Neurological Based Communication Disorders Flashcards
Ischemic strokes
caused by interrupted blood supply to the brain.
Thrombosis-due to atherosclerosis, a condition in which cholesterol and other fatty substances build up in the blood, narrowing arteries and obstructing blood flow.
embolism: embolus is a mass of arterial debris or clump of tissue from a tumor that originates somewhere else in the body, travels to the brain and gets lodged in a smaller artery and blocks the flow of blood
Both deprive a focal area of brain tissue of the blood supply causing ischemic stroke or infarct (irreversible cell death that occurs within an hour)
Hemorrhagic strokes
caused by bleeding in the brain due to ruptured blood vessels, with hypertension (high blood pressure) being a major risk factor.
Ruptures can be Intracerebral (within the brain) or extracerebral (within meninges, resulting in subarachnoid, subdural, and epidural varieties of strokes).
These strokes have a severe thunderclap headeache. worse prognosis than with ischemic strokes. Surgery is needed to stop the bleeding from a hemorrhage.
paraphasia
expressive language error that is not the result of a motor deficit.
semantic: substitution of one word for another (e.g., marker for pencil)
phonemic: error at the sound level (tup for cup)
neologistic: nonwords (skeen instead of pencil)
perseveration
word that is repeated inappropriately for the intended word.
Logorrhea
excessive and inappropriate production of speech (tangential and often meaningless)
empty speech
substitution of general words like this, that, stuff for specific words
agrammatic speech
ommission of grammatic features in speech; speech that consists mostly of content words (nouns, verbs) and lack function words (articles, conjunctions, etc)
anomia
naming difficulty
circumlocution
production of nonspecific words and “beating around the bush” often due to word finding problems.
automatic language
language that is rote or overleared and thus spared (e.g., alphabet, counting, familiar songs)
List of nonfluent aphasias
brocas
transcortical motor
mixed transcortical
global
Brocas aphasia
involves brocas area in the posterior frontal lobe in the left hemisphere
-impaired naming
-non-fluent, halting speech with limited word output
-agrammatic/telegraphic speech
-Impaired repetition of words/sentences
-better auditory comprehension than expressive communication
-awareness of errors
-co-existing motor speech disorders like apraxia and dysarthria
-impacted writing/reading
Transcortical Motor Aphasia
lesions in supplementary motor cortex (area anterior to brocas area)
-absent or reduced spontaneous speech
-non-fluent, paraphasic, agrammatic, and telegraphic speech
-intact repetition (distinguishing characteristic)
-echolalia/perserverations
-attempts to initiate speech with motor activities such as clapping, head nodding, and hand waving
-generally good comprehension
-impaired reading/writing
-apathy/withdrawal/little interest in communication
**Like brocas but intact repetition skills
Mixed Transcortical aphasia
somewhat rare nonfluent aphasia. caused by lesions in watershed area (arterial border zone of the brain (between the areas supplied by the MCA, ACA, PCA
-limited spontaneous speech
-automatic, unintentional, involuntary nature of communcation
-severe echolalia (parrotlike repetition). distinctive feature
-nonfluent
-impaired auditory comprehension
-impaired reading, writing
Global Aphasia
most severe form of nonfluent aphasia. Caused by extensive lesions affecting all language areas usually due to occlusion of the middle cerebral artery. Widespread destruction of frontotemporoparietal regions is common.
-profoundly impaired receptive AND expressive language, repetition, naming, reading, writing,
-co-existing verbal and non verbal apraxia
-right sided paralysis/paresis and neglect of the left side is common
Fluent aphasias
Wernickes
Transcortical Sensory
Conduction
Anomic
Subcortical
Crossed aphasia
Wernickes
lesions in wernickes area. superior temporal gyrus in LH of the brain.
-incessant, effortlessly produced flowing speech with normal, or even abnormal (logorrhea), fluency with normal phrase length
-rapid speech rate with normal prosodic features and good artic
-severe anomia
-poor auditory comprehension
-empty speech
-circumlocation
-reading/writing deficits
-anosognosia: inability to recognize or acknowledge deficits
-individuals are generally free from paresis or paralysis
Transcortical sensory aphasia
fluent aphasia 2/2 lesions in the temporoparietal region of the brain
-fluent speech
-paraphasic/empty speech
-severe naming problems
-good repetition skills
-normal automatic speech
-good reading (aloud) but poor comprehension
similar to wernickes except repetition is intact whereas it is impaired in wernickes
conduction aphasia
lesion in area between broca’s and wernickes area
-diproportionate impairment in repetition (distinguishing characteristic)
-variable fluency across patients but normally less than wernickes
-paraphasic speech
-marked word finding
-efforts to correct errors
-near normal auditory comprehension
*similar to wernickes but CA have good auditory comprehension
anomic aphasia
-debiliating word finding difficulties
-generally fluent speech
-good auditory comp
-Normal reading/writing
*most language functions intact except for naming
subcortical aphasia
extensive SUBCORTICAL damage (with or without cortical involvement)-basal ganglia, cerebellum, thalamus damage
-BG: anomic, global, wernickes, or TMA
-Thalamic: fluent aphasia
-Cerebellar: more subtle. limited fluency, mild anomia, agrammatism, mild speech comp
Crossed aphasia
aphasia that occurs due to right hemisphere lesion in right handed individuals. symptoms include those of MTA in some and transient fluent aphasias in others
Aphasia considerations in bilingual populations
The first language or second language may be the most impaired/intact
REcovery of first OR second might be easiest for pt
may mix languages
need to analyze individual patterns and differences
Assessment of aphasia
-standardized testing
-functional communication
-repetition
-naming
-sentence production, narration, discourse
-auditory comp
-reading/writing
-assess auto speech and singing
-bilingual assessments with interpreter
3 types of aphasia treatment
restorative: regain skills
compensatory: compensate skills/behaviors
social: assist with social interactions
semantic feature analysis
selects words that belong to a particular family because of their shared meanings
for each stimulus, ask about group, description, and function (e.g., where do you find it? how do you describe it? what category does it belong to?)
Treatment of verbal expression (expanded utterances)
systemically increasing the length and complexity of target responses. conversational speech is final target. expand from phrases-sentences-narrative-conversation
alexia
loss of acquired reading skills due to brain damage
agraphia
loss or impairment of acquired writing skills due to lesions in the foot of the medial frontal gyrus of the brain
agnosia
impaired understanding of the meaning of certain stimuli, without peripheral sensory impairment.
auditory agnosia: impaired understanding of the meaning of auditory stimuli, normal peripheral hearing, difficulty in matching objects with their sound, and normal visual recognition of objects
auditory verbal agnosia: impaired understanding of spoken words, normal peripheral hearing, normal recognition of nonverbal sounds, normal recognition of printed words, and normal verbal expression and reading
visual agnosia: rare.
They cause impaired visual recognition of objects, which may be intermittent
tactile agnosia: impaired tactile recognition of objects when visual feedback is blocked and impaired naming and description of objects clients can feel in their hands
Alzheimers disease
most common form of dementia. Its considered a cortical dementia and accounts for 60-70% of irreversible dementia. More women than men are affected.
Frontotemporal Dementia
due to degeneration of the frontal and temporal lobes. includes behavioral variant of FTD and PPA.
Degeneration of nerve cells in the L and R frontal lobes, temporal lobe, or both lobes in two hemispheres
symptoms of behavior variant of FTD which is most common, is notable behavioral changes, emotional disturbance, and impaired judgment
Progressive loss of vocab and anomia, impaired comp of speech and printed material
parkinsons disease
basal ganglia and brainstem degeneration
presence of abnormal structures called Lewy Bodies
frontal lobe atrophy
reduced dopamine
neurofibrillary tangles like in dementia
slow volutary movement
hypophonia
micrographia
masked face
huntingtons disease
typical age of onset is 35-40. affects males and females equally. Malformed protein called huntingtin kills the brain cells that control movement. May be misdiagnosed as PD until choreiform movements become evident.
chorea: irregular spasmodic involuntary movement of the neck, head, and face
incrasingly uncontrollable tic like movements
gait disturbance
slow movement in later stages
behavioral disorders (schizo like behaviors)
deterioration of speech/language with muteness in final stages
HIV dementia
HIV itself can cause dementia or opportunistic brain infections can impact people with HIV.
vascular dementia
vascular diseases may cause damage resulting in dementia. small, cortical ischemic strokes are the most common etiology.
lewy body dementia
caused by lewy bodies (excessive protein deposits in neuronal cell bodies) causing similar presentations as PD and alzheimers.
Wernicke Korsakoff syndrome
dementia related to alcohol use.
treatment of dementia
main concern is to offer intervention that will slow progression. In the early states and intermediate stages, communication, memory, and behavioral management can be targeted in tx.
Management of daily activities with funcational tx. Provide family education, counseling, and support.
Right hemisphere disorder
left neglect
denial of illness
confabulation regarding disability
facial recognition deficits
constructional impairments:
attentional deficits
disorientation-confusion about space, not knowing where they are
visuoperceptual deficits
understanding emotional tone of voice and others emotions and expressing their own
communication:
dif comprehending abstract meanings in speech
prosodic deficits: understanding others prosody or producing their own.
impaired discourse/narrative skills
canfabulation/excessive speech
pragmatic difficulties
assessment of RH disorder
screen/diagnostic tests
talk with family/get baseline
treatement of RH disorders
tx targets:
denial and indifference
impaired attention
impulsive behavior
discourse problems
pragmatics
impaired reasoning
impaired inference
implied meaning/metaphor, etx
visual neglect (visual scanning)
**needs to be functional and pt specific
Traumatic brain injury
injury to the brain sustained by physical trauma or external force. can be open head or closed head or mild TBI (concussion) or blast trauma
assessment of TBI
bedisde assessment
assessment of memory
assessment of executive functions
also assess communicative problems post TBI (dysarthria, comprehension, naming, perseverations, pragmatics, reading/writing, daily living skills)
treatment of TBI
cognitive rehab and communication treatment. All tx tasks should be pt specific and functional.
