L6: Classification Systems for Aphasia Flashcards
what are classification systems?
correlations bw groups of behaviours (symps) and sites of lesions determined by autopsy or neuroradiology studies
what are the benefits of classification systems?
provide a common language amongst clinicians
presume lesion localization and most likely etiology
highlight exceptionalities
however…. correlations do not supprt conclusively simplistic brain behaviour relationships
what are the risks of classification system usage?
classifying can cast a person into preconceived set of behaviours
ignoring critical assessment in areas the classification system does not cover
w/i group variance often is larger than bw group variance for dimensions on which treatment may be being based
what are the 3 non-fluent aphasias
broca’s
global
transcortical motor (TCM)
what are the 3 fluent aphasias
wernicke’s
transcortical sensory
conduction
anomic
what are the 6 categorization parameters for boston classification?
spontaneous language (fluent vs non)
repetition
auditory comp
reading comp/matching
reading aloud
writing
what are the categorization paramaters of spontaneous language? (non fluent vs fluent )
content (morphosyntactic, semantic and pragmatic considerations)
naming - confrontation (object, picture, action) vs generative vs responsive
error analyses
paraphasias (type and proportion of occurence)
what are the categorization paramaters of repetition?
single words
phrases
real vs non words
what are the categorization paramaters of auditory comp?
sound, word, sentence, paragraph
concrete vs abstract
what are the categorization paramaters of reading comp and matching?
letter, syllable, word, clause, sentence paragraph
what are the categorization paramaters of reading aloud?
single word and phrases
real vs nonwords
what are the categorization paramaters of writing?
spontaneous (letter, syllable, word, clause, sentence, paragraph)
copying
spelling and dictation
what are the 5 main parameters of nonfluent vs fluent speech? (first 3 being most distinctive)
articulatory agility
grammatical form
melodic line
average phrase length
anomia
articulatory agility refers to (nonfluent vs fluent speech)
distinguished from motor speech production (ex. dysarthria) on basis of variability of performances
inc effort to speak
mispronunciations at phoneme and syllable levels (ex. phonemic paraphasias)
self corrections, restarts and reformulations, sound and syllable reps
inc effort aggravates inaccuracies
grammatical form refers to (nonfluent vs fluent speech)
do they have their grammatical markers?
agrammatism = absent or incorrect use of grammatical structures, non-meaningful filler words or phrases
melodic line refers to (nonfluent vs fluent speech)
prosodic features (duration, rate, loudness, pitch, contours, stress patterns)
pauses/hesitations (filled - ex. um, unfilled - periods of silence), rhythm disrupted
average phrase length refers to (nonfluent vs fluent speech)
of words in a breath group or w/i sig pause
average 3 longest utterances produced under 3 conditions
words produced in a specified time period
what are the 3 conditions for average 3 longest utterances? (aka # of words in a phrase that determine nonfluent vs fluent speech)
all correct and incorrect words that are articulated clearly enough for transcription
9 or > = fluent
0-5 = non-fluent
6-8= borderline fluent
anomia refers to (nonfluent vs fluent speech)
paraphasic errors
anterior (non-fluent) refers to lesions that are …
anterior to central sulcus, superior to sylvian fissure
posterior (fluent) refers to lesions that are …
posterior to the central sulcus, inferior to sylvian fissure
What are some of the main characteristics of anterior/non-fluent aphasia?
(consider: phrase length, content vs functor words, words per min, vocab, forms, auditory comp)
short phrases (2-3 words)
high % content words rather than functor (ex. articles)
low words per min
restricted vocab
retains overlearned forms and serial items
fairly good auditory comp by poorer performance on longer, more complex structures
What are some of the main characteristics of anterior/non-fluent aphasia?
(consider: writing, reading, co-morbidities, effort, syntax) PART 2
impairment in spoken language mirrors writing impairment
mild reading comp disturbances
oral and verbal apraxias often co-existing
w recovery, more effortful productions
syntax impaired
What are some of the main characteristics of posterior/fluent aphasia?
(consider: phrase length, articulation, word classes, expressive vocab, word associations, comp skills)
normal phrase lengths
facility of articulation
use of all word classes but fewer substantives
may or may not have semantically empty expressive language, sometimes filled w jargon and paraphasias (phonemic, verbal, and semantic)
general word associations are poor or bizarre
mildly impaired or poor comp skills
What are some of the main characteristics of posterior/fluent aphasia?
(consider: reading, writing, rep tasks, melody, awareness) PART 2
reading aloud, reading comp, and writing impaired
paraphasic errors on rep tasks
normal melody and rhythm
can be generally unaware of errors
Broca’s aphasia is a type of
anterior/nonfluent aphasia
What are the spoken language characteristics (neurolinguistic) of Broca’s aphasia? (8 of them)
verbal output laboured, sparse and halting
poorly articulated utterances, misarticulations prominent
short phrases (telegraphic, text like)
agrammatic output (functor missing/restricted vocab/grammar)
dysprosodic
AOS
During recovery: effortful/short phrases
confrontation naming mildy impaired (aided by phonemic cueing)
agrammatic output refers to
functor words missing, utterances primarily substantive
restricted vocab and grammatical forms (verbs omitted more than nouns, that is nouns more freq than verbs)
agrammatism is present ____ language domains/models, associated with ______ output (_____ words/min)
across
slow, efffortful
reduced
agrammatic spoken language may be _______ in fluency, BUT _____ nonfluent language is agrammatic
reduced
not all
aka not all nonfluent aphasias show agrammatism
agrammatism often shows _____ of verbs, ______ proportion of verbs to nouns (type token ratio)
omission
declining
type-token ratio =
discourse measure that takes a ratio of one word class and compares it to another word class (ex. Verbs vs nouns)
agrammatism often involves omission of function words such as…
prepositions, articles, and conjunctions
agrammatism: verbs are typically _____ or in ____ form
inflected or ing form
agrammatism: ______ of bound morphemes often occurs
omission
agrammatism: word order may be ______ in production even in the presence of _____ issues
preserved
comprehension
agrammatism: sentence comprehension is impaired in speech and/or accuracy and usually shows….
non-canonical sentences (ex. negs or passives)
longer sentences (typically more propositions/ideas)
sentences requiring wh- phrase movements (Broca’s)
What are the repetition characteristics (neurolinguistic) of Broca’s aphasia? (5 of them)
rep almost always abnormal
less abnormal than fluency but still abnormal
omits functor words
difficulty repeating same syntactical wording
know they are not repeating same words in same order
in Broca’s aphasia comprehension is distinctly ____ than expression
better
What are auditory comp characteristics (neurolinguistic) of Broca’s aphasia? (4 of them)
Im pretty sure these are things where their auditory comp is weaker but double check
complex sentences: one independent cause plus 1+ dependent clause
multiple concepts: compound sentences w 2+ independent clauses
reversible sentences: reversible implausible better understood than reversible plausible
processing word order (rely on syntax)
in Broca’s aphasia (nonfluent/posterior) reading comprehension is…
less impaired than verbal and writing skills but still impaired
in Broca’s aphasia (nonfluent/posterior) reading aloud is…
impaired bc of probs w verbal expression and phonemic programming
in Broca’s aphasia (nonfluent/anterior) writing is…
poor and matches verbal output
letters are formed poorly/oversized … and telegraphic
Where is the site of the lesion for Broca’s aphasia?
L-lateral frontal love, posterior/inferior portions of F3 IFG, extending t adjacent subcortical white matter
80% of Broca’s aphasia patients exhibit ______ because of proximity to precentral motor strip
R-hemiplegia (more sig for arm than leg, leg is more medial on homunculus)
hemiparesis = muscular weakness on one side of the body
Broca’s aphasia may be correlated with ____ due to involvement of association area for sequenced actions
ideomotor apraxia
inability to carry out command or act that can be performed spontaneously
Limb or bucco-facial/nonverbal apraxia
Patients w Broca’s aphasia may exhibit personality changes due to…
disturbances to frontal lobe and the afferent and efferent connections to the limbic system (hypothalamus, amygdala, thalamus, hippocampus etc)
Transcortical motor aphasia resembles Broca’s aphasia but … (hallmark feature!!!)
repetition is robust
transcortical motor aphasia is a type of
non fluent/anterior aphasia
describe the spoke language symptoms of transcortical motor aphasia
nonfluent spontaneous spoken output
agrammatic verbal output
telegraphic/text like
mostly content/substantives and few functors
serial spoken language is robust
in transcortical motor aphasia, confrontation naming is usually defective bc of ______, however this is inconsistent
word finding problems
in transcortical motor aphasia, contextual cues and semantic cues helpful, but _____ cues not helpful
phonemic
auditory comp in transcortical motor aphasia is
minimally impaired, approaches normal
reading comp in transcortical motor aphasia is _____, reading aloud is …
good
poor bc of articulation and agrammatic, nonfluent output
writing in transcortical motor aphasia …
poor graphics (misshapen letters, especially large ones)
spelling is also poor
site of lesion for transcortical motor aphasia is
middle and anterior portions of 2nd and 3rd frontal gyri and sometimes anterior portion of 1st frontal gyrus
can affect motor and premotor cortex, anterior and superior to broca’s
transcortical motor aphasia involves the following neurobehavioral correlates…
personality changes and emotional lability
broad spectrum of motor changes (paralysis or paresis) depending on sites and extent of lesion
global aphasia is a type of
non-fluent/anterior aphasia
global aphasia involves severe reduction in…
ALL language modalities
minimal verbal output
may be limited to 1-2 word utterances including stereotypes, serial forms, automatic utterances
global aphasia may involve ______ utterances, _____ and _____ paraphasic errors
nonsense
neologisms
jargon
in global aphasia, _____ output may be severely compromised
nonverbal, i.e. gestures
stereotypical response =
involuntary utterance that is routinely used in replace of a propositional utterance (which is voluntary and novel in meaning)
in global aphasia they may respond to _____ communication or ____ systems but prognosis is _____
augmetative
gesture
poor
in global aphasia:
repetition =
auditory and reading comp=
reading aloud =
writing =
sig impaired
severely impaired
severely impaired
writing usually w non-dom hand, agraphic and linguistic disturbances
site of lesion of global aphasia is
variations in regions involved but primarily extensive distribution thru L hemisphere
large perisylvian, extending into subadjacent white matter
what are the neurobehavioural correlates of global aphasia?
associated w neuropsychological disturbances (agnosias, emotional lability, parietal lobe symps, attention deficits)
neurological deficits (paralysis - upper and lower limbs, incontinence, visual field probs)
agnosia
inability to process sensory info
lack of knowing, lack of recognizing people, lack of recognizing objects
