Neurogenic Communication Disorders Flashcards
includes terms and definitions, damaged regions, aphasia types, and dysarthria types
working memory
ability to hold a given amount of information for immediate processing
short-term memory
retention of information for longer than 30 seconds lasting hours
long-term memory
retention of information for months and/or years
declarative memory
recall of facts
episodic memory
recall of specific and recent events
procedural memory
recall of sequences necessary for given tasks
focused attention
the ability to “focus” on and respond to stimuli and information
sustained attention
the ability to “sustain” or hold and manipulate information
selective attention
the ability to attend and “select” information within a larger set
alternating attention
the ability to switch or “alternate” attention between tasks
divided attention
the ability to attend and “divided” focus on multiple things at once
types of neurogenic communication disorders
- non-fluent aphasia
- fluent aphasia
- dementia
- right hemisphere disorder (RHD)
- apraxia
- dysarthria
- TBI
non-fluent aphasia
- also known as Broca’s or Expressive aphasia
- posterior inferior frontal gyrus in left hemisphere (Broca’s area)
- effortful, telegraphic speech and impaired grammar
- auditory comprehension > expression
fluent aphasia
- also known as Wernicke’s or Receptive aphasia
- posterior, superior left temporal lobe (Wernicke’s area)
- fluent, copious verbal output
- poor auditory comprehension
dementia
- persistent or progressive deterioration of cognitive functions
- memory deficits are most characteristic
- may also impact language, emotional, personality, etc.
right hemisphere damage/disorder (RHD)
- acquired following a brain injury
- visuospatial deficits, visual (left) neglect
- anosognosia
- prosodic, inferencing, and discourse deficits
- sustained and selective attention deficits
anosognosia
denial and poor awareness of impairment
apraxia
- inferior posterior left hemisphere damage
- deficit to motor planning with normal speech musculature
- articulation characterized by groping, inconsistency, and errors of sound/syllable sequencing
treatment of apraxia may focus on…
- auditory visual stimulation
- oral motor repetition
- phonetic placement
- slowing down rate of speech
dysarthria
- type of dysarthria will depend on site of damage
- slowness, weakness, and incoordination of speech musculature
types of dysarthria
- flaccid
- spastic
- ataxic
- hypokinetic
- hyperkinetic
- unilateral upper motor neuron
TBI: penetrating
scalp/skull broken, fractured, open TBI
TBI: non-penetrating
skull is not broken or fractured, closed TBI
possible deficits following TBI
- word retrieval and naming deficits
- pragmatic deficits (e.g., impaired prosody, topic maintenance, etc.)
- irritability and unreasonable behaviors
- dysarthria
- preseverations, poor attention
- reading and writing deficits
neurogenic communication: signs and symptoms
- anomia
- paraphasia
- perseveration
- agrammatism
- alexia
- agraphia
- neologism
- circumlocution
- jargon
anomia
- problem with word finding
- anomia is a symptom of aphasia
- anomic aphasia
anomic aphasia
only deficit is word retrieval
paraphasia
error in which an incorrect word, part of word, or sound is substituted for an intended target word
phonemic paraphasia
- few phoneme mistakes, mostly correct word
- ex: lork –> fork
semantic paraphasia
- word substituted for word with similar meaning
- ex: fork –> spoon
neologistic paraphasia
- word substituted for a made up word
- ex: fork –> fannak
agrammatism
- grammar deficits, inadequate sentence production
- typically individual uses content words and omits function words
agraphia
- acquired writing impairment following brain damage
- motor dysfunction or spelling impairment deficits
neologism
- error type in which a new word is created
- the word has no meaning to the speaker and is entirely different from intended word
circumlocution
- talking around the intended word or idea
- used as a strategy in speech therapy to improve word finding
jargon
continuous fluent utterances that make little sense but appear to make sense to the speaker, typically seen in fluent aphasia
neurogenic communication disorders
communication problems that arise following damage to the brain/nervous system
frontal lobe
- executive function deficits (problem solving, reasoning)
- memory loss, consciousness, impulse control
- motor planning candor programming (apraxia, dysarthria)
parietal lobe
- sensory deficits
- difficulty reading/writing, spatial relationships
- mathematical deficits
temporal lobe
- deficits in auditory perception/sensation/integration
- categorization difficulties, memory and recognition deficits
- left temporal = verbal information, right temporal = nonverbal information
occipital lobe
- visual deficits
- alexia = word blindness, reading impairment
- agraphia = writing impairment
basal ganglia
- hypokinetic dysarthria = slow limited movements
- hyperkinetic dysarthria = quick, involuntary movements
hippocampus
- memory impairments
- fears and anxieties may increase
anterior cerebral artery stroke (ACA CVA)
- may have deficits in memory, emotion, sensory, motor speech
- cortical = apraxia
- subcortical = dysarthria
brainstem
- attention deficits, consciousness, non-voluntary function damage
- CN damage = can present as dysarthria and/or dysphagia
- midbrain (dopamine producer): Parkinson’s (hypokinetic dysarthria)
cerebellum
- motor coordination and balance deficits
- ataxia = slurred speech, stumbling, incoordination (appears drunk)
left hemisphere damage
- expressive deficits
- receptive deficits
- global deficits
- cognitive impairment
- right visual field impairment
right hemisphere damage
- spatial + perceptual deficits
- discourse + pragmatic deficits
- impulse behavior + attention difficulty
- judgement + reasoning problems
- poor awareness of deficits
ischemic CVA
- occurs due to blockage of a blood vessel
- most common cause of stroke: thrombotic, embolic
ischemic CVA: thrombotic
blood clot develops in blood vessels inside brain, interrupted blood flow
ischemic CVA: embolic
blood clot develops elsewhere in body + travels to brain through brainstem
hemorrhagic CVA
- occurs due to bleeding, blood vessel rupture
- high blood pressure is most common cause
- intracerebral
- subarachnoid
hemorrhagic CVA: intracerebral
- most common, artery bursts
- flooding tissues with blood
hemorrhagic CVA: subarachnoid
bleeding in the area between arachnoid matter + pia mater
transient ischemic attack
- TIA, often called “mini stroke”
- temporary clot
- may be warning sign for future stroke
posterior cerebral artery (PCA)
- temporal + occipital lobes
- writing deficits
- memory + cognitive communication deficits
middle cerebral artery (MCA)
- hemiplegia
- dysphagia
- Broca’s/Wernicke’s aphasia
- impaired vision
anterior cerebral artery (ACA)
- hemiplegia
- flat affect
- impulsivity
- auditory comprehension deficits
anoxia
- lack of oxygen to brain
- symptoms/treatment will vary based on cause + length of time without oxygen
types of anoxia
- anoxic
- anemic
- toxic
- stagnant
ataxia
- degenerative disease of nervous system
- symptoms will mimic being drunk: lack of coordination, slurred speech, falling, fine motor deficits, eye movement abnormalities
aneurysm
abnormal ballooning, forms in blood vessel
encephalitis
inflammation of the brain and/or spinal cord
types of aphasia: Broca’s area
- site of damage: posterior inferior frontal lobe of left hemisphere
- insight: generally aware
- expressive language: halting, effortful, nonfluent, agrammatic, telegraphic
- receptive language: intact
- repetition: impaired
- writing: impaired
- reading: varies
types of aphasia: Wernicke’s area
- site of damage: left posterior superior temporal gyrus
- insight: impaired
- expressive language: neologisms, paraphasia, ok grammar, intact prosody
- receptive language: impaired
- repetition: impaired
- writing: impaired
- reading: impaired
types of aphasia: transcortical motor
- site of damage: supplementary motor cortex, area just anterior to Broca’s
- insight: generally impaired
- expressive language: dysfluent speech, anomia
- receptive language: intact
- repetition: intact (hallmark differential from Broca’s)
- writing: impaired
- reading: n/a
types of aphasia: transcortical sensory
- site of damage: posterior to Wernicke’s area at the temporo-occipital-parietal junction
- insight: generally impaired
- expressive language: fluent speech, semantic paraphasia
- receptive language: impaired
- repetition: intact
- writing: varies (may have visual deficits)
- reading: varies (may have visual deficits)
types of aphasia: conduction aphasia
- site of damage: supramarginal gyrus of parietal lobe (posterior to primary sensory cortex, just above Wernicke’s area)
- insight: aware
- expressive language: fluent speech, phonemic paraphasia, anomia
- receptive language: intact (relatively)
- repetition: impaired
- writing: n/a
- reading: n/a
types of aphasia: transcortical mixed
- site of damage: damage anywhere within language areas
- insight: generally aware
- expressive language: fluent speech, isolation anomia
- receptive language: intact
- repetition: intact
- writing: intact
- reading: intact
types of aphasia: global aphasia
- site of damage: site of lesion will vary, damage to multiple areas
- insight: varies
- expressive language: word finding, anomia
- receptive language: impaired (variable), unable to comprehend word meaning
- repetition: varies
- writing: varies
- reading: varies
types of dysarthria: flaccid
location- lower motor neuron
main etiologies:
- surgical trauma
- neuropathies (e.g., Bell’s palsy)
- muscle disease
- myasthenia gravis
- degenerative disease
- brainstem stroke (CVA)
flaccid dysarthria: speech characteristics
- hypernasality nasal emissions
- imprecise consonants
- breathy, wet, hoarse voice
- mono pitch/loudness
- slow and slurred DDKs
- tongue fasciculations
types of dysarthria: spastic
location- bilateral upper motor neuron
main etiologies:
- cerebrovascular (CVA)
- degenerative disease
- TBI
- infection (e.g., meningitis)
- cerebral palsy (CP)
spastic dysarthria: speech characteristics
- hypernasality
- harsh, breathy voice
- strained and strangled voice
- mono loudness
- low pitch, mono pitch
- imprecise consonants
- excess and equal stress
types of dysarthria: ataxic
location- cerebellum
main etiologies:
- cerebellar stroke or injury
- cerebellum atrophy
ataxic dysarthria: speech characteristics
- slow, slurred speech
- excess and equal stress
- irregular, incoordination
- imprecise consonants
- distorted vowels
- mono pitch, mono loudness
- prolonged phonemes
types of dysarthria: hypokinetic
location- basal ganglia (dopamine depletion)
main etiologies:
- Parkinson’s disease
hypokinetic dysarthria: speech characteristics
- mono pitch, mono loudness
- short rushes of speech
- low, flat pitch
- variable rate of speech
- breathy, harsh voice
- reduced stress
- inappropriate silences
- DDKs, fast and imprecise
types of dysarthria: hyperkinetic
location- basal ganglia (excess dopamine)
main etiologies:
- Huntington’s disease (HD)
hyperkinetic dysarthria: speech characteristics
- involuntary movements at rest and during speech
- articulatory breakdowns
- voice stoppages
types of dysarthria: unilateral UMN
location- unilateral upper motor neuron
main etiologies:
- unilateral stroke (CVA)
unilateral UMN dysarthria: speech characteristics
- unilateral facial weakness
- harsh voice
- articulatory imprecision
dysarthria: formal assessments
- Assessment of Intelligibility of Dysarthric Speech (AIDS)
- French Dysarthria Assessment (differential diagnosis between types)
dysarthria assessment: structure and function
- Oral Facial Sensory Motor Examination (OFSME): facial symmetry, labial movement, mandible, dentition, tongue, palate, speech
- assess 6 cranial nerves for lower motor/upper motor neuron damage: muscle appearance and/or function (strength, range of motion, speed)
- diadochokinetic rates (DDKs): evaluate speech like movements (e.g., pa, patuh, patuhkuh)
dysarthria: phonatory assessment
- pitch and quality
- pitch variability and loudness variability
dysarthria: restorative treatment
goal is to improve and restore lost function
dysarthria: compensatory treatment
goal is to compensate for deficits and reduce overall impact
dysarthria treatment
- improve respiratory support for speech
- management and treatment of resonance
- phonation and speech intelligibility
- treatment should not include non-speech oral motor exercises (no research)
dysarthria treatment: phonation and speech intelligibility
- maximum vowel prolongation
- diaphragmatic breathing
- postural adjustments
- bearing down, pulling, and pushing
- pacing and phrasing
- vocal function exercises
- over-articulation
dysarthria treatment: maximum vowel prolongation
- sustained vowel: target duration and loudness
- feedback: SLP cues, recording, volume meter
dysarthria treatment: diaphragmatic breathing
proper breathing for speech
dysarthria treatment: postural adjustments
optimize physiological support for speech
dysarthria treatment: bearing down, pulling, and pushing
achieve vocal fold medialization
dysarthria treatment: pacing and phrasing
planning breaths for speech to avoid running out of air
dysarthria treatment: vocal function exercises
- to improve phonation, loudness
- inappropriate for spastic dysarthria
dysarthria treatment: over-articulation
over emphasizing articulatory movements to improve speech intelligibility
