EXAM 2 Flashcards
Cognitive Impairments of Aphasia
Attention: left neglect in RH stroke
Memory: WM in language processing
Executive Functioning: difficulty in discourse
Fluent Aphasia
Damage to the posterior portion of language center in the dominant hemisphere.
Talk with easy flow
Normal/fast rate, good intonation and stress.
WFD
Nonfluent Aphasia
Damage to the anterior portion of language center in DH.
Omit grammatical morphemes or function words.
Slow, effortful, frequent pauses, disrupted prosody.
Fewer than normal words.
WFD
Types of Fluent
Wernicke’s (poor repetition)
Conduction (poor repetition)
Transcortical Sensory (Good repetition)
Anomic (good repetition)
Types of Non-Fluent
Global (poor repetition)
Broca’s (poor repetition)
Transcortical Motor (good repetition)
Mixed Non-Fluent (good repetition)
Non-fluent Global
Alert
Language Characteristics: All language functions severely affected. impaired reading, writing, word retrieval, auditory comp, speech production.
May have preserved ability to read simple words and recognize pictures and gestures.
Unable to produce even a single word verbally.
Most have cognitive and motor deficits
Worst prognosis for recovery
Non-Fluent Broca’s
Comprehension: relatively preserved. Comp of syntactically complex sentences is often impaired
Oral Expression: Anomia, shorts phrases, halting, effortful, confluent speech, agrammatic output, may have some over-learned phrases.
Poor reading and writing.
Top-Down Processing
Use context and experience to function.
Does not involve language.
I.E. drama in a foreign language
preserved intelligence and cognitive functions compared to CDD
Non-Fluent Transcortical
Non-fluent and lack of spontaneous speech.
Agrammatism, short and telegraphic phrases
Short incomplete utterances that may contain some grammatical words.
Unusual delays in initiation
Fairly good auditory comp
repetition better than other nonfluents
Mixed Non-Fluent/transcortical
Between global and Broca’s (better than global worse than Brocas)
Recover from Global
Verbal output is limited to stereotypic utterances.
Poor auditory comp
Severe anomia
Better repetition
Fluent Wernickes
Comprehension: Severly impaired, great difficulty understanding speech of both others and themselves.
Oral Expression: Poor repetition, anomia (semantic and phonemic paraphasias), fluent with good prosody, well articulated, rapid rate, use jargon, Paragrammatism, paraphasia.
Alexia and agraphia
Anosognosia: inability to recognize their own deficits
Fluent Transcortical Sensory
Like Wernicke’s but good ability to repeat.
Language: fluent spontaneous speech with ease of articulation, good prosody, poor auditory comp, good repetition function.
poor word retrieval with more semantic paraphasias
Fluent Conduction
Damage to arcuate fasciculus.
Fair to good aud. comp
Fluent spontaneous speech
Fair articulation and prosody.
Anomia: may disrupt speech flow and use circumlocution
Significantly poor repetition
Show awareness and self correct
Fluent Anomic
The least severe aphasia syndrome.
Marked difficulty with naming.
No other significant receptive and expressive deficits
Fluent speech but pauses due to WFD.
May have difficulty with categories (grammatical or semantic)
Aware of deficits
Which Aphasias can repeat?
Mixed transcortical
Transcortical Motor and Sensory
Anomic
Subcortical Aphasia
Results from damage to the subcortical regions.
Diaschisis
Symptoms depend on site and severity
Crossed Aphasia
Occurs when a persons language center is not in the expected hemisphere
Unclassified aphasia
Possible Reasons:
Unusual combination of lesion sites within LH
Atypical cerebral dominance and individual variability of brain organization
Other medical conditions
Assessment of Naming
Anomia: common LH stroke symptom
Word retrieval depends on lexical semantic, lexical network, and lexical phonologic word forms
May show category specific deficits
Diagnosis of Aphasia: Anomia
WFD
Tasks: Confrontation Naming
Automatic-closure naming
Responsive naming
Generative Naming
Discourse
Confrontation Naming
Name pictures of objects or actions
Pay attention to naming errors (phonemic, semantic, both)
Generative Naming
Words grouped semantically (e.g. animals)
Discourse
Conversation, picture description, short narrative, procedural.
Good for mild WFD
Natural
Speech Fluency and Phrase Length (diagnose aphasia)
Phrase length: # of words produced in a breathe unit
Get average of 3 longest utterances produced under 3 conditions
Phrase length fluency
0-5 = nonfluent
6-8 = borderline fluency
9+ = fluent
Disorders in Sentence Production in Aphasia
Common with non-fluent and agrammatic aphasia
Morphology deficits: make errors on free and grammatical morphemes. omit function words. difficulty with verb tense.
Sentence and Discourse Production Tasks ( to diagnose aphasia)
Sentence production task: word definition and make a sentence from a word
Discourse production task: picture description, conversational discourse, story-telling, sequential events, video narration
Auditory Comprehension (diagnose aphasia)
Both top down and bottom up approach
Syntactically simple and complex sentences.
Test all linguistic units (single words, sentences, discourse)
PWA have slow processing speed
Can’t repeat doesn’t mean deficit
Can repeat means its intact
Auditory Comprehension Tasks
- Single word aud. comp: point
- Sentence comp: follow spoken command, respond to question
- Comp of spoken discourse: respond to questions about a paragraph read by clinician
Repetition Skills (diagnose aphasia)
High frequency: one syllable and emotionally relevant words are easier to repeat.
Need to compare real words and non-real words
Naming and repetition tasks can be used together.
Discourse production in aphasia
Functional communication
PWA communicate better than they talk
Lexical-syntactical breakdown
WFD, paraphasias, syntactic errors, omit grammatical morphemes
Conversation Breakdown
Psychosocial breakdown
Assess Discourse
Consider influencing factors
5-10 minute sample
Conversation analysis: communication competence or functionality, strategies used, outcome of strategies
Dual Route Model of Reading
Step 1: Visual Feature analysis
Step 2: Letter analysis
Step 3: Lexical reading route and comprehension. Lexical non-semantic route. lexical non-reading route
Alexia
Lesion to angular gyrus
Aphasia causes central alexia
PWA often have mild alexia
Phonological/deep alexia is most common type in aphasia
Assess Alexia/Dyslexia (Central deficits)
Word recognition is a mix of nonwords and real words.
Semantic processing: written word to definition matching
Non-lexical processing: use real or non-words
Comprehension of Printed Sentences and texts
Functional reading tasks
Models of Writing
No single brain region is the center of writing.
Agraphia/Dysgraphia
Agraphia: acquired written language disorder
Can be present in isolation
Either central or peripheral
Agraphia vs aphasia (similar to their verbal skills)
Assess Agraphia/Dysgraphia
Assess linguistic (central) and motor (peripheral)
If can’t write, assess spelling using anagrams or alphabet/keyboard.
Agraphia/Dysgraphia Tasks
- Automatic writing (alphabet, numbers)
- Writing confrontation naming (written picture/object)
- Writing to dictation (detect spelling problems, not word retrieval)
- Copying
- Spontaneous writing sample
- Functional writing task
Assess Functional Communication Gesture and Drawing
Gesturing deficits may accompany aphasia. Used to determine if gestures aid aud comp and evaluate potential for acquiring simple forms to gestural communication
Drawing: reproduce and spontaneously draw
Assess Functional Communication
Communicative Gesture: imitate, movement on command, spontaneous movement
Errors: content errors
Drawing
AAC
WHO-ICF
Body function and structure
Activity and Participation
Environmental Factors
Personal Factors
Phonemic Paraphasia
Errors unrelated to motor deficits
substitution, omission, deletion, or transposition
Semantic Paraphasia
clear semantic relationship between desired word and spoken word
Neologistic paraphasia
Non-word substitutions
Agrammatism
No grammar
1. simplification of grammatical structure
2. Omission of grammatical morphemes
3. Reduced Production
Paragrammatism
Grammar errors
Misuse of grammar
Grammatical elements are present but incorrect
Jargon
Speech is lengthy, fluent, well-articulated and effortless (typical of fluent)
Incomprehensible speech production
Often show paraphasias
Perseveration
Inappropriate reoccurrence or uncontrolled repetition of a previously produced response.
Usually a response the PWA produced earlier
Not intentional or foreseeable
Characteristics of Aphasia
Echolalia
Repetition deficits: damage to arcuate fasciculus
Empty Speech
Automatic Speech: Preserved ability of overlearned language
Stereotypic Speech
Alexia
Agraphia
Empty Speech
Fluent speech that contains general, vague, unspecific referents but is semantically and syntactically intact
Replace key words with “it” or “that thing”
Stereotypic Speech
Global aphasia
Very restricted form of expression
Involuntary
An attempt to communicate
