Lecture 3: Sequelae of TBI 2

Question 1

Neurodiagnostic purpose

Answer 1

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

Question 2

Neurodiagnostic Methods used most often in diagnosis of stroke:

Answer 2

MRI, CT, SPECT scans

Question 3

Prevalence

Answer 3

total number of disease cases at a given period of time

Question 4

Incidence

Answer 4

Number of new cases during some time period

Question 5

Prevalence of Strokes

Answer 5

3rd leading cause of death in US; mortality rates differ across types; leading cause of disability

Question 6

Which type of strokes more common?

Answer 6

ischemic more than hemorrhagic

Question 7

Which type of aphasia more common in younger pts?

Answer 7

Broca’s aphasia

Question 8

Which type of aphasia more common in older pts?

Answer 8

Wernicke’s

Question 9

Pts with aphasia grouped according to…

Answer 9

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

Question 10

Receptive & Expressive Aphasias

Answer 10

References deficits in language comprehension &/or production; can also be mixed type; generally correlated w/ differing sites of lesion

Question 11

More anterior cerebral lesions tend to be associated with

Answer 11

Language production problems

Question 12

Lesions more posteriorly located in the cerebrum tend to produce

Answer 12

more comprehension related issues

Question 13

Nonfluent aphasias are considered_____

Answer 13

expressive aphasias

Question 14

Fluent aphasias are considered _______

Answer 14

receptive aphasias

Question 15

Aphasia Symptomatology

Answer 15

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

Question 16

Paraphasias

Answer 16

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

Question 17

3 Primary Types of Paraphasias

Answer 17

Verbal (global) paraphasia
Neologistic paraphasia
Phonemic (literal) paraphasia

Question 18

Verbal paraphasia

Answer 18

AKA global paraphasia
Entire word is substituted
2 Types: semantic paraphasia & random paraphasia

Question 19

Semantic Paraphasia

Answer 19

Type of verbal paraphasia

Substituted word is semantically related to the 1 intended (says son for daughter)

Question 20

Random Paraphasia

Answer 20

Type of verbal paraphasia

Substituted & intended words are not semantically related (window for banana)

Question 21

Neologistic paraphasias

Answer 21

References use of meaningless, invented words

Pts may refer to an object by their invented, nonsensical term

Question 22

Phonemic Paraphasias

Answer 22

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

Question 23

Fluency

Answer 23

Speech that approximates normal rate, typical word output, length of sentences, & melodic contour

Question 24

Disorders of Fluency

Answer 24

Aspects of language production; Fluent speech flows & is produced with less effort & is smooth & devoid of too many interruptions

Question 25

What is fluent speech considered?

Answer 25

produce 5+ connected words

Question 26

Fluency is considered significantly impaired when...

Answer 26

Word output is less than 50 words a minute in conversation

Question 27

Pts who are nonfluent

Answer 27

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

Question 28

Auditory Comprehension

Answer 28

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

Question 29

Repetition

Answer 29

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.

Question 30

Paragrammatism

Answer 30

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

Question 31

Agrammatism

Answer 31

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

Question 32

Anomia

Answer 32

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

Question 33

Divergent Confrontational Naming

Answer 33

Name 3 fruits

Question 34

Convergent Confrontational Naming

Answer 34

apple, pear, and orange are all _____

Question 35

Agraphia

Answer 35

writing problems associated with cerebral lesions

Question 36

Grapheme Expression

Answer 36

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

Question 37

Reading Problems

Answer 37

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

Question 38

Alexia

Answer 38

Loss of or inability to comprehend written language

Question 39

Aphasia is not:

Answer 39

schizophrenia or dementia

Question 40

Dementia

Answer 40

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

Question 41

Schizophrenia

Answer 41

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

Question 42

8 Must-Knows

Answer 42

``` Site of lesion Oral expression Repetition Naming Auditory comprehension Oral reading Reading Comprehension Grapheme expression ```