Midterm

Question 1

What is the definition of aphasia according to the basics and according to Papathanasiou?

Answer 1

“Acquired selective impairment of language modalities and functions resulting from a focal brain lesion in the language dominant hemisphere that affects the person’s communicative and social functioning, quality of life, and the quality of life of his or her relatives and caregivers.”

Question 2

What is the definition and characteristics of right hemisphere syndrome?

Answer 2

RH Syndrome is a communication disorder that is difficult to detect.

Results from damage to the RH affects the non-linguistic aspects of communication with relatively intact cognitive abilities.

It needs to be studied more.

Mechanics are in tact but have problems with visual spatial tasks (e.g. They can write their name but they can’t space it out correctly).

Question 3

What are the symptoms of RH syndrome?

Answer 3

• prosody problems
• discourse production/comprehension
• pragmatics, emotional/nonverbal communication
• theory of mind
• implied meanings
• humor comprehension
• visual spatial aspects of reading and writing
• executive functioning: planning, organization, problem
  solving, time management
• left side neglect: inability to see the left side and they don’t know it is there until they are specifically asked about it).

Question 4

Where is the visual memory of the word “dog” stored?

Answer 4

• in the SECONDARY VISUAL CORTEX (V2)

- you might even have a visual memory of your own dog

Question 5

Where will you have a visual representation of the word “dog?”

Answer 5

in your LEFT OCCIPITAL LOBE

Question 6

Where is the academic definition of the word “dog” in your brain?

Answer 6

housed in the LEFT & RIGHT PARIETAL LOBE

Question 7

Where will information of how you FEEL about “dogs” or your your own dog be held in your brain?

Answer 7

LIMBIC SYSTEM

Question 8

Where will memories for what a dog smells like, feels like, and emotional memories about a dog that scared you in the past be stored?

Answer 8

LIMBIC SYSTEM

Question 9

Where is the motor memory for saying/writing the word “dog” stored?

Answer 9

BROCA’S AREA

Question 10

What is the main point of noting that the representation of a word comes from so many areas of the brain (parietal, limbic system, occipital lobe, Broca’s, Wernicke’s)?

Answer 10

Everything is implicated (involved) in “where words are stored.”

Question 11

What does the LEFT & RIGHT VISUAL PRIMARY (V1) do?

Answer 11

Sees the object first.

Question 12

What does the LEFT & RIGHT VISUAL SECONDARY (V2) do?

Answer 12

Recognizes the object from your visual memory of it.

Question 13

What does the AUDITORY PRIMARY (located in the temporal lobe) do?

Answer 13

Hears others and yourself say the word while connecting the visual memory with the auditory memory of it.

Question 14

What does the LEFT & RIGHT PARIETAL LOBE do?

Answer 14

Holds thoughts and academic memories.

Question 15

What does the ANGULAR GYRUS or TEMPORAL/OCCIPITAL/PARIETAL JUNCTION do?

Answer 15

It is the tertiary area that translates thoughts into components responsible for language.

For example: sight into language, touch into language, hearing into language, and emotions into language.

Basically, it translates one modality into the next modality.

Question 16

What does Wernicke’s area (left secondary auditory cortex) do?

Answer 16

Holds auditory memories for words, word forms, and connects them to visual memory/auditory memory to retrieve a word.

Question 17

What does the right analogous area to Wernicke’s area do?

Answer 17

Holds auditory memories for intonation forms such as rising intonation for a question in English (i.e. sarcasm is here, sarcasm is an auditory memory and a motor memory).

Question 18

What is Broca’s area responsible for?

Answer 18

• Motor patterns for speech sounds and words.
• Syntax.
• It is a pattern generator.

Question 19

What is the right analogous area to Broca’s responsible for?

Answer 19

Motor patterns for intonation aspects of speech signal.

Question 20

What is the left and right motor cortex responsible for?

Answer 20

From it arises upper motor neurons.

Question 21

What is the limbic system responsible for?

Answer 21

• Emotional memories
• Emotional words (e.g. cursing)
• Emotional aspects of speech signal
• Emotional aspects of overall communication.
• Emotion comes out in one’s speech, one’s emotional state also affects how one receives information.

Question 22

Where is the auditory memory of words stored?

Answer 22

Wernicke’s area

Question 23

General description of Broca’s aphasia.

Answer 23

When a patient has a lesion in Broca’s area they present with apraxia of speech. The apraxia causes a person’s speech to be halted and effortful without syntax. They recognize their errors but they can’t find the right words and the right motor patterns to say what they want to say.

Question 24

General description of Wernicke’s area.

Answer 24

The lesion occurs in Wernicke’s area when someone has Wernicke’s aphasia. The patient is unable to “make a match” between sounds and words. They don’t recognize their own errors. They think they are saying and hearing the right thing when saying sounds and words when they are actually producing errored sounds and words.

Question 25

Conduction aphasia

Answer 25

This occurs when there is damage to the articulate fasiculous between broca’s area and wernicke’s area. When this happens the patient can’t imitate speech.

Question 26

Global aphasia

Answer 26

This is a combination of Broca’s, Wernicke’s, and Conduction aphasia. It is caused by a very large stroke because it is big enough to affects all three areas.

Question 27

Anomic aphasia

Answer 27

Patients will have:

• word finding problems
• no apraxia
• good syntax

This kind of aphasia can be caused by damage to any of the language-oriented areas.

Question 28

Transcortical aphasia: Transcortical sensory

Answer 28

Damage occurs between wernicke’s area and the angular gyrus.
The patient will have:
- impaired comprehension
- the ability to repeat and recognize phonemic patterns
- but will not be able to understand meanings other than very basic concepts.

Question 29

Transcortical aphasia: Transcortical motor

Answer 29

Damage occurs in front of Broca’s area. This is the connection between broca’s area and motor strip. Therefore, patients with this damage will not talk at all.

Question 30

Transcortical aphasia: Transcortical mixed

Answer 30

This is a mix of transcortical motor and transcortical sensory. How does the patient present?

Question 31

phonemic paraphasia

Answer 31

This happens when less than half the sounds of what is stated is in error (i.e. top bop).

Question 32

semantic paraphasia

Answer 32

This occurs when the word you say is an actual word, but it is not the word you intended to say.

For example, target word = boy, related word = girl, unrelated word = car.

Remember: Physically your words are clustered together, so sometimes what someone says, may seem unrelated to you but it may be related to them. For example, if they said “red” for “car” it may be because they drive a red car.

Question 33

anomia

Answer 33

When someone has difficulty finding a word. This is universal among all types of aphasia.

It is NOT that you don’t come up with the word or that you have to give the wrong word.

Anomia just means that the fluency of your speech is impaired.

Question 34

stereotypes

Answer 34

This occurs when someone produces only one word form (i.e. lady said “four” to everything, or saying “okie dokie” to everything, “on a wednesday”

• Singing can break this which indicated the individual hasn’t actually lost their language.

Question 35

perseveration

Answer 35

This occurs when somone is stuck on a response. They say the same response they just said for the last question. It can be verbal, a thought, or an action (crumbling paper), the individual’s brain has captured a behavior and cannot move onto the next. Think of a broken record.

Question 36

undifferentiated jargon

Answer 36

When one sound form stays for the whole length of the utterance.

Individual is improving when they move from undifferentiated jargon to differentiated jargon.

Question 37

neologistic jargon

Answer 37

When neologistic paraphasias are produced. The speech is unintelligible.

Question 38

semantic jargon

Answer 38

When a patient is actually producing words but they have no collective meaning. They are having unrelated verbal paraphasias.

For example, “my job was…original…him…concerned with…particulars…of..so that I could tell him exactly what to take, and where to…take it from…so that I could get away to the….gestures for the conditions of one side…which would give me particular items or discussion according to that. I should have then convolve to the complete asculation…which would give me particulars to tendon but I am not…not…available throwing back particulars until they were given to me.”

Question 39

agrammartism

Answer 39

Represented by a lack of function words (a, the, ing). There is a lack of morpheme endings. The patient only uses content words and verbs at their base. This is associated with broca’s aphasia.

Question 40

Neologism

Answer 40

More than half of sounds are in error (i.e. take for top). The patient will never use phonemes that aren’t in their language or non-words with no intelligible meaning.

Question 41

alexia

Answer 41

The impaired ability to read.

Question 42

agraphia

Answer 42

It is an impairment for writing while language is intact. They don’t look at the paper when they are writing. They won’t be able to read what they wrote. They are still able to write because there’s a motor memory involved with writing.

Question 43

Explain how depression can affect language, cognition, and therapy.

Answer 43

Depression mostly directly affects our limbic system, which controls emotion. Emotion is related to memory because you learn things that have an emotional value to you. Therefore, depression affects your ability to learn new material, because you will not be able to see the value in it. Depression is also found to be common in people with dementia. This causes lack of willingness to participate in assessment and treatments and therefore needs to be treated.

Question 44

How many people are affected by depression from post stroke aphasia? What does it affect?

Answer 44

62-70% of people with aphasia suffer from post-stroke depression.

• it affects quality of life and attitude towards therapy (motivation)

Question 45

What is “depression after discharge?”

Answer 45

When discharge causes them to see lack of hope.

Question 46

Can family members of aphasia patients be depressed? Explain.

Answer 46

Yes, family members of aphasia can also be depressed and that can result in them not providing all of the useful information needed about the patients or not performing good follow-up procedures when the patient is back at home.

Question 47

What is a CT stand for in CT scan?

Answer 47

computerized tomography

Question 48

What is a CT used for?

Answer 48

To visualize the internal structure of the brain and to study the effects of certain neuropathologies.

• measures density
• uses radiation through the skull, measures the amount of radiation that goes through and depicts the brain from there
• it is density dependent (the denser areas will be depicted as the white regions on the scan)
• bright ball in clear solution
• emergency CT scan might not show stroke damage (will always show hemorrhagic strokes but not ischemic strokes due to the change not being present)

Question 49

What does MRI stand for?

Answer 49

magnetic resonance imaging

Question 50

Explain the technique of an MRI.

Answer 50

Technique involves noninvasive radiation by harmless radio waves directed to subjects located within a powerful magnetic field. Able to provide images of static tissue with a high degree of natural contrast between normal and abnormal tissue, between gray matter and white matter, and between gray matter and cerebral spinal fluid.

Question 51

What are the strengths of an MRI?

Answer 51

• no radiation is used and it is technically non-invasive
• involves a manipulation of electrons (mainly hydrogen atoms)
• better at small lesions compared to CT scans, it is more detailed
• better at detecting iron

Question 52

What are the limitations of an MRI?

Answer 52

• takes a long time to do because you cannot completely control the electrons
• the individual cannot move during the scan and if the individual does, the scan has to start over again
• complex calculations are needed

Question 53

What does PET scan stand for?

Answer 53

positron emission tomography

Question 54

What is the technique of a PET scan?

Answer 54

It is an imaging technique that allows one to view brain metabolism. Looks for gamma rays that are emitted from the brain. In order for the gamma rays to be produced, a radioactive substance is injected into the patient. The substance is commonly known as FDG or radioactive glucose. The accumulation of FDG in the brain tissue is visualized on the scan, the gamma rays are detected by the machine to identify the quantity and location of the isotope.

Question 55

What are the strengths of a PET scan?

Answer 55

• looks at functioning via different colors representing activity
• can be done to measure oxygen, protein, glucose metabolism

Question 56

What are the limitations of a PET scan?

Answer 56

• while it does look at physiology, it can only look at one factor at a time
• radiation is put inside your bloodstream, and is measured leaving your body (what you are using at the time)

Question 57

What does fMRI stand for?

Answer 57

functional MRI

Question 58

Strengths of fMRI?

Answer 58

• no radiation and non-invasive
• has basics of an MRI while able to follow function not just structure
• has the most potential for measuring language and cognitive functions
• looks at blood flow
• most recently it has been used to look at the activation of specific regions of the brain during various tasks (for example: visual stimulation, auditory stimulation)

Question 59

What are the limitations of an fMRI?

Answer 59

limitations?

Question 60

How can a brain autopsy sometimes still tell more about how a brain is damaged than neuroimaging techniques?

Answer 60

Brain autopsies may reveal more about how a brain is damaged because none of the neuroimaging techniques are real pictures of the brain. Rather, they are representations of the brain along one dimension based upon a specific measurement (density, water/hydrogen content, oxygen/protein/glucose metabolism, blood flow). For example, CT scans measure density. Damaged/dead tissue has a different density than normal tissue, and that information may be picked up through a CT scan to reveal damaged/dead tissue. However, if the damage does not cause a density change in the tissue, no information regarding the presence or location of damage will be revealed through a CT scan. Overall, we select the neuroimaging technique we want to use which will give us information about the brain with regards to the aspect we are trying to measure (density, water/hydrogen content, etc), and we must then infer about the damage from that information. On the other hand, a brain autopsy literally means “to study and directly observe the body.” This is done post-mortem through a removal and dissection of the brain so that the actual tissue is being examined directly. There may be problem-solving and inferencing involved; however, it is based upon the direct observation of the tissue and not from a “picture” which is an indirect representation of any damage in and of itself.

Question 61

You do a full evaluation of communicative functioning for a patient. The neuroimaging techniques do not explain the difficulties you are seeing. Which do you believe and why?

Answer 61

I would believe the patient and/or the caregiver that the patient is having communicative problems even if the Computerized Tomography (CT) scan does not show any brain damage. The CT scan measures density; any brain damage will not be visible on a CT scan until there is a change in the brain’s density (dead tissue is darker than healthy brain tissue). This change could take up to 2-3 days before becoming visible. Further, the location of the damage will impact the severity of communication functioning. For example, damage occurring lower down in a large artery will be more severe, with more brain damage due to the region of the brain served by that large artery than if the damage occurred higher up in a smaller artery and only a small portion of the brain had damage because blood could not reach that part.

Question 62

True or False. Most of the patients that you see will be pure aphasics. Explain your answer.

Answer 62

False. Most patients we see will have aphasia because, “strokes and clots don’t care about where they go in the brain so very rarely do you see someone who has purely broca’s aphasia or purely wernicke’s aphasia.”

Question 63

Why should you always evaluate the person’s strengths as well as his or her weaknesses?

Answer 63

The strengths should be evaluated along with the weaknesses because the strengths will be able to help or compensate for the weaknesses that the client has and can incorporate the client’s strengths into therapy to improve on the weaknesses.

Question 64

ICF Framework to describe RH syndrome.

Answer 64

Body structure: damage to the structure of the brain (right hemisphere)
Body Function: patients with RHS will typically experience problems with:
- melody of speech - intonation
- expression of spoken language in discourse, particularly with pragmatics
- visual perception: as the visual spatial aspects of reading and writing are impacted (i.e. left side neglect)
- Global psychosocial functions- Theory of Mind
- Higher-level cognitive functions, including organization and planning, insight, problem-solving, and time management.

Activity/Participation: problems with:

• communicating and receiving spoken messages, due to difficulty with expression and reception of language in discourse
• Communicating with receiving non-verbal messages, due to difficulty with emotional and non-verbal communication
• Solving problems- as these patients struggle with higher-level cognitive functions.

Environmental factors: immediate family, friends, acquaintances, peers, collegues, neighbors can be facilitators or barriers. However, strangers could only be a barrier. For example, if a cashier at at store makes a figurative remark, the patient with RHS may take it literally and it may lead to a break in their communication or a conflict. Health professionals (SLP) and health services can educate the patient and family and provide services to improve higher-level cognitive and language functions (facilitator). The health system may inhibit or help the patient recover, depending upon whether the insurance company is willing to pay for the health care services (facilitator or barrier).

Question 65

ICF Framework to describe Broca’s aphasia:

Answer 65

Body structure: damage to the structure of the brain (Broca’s area)
Body Function: problems with:
- expression of spoken language, due to loss of automatic ability to produce words
- fluency of speech, due to speech apraxia
- reception of spoken language, due to difficulty to follow directions and understanding sentences
- integrative language functions, due to difficulty with syntax
- mental function of sequencing complex movements, due to speech apraxia

Activity/Participation: problems with-

• shopping, due to social interaction with strangers
• communication with receiving a spoken message, due to following directions and understanding sentences
• speaking, conversation, and discussion, due to speech apraxia
• employment in the situation that the patient in a career that requires verbal communication

Environmental factors: strangers may be a barrier for the Broca’s patient. For example, if a salesperson on the other end of the line over the phone is unaware that the patient has Broca’s aphasia, the person may not give the patient an adequate amount of time to respond and hang up the phone. The attitude of the patient is an environmental factor that would likely be a facilitator.

Question 66

ICF Parameters of Wernicke’s aphasia.

Answer 66

Body structure: damage to the structure of the brain (Wernicke’s area)
Body Function: problems with
- expression of spoken language, due to production of jargon and paraphasias
- reception of spoken language, due to poor language comprehension (they can hear sounds but can’t make a match)
- integrative language functions, due to lack of comprehension and fluent, jargon, speech production
- insight, due to lack of awareness of producing unintelligible utterances
- assisting others, due to lack of ability to effectively communicate
- basic interpersonal relationships, due to lack of comprehension and effective speech production

Environmental Factors: the attitude of the patient may potentially be a barrier in this case. Since the patient is usually unaware that his speech production is unintelligible to the listener, the patient may be in denial that he needs any speech services. In addition, strangers could certainly be another barrier. For example, a store clerk may get the false impression while interacting with a patient with Wernicke’s aphasia that something is wrong with them mentally when they are not understanding their speech.

Question 67

ICF Parameters of global aphasia:

Answer 67

wernicke’s, broca’s and conduction combined

Body Structure: damage to the structure of the brain (damage to Broca’s, Wenicke’s, and arcuate fasiculus)
Body Function: problems with
- expression of spoken language
- reception of spoken language
- integrative language functions
- fluency of speech
- speech discrimination
- mental function of sequencing complex movements, due to possible speech apraxia
-insight, due to possible lack of awareness of poor communication

Activity/Participation

• shopping due to required social interaction with strangers
• communication with receiving spoken message
• speaking, conversation, and discussion, due to speech apraxia
• employment, due to required communication
• assisting others, due to lack of ability to effectively communicate
• basic interpersonal relationships, due to lack of comprehension and effective speech production

Environmental Factors
- the attitudes of the patient and the family can potentially be a barrier. Patients with Global aphasia have the poorest prognosis and usually require an AAC device. The level of the patient’s improvement is dependent upon the individual and the support that they have in their environment. In addition, especially when patients have an AAC device, strangers can be a barrier as well. Strangers may be impatient to wait to get a response from the patient as they are using their AAC device to communicate.