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Aphasia > Lecture 4: Nonfluent Aphasias > Flashcards

Lecture 4: Nonfluent Aphasias Flashcards

1
Q

Other names for nonfluent aphasias:

A

expressive aphasia, motor aphasia, anterior aphasia

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2
Q

Major General symptoms of nonfluent aphasias:

A

Decreased rate of speech, decreased phrase length, decreased prosody, decreased initiation of speech, decreased talking in general, increased effort

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3
Q

4 Nonfluent Aphasias

A

Broca’s, global, transcortical motor, mixed

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4
Q

Broca’s Aphasia Background

A

first described in 1861
Associated with damage to the cerebral language areas surrounding the sylvian fissure but not extending to Wernicke’s area
Hallmark characteristic: fluency impairment

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5
Q

Broca’s Aphasia Neuroanatomical Bases

A

Posterior-inferior (3rd) frontal gyrus of the left hemisphere known as Broca’s area (44 and part of 45)
Area known as anterior language cortex
MCA blood supply
Lower part of the premotor cortex

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6
Q

General Characteristics of Broca’s Aphasia

A

More easily recognized than Wernicke’s
Typical present with contralateral hemiplegia or hemiparesis; weakness of (r) facial muscles
Most motor problems improve over time
Pts often very depressed; catastrophic reactions refusing to cooperate or continue testing

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7
Q

Language Characteristics of Broca’s Aphasia

A 
Nonfluent and effortful speech
Agrammatic speech
Impaired repetition of words/sentences
Impaired naming
Questionable auditory comprehension
Oral reading
Writing problems
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8
Q

Broca’s Aphasia Site of Lesion

A

Posterior-inferior central gyrus of the left hemisphere

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9
Q

Verbal Expression in Broca’s Aphasia

A

Severely impaired; agrammatic; telegraphic; dysprosodic; possible AOS; minimal paraphasias

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10
Q

Auditory Comprehension in Broca’s Aphasia

A

Better than expression; some degree of deficiency in some pts; essentially intact for most

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11
Q

Naming in Broca’s Aphasia

A

Impaired

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12
Q

Repetition in Broca’s Aphasia

A

Impaired, especially for grammatical features

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13
Q

Oral Reading in Broca’s Aphasia

A

Impaired; similar to oral expression

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14
Q

Reading Comprehension in Broca’s Aphasia

A

Impaired to some extent

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15
Q

Writing in Broca’s Aphasia

A

Impaired

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16
Q

Transcortical Motor Aphasia Background

A

Extrasylvian aphasic syndrome; lies outside of perisylvian language zones
Nonfluent aphasia with good repetition skills
Hallmark characteristic: discrepancy between language production problems (impaired) & spared repetition skills

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17
Q

Neuroanatomical Bases in TMA

A 
Anterior superior frontal lobe
Usually above or below Broca's area
Lesions often impact association pathways
Impacts supplemental motor area
Supplied by anterior cerebral artery
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18
Q

General Characteristics in TMA

A

Similar to Broca’s aphasia
Motor disorders: rigidity of UE, akinesia, bradykinesia
Hemiparesis
Pts may demonstrate apathy or behavioral withdrawal: exhibit little to no interest in using language

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19
Q

Language Characteristics of TMA

A

Muteness, echolalic, reduced spontaneous speech
Agrammatic speech, paraphasic
Impaired naming with intact repetition
Relatively intact serial speech
Intact knowledge of grammar/ meaningfulness
Limited naming; may use motor prompts (snapping, etc. to get going)
Better comprehension than production

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20
Q

TMA site of lesion

A

Deep portions of the left frontal lobe below or above Broca’s area

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21
Q

Verbal expression in TMA

A

Impaired; initially mute; paraphasic; agrammatic; telegraphic; limited word fluency; pt will have no apraxia of speech

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22
Q

Auditory Comprehension in TMA

A

Intact for simple; subtle problems with complex material

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23
Q

Naming in TMA

A

Mildly impaired; better for confrontational naming

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24
Q

Repetition in TMA

A

Intact; may demonstrate echolalic and perseverative speech

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25
Q

Oral Reading in TMA

A

Impaired

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26
Q

Reading Comprehension in TMA

A

Good except for syntactically complex material

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27
Q

Writing in TMA

A

Impaired

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28
Q

Mixed Transcortical Aphasia (MTA) Background

A

Rare nonfluent aphasia type
Combine TMA and TSA
Language impairment is severe and extensive
Pts retain repetition skills (Hallmark & distinguishing feature from global aphasia)
Has been labeled isolation aphasia

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29
Q

Neuroanatomical Bases of Mixed Transcortical Aphasia

A

Caused by various conditions that decrease blood flow throughout cerebral arteries: hypoxia of various origins, cardiac arrest, cerebral edema, multiple embolic strokes
Supplied by MCA, & anterior/posterior cerebral arteries
Broca’s, Wernicke’s, & arcuate fasciculus are spared

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30
Q

General Characteristics of Mixed Transcortical Aphasia

A

Varied clinical picture
Bilateral UMN paralysis
Severe spastic quadriparesis (weakness of all 4 limbs)
Visual field deficits (typical problems is right hemianopia)
Weakness in hip/shoulder muscles
Severe brain damage

31
Q

Language Characteristics of Mixed Transcortical Aphasia

A 
Extremely limited spontaneous verbal expression, echolalic
Severely impaired fluency
Severely impaired auditory comprehension
Marked naming difficulty
Unimpaired automatic speech
Normal articulation
Severe reading deficits
Severe writing impairments
32
Q

Lesion site: Mixed Transcortical Aphasia

A

watershed area (pg. 113)

33
Q

Verbal expression: mixed transcortical aphasia

A

Often severely impaired; Agrammatic with paraphasias

34
Q

Auditory Comprehension: Mixed Transcortical Aphasia

A

Often severely impaired

35
Q

Naming: Mixed Transcortical Aphasia

A

Impaired

36
Q

Repetition: Mixed Transcortical Aphasia

A

Good but parrot-like; nonfunctional repetition

37
Q

Oral Reading: Mixed Transcortical Aphasia

A

Often severely impaired

38
Q

Reading Comprehension: Mixed Transcortical Aphasia

A

Often severely impaired

39
Q

Writing: Mixed Transcortical Aphasia

A

Impaired

40
Q

Additional Info on Mixed Transcortical Aphasia

A

“Broca’s aphasia with decreased auditory comprehension

41
Q

Global Aphasia Background

A

May account for 30-55% of pts with aphasia
Most severe form of aphasia; has a generalized effect on communication skills
Impacts all modes of communication & spares no particular skill (which is hallmark)
Possible for it to evolve into another type of aphasia
Be careful of prognosis

42
Q

Neuroanatomical Bases of Global Aphasia

A

Lesion likely to involve entire perisylvian region affecting both Broca’s and Wernicke’s areas
Subcortical areas may even be impacted
More common sites are impacted by MCA
Widespread destruction of left fronto-temporo-parietal regions

43
Q

General characteristics of global aphasia

A

Presence of strong neurological symptoms; weakness; paralysis; sensory loss
Apraxia including both verbal & oral types
Hemi-neglect

44
Q

Hemi-neglect

A

left neglect is common in right hemisphere damage

45
Q

Language Characteristics of Global Aphasia

A

Globally impaired communication skills
Severely impaired fluency
Impaired repetition, naming, reading, writing
Impaired auditory comprehension

46
Q

Global Aphasia Site of Lesion

A

Widespread damage; left fronto-temporo-parietal regions

47
Q

Verbal expression in global aphasia

A

Severely impaired; minimal vocalizations

48
Q

Auditory comprehension in global aphasia

A

Impaired; maybe personally relevant info; some y/n ?s

49
Q

Naming in global aphasia

A

Impaired

50
Q

Repetition in global aphasia

A

Impaired

51
Q

Oral reading in global aphasia

A

Impaired

52
Q

Reading comprehension in global aphasia

A

Impaired

53
Q

Writing in global aphasia

A

Impaired; no meaningful; may copy letters &/or write name

54
Q

General Nonfluent Aphasia Treatment

A

Coarticulated speech; auditory comprehension; oral expression tasks; understanding written language/reading; writing strategies

55
Q

Coarticulated speech

A

Build on level of success (syllables, words, phrases…)

56
Q

Auditory comprehension strategies

A

Point, follow commands, understand complex material

57
Q

Oral expression tasks may range from:

A

Oral-motor skills, automatic sequences, repetition, answering questions, naming, & word fluency to reading words & sentences aloud

58
Q

Understanding written language (reading)

A

Identify letters, words, match words and pictures, read sentences and paragraphs

59
Q

Writing Treatment

A

Improve mechanics for writing basic info, the alphabet, numbers, writing to dictation, writing names, & writing about a picture or event

60
Q

Treatment Strategies: Consider spared abilities/functional levels:

A

Good writing: apply directly to communication
Some writing: consider a writing/spelling therapy program
No writing, some drawing: consider a communicative drawing therapy program
No writing, some gesturing: consider a communicative gesturing therapy program
Gestural-verbal training increases naming for some people with aphasia

61
Q

PACE approach

A

Prompting Aphasics’ Communicative Effectiveness; Pulvermuller & Volkbert, 1991
Uses compensatory strategies to facilitate communication: encourages exchange of information; provide a stimuli pic face down b/t pt & clinician & the pt must look at it & use any available means to communicate the message (charades with all modalities)
SLP guesses and provides feedback

62
Q

Mapping Treatment

A

For agrammatism
Targets sentence structure & thematic roles by identifying subject & object of sentences
Uses pictures

63
Q

Sentence Production Program for Aphasia (SPPA)

A

Helm-Estabrooks & Nicholas 2000
Used to improve conversation with pts who have nonfluent aphasia & who are agrammatic speakers
Attempts to increase phrase length, content, & grammar
Focuses on 8 sentence types using a thematic base

64
Q

Melodic Intonation Therapy (MIT)

A

Sparks & Deck 1986
Approach that uses melodies & intonation patterns of the intact right hemisphere
4 levels: 1: intoning a melodic line; 2: hand tapping saying syllables; 3: answering questions; 4: practice with drilled phrases & sentences
Pictures used initially & later program cues reduced

65
Q

Response Elaboration Training (RET); Kearns 1991

A

Program using loose training w/ pt-initiated responses (without restrictions)
Uses simple line-drawn picture stimuli requiring personal interpretation
SLP scaffolds responses (doesn’t provide corrections to pt responses)
6 steps: 1: Elicit spontaneous response to pic; 2: Model & reinforce pt’s response; 3: Provide ‘wh’ cues for pt to elaborate; 4: reinforce elaboration & model sentence; 5: repeat & have pt repeat; 6: reinforce & provide another model

66
Q

Equivocal Responses

A

Vague, confusion, ambiguous

67
Q

Treatment for Equivocal Responses

A

use 2 notecards w/ “yes” on 1 & “no” on other; pt repeats words 5 times each while looking at cards; assist the pt to say word & nod “yes” & then “no” when given a cue; present yes/no ?s for pt responses (request responses to simple ?s)
Establish a baseline & begin treatment with personal, environmental, informational ?s
Use pics to help understand ?s; chart responses

68
Q

Gestural Response Therapy

A

Core vocab chosen based on pt needs (begin w/ 5-10 words); Clinician makes gesture while saying a word; clinician repeats word with pt; pt imitates gesture immediately then after brief delay; pt gestures after clinician says and writes the word; pt writes word if possible when seeing gesture

69
Q

Card Therapy/Treatment (Deck of Cards)

A

Improve sequencing of #s on cards by putting them in order
Match cards according to suit & number (use 2 decks)
Respond to commands using cards (pick up the ace)

70
Q

Writing Hierarchy

A

Trace word–>copy word–>say word for pt to identify in writing–>ask pt to write word to dictation–>ask pt to write word given a picture–>ask pt to write word in response to a ?

71
Q

Communication Boards

A

use communication boards w/ pics & words: alphabet & word boards usually ineffective for individuals w/ global aphasia
Include pics of people & familiar objects
Use pics of real objects, actions, places

72
Q

Teaching Pts to Use Communication Boards

A

Point when an item is named (immediate then with a delay)
Keep board visually simple at 1st & then expose more items with time when success is achieved
Consider a more high-tech AAC device if possible and financially feasible

73
Q

Using AAC

A

When introducing a device, assess device’s communicative capabilities & compare it with client’s needs; consider operational demands regarding client’s motor, sensory, cognitive skills
Adapt device to the client’s situations & available support
Train client & family how to use device
Monitor its use for functional language

74
Q

Functional AAC Considerations: How functionally can the patient:

A

Get someone’s attention, give yes/no answers, call for help, indicate understanding of what’s being said, respond without words, say the name of person nearby, communicate needs, wants, pain (if any), have social times with friends and family, understand written communication, communicate their emotions, describe something, have 1-on-1 convo, get involved in group talk about self, participate in group convo

Aphasia (8 decks)

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