Exam 2 Study Guide Flashcards
Do we know that treatment for aphasia makes a difference in the brain structure?
Yes.. Liepert in 2000 said: Noticeable changes in motor cortices after only 1.5 hrs.
Weiler & Rinjntjes (1999): Training correlated with changes in language-related areas in :
– Right Hemisphere:
- Middle superior temporal gyrus
- Supramarginal gyrus
Is neural plasticity a new idea in aphasiology?
No, Hughlings Jackson, Luria, Geschwind all suggested elements of plasticity
There were conflicting views originally and many of them thought the brain was hard-wired for specific functions but Hughlings Jackson, Luria, Geschwind all suggested elements of plasticity. Since 1990s, they have done some specific studies (think back to the article about the violinists, blind people, etc.)
What are the main mechanisms of repair?
Two Main Mechanisms
– 1. Recruitment of cortical areas in undamaged hemisphere
– 2. Extension of specialized areas adjacent to the lesioned site.
What happens in recovery? What are the dominant mechanisms in theory?
- Bilateral Redundancy in the neural representation of function- Redundancy for swallowing, speech
- Synaptic Neuronal Sprouting- nerves will sprout dendrites, nerves can/do regenerate
- Reinforcement of existing neuronal circuits- strengthening current circuits that are functioning
- Formation of new polysnaptic connections: Rebuild pathways around the damaged areas- new circuits and connections
- Resolution of initial edema- concussion caused from swelling of a brain in most cases
–>will often remove a piece of the skull to let the brain swell out
–>There are more people to die from swelling after stroke than from the actual stroke
–>Can take about 6 months for swelling to go down
– Release of inhibition
In Weiller’s study of Wernicke’s aphasics, what did he find regarding recruitment of the right hemisphere?
– Broca’s area – Left lateral prefrontal cortices – Right superior temporal gyrus – Right Inferior premotor – Right Lateral Prefrontal cortices – No activation in Left Superior Temporal Gyrus
His Hypothesis: Sensorimotor and language functions are represented in extended, variable, heavily parallel processing, and bilateral networks with several levels of representation. Reweighting of activity within and between the various levels of the preexisting network, rather than any more radical substitution of function, constitutes the dominant principle underlying recovery.
Weiller, et. al. (1995) Normal subjects – language tasks: left, of course, but right hemisphere also activated.
Damaged Cortices: Could be that right hemisphere activation relates to non-linguistic features and is irrelevant to the recovery of language (Liepert, 2000).
Which age group shows the most plasticity of the brain, children or adults?
- Children showed greater than normal language participation of the right hemisphere and atypical symmetry with early onset
- Children have greater language participation in the R hemi, so if they have damage, R hemi will develop lang.
Johanssen Article Info.:
What are 6 possible causes for training induced neurological changes after a stroke?
- Deafferentation
- Removal of inhibition
- Activity dependent synaptic changes
- Changes in membrane excitability
- Growth of new connections
- Unmasking of preexisting connections
Aphasiologists are enthusiastic about stem cell transplantation/implantation. What are the implications for stroke rehabilitation?
- Neural stem cells have been found to be as effective as fetal stem cells at proliferating and differentiating into neurons and glia in tissues.
– Transplanted cells interact with the host tissue by forming connections.
– The best improvements have been found in studies that combined stem cell transplants and housing in enriched environments post-transplant.
– The environmental signals work to promote stem cell differentiation.
What have been the effects of an enriched environment on brain plasticity? How does this translate to aphasia treatment?
- Research studies have shown that postoperative environments can affect the recovery of lesioned lab animals
- Rats with experimentally induced brain damaged were placed in different types of environments for recovery. The rats in the enriched environment performed considerably better than the rats housed in the standard laboratory environments.
- These results held true even for the rats that were postponed access to the environmentally enriched environment for 15 days post trauma.
– This study also compared social interaction to physical activity in the recovery process.
– It was found that rats with social interaction performed better than just rats with physical activity. However, the rats that were placed in environments with rich with social interaction and physical activity fared better overall.
What do you need to know about the location and size of the lesion before beginning treatment planning?
— Location and Size of the
Location and size of lesion predict treatment response.
– Subcortical structures- small lesion in thalamus can be detrimental. (relay station)
Helm Estabrooks says: lesion information is seldom used as a guide to aphasia therapy, although this information might inform treatment decisions.
Why are cognitive processes important to overall success of aphasia treatment?
- Attention
- Memory
- Executive Functions
- Visuospatial Skills
Hinckley, Carr & Patterson (2001)-study of 12 patients with aphasia: found not language scores but cognitive scores that made a difference.
Helm-Estabrooks, Bayles, Ramage, & Bryant (1995)-Therapists must screen for cognition
-Often the assumption is that aphasia is an isolated language disorder, and other domains of cognition are not affected by the stroke. Not true. Say it’s difficult to predict the extent to which other domains of cognition will be spared or impaired in patients with aphasia.
What meta-cognitive skills must be intact for effective learning/treatment?
Self-awareness Insight Motivation Self-Monitoring Self-Initiation Goal-oriented Behavior
What are some considerations of aphasia therapy that are unique (i.e. differ from treatment with children)?
Teach compensatory strategies-access the vocab you used to have.
– Not teaching/re-learning
– Not necessarily shooting for 100% recovery
– Goal might be for functional not back to original
Prognosis issues for the family and client
Repeated practice, more intensive and massed
– A lot of repetition. Intensive massed practiced
Client-specific goals
Co-treatment issues
– Likely to work with PT or OT
Funding issues: Insurance companies only give 12-20 sessions after stroke
– The Center for Individuals with Physical Disabilities
Discharge decisions
– When do you stop?
What does Rosenbek say is the most important goal of aphasia therapy?
prepare the client for a lifetime of aphasia
– get them to a point where they can live with their disabilities
– Mild strokes may get back to 100%
What are some of his other suggestions for effective treatment?
Be open to trying new approaches
Aphasics are often unchanged in all ways except communication-treat the person not the aphasia
– Remember they are the same person, just cannot communicate in the same way
Aphasiology has its limits
Treatment is not limited to Communication
Individual treatment is essential
Testing is crucial
Listening is the most important part of testing
Therapy must be structured
No single set of procedures is adequate
Concentrate on antecedent versus consequent events; success is its own reward
Exploit strengths
– Figure out what they can do and focus on that
Work toward generalization
Make the client his/her own clinician
– Self-monitoring: only with them 1 hour a day a couple times a week.
Involve others
Avoid treatments that make them feel abnormal
– Abnormal- may be things you don’t think are weird. Comm notebook, signing, etc
Beginnings and endings are awful!!
Recognize when improvement may not be worth the cost
Modern technological advances
Gaiety has its place in treatment of aphasics
What is spontaneous recovery?
Spontaneous recovery is the recovery made without any treatment. “Separating spontaneous improvement from treatment effects has been a challenge for clinical scientists.”
The body healing itself without any therapy, most likely due to a reduction of edema or swelling in the damaged hemisphere, a return to normal blood flow or circulation in the undamaged hemisphere, and collateral or compensatory blood circulation in the damaged hemisphere.
Does aphasia therapy work? What does the Robey article tell us about treatment in general?
Meta-analysis of treatments of aphasia.
Conclusion: Aphasia treatments are effective and all patients should be offered
Holland article information:
Explain the terms:
Effectiveness
Efficacy- defined as the individual’s improved communicative behaviors that were reached through speech and language therapeutic interventions
Efficiency
Effect
Stroke is the _______leading cause of death in the USA, according to this article (Holland)
_3rd _
Holland article information:
What are the effects of a stroke and aphasia on the individual, the family and the role in society?
Aphasia is an acquired language disorder meaning it is not present since birth. Therefore, when one acquires aphasia, it affects their social aspects of their lives as well. People with aphasia often become socially isolated due to their difficulties communicating with others.
Individuals with aphasia often experience a loss of income, loss of safety due to their inability to communicate their needs for help, an increased dependency on others for tasks including reading schedules, going shopping, making appointments, etc.
Individuals with aphasia often find they cannot function in a society where they cannot communicate.
The individual’s spouse may also experience social isolation.
o There is a common misperception by family members that their loved one is not the same. Aphasia is a loss of language, not a loss of cognition and intellect
o Family member often have to take on new roles such as caregiver, primary income provider, etc.
Holland article information:
What standards comprise a Class I study, a Class II study and a Class III study?
“Class I: Evidence provided by one or more well-designed randomized controlled clinical trials”
“Class II: Evidence provided by one or more well-designed randomized clinical studies such as case-control, cohort studies, and so forth”
“Class III: Evidence provided by expert opinion, nonrandomized historical controls, or one or more case reports”
According to Holland, most aphasia studies are _________ studies.
Class_III_
What are some potential problems with this?
How can we predict who will improve and who will not improve? (Porch article, and PICA predictive mechanisms)
Factors to consider: site and extent of lesion & availability of treatment
High-Overall Prediction Slopes (HOAP slope) from PICA (Porch, 1981)
Intra subtest variability
Aten and Lynn (1978) Intra-subject Variability on the PICA not a predictor of progress
o People with not a lot of variability between subtests yield a better prognosis than those who subtest scores are varied
HOAP: High Overall Prediction
Highest individual item scores=overestimation of ability
Broader range of sampling needed for prediction
Represents several levels of processing across gestural, verbal, graphic subtests
Use Appendix D only at 1-month post-onset
More than 1 month-use HOAP Slopes
Factors such as: Age, Education, Auditory Comprehension, reading, speaking, writing
PICA most predictive power: Number of treatment sessions, Months post onset, Age
BDAE most predictive power: Confrontational naming, body part identification, complex ideational material
WAB: Age (younger), length of hospitalization (shorter), gender (male), type of stroke (hemorrhage), side of lesion (right)
What are some of Rosenbek’s recommendations regarding optimal vocabulary selection?
Understanding words- body parts, objects, food items, action pictures
Understanding descriptions- pictures of objects, objects, products and advertisements
Understanding shorter yes/no questions- yes/no (factual, absurdities)
Understanding sentences- yes/no
Understanding questions- point to
Understanding shorter directions (objects, body parts, etc)
Response switching
Imposed delays
Sequential assembly
What is meant by the term “agrammatism” in reference to non-fluent aphasia?
A pattern of sentence production that reflects an absence of grammatical structure.
Often Convey adequate messages-”structurally impoverished strings of content words” (Thompson, 2001)
Short, simple S-V and SVO structures that are often ill formed.
Cannot produce complex sentences
– Use content words not function words
– Can usually get their points across
What are the essential goals of treatment for Broca’s aphasia?
Add to the repertoire of agrammatic responses (more chronic cases)
– Rosenbek(1989) “believes that a greater number of agrammatic utterances communicates more than a lesser number of grammatic ones.” (pg. 220) Emphasize communication rather than correctness
Expand the complexity and/or length of utterances (acute cases)
In the HELPSS program, Helm-Estabrooks gives a hierarchy of sentence structure. Be able to sort out the order of presentation.
One sentence type is trained at a time, easiest first. Efficacy studies- improve on those trained but limited generalization.
- Imperative Intransitive Sit down.
- Imperative transitive Drink your milk.
- Wh-Interrogative
Where are my shoes? - Declarative transitive He teaches school.
- Declarative intransitive He swims.
- Comparative He’s taller.
- Passive
The car was towed. - Yes-no questions
Did you watch the news? - Direct and indirect object
He brings his mother flowers. - Embedded sentences She wanted him to be rich.
- Future
He will sleep.
How would you administer Rosenbek’s changing criteria method with a Broca’s aphasic?
Criterion 1: reinforcing 1-2 word utterances,
Criterion 2: 3-5 word utterances,
Criterion 3: 6-8 word utterances.
Criterion 4: more than 9 words.
Series of questions and answers using pictures as stimuli
Start at higher level for less severe clients.
Language stimulation cards
Changing Criteria Program Questions: Select two per picture
1. How many people, animals, objects do you see?
2. What is/are the person(s) wearing?
3. What is/are the person(s) holding?
4. What color are the clothes, sky, objects?
5. What is around the neck, waist, write?
6. How old is the person, animal, object?
7. Where is the person, animal object?
8. What time is it?
9. What are they(________)? add a verb
10. What are they doing?
Define “global aphasia.”
“All aspects of language are so severely impaired that there is no longer a distinctive pattern of preserved versus impaired components.”
Global aphasia is a severe, acquired impairment of communicative ability across all language modalities; no single communicative modality is preserved. Visual nonverbal problem-solving abilities are often severely depressed as well and are usually compatible with language performance. Patients often have a profound volitional performance deficit as well. Usually results from extensive damage to the language zones of the left hemisphere.
Is the diagnosis of global aphasia considered to be rare?
30-55% of Aphasics
Higher in the acute stages
Global aphasia often evolves to _ (which syndromes)_____________aphasia syndromes.
May evolve to Broca’s, Wernicke’s, anomic, or conduction aphasia (Peach, 2001)
o More likely in younger patients
o If they receive treatment early
According to Peach, how many global aphasic clients will evolve to less severe syndromes?
¼ to ¾ will recover to a less severe syndrome
Localization: Global aphasia is usually caused by damage to what areas of the cortex?
Lesions in the entire perisylvian region
– Broca’s Area
– Wernicke’s Area
– Deeper white matter of the brain
– Basal ganglia, internal capsule, thalamus
Middle Cerebral Artery Lesions
Which artery is often involved in a diagnosis of Global Aphasia?
Middle Cerebral Artery Lesions
What five areas did Farro identify as common lesion sites for global aphasia?
- Large MCA encompassing anterior and posterior regions
- Anterior with variable damage to underlying deep nuclei and white fiber tracts
- Subcortical infarction
- Parietal involving supramarginal and angular gyri
- Simultaneous infarctions in frontal and temporo-parietal regions
Of those sites, which has the best prognosis?
Type 3. Best prognosis
Which has the worst prognosis?
Type 1. Prognosis very poor
**Type 2. Good prognosis - Some cases had recovered completely after 6 months
Two of which characteristics are considered negative prognostic indicators with Global aphasics?
May not be able to achieve functional verbal communication:
Stereotypic utterance along with severely impaired comprehension
Inability to match objects
Unreliable yes/no response to questions
Semantic or neologistic jargon without awareness and self-correction
Some aphasiologists do not recommend treating patients with global aphasia. Why?
Globally aphasic people deserve treatment and that treatment can be worth everyone’s time. Verbal expression may not be a realistic long-term goal for such persons, but short-term attempts to establish or expand it are a legitimate therapeutic activity for both acute and chronically globally aphasic people
How are the goals different for working with global aphasic clients?
Tx for compensation rather than stimulation
Consider Quality of Life issues and functionality above all.
List some stimulation approach activities that could be useful with global aphasic clients.
Stimulation Approaches
Auditory Comprehension
• Matching Pictures
• Eliciting appropriate responses
• Playing cards
Verbal Expression
• Associating meaning with speech movements
• Conversational prompting
• VCIU
List some compensatory approaches.
Compensatory Approaches o Gestural Programs • Amer-Ind Codes • VAT • Pantomime • Limited manual sign system
o Gestural-Assisted Programs • Preparatory training • Communication Boards • Blissymbols • Drawing • Computer-Aided Visual Communication • Lingraphica
List some gestural programs that could be useful with global aphasic clients.
Electronic/ Non-electronic AAC devices
Drawing
Computer-aided visual communication (C-VIC), Steele, (1992)
Lingraphica software, a more sophisticated C-VIC
C-Speak Aphasia: based on C-VIC
Promoting Aphasics Communicative Effectiveness (PACE)
Describe a treatment sequence for strengthening gestural responses.
Clinician simultaneously gestures and says the word
Clinician says the word and clinician and client gesture simultaneously
Client imitates gesture
Client imitates gesture after enforced delay
Client gestures in response to auditory stimulus
Client gestures following delay
Client gestures to written stimulus
Client gestures following delay
Client writes word in response to gestures with spoken word
Client gestures in response to appropriate stimuli
List some gestural-assisted programs that could be useful with aphasic clients.
Gestural-Assisted Programs • Preparatory training • Communication Boards • Blissymbols • Drawing • Computer-Aided Visual Communication • Lingraphica
How can global aphasics benefit from AAC devices?
Electronic/ Non-electronic AAC devices
Drawing
Computer-aided visual communication (C-VIC), Steele, (1992)
Lingraphica software, a more sophisticated C-VIC
C-Speak Aphasia: based on C-VIC
Promoting Aphasics Communicative Effectiveness (PACE)
List some treatment goals recommended by Collins for working with global aphasics.
- Auditory comprehension, one-step commands in well- controlled situations.
- Yes/No questions consistently in controlled situations
- Spontaneously produce several written responses or approximations or functional or salient words of daily living.
- Improve production of several simple gestures
- Improve drawing so that messages can be conveyed
- Ensure a small basic core of communicative intentions can be conveyed
- Elicit production of a few spoken words.
Describe the technique of “Response Shaping.” How could it be used with someone with global aphasia?
Make requirements clear
Physically assist with 5 repetitions of one response then the other using cards and gestures.
Present four, then three, then two “yes/no” stimuli while saying the word. Pause 5 seconds between responses.
Always correct the response don’t move on until a correct response has been produced.
Request a gestured ‘Yes” response to two simple questions while assisting with the gestures and saying the word
Request 5 repetitions of gestures “yes” then “no” Facilitate with physical or verbal cues, if necessary
Alternate the requests for “yes” and “no” at 5-second intervals.
Stabilize the response when playing a game, etc.
How could you use VCIU (see page 193 of text) with Global aphasics?
Functional Goal: Stimulate the use of propositional speech for functional communication
For subcortical CVAs primarily. Limited to a few words, may be stereotypic expressions
Need to be able to read single words
Use words the patient has been heard to utter.
How could you use VAT (See page 253 of text) with global aphasiacs?
Purpose: “To increase the ability of patients with poor verbal skills to produce representational gestures for purposes of functional communication,” (Helm-Estabrooks, pg. 253)
Candidates: Severe aphasia without verbal skills or written language
Can produce some spontaneous gestures
Nonverbal cognitive tasks OK
Alert, cooperative and motivated with good attention span.
Specific steps and levels (see Table 18.1 in Text)
After completion, expand gestural repertoire.
How could you use CDP ( page 275 of text) with a global aphasic client?
Purpose: for patients who are unable to convey messages through speech or writing but can draw.
Skills needed for CDP Program: (Table 19.1 on page 275)
Steps 1-10 for CDP Program (pg. 280)
Define “anomia”
“Difficulty naming objects or persons; difficulty recalling nouns during conversation; a problem found in most types of aphasia.”
Is there agreement in the literature regarding the localization of naming functions?
No
How does the term “Anomia” differ from “anomic aphasia”?
Nominal aphasia (anomic aphasia, amnesic aphasia) is a severe problem with recalling words or names
Anomic aphasia (anomia) is a type of aphasia characterized by problems recalling words or names. Subjects often use circumlocutions (speaking in a roundabout way) in order to express a certain word for which they cannot remember the name. Sometimes the subject can recall the name when given clues. In addition, patients are able to speak with correct grammar; the main problem is finding the appropriate word to identify an object or person.
Define Benson’s anomia types:
Word Production Anomia:
Knows it, recognizes it, represents it in all modalities—can’t say it!
Motor speech component (apraxia?)
Treat with motor speech treatment
Define Benson’s anomia types:
Word Selection Anomia:
True anomia: comprehends it, can gesture, describe, write, draw but not name. “Tip of the tongue” phenomenon.
Treat with strengthening self-generated cues.
Define Benson’s anomia types:
Semantic Anomia:
Do not recognize the words, can’t produce them.
Damage to the semantic field—nothing on the tip of the tongue.
See this in dementia/TBI as well as CVA
Describe the difference between a facilitation approach (traditional Schuellian approach) and a didactic treatment approach
Facilitation (Schuellian treatment at its best!)
o Clinician chooses stimuli – high frequency of occurrence
o Manipulate the timing, order, form – objects, pictures, written words- and mode of stimulus (auditory, visual, auditory-visual)
o Repeat until they get it right!
o Best for acute aphasics
o Most of the work lies with the clinician
Didactic Treatment Approach
o Clinician selects the stimuli w/ help from the client
o Still manipulates timing, order, form, and mode of presentation
o Emphasis less on No. of correct responses and more on teaching the client to self-cue and cope with errors, communicating
o Most useful with chronic aphasics
o May have greater chance of helping the client long-term
Brown’s hierarchy
Functional or descriptive (It has a metal blade)
Embedded in a sentence (You use a ___for shaving.)
Synonyms or antonyms
Rhyming
Spelling the word
Open-ended sentences (You shave with a _____.)
Automatic completions (“A straight-edged _____.)
Phonemic cues (/re/ or /r/)
Repetition (razor)
Linebaugh & Lehner’s Heirarchy
- Confrontation naming
- Direction by the clinician to have the client state the function and try to name
- Direction by the clinician to have the client demonstrate the function and try to name
- Statement of function by the clinician
- Statement of function by the clinician accompanied by demonstration
- Sentence completion provided by the clinician
- Sentence completion plus silent posturing of the target word’s first sound provided by the clinician
- Sentence completion plus audible production of the target’s first sound provided by the clinician
- Sentence completion plus audible vocalization of the target word’s first and second sounds by the clinician
- Imitation.
What did Pease and Goodglass find as the most facilitating type of cue? Which was second most successful? Which was third-most successful? Which was 4th most successful?
Six Cues:
- ) First sound (most facilitating)
- ) Provide a sentence completion cue (2nd most)
- ) Environmental context or location
- ) Provide rhyming word (3rd most)
- ) Provide a statement of function
- ) Provide a Super-ordinate (4th most)
Describe an approach for naming that would utilize self-generated cues.
Self-generated cues (write, sound out, sentence completion)
Multi-modality/Self-Cues
Wernicke originally defined the area for fluent aphasia as the
posterior superior aspect of the left temporal lobe and its posterior extension.
Although researchers have extended the area responsible for Wernicke’s aphasia, what is the role of the PST regarding prognosis for recovery?
PST lesion = poor prognosis for aud. comp.
Absence of PST lesion = good prognosis (even if initially more severe)
The most severe have lesions in PST extending into infrasylvian portion of the supramarginal gyrus
– PST- central point for auditory comprehension
Describe Wernicke’s aphasia. What does it sound like?
Combination of fluent and jargon-filled speech and poor auditory comprehension
• -Characterized by fluent sometimes excessive verbal expression
• -Grammatically intact
• -Full of paraphasias and neologisms that can render the speech unintelligible.
What are the primary areas of focus for treatment?
Primarily have to focus on: Jargon, anomia, paraphasias combined with significant auditory comprehension deficits
Do fluent aphasics also have paresis or hemi-paresis?
No, motor cortex remains intact
How would you address reduction of jargon during treatment of Wernicke’s aphasia?
Jargon: Move from intelligible yes/no answers to short intelligible answers.
Jargon: Advance to longer answers, more information.
Use other communication modes: write, draw or gesture
Why does Marshall think that treatment of Wernicke’s aphasia could be challenging for the novice clinician?
Wernicke’s are confusing to work with.
May prefer to work in a contextual situation
Many communicate better in context
They are confusing to work with because they may prefer to work in a contextual situation, and many of them communicate better in context.
What are some specific treatment techniques to use with Wernicke’s aphasia?
Davis (2001): “Treatment of comprehension is the first step….”
Rosenbek (1989) says to “Help the Wernicke’s aphasic reduce distractibility and impulsivity is first step.”
– Structure environment/session
– Help the client learn to wait, not interrupt
Jargon: Move from intelligible yes/no answers to short intelligible answers.
Jargon: Advance to longer answers, more information.
Use other communication modes: write, draw or gesture
Aud. Comp.: Islands of language clarity= ability to comprehend single printed words. Use this as a starting point.
What do researchers suggest as aids to treatment with Wernicke’s aphasia in regard to?
Length of message: shorter vs. longer
Complexity: affirmative vs. negative/active, declarative vs. passive
Reversibility and plausibility: reversibility harder to comprehend than nonreversible, plausible easier
Vocabulary level: frequent
Redundancy: paraphrase and highlight
Timing variables: rate, pause types, alerting signals, stress
What did you learn about optimal treatment techniques from the Jill Bolte Taylor Website assignment?
x
What are the characteristics of cortical versus sub-cortical aphasias? (Table 4.2 Helm-Estabrooks)
Says little about subcortical aphasia
“Characteristics have not been defined yet.”
Helm-Estabrooks calls them “borderline fluent” aphasics”
“…with great variability in number of words/breath
Hypophonia or low speech volume distinguish subcortical from cortical aphasia.
Labeled according to site.
Are all deep structures sub-cortical and not cortical?What about the insula?
No, the insula she considers to be cortical but it is also kind of sub-cortical because it wraps around the whole cortex.
What does Helm-Estabrooks call sub-cortical aphasics?
Fluent, Non-fluent or Borderline fluent?
Borderline fluent- great variability in number of words uttered in one breath unit, have characteristics of both.
What are the symptoms of thalamic lesions?
Hemiplegia, hemisensory loss, right-visual field problems, maybe coma
Mutism initially or hypophonic (low volume)
Eventually variable phrase length and paraphasic and perseverative with bizarre word choices
Severe anomia (naming problems)
Variable auditory comprehension for conversational speech but poor for complex material
Relatively good repetition
Decreased paraphasia while repeating
Impaired reading and writing
What are the symptoms of anterior damage to the internal capsule and putamen of the basal ganglia?
Dysarthria, hypophonia, imprecise articulation
Variable phrase length from 4-6 word phrases to nearly normal
Semantic & phonemic paraphasias with a range of grammatical constructions.
Mild or no repetition problems
Anomia: Moderate naming or word-finding problems
Mild auditory comprehension problems
Moderate reading problems
Severe writing problems
What are the symptoms of damage to the posterior capsular-putamenal lesions?
Hypophonic, well-articulated, grammatical speech
Semantic, phonemic and neologistic paraphasias
Fluent speech, variable phrase length
Severe auditory comprehension deficits
Anomia: severe naming and word-finding problems
Poor repetition problems
Moderate reading problems
Moderate writing problems
What happens if both anterior and posterior areas are damaged?
Global aphasia
Non-fluent and extremely limited spontaneous speech
Stereotyped monosyllabic utterances or single-word productions
Severely dysarthric
Severely impaired Auditory comprehension
Significant naming and repetition
Serious reading and writing problems.
How does Helm-Estabrooks recommend addressing sub-cortical lesions? Are there any differences from cortical aphasia treatment?
Mirrors the symptoms of other aphasias at this time
Future Directions:
Gating effect
Motor Learning Theory
Parallel distributed processes (PDP) theory
Plaut models of computer simulations
Is it common to have a bi-lateral lesion?
Where are they usually located?
No, it’s rare.. .3% of cases
Usually aneurysm of anterior communicating artery and subarachnoid hemorrhage
Do bilateral CVAs generally have a positive outcome?
No, poor outcome if not fatal
What does “agnosia” mean?
A loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss
What is prosopagnosia?
Difficulty recognizing familiar faces, difficulty choosing pictures of faces just shown, problems naming the pictures of faces of famous people. Also known as ‘'’faceblindness’’’ and ‘'’facial agnosia’’’: Patients cannot consciously recognize familiar faces, sometimes even including their own. This is often misperceived as an inability to remember names.
What is Anosonosia?
This is the inability to gain feedback about one’s own condition and can be confused with lack of insight but is caused by problems in the feedback mechanisms in the brain.
What is Autotopagnosia?
Difficulty distinguishing environmental and non-verbal auditory cues including difficulty distinguishing speech from non-speech sounds even though hearing is usually normal.
What is phonagnosia?
Inability to recognize familiar voices, even though the hearer can understand the words used.
What is simultanagnosia?
Inability to perceive simultaneously the multiple details of a visual display
What is asteriognosia?
Connected to tactile sense - that is, touch. Patient finds it difficult to recognize objects by touch based on its texture, size and weight. However, they may be able to describe it verbally or recognize same kind of objects from pictures or draw pictures of them. Thought to be connected to lesions or damage in somatosensory cortex
