Lecture 3: Sequelae of TBI 2 Flashcards
Neurodiagnostic purpose
Means often used to diagnose neural pathology & associated deficits; some methods are post-hoc, some are invasive, & some are inferential; may be static or dynamic
Neurodiagnostic Methods used most often in diagnosis of stroke:
MRI, CT, SPECT scans
Prevalence
total number of disease cases at a given period of time
Incidence
Number of new cases during some time period
Prevalence of Strokes
3rd leading cause of death in US; mortality rates differ across types; leading cause of disability
Which type of strokes more common?
ischemic more than hemorrhagic
Which type of aphasia more common in younger pts?
Broca’s aphasia
Which type of aphasia more common in older pts?
Wernicke’s
Pts with aphasia grouped according to…
fluency of speech; some pts have relatively preserved fluency of speech while others have marked difficulty in producing & sustaining fluent speech: so either fluent or nonfluent; classification based on both deficiencies of language & anatomical considerations
Receptive & Expressive Aphasias
References deficits in language comprehension &/or production; can also be mixed type; generally correlated w/ differing sites of lesion
More anterior cerebral lesions tend to be associated with
Language production problems
Lesions more posteriorly located in the cerebrum tend to produce
more comprehension related issues
Nonfluent aphasias are considered_____
expressive aphasias
Fluent aphasias are considered _______
receptive aphasias
Aphasia Symptomatology
Most pts will demonstrate a set of common sx
Various paraphasias; D/o’s of fluency; Auditory comprehension; Repetition; Paragrammatism vs. agrammatism; Anomia; Writing problems; Reading problems; Visual (gestures); Apraxia vs. dysarthria or both
Paraphasias
Errors in speech consisting of unintended words or sound substitutions; often considered a central sign of aphasia; most are present in all types of aphasia & can’t be considered significant factor in diagnosis of specific types
3 Primary Types of Paraphasias
Verbal (global) paraphasia
Neologistic paraphasia
Phonemic (literal) paraphasia
Verbal paraphasia
AKA global paraphasia
Entire word is substituted
2 Types: semantic paraphasia & random paraphasia
Semantic Paraphasia
Type of verbal paraphasia
Substituted word is semantically related to the 1 intended (says son for daughter)
Random Paraphasia
Type of verbal paraphasia
Substituted & intended words are not semantically related (window for banana)
Neologistic paraphasias
References use of meaningless, invented words
Pts may refer to an object by their invented, nonsensical term
Phonemic Paraphasias
AKA Literal paraphasias
Substitution of 1 phoneme for another (loman for woman) or the addition of a phoneme (wolman for woman)
Different diagnosis than apraxia of speech or speech sound disorder
Fluency
Speech that approximates normal rate, typical word output, length of sentences, & melodic contour
Disorders of Fluency
Aspects of language production; Fluent speech flows & is produced with less effort & is smooth & devoid of too many interruptions
What is fluent speech considered?
produce 5+ connected words
Fluency is considered significantly impaired when…
Word output is less than 50 words a minute in conversation
Pts who are nonfluent
Tend to speak with a degree of muscular effort not seen in normally fluent speakers
Speech may be slow, deliberate, or limited
Utterances may contain fewer words than normal
Speech is usually hesitant
Auditory Comprehension
Most pts with aphasia have some degree of difficulty with it
Not dependent necessarily upon fluent or nonfluent status; it’s degree of severity that varies
Assessed from simple tasks to more complex multi-steps
Repetition
pt’s imitation of single words, phrases, & sentences
Usually more frequently present in cases of impaired auditory comprehension; not always the case
Must rule out true deficit vs. inability to repeat secondary to apraxia, etc.
Paragrammatism
Seen in fluent aphasias
Substitution/addition of inappropriate sequences (verb tense confusions, gender case issues, incorrect choice of prepositions, misuse of inflections, juxtaposition issues)
Cocktail party speech
Agrammatism
Seen in nonfluent aphasias
Simplification/reduction of grammatical construction
Omission of articles, connected words, auxiliary verbs, inflectional morphemes
Pt’s will only use content words
Telegraphic speech
Anomia
Word finding difficulty usually persists for those that recover
Present in confrontational naming
Word frequency & semantic categories: words that are less frequent in everyday language
Not particularly useful when differentiating types of aphasia (more of a general problem)
Persistent & severe word-finding & naming difficulties are dominant; pt may have anomic aphasia
Divergent Confrontational Naming
Name 3 fruits
Convergent Confrontational Naming
apple, pear, and orange are all _____
Agraphia
writing problems associated with cerebral lesions
Grapheme Expression
Most all pts will demonstrate some difficulty with writing
Problems will generally reflect problems seen in verbal expression: agrammatic, effortful sparse speech seen in pts w/ Broca’s aphasia will demonstrate agrammatic, effortful, sparse writing
May exhibit poor letter &/or word formation
May reverse, confuse, or substitute letters
Self-correction may be poor; nonsensical words & poor orthographic skills
May be totally unreadable
Reading Problems
Again, variety is noted in pts with aphasia
Some have difficulty reading secondary to verbal expressive problems
Others may demonstrate poor comprehension of what is read silently or orally
Alexia
Loss of or inability to comprehend written language
Aphasia is not:
schizophrenia or dementia
Dementia
Progressive neurological disease in which communicative & cognitive skills, along with social & personal behaviors continue to deteriorate
Alzheimer’s; Pick’s & Parkinson’s can also cause it
Schizophrenia
Psychiatric disorder characterized by disordered thought, affect, & behavior
Pts exhibit irrelevant speech & disturbed thinking
Disassociation from reality with hallucinogenic qualities
Typically diagnosed earlier in life than aphasia
Onset is usually more gradual
8 Must-Knows
Site of lesion Oral expression Repetition Naming Auditory comprehension Oral reading Reading Comprehension Grapheme expression
