Exam 2 Flashcards

Question

Treatment of speech production

Answer 1

- volitional speech (word level) * sentence completion tasks * word repetition * confrontation naming drills-->show picture "what is this" - Sentence production * sentence imitation drill (not complete imitation but partial) * repetition--> elaboration drill pt answers then repeats * story completion drill--> like sentence but longer * story elaboration--> verbal or with pictures, look at picture & tell story - Connected speech

Answer 2

- Survivor writing skills - Signing name on checks, forms, ect (1. Copy lets, 2. Combine) - Writing checks - Writing shopping list - writing bday card * *for patient needing more... - progress from letter to word to sentences, ect - spelling commercial available spelling help, materials, computer programs, ect.

Answer 3

- in general, it is a semantically based self cueing approach. The patient generates their own cues for each target word. - indicates more lasting benefits when words are trained using self cueing vs. a cue given by clinician - see hand out

Answer 4

Promoting aphasics communicative effectiveness (PACE) - concentrates on the ideas to be conveyed rather than linguistic accuracy - the clinician & client participate equally as senders & receivers. The speaker has free choice as to which modality is used to convey message - Feedback from the listener concentrates on adequacy of the message

Answer 5

- assumes based on research about lexical retrieval that our semantic system is like a web of concepts - semantic feature analysis is a organized method of activating these semantic networks - trying to build a web of concepts by activating semantic networks features to enhance retrieval

Answer 6

- these are related to PACE & involve placing an opaque barrier between the client & clinician - typically, both participants have the same materials on their sides of the barrier (wall) - you give directions on where to place items you both have, boards should look the same after - messages are conveyed regarding materials or how to move them, then barriers are removed

Answer 7

- the original program takes non fluent aphasic patients from intoning(singing) simple 2 syllable phrases to more than 5 syllables across tx - the patient is presented with visual cues for the target phrases & phrases are intoned with 2 pitches - the patient uses higher pitch for stressed words & lower pitch for non stressed words - also tapping the left hand along with each syllable

Answer 8

- make it clear to patient what the goal of this activity is - physically assist the patient with five reps of "yes" (head nods) same with "no" - request gestured "yes" response to two ambiguous questions. Do the same for no. (E.g. Is your name ___) - start with simple questions - begin tx of personal, environment, and informational questions.

Answer 9

- Begin training with one gesture - when it is intact, add a second - drill until patient can alternate between two gesture - add a third gestures & repeat the process until all 3 are reliable

Answer 10

- use boards that have pictures and the written word under the picture - try to personalize the pictures - repeated training trials are needed - choose only one picture from board and drill on it - then choose one maximally different foil and request the patient to point to target item, continue to three, four, and more items - you'll probably need to do each of these steps in repeated groups of five

Answer 11

- takes a patient through several steps involving object manipulation in order to train pantomimic gestures - the program begins with perception & recognition of objects - then it moves to gesturing with object in hand - then gesturing without object - **acting out what you would do with object

Answer 12

 Aphasia is an acquired impairment of the cognitive system for comprehending (receptive) and formulating language, leaving other cognitive capacities relatively intact (Davis, 1993).  Many times pts know what’s going on they can’t formulate the words. They also know that there is a problem.

Answer 13

1. Cognitive process— organizing your thoughts, memories, and emotions in order to say what you want. (TBI) 2. Linguistic process—taking thoughts memories and emotions and finding the verbal symbols that follow the rules of language (aphasia) 3. Motor speech programming— selecting sensory motor programs that activate speech muscles in the correct sequence so that you can smoothly produce the verbal symbols organized in step two. (apraxia) 4. Neuromuscular execution—transmitting the sensorimotor programs through the CNS and PNS correctly so that the speech muscles move with the correct force, direction, and timing to produce spoken words. (Dysarthria)

Answer 14

 Internal carotid—Branches from the common carotid artery and travels to the Circle of Willis.  Vertebral-basilar – branches from the subclavian arch, travels inside cervical vertebra to the level of the brainstem. Then left and right portions join to form the basilar artery, which travels to the Circle of Willis.  External carotid— also branches from the common carotid artery; supplies blood to the face and meninges

Answer 15

 Anterior cerebral— branches from COW, supplies the medial surface and very top of frontal lobe. It does penetrate cortex to supply blood to subcortical areas.  Middle cerebral— branches from COW, serves the insula and nearly all the lateral surface of the cerebral hemisphere.  Posterior cerebral— branches from the COW, serves the bottom of temporal lobe, occipital lobe and medial parietal lobe.

Answer 16

 Is an arterial interconnection between the two internal carotid and the basilar artery  Can provide an alternate blood supply to the cortex if one of the carotid or basilar arteries are blocked  This safety value function can only occur when the blockage is BELOW the COW. The COW is only functional if the blockage is below.

Answer 17

Primary visual cortex makes a basic analysis of visual sensation from the eye. The primary auditory cortex makes a basic analysis of auditory sensation from what we hear. Signal is then sent to Wernicke's area. Wernicke's has access to semantic memory which contains our knowledge of the world, word meanings, facts, and so forth. Wernicke's has access to lexicon which contains information on what words sound like (phonology) or look like. Wernickes job is to attach meanings to the words we hear and read and construct a neural cod of phonemes and graphemes and communicate it with Broca's. Broca's area then takes the neural code and turns it into a motor code than can be implemented by the speech muscles.

Answer 18

• Little effort needed to produce their speech. • Length of uttered phrases is normal (5-8 words) • There are few problems with either prosody or articulation o aka: Receptive Aphasia • Paraphrasias present: literal, verbal/semantic, neologistic. • Is a fluent type of aphasia • Auditory comprehension is disturbed: o Pt retains the ability to understand some single words, phrases, and sentences. • Can typically do the “hi how are you” o May understand only the first few words spoken. • So pt may have problems following directions depending on how much comprehension they have. o Even words initially understood may not be comprehended if they are retested immediately—rapid fatigue of comprehension. • So they may get the answer right the first time but then the second time they would get the answer incorrect. o They may have problems with topic switching. • Pt may still keep talking about the topic they were on because they can’t comprehend that you’ve changed the subject. • Environmental distractions decrease comprehension. o Reading is impaired and may parallel their problems with auditory comprehension. o Writing is always abnormal. There may be properly formed letters, but many words are meaningless. • Example on page 302. looks like writing and is smooth but many of the words are meaningless. Not really connected, words are there and it’s English but it’s not relevant. • Fluent aphasia with no artic errors, use the term Press of Speech (it just runs on). Because there is nothing telling them that their speech is wrong. Circumlocution (talking around the subject) • commonly won’t see a right-sided hemiparesis compared to broca’s aphasia • Empty speech that doesn’t give us a lot of details.

Answer 19

 Nonfluent, effortful verbal output  Sparse words, poor articulation possible  Most common in terms of the aphasias  Usually speaks in short phrases  Speech contains more content words compared to the number of function words, more nouns, verbs, less connection words.  Pts with broca’s seem to really look like they are working to talk (how it appears)  Naming is poor—lots of word finding problems.  Prosody and rhythm are distorted  Not really a great rhythm to their speech.  Syntax is "telegraphic.”  Auditory comprehension may be functional for ordinary conversation, but is still impaired  Reading comprehension of single words and short sentences may be functional.  Functional here means enough to do day to day simple activities.  Writing is impaired—oversized letters, poorly formed letters, many misspellings, letter omissions.  Letters aren’t formed properly, the writing mimics the speech.

Answer 20

This aphasia is characterized by:  Relatively fluent, intelligible speech  Functional comprehension  Poor repetition (HUGE when comparing the Aphasias)  May understand what they are needing to do know they are failing, better at saying what they want to say but not what you want them to say. So spontaneous speech is better than imitation.  Brain damage leading to this type of aphasia most often involves the left lower parietal lobe and upper temporal lobe.  Lower postcentral and supramarginal and the insula  Articulate Fasisculus if the white is damaged the message cannot be sent. You will understand if there is damage but you will not be able to repeat what is said.  There is disagreement over the exact location of the damage in this aphasia.  Is the damage to the subcortical white matter (i.e., arcuate fasciculus) or .....  Is the damage to the cortical areas mentioned in the prior slide?  Always a disagreement as to where the damage is. When looking at groups you can find patterns of lesions and areas that are affected. But when comparing individuals they may have lesions in different parts of their brains.  The mechanics of how this damage results in the symptoms of conduction aphasia have been explained in several ways.  The oldest is the disconnection theory, which states that damage to the arcuate fasciculus “disconnects” Wernicke’s area from Broca’s area.  Another theory states that conduction aphasia is a special type of apraxia  A third theory states that the symptoms are the result of a disturbance of phonemic memory processing.  People with conduction aphasia have a noticeable difference between their ability to name an object and point to it. 1. Pointing is easy and accurate, because of functional auditory comprehension. 2. Naming an object, however, can result in some literal paraphasias. 3. Reading can be functional for simple, day-to-day materials. 4. Writing will have some disturbances. There may be well-formed letters but lots of letter omissions and substitutions.  Tends to mimic speech, writing becomes worse when trying to copy a message and write it out.  IN general the main characteristic of this aphasia is poor repetition.  For reps multisyllabic words are more challenging.

Answer 21

 "A severe, acquired impairment of communicative ability, which crosses all language modalities, usually with no modality substantially better than any other" (LaPointe, 1997).  In general, this type of aphasia occurs when the area of lesion covers a large portion of the cortex in the left hemisphere.  A type of aphasia that there is no one area that is better than another. A larger lesion site. The aphasia can change or evolve as a pt improves and starts to look like another type of aphasia.  Unlike what is typically seen in Broca’s, Wernicke’s and conduction aphasia, patients with global aphasia will probably show a decrease in nonverbal problem solving abilities.  When the area of damage is larger more cognitive functions are damaged. Although some pts have normal cognitive functions and do okay on nonverbal tests. Global aphasia can be subtyped as acute, evolving, or chronic. Acute global aphasia: is what may occur in the very early stages after a left hemisphere lesion. May have difficulty even answering a simple yes/no questions. A lot of jargon and paraphasias if there is any speech. Can also be nonverbal. May speak in over learned phrases. Evolving global aphasia is a term that is used to describe a patient with severe aphasia who is beginning to recover some language functions, usually found within the first week post onset. When a pt who was globally aphasic is starting to recover some language function. Able to understand, maybe answering simple yes/no questions, some verbal output. Chronic global aphasia describes a patient with a severe aphasia that is not changing. Generally, this stabilization happens from 1 week to 1 month post onset. Has had time to rehabilitate but is not showing any signs of recovering will have a chronic global aphasia.

Answer 22

 This is an aphasia subtype characterized by 1. Mild comprehension deficit 2. Fluent, syntactically coherent utterances, but..... 3. Utterances filled with indefinite nouns and pronouns. 4. Many word finding difficulties  There is some controversy about whether to say that anomic aphasia is a separate aphasia subtype or that it is only a mild type of Broca’s aphasia.  Pts only have difficulty with naming. And their speech is relatively fluent unlike Broca’s Aphasia. These pts have word finding issues.  Anomic aphasia often results from the diverse set of causes. Many different areas of lesion or types of damage can result in word finding difficulties.  These pts may exhibit circumlocution  This diagnosis is for pts that have no other impairments.  Note: All individuals with aphasia will demonstrate anomia (e.g., word finding difficulties). Only a few can be diagnosed as having anomic aphasia.  Damage, unless it hits somewhere in the motor strip, you should have normal motor skills  Damage to the extrasylvian area in the left hemisphere. Can also be seen in right hemisphere strokes sometimes as well.  However, since anomic aphasia can occur after damage to most anywhere in the left hemisphere, the suggestion that it can be a mild Broca’s aphasia probably is not valid.  This type of aphasia is not as severe. Show word finding issues even when all other aspects have been recovered.  Extra Sylvian Aphasia  Conversational language fluent but relatively empty of specific content  Auditory comprehension- good  Repetition of spoken language- good  Naming- very bad (anomia= without naming)  Writing- good  Motor system usually normal