LECTURE #13 - neurogenic communication disorders 2 Flashcards
what is the most common dysarthria type ?
mixed dysarthria
what is mixed dysarthria ?
two or more pure dysarthria types
what are the causes of mixed dysarthria ?
- More diffuse damage than other dysarthrias
– Commonly associated with degenerative disorders (e.g., ALS, MS)
how many dysarthria types ?
6
what are the dysarthria types ?
- hyperkinetic
- hypokinetic
- spastic
- flaccid
- ataxic
- mixed
what is the two acquired speech disorders
dysarthria and aphasia
what is dysarthria ?
is a speech problem. It makes it hard to control the muscles needed for speaking, which can result in slurred or unclear speech. It’s caused by damage to the nerves or muscles that control speech.
what is aphasia ?
is a language problem. It affects your ability to understand or produce words, but the muscles used for speaking are fine. It’s usually caused by brain damage (most commonly from a stroke).
FILL IN THE BLANK
_______ affects what you say, while _________ affects how you say it.
aphasia affects what you say, while dysarthria affects how you say it
what is apraxia ?
Acquired neurological impairment in motor speech
planning and programming
what does apraxia lead to the inability of ?
Inability to voluntarily select and program skilled
motor movements for speech
TRUE OR FALSE
apraxia is related to weakness, slowness, paralysis
FALSE
Unrelated to weakness, slowness, paralysis
what term is used to describe a problem to plan and program (not muscle weakness) ?
apraxia
what are some speech characteristics of apraxia ?
- Groping attempts and great variability
- Repeated attempts to correct errors
- Complex, long words are difficult
how many purposes of assessment of dysarthria are there ?
5
what are the 5 purposes of assessment of dysarthria ?
– Determine if speech is abnormal
– Evaluate nature/severity of difficulties
– Determine cause of difficulties
– Determine need for intervention
– Identify directions for treatment
what does MSE stand for ?
motor speech exmaination
what is motor speech exmaination ?
is a key part of the assessment for dysarthria, focusing on how well the muscles and motor control systems involved in speech are functioning.
what is the goal of MSE ?
is to identify the specific type of dysarthria and the areas of speech production that are most affected
about how much % of the distribution of acquired motor speech disorders is apraxia ?
8%
in regards to the distribution of acquired motor speech disorders is majority apraxia or dysarthria ?
dysarthria
how many things do we look for in the assesment of dysarthria ; motor speech examination ?
5
what are the 5 things we look for during a motor speech examination ?
- Respiration
- Phonation
- Resonance
- Articulation
- Intelligibility
TRUE OR FALSE
during a MSE, only 1 factor at a time can be present?
FALSE
all 5 can be present
factor #1 : respiration
what is the respiration portion of MSE ?
– Observe posture and general appearance
– Observe rate of respiration
– Sustained phonation of
open vowels
– Measure respiratory
pressure/flow (manometer)
why is posture important in respiration ?
it gives breath support to produce speech (breath support)
when observing rate of respiration, what is a typical rate ?
12-20 breaths cycle per minute
what is a manometer ?
tube with fluid and measure how much breath support there is
factor #2 : phonation
what is the phonation portion of MSE ?
– Laryngeal mechanics
– Phonation time and voice quality
– Vocal flexibility and coordination
what is an example of something you may do to assess the laryngeal mechanics ?
ask to cough and grunt to see if larynx is working
what is an example of something you may do to assess the phonation time and voice quality of an individual ?
- ask them to perform the sound “aaaaaa” for a long time
- can they hold it ?
- how can they phonate in different contents
if you ask someone to cough or grunt and its quiet or you can hear them inhalling with difficulty… what will this show us ?
that their vocal folds are not fully properly apart like they are supposed to be
factor #3 : VP function and resonance
what is the phonation portion of MSE ?
– Velopharyngeal mechanics
* Visual assessment of resting palate
* Observe palate during repeated /ah/
– Resonance
* Perceptual evaluation of hypernasality and distorted consonants
what does VP stand for ?
velopharyngeal mechanics
what is resonance ?
is the quality of sound produced by the vocal cords as it travels through the throat, mouth, and nose. It affects how rich or nasal the voice sounds
where is the Velopharyngeal area located ?
is located at the back of the mouth and the upper part of the throat, specifically between the soft palate (velum) and the pharynx.
what does the velopharyngeal area control ?
the opening and closing of the passage between the nose and mouth, allowing air to flow either through the nose or mouth, which affects speech resonance and nasal sounds.
factor #4 : articulation
what is the articulation portion of MSE ?
– Articulatory mechanics (oral mech examination)
– Speech movements
* Syllable and phrase repetitions
* Puh-tuh-kuh
* Multisyllabic words
– Samples of speech in several contexts
what is the oral mech examination ?
looking at how articulators function
is it better to get more than one sample of speech or only one ?
better to perform more than one as people perform different in different contexts
factor #5 : intelligibility
what is the intelligibility portion of MSE ?
– Observation in multiple contexts
– Perceptual rating scales and measures
– e.g., Assessment of Intelligibility of Dysarthric Speech (Yorkston & Beukelman, 1981)
* % Intelligibility
* Speech rate for sentences (words/minute)
* Intelligible words/minute
* Unintelligible words/minute
what does intelligibility mean in simplest terms ?
means how easily someone can understand what you are saying
what are 3 indirect activities and compensatory strategies for intervention for dysarthria ?
- sensory stimulation
- muscle strengthening
- posture and speaking position
explain “sensory stimulation” :
This involves using touch, sound, or other senses to help improve the control of muscles needed for speech. It’s sometimes debated whether it works well for everyone.
explain “muscle strengthening” :
This includes exercises to make the muscles used for breathing, voice production, speaking, and resonance (sound quality) stronger. Some experts are not sure how effective it is for speech issues.
explain “posture and speaking position” :
Changing how a person sits or stands can help improve speech. This may involve working with an occupational therapist or doctor to find the best position for clearer speaking.
which 1 out of 3 indirect activities and compensatory strategies for intervention for dysarthria are NOT contreversial ?
posture and speaking position
which of the three indirect activities and compensatory strategies for intervention for dysarthria “exercises to improve respiration, phonation, articulation and resonance” ?
muscle strengthening
which of the three indirect activities and compensatory strategies for intervention for dysarthria “increases motor control”. ?
sensory stimulation
what are some examples of direct interventions for dysarthria ?
- Rate reduction therapy
- Amplification devices
- Delayed auditory feedback device
- LSVT (lee silverman voice therapy)
what is rate reduction therapy ?
This involves teaching the person to speak more slowly. Speaking at a slower pace can make speech clearer and easier to understand.
what are amplification devices ?
These are devices, like microphones, that help make the person’s voice louder, which can be helpful if they have a weak or soft voice.
what are delayed auditory feedback devices ?
This device plays the person’s voice back to them with a slight delay. It helps them hear their speech and improve control, making it clearer.
what is the Lee Silverman Voice Therapy ?
This is a specialized therapy designed to help people with speech difficulties, especially those with Parkinson’s disease.
what does the Lee Silverman Voice Therapy focus on ?
It focuses on increasing the loudness of the voice by teaching the person to speak more loudly and clearly. The idea is that louder speech helps improve overall communication and voice strength.
what does changing the environment mean; as a form of intervention ?
This means making adjustments to the person’s surroundings to make it easier for them to communicate. For example, reducing background noise, improving lighting, or making sure the person has a quiet space to talk can help them be better understood.
what does LSVT stand for ?
Lee Silverman Voice Therapy
what is the intensive therapy for Parkinson speech ?
Lee Silverman Voice Therapy
what does the Lee Silverman Voice Therapy focus on ?
Focus on laryngeal adduction, increased vocal effort, and recalibration of intended intensity
what training is involved in changing the environment; as a form of intervention for dysarthria patients ?
- Training patient and caregivers to minimize environmental impact on speech intelligibility
- Train patient to monitor listeners’ comprehension
- Train listeners to advise when they don’t understand
in regards to intervention for dysarthria; what is its focus ?
Focus on improvement of speech clarity and
naturalness
TRUE OR FALSE
Type of intervention, course, and prognosis vary with dysarthria type
TRUE
what may some treatments for dysarthria include ?
– Indirect activities or compensatory strategies
– Direct interventions
– Changes to the environment
– Augmentative and Alternative Communication (AAC)
which indirect intervention of dysarthria include applying vibration to articulators to try to stimulate motor movement / brushing on weaker articulators to try and stimulate ?
sensory stimulation
which indirect intervention of dysarthria act as a “physio but for speech” ?
muscle strengthing
TRUE OR FALSE
better posture = better speech
TRUE
in regards to direct interventions, what do people prefer ?
am[lification devices
TRUE OR FALSE
parkinsons causes to talk less
TRUE
a focus on laryngeal adduction, increased vocal effort, and recalibration of intended intensity does what?
leads to a big improvement on quality and loudness
what are AAC devices ?
are tools that help people with speech or communication difficulties express themselves. These devices can range from simple picture boards to high-tech speech-generating devices that produce spoken words. AAC devices are used when a person can’t communicate effectively with speech alone, allowing them to use symbols, text, or voice output to communicate their needs, thoughts, and feelings.
what do AAC devices stand for ?
Augmentative and Alternative Communication
what are the 2 identifying characteristics of assessment for apraxia ?
(1) articulatory error patterns and (2) consistency of errors
define : “Articulatory error patterns” :
- substitution, distortion errors common
- ommiting sounds are less common
- looking for errors “are they consistent” ?
define : “Consistency of errors” :
- Phonemes are correct in one instance and incorrect at other times
- Related to variations in context
- Typically more consistent in natural settings
- usually inconsistent
- error in one context can be natirally conducted in another context
how many assessments of apraxia are there ?
5
what are the 5 assessments of apraxia ?
- Non-speech oral motor movements (stick out tongue and puff out cheeks)
- Non-speech movement sequences (kiss & smile movement)
- Repetition of syllables ““puh-tuh-kuh”)
- Repetition of words (give words & see where they break down)
- Repetition of phrases (give phrases for them to repeat and see where they break down)
how do professionals chose the type of intervention for apraxia ?
depends on severity of impairment
what are the general treatment principles of intervention of apraxia ?
– Intensive treatment required (massed practice over a long interval)
– Many repetitions required
– Progress through a hierarchy of task difficulty (focused on sequencing)(start at where it is hard and move towards where its harder and harder)
– Overall goal = successful communication (not perfection)
what are some example intervention for apraxia ?
– Sound-sequencing therapy
– Pacing therapy
– AAC
what are Neurogenic Language Disorders ?
are communication problems caused by brain damage or injury
how do Neurogenic Language Disorders affect a person ?
These disorders affect a person’s ability to understand or produce language, and they can result from conditions like strokes, brain tumors, or traumatic brain injuries
what is an example of Neurogenic Language Disorders, acquired language disorder?
aphasia
what type of disorder is aphasia ?
an acquired language disorder
what type of disorder is aphasia ?
a language disorder
what is aphasia ?
Difficulty with language (understanding or speaking), but the muscles for speaking are fine.
TRUE OR FALSE
different types and severity depending on location and size of region(s) involved
TRUE
what does the left hemisphere control ?
controls most language processes in most people
what does focal damage to left hemisphere results in?
aphasia
what does the right hemisphere control ?
Right hemisphere contributes (to lesser extent) to language functions
what does right hemisphere damage result in ?
to cognitive-communication disorders (usually not aphasia)
what does CVA stand for ?
Cerebrovascular Accident
what is Cerebrovascular Accident also known as ?
stroke
what is majoritu of aphasia cases ?
Cerebrovascular Accident
what are some subtypes of Cerebrovascular Accident ?
- ischemic (thrombotic, embolic)
- transient ischemic attack
- hemorrhagic (includes aneurysm, arteriovenous malformation)
what are some causes of phasia ?
- Traumatic Brain Injury (TBI)
- Brain infections
- Degenerative brain disorders
- Tumors
what are some expressive deficits of examples of language impairments in aphasia ?
Word finding difficulties (anomia)
– Reduced vocabulary
– Omission/addition of words or grammatical markers
– Word substitutions
– Delayed or reduced output of language
– Stereotypic language
– Hyperfluent speech
what are some language comprehension deficits of examples of language impairments in aphasia ?
Impaired interpretation of linguistic information (words, grammar, syntax, etc.)
how many types of aphasia are there ?
2
what are the 2 types of aphasia ?
fluent and nonfluent aphasia
what is fluent aphasia ?
- Main problems in understanding spoken and
- Word substitutions, neologisms, and often verbose verbal output
what is nonfluent aphasia ?
- Main problems in producing spoken and written language
- Slow, labored speech, and word retrieval and syntactic problems
what are the two types of fluent aphasia ?
wernicke or anomia
what are the two types of nonfluent aphasia ?
broca or mixed
between the following :
- ischemic (thrombotic, embolic)
- transient ischemic attack
- hemorrhagic (includes aneurysm, arteriovenous malformation)
which block oxygen ?
- ischemic (thrombotic, embolic)
- transient ischemic attack
what is an anerurysm ?
burst blood vessel in brain
what is transient ischemic attack ?
fatty deposit or block in artery
what does “thrombotic” mean ?
blood clot bloacking artery that starts in brain
what does “embolic” mean ?
blood clot bloacking artery that starts somewhere else in body and goes to brain
what is anomia ?
difficulty finding the words you want to say
what is the main problem in those with fluent aphasias ?
main problem in understanding spoken and written language
TRUE OR FALSE
those with fluent aphasia has an issue in talking ?
FALSE not an issue in talking
where is the site of lesion in nonfluent aphasia cases ?
Site of lesion often in or near left frontal lobe
where is the site of lesion in fluent aphasia cases ?
Site of lesion often posterior in left hemisphere
what are some language examples of fluent aphasia (wernicke) ?
- may say words that make little sense
- may use made-up words such as “fragile” and are not aware of doing so
- may produce a full-length sentence that has no meaning. it sounds like a sentence but there is no content to what is being spoken
what are some language examples of fluent aphasia (anomia) ?
- may have difficultues naming certain words
- patients tend to produce gramatically correct, yet empty speech
- language comprehension tends to be preserved
what are some language examples of nonfluent aphasia (broca) ?
- may struggle to say words and form a sentence
- affected people often omit small words such as “is”, “and” and “the”
- often aware of their difficulties and can becomes easily frustrated by their speaking
what are some language examples of nonfluent aphasia (mixed or global) ?
- may be completly nonverbal, and/or only use facial expressions and gestures to communciate
- may understand some words
in wernicke’s aphasia, where do we see damage ?
Damage in temporal lobe, sometimes reaching into parietal lobe, in language dominant hemisphere
describe “Wernicke’s Aphasia” :
- Spoken language flows well with normal prosody, but content often lacks meaning
- Significant comprehension problems
- Limited awareness of problem
how many total forms of fluent aphasia are there ?
4
what are the four fluent aphasia’s ?
1) wernicke’s
2) transcortical sensory
3) conduction
4) anomic
in transcortical sensory aphasia, where do we see damage ?
Damage to language-dominant hemisphere at temporal-occipital border or parietal region
in conduction aphasia, where do we see damage ?
Damage to connecting pathway in temporal-parietal region
in anomic aphasia, where do we see damage ?
Not identified with specific brain area/lesion site
describe “transcortical sensory Aphasia” :
- Classic symptoms of Wernicke’s profile except stellar repetition skills and echolalia
- not really understanding what is being said
describe “Conduction Aphasia” :
- Hallmark difficulties in repetition
- have all symptoms of wrenickies but has trouble repeating
describe “anomic Aphasia” :
- Relatively few deficits in language expression and comprehension except naming/word retrieval
- trouble finding the right word and naming
what are the three nonfluent aphasia’s ?
1) broca’s
2) transcortical motor
3) global
with broca’s aphasia, where do we see damage ?
Frontal lobe damage
what type of language comprehension does one with broca’s aphasia have ?
- Mild-to-moderate language comprehension
problems - Longer and more complex messages
- When contextual cues removed
describe “broca’s aphasia” :
Speech is slow and effortful, but understanding is mostly fine. People can think of what they want to say but struggle to speak clearly and form sentences.
describe “transcortical motor aphasia” :
Similar to Broca’s aphasia, but people can repeat words or phrases easily. Speech is also slow, and they may have trouble starting or continuing conversations.
describe “global aphasia” :
severe language impairment, affecting both speech and understanding. People with global aphasia have difficulty speaking and understanding speech, often with very limited ability to communicate.
in summary, which type of aphasia = Slow speech, good understanding ?
Broca’s
in summary, which type of aphasia = Slow speech, can repeat words ?
Transcortical Motor
in summary, which type of aphasia = Severe difficulty with both speaking and understanding.
Global
TRUE OR FALSE
those with broca’s aphasia have awareness of the problem ?
TRUE
with transcortical motor aphasia, where do we see damage ?
frontal lobe damage
what type of language comprehension does one with transcortical motor aphasia, have ?
Symptoms similar to Broca’s Aphasia except have repetition skills that far exceed spontaneous speech
with global aphasia, where do we see damage ?
Large region of brain damage or multiple sites of brain injury in language-dominant hemisphere
what type of language comprehension does one with global aphasia, have ?
- Deficits across all language modalities
- Limited functional communication
- Poor language comprehension
what does CCDs stand for ?
Cognitive-Communication Disorders
what is Cognitive-Communication Disorders ?
Wide range of communication problems that result from damage to regions of brain that control thinking
with Cognitive-Communication Disorders, difficulties in communication that arise from ….
problems with cognition
what is communication ?
listening, speaking, reading, writing, conversation and social interaction
what is cognition ?
attention, memory, organization, information
processing, reasoning, executive functions
what are some causes of CCDs ?
Traumatic Brain Injury (TBI)
– Often includes frontal lobe damage
* Stroke
* Encephalitis due to toxins or anoxia
* Tumours
* Dementia
what is the most common nonfluent aphasia ?
broca’s aphasia
when do most people get broca’s aphasia ?
after stroke
what is CCDs commonly associated with ?
TBI
the following is which CCD communication profiles ?
– Wide range of deficits related to injury severity
– Commonly disturbed area is pragmatics, e.g.,
* Inappropriate
* Poor topic maintenance
* Difficulties with conversational turn-taking
– May also have impairments in speech (dysarthria, apraxia), voice, and swallowing, and personality changes
Traumatic Brain Injury
what is dementia ?
– Intellectual decline due to neurological causes
* e.g., Alzheimer disease, Parkinson, ALS, AIDS, etc.
what are teh core areas of impairment of dimentia ?
- Memory
- Language and communication
- Visuospatial skills
- Reasoning/judgment/abstract thinking
- Social cognition/personality
what is alzheimer’s disease ?
is a progressive brain disorder that causes memory loss, confusion, and difficulty thinking and solving problem
what is the most common cause of dimentia ?
Alzheimer’s disease
what condition affects a person’s ability to perform daily activities ?
dimentia
over time what does alzheimer’s disease lead to ?
eads to severe memory loss, changes in behavior, and difficulty communicating
what is the exact cause of alzheimer’s disease ?
The exact cause is not fully understood, but it involves the build-up of abnormal proteins in the brain that disrupt normal brain function.
what are the three stages of Alzheimer’s disease ?
- early/mild
- middle/moderate
- later/severe
describe the “early/mild” alzheimer disease :
word finding difficulty, problems understanding more abstract language (e.g., humour, sarcasm, metaphors)
describe the “middle/moderate” alzheimer disease :
More obvious word finding difficulties, reduced vocabulary and syntax, pronoun confusion, topic digression, reading/writing errors
describe the “later/severe” alzheimer disease :
Severe word finding difficulty, generic terms, repetitive, grammar/syntactic errors, minimal comprehension, jargon, echolalia, mutism
TRUE OR FALSE
Assessment for aphasia occurs in multiple phases as client recovers
TRUE
what is the initial assessment we do for those with aphasia ?
bedside assessment (formal testing postponed until patient is stable)
what do components of an assessment of aphasia include ?
– Medical history
– Interview with client and family
– Oral peripheral exam (to identify any co occurring speech impairments)
– Hearing testing (to identify any co occurring hearing impairments)
– Direct language testing
assessments of aphasia should assess overall communication skills and all modalities and aspectts of language in what four categories ?
- oral language
- auditory comprehension
- writing
- reading
describe oral laguage assessment of aphasia :
- Recite days/months
- Name objects or pictures
- Complete phrases/sentences
- Repeat words/phrases
- Formulate sentences
describe auditory comprehension assessment of aphasia :
- Answer questions
- Point to objects
- Follow directions
- Answer questions about discourse
describe writing assessment of aphasia :
- Copy letters, shapes, words
- Write letters, words and sentences (when spoken by examiner)
- Formulate and produce narratives
describe reading assessment of aphasia :
- Match pictures, letters, shapes
- Match words to pictures
- Read printed letters, words phrases
- Answer printed questions
- Answer questions about text
what are the methods of assessment of aphasia ?
– Consideration of premorbid state
– Observation/interpretation of client behavior
– Caregiver interview
– Standardized tests
what are some examples of standardized tests in assessment of aphasia ?
– Boston Diagnostic Aphasia Examination
– Western Aphasia Battery
– Boston Naming Test (takes two hours to conduct)
what is a WAB sample ?
refers to a sample of speech or language used, which is a commonly used test to assess and diagnose aphasia.
what does the WAB sample measure ?
The WAB measures a person’s language abilities in areas like speaking, comprehension, reading, and writing.
what does WAB sample stand for
Western Aphasia Batter
in aphasia treatment, what is the goal of therapy?
- Maximize recovery of impaired function
- Assist in development of compensatory communication strategies
- Help patient adjust to residual deficits of brain injury
what are the types of treatment of aphasia ?
- auditory comprehensino
- discourse comprehension
- reading comprehension
- word retrieval
- sentence production
when is treatment for aphasia effective ?
- It is delivered by qualified personnel
- Patients with irreversible aphasia are excluded from trials
- Intensity, content, duration and timing of intervention are appropriate
- Sensitive and reliable measures are used to document treatment effects
what are the three kinds of comprehension we aim to improve in aphasia treatment ?
- auditry comprehension
- discourse comprehension
- reading comprehension
what does auditory comprehension in the realm of treatment of aphasia include ?
– Listening comprehension and memory
– Single word comprehension
– Understanding spoken sentences
what does word retrieval in the realm of treatment of aphasia include ?
- sentence completion
- Word/phrase repetition
- Naming drills
- Cueing
- Strategies
- connected speech
- writing
what does sentence production in the realm of treatment of aphasia include ?
- Imitation
- repetition-elaboration
- story completion
- question
- answer
what does connected spech in the realm of treatment of aphasia include ?
– Picture description
– Prompted storytelling
– Conversation
what are some other exmaples of other interventions of treatment to of aphasia ?
- AAC
- New interventions: stem cell therapy, transcranial magnetic stimulation, medications
- Melodic Intonation Therapy (Using intonation (melody, rhythm, and stress) to increase length of phrases and sentences)
in regards to predicting recovery in aphasia patients, the amount and speed of language recovery influenced by…
– Spontaneous recovery
– Language/communication therapy
– Severity of impairment at onset
– Aetiology
– Size and location of damage
– Type of aphasia
– Other factors (e.g., sex, education level)
what is the purpose of assessment of CCDs ?
– Identify changes in language performance and behaviour
– Identify cognitive impairments (attention, memory, organization) impacting communication
– Identify impact of disorder on overall functioning
how do we do assessment of CCDs ?
− Examine all aspects of communication, including listening, speaking, gesturing, reading, writing and pragmatics
– Evaluate cognitive-communication skills related to attention, orientation, memory, planning, organizing, reasoning, problem solving
– Include observations in daily environment, interviews with communicative partners
what are the goals of treatment of CCDs ?
– Emphasize intact abilities
– Compensate for deficient abilities
– Maintain highest level of functioning possible
– Help others maximize client’s communicative participation
TRUE OR FALSE
for treatments and assessments, we tailor it to the unique needs of individual and
caregivers ?
TRUE
what are some examples of treatment of CCDs ?
– Memory training and memory aids
– Cognitive stimulation therapy
– Caregiver training in supportive communication techniques
– Environmental modifications
– AAC
– Improve specific aspect of language (e.g., reading comprehension, language formation)
what is the FOCUSED approach ?
is a communication therapy technique specifically designed to help people with aphasia improve their language skills, particularly in conversation.
what does FOCUSED stand for ?
F = face
O = orient
C = continue
U = unstick
S = structured
E = exchange
D = direct
