase length
o Anomic: can’t name many items w/in a category
o Good auditory comprehension for simple conversations
o BUT GOOD REPETITION (repetition impaired in Broca’s)
Transcortical Mixed Aphasia:
-Site of Lesion: Somewhat rare, Not listed as part of the Boston Classification System (BDAE, 1983)
o Caused by hypoxia, acute carotid occlusion or stenosis, heart attacks, cerebral shock, multiple embolic strokes of the MCA branches
o Posterior parietal, temporal lobes
-Characteristics:
o A variety of sensory/physical problems: Spastic quadraplegia, Visual field defects, etc.
o Extremely limited spontaneous verbal
o Automatic unintentional and involuntary communication and automatic speech
o Parrot-like repetition, echolalia, or repeat 3-4 nonsense words
o Severe fluency and writing impairments.
o No auditory comprehension skills!
o Severe naming problems, neologisms
Global Aphasia:
-Site of Lesion: Effects entire perisylvian area, extending deep into the white matter (MCA area)
o Left frontal, temporal & parietal lobes
-What they can do:
o Follow whole body commands
o Distinguish meaningful vs. Non-meaningful speech
o Identify environmental sounds
o Recognize familiar faces, people, songs
o Sense of humor intact
o Interpret facial gestures and expression
o Respond to personally relevant language
o Alert, task oriented and responsive
o Socially appropriate even with one syllable!
Wernicke’s Aphasia:
-Site of Lesion: Posterior third of the superior temporal gyrus
-Characteristics:
o Often do not have physical limitations or hemiparesis, normal right visual function
o Sound confused, but not as frustrated as Non-fluent, Not as aware of their disorder. Acuse others of speaking in a code, mumbling, etc.
o Get depressed and socially isolated
o More severe anomia
o Prolific output (maybe even logorrhea or exhibit press of speech) Talk a lot – don’t say much!
o Rapid rate but effortless, fluent speech with good articulation and normal prosody.
o Normal phrase length with intact grammatical forms
o Poor auditory comprehension- dominant characteristic
o Poor repetition skills
o Language errors such as: paraphasias, fillers, empty speech, extra syllables, perseverations, neologisms, and jargon.
o Impaired reading and writing
-Comprehension Characteristics:
o Difficulty comprehending certain elements of spoken speech
o Extreme difficulty in understanding most
o Comprehending the names of common objects
o Greater difficulty comprehending sentences
o Difficulty distinguishing spoken words that contain minimally different phonemes
o Seem to understand conversation on a topic but not when a new topic is introduced
o Need extra time for new conversational topics
o More impairment in background noise, movements, and other conversations
o Comprehension tied to a given context
o Turn taking may be minimal
o Can’t repeat
Anomic aphasia:
-Site of Lesion: Angular gyrus
-Characterisitcs:
o Word-finding problems
o Auditory comprehension good- pointing OK
o Repetition is good
o Circumlocutions or vague unspecific words used to compensate
o Verbal Paraphasic errors –substitution of words
o Fluent, well-articulated speech except for word-finding pauses, syntax is normal
o Writing and oral reading are normal and comprehension good.
Transcortical Sensory Aphasia:
-Site of Lesion: Posterior parieto-temporal (sparing Wernicke’s area) Often posterior middle temporal gyrus, maybe angular gyrus and visual/auditory association cortex involved.
-Characterized by:
o Fluent but anomic (significant-disrupts flow of speech): semantic paraphasias, perseverations, fillers and non-specific words.
o Normal phrase length with good syntactical arrangements
o Poor auditory comprehension
o BUT GOOD REPETITION SKILLS (Wernicke’s can’t repeat) but poor comprehension of the material repeated.
o Echolalic (Wernicke’s not usually) and echo grammatically incorrect forms and nonsense syllables.
o Can’t point, follow commands, or answer yes/no questions.
o Normal automatic speech and complete songs, rhymes once started by the clinician
o Poor reading comprehension: Read aloud OK but substitute words and don’t understand it.
o Writing similar in problems to expressive skills
