Final Exam- Study Guide Flashcards
Why does Rosenbek say that auditory comprehension is sometimes called the “veiled disorder” of aphasia?
“A deficiency in the ability to process or understand spoken language that cannot be accounted for by peripheral sensory deficit, generalized cognitive deficit, or primary disturbances in attention or arousal.”
Where on the cortex is auditory comprehension localized?
Posterior superior aspect of the left temporal lobe and its posterior extension
PST lesion =
Absence of PST lesion =
poor prognosis for aud. comp.
good prognosis (even if initially more severe)
The most severe have lesions in
PST extending into infrasylvian portion of the supramarginal gyrus
What are the key components of comprehension (according to Rosenbek?)
- Stimulus detection
- Discrimination of stimuli
- Retention
- Categorization
- Sequential retention
What are some specific tests for Auditory Comprehension?
The Proust-Lichtheim Test
Liepmann
Pierre Marie – Three Papers Test
Coin and Bowl Test, Hand, Eye, and Ear Test, Man, cat and Dog test.
Goldstein (1948) – contextual basis
1872: The Proust-Lichtheim Test:
Liepmann:
Pierre Marie:
Goldstein:
Raise Fingers, squeeze hands, blink, etc.
nodding agreement test
yes/no questions
“Here are three pieces of paper of different sizes, give the largest one to me, crumple the middle one and throw it on the floor and as for the smallest one- put it in your pocket.” Relies on MEMORY, PRODUCTION and EDUCATION to some extent
1st to stress context and pragmatics- everyday questions related to personal interests
What are some activities within general aphasia tests that assess auditory comprehension skills?
Minn. Test for the Differential Dx of Aphasia (MTDDA)
Token Test
Revised Token Test
Aud. Comp. Test for Sentences (ACTS)
Functional Auditory Comprehension Task (FACT)
Yes/no questions
1,2,&3 step commands
What are some of the basic tenets of the following treatment approaches that address auditory comprehension issues?
Linguistic Stimulation approach:
Pointing to objects by name
Following Commands
Answering questions
What are some of the basic tenets of the following treatment approaches that address auditory comprehension issues?
VAT:
VIC:
CAIAC:
PACE:
TWA:
CAIAC:
Goal: “To improve the understanding of spoken messages in natural settings and everyday situations.” (pg. 335)
Candidates: (Table 23.1, pg. 346)
Alert, little fatigue
Moderate to severe auditory comprehension deficits
Moderate non-linguistic cognitive problems
Good visual perceptual skills
Basic graphomotor skills
Ability to complete homework
Nonlinguistic variables can influence performance on tasks requiring comprehension of spoken messages.
Experience that employing drills of verbally presented linguistic stimuli have questionable effectiveness.
None of CAIAC tasks require obvious processing of verbal stimuli or any verbal output.
All tasks require attention and conceptual knowledge of shape and size.
Attention Tasks:
Abstract design cancellation (pg. 348-349)
Alternating graphomotor patterns (pg. 351)
Symbol trails task (pg. 352-353)
Conceptual Knowledge tasks:
Odd-man out designs (what doesn’t belong) (pg. 35)
Actual size/weight judgments(pg. 356)
Sorting semantically related pictured objects (pg. 357)
Odd man out pictured objects (pg. 358)
TWA:
Goal: “To improve ability of individuals with moderate to severe Wernicke’s aphasia to understand spoken messages in everyday settings and situations”
Candidates: Moderate to severe Wernicke’s aphasia
Severely-moderately impaired single word comprehension
Severely-moderately impaired repeating of single words, phrases and sentences
Relatively preserved single-word reading comprehension
Some ability to read aloud a few single words with high emotional value
Based upon theory of “re-auditorizaton”
Pre-test: must be able to read 4/15 single words from ADP.
Baseline Step
Treatment Steps:
Reading comprehension-match printed to pictorial
Oral Reading-read word aloud
Repetition-repeat with only picture
Auditory Comprehension-select from field of 6
Can sub-cortical lesions alone cause aphasia?
Yes, severe aphasia because everything goes through the thalamus
If damage to a sub-cortical structure causes aphasia, does that mean that these structures have language functions?
No, its function is to relay the information from the cortex. The relay station is damaged, therefore aphasia is likely to occur
Are all deep structures sub-cortical and not cortical? What about the insula?
No, the insula has lead us to believe it is more of a cortical structure
What are the characteristics of cortical versus sub-cortical aphasias?
“Characteristics have not been defined yet.”
They have a greater variability in number of words/breath
Great variability in number of words uttered in one breath unit
Hypophonia or low speech volume distinguishes subcortical from cortical aphasia.
What does Help-Estabrooks call sub-cortical aphasics?
Borderline fluent
What are the symptoms of thalamic lesions?
Auditory Comprehension skills:
Highly variable
Repetition skills
Good
What are more 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?
Auditory Comprehension skills:Relatively good
Repetition Skills: Good
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?
Auditory Comprehension skills: Poor
Repetition Skills: Poor
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?
Mirrors the symptoms of other aphasias at this time
Is it common to have a bi-lateral lesion?
Rare to have simultaneous lesions Rare to have simultaneous lesions
(16 reported cases or 0.3% of CVAs)
Where are they usually located?
Usually due to aneurysm of Anterior Communicating Artery and subarachnoid hemorrhage
Do bilateral CVAs generally have a positive outcome?
Often poor outcome if not fatal
What is meant by “alexia”?
Suffer from reading problems while other language-related skills such as naming, oral repetition, auditory comprehension or writing may still be intact.
What type of reading tasks should be the function of early aphasia therapy?
Target survival reading skills
Reading letters, menus, checkbooks, bank statements, medicine labels, phone books calendars, maps, product labels, emergency signs, etc.
List some treatment considerations for working with reading with a moderate to severe aphasic.
Functional Verbal Expression is the Priority for severe aphasics
Basic/Functional Reading skills may be important for mild-moderate aphasics
“The first step in designing a reading treatment program is to assess the premorbid level of literacy and the current need for and interest in reading.”
Silent reading comprehension more important than oral reading
How do writing problems differ in anterior versus posterior left hemisphere CVAs?
Anterior left: structurally poor writing: misspelling, poor letter formation
Posterior left: Word order, word omission, letters formed OK
How do writing problems differ between left hemisphere CVAs and right hemisphere CVAs?
Left Hemisphere: More pronounced structural and syntactic writing problems than right hemi
Right Hemisphere: Spatial aspects, Left neglect, Margin errors
What are the main types of agraphia ?
Pure Agraphia
Deep Dysgraphia
Phonological Dysgraphia
Surface Dysgraphia
Pure Agraphia-
unusual syndrome
agraphia without anything else going on
Deep Dysgraphia-
Route between word meaning and written form impaired.
Spelling errors semantically related. Better at concrete nouns, greater difficulty with abstract nouns.
Functor words VERY difficult.
Connective pathway disorder
Phonological Dysgraphia-
impaired phoneme to grapheme conversion rules. Preserved ability to write real words, inability to write pseudo words.
Sounding out words and thinking of the associated grapheme that goes with it
Surface Dysgraphia-
Phonetic errors but able to write pseudowords
MOTORIC ORIGINS:
Apraxic Agraphia
Motor Agraphia
Micrographia
Hyperkinetic agraphia
Apraxic Agraphia-
Inability to use a writing tool to form symbols even with a model. Could be a component of ideomotor apraxia. Better ability with anagrams or typewriter or spelling aloud
