Non-Fluent Aphasia Flashcards
Non-Fluent Aphasias
may be referred to as: expressive aphasia, motor aphasia, or anterior aphasia
major symptoms characteristic of nonfluent syndromes of aphasia (generalities)
- decreased rate of speech
- decreased phrase length
- decreased prosody
- decreased initiation of speech
- decreased talking in general
- increased effort
What are the Non-fluent Aphasia
broca’s aphasia
global aphasia
transcortical motor aphasia
mixed aphasia
Broca’s Aphasia
first described in 1861
associated w/damage to the cerebral language areas surrounding the sylvian fissure but not extending to Wernicke’s area
Broca’s Aphasia Neuroanatomical Bases
posterior-inferior (third) frontal gyrus of the left hemisphere is known as Broca’s area (Brodmann’s areas 44 and part of 45)
area known as the anterior language cortex
middle cerebral artery blood supply
lower part of the premotor cortex
Broca’s Aphasia General Characteristics
more easily recognized than Wernicke’s pts
typically present w/contralateral hemiplegia or hemiparesis
weakness of [r] side facial muscles
most motor problems improve over time
pts are often very depressed; catastrophic reactions refusing to cooperate or continue testing
Broca’s Aphasia Language Characteristics
nonfluent and effortful speech agrammatic speech impaired repetition of words/sentences impaired naming questionable auditory comprehension oral reading writing problems
Broca’s Aphasia 8 must knows chart
Look at power point
Transcortical Motor Aphasia (TMA)
extrasylvian aphasic syndrome; lies outside of the perisylvian language zones
nonfluent aphasia w/good repetition skills
TMA Neuroanatomical Bases
anterior superior frontal lobe
usually above or below Broca’s area
lesions often impact association pathways
impacts supplemental motor area
supplied by the anterior cerebral artery
TMA General Characteristics
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
TMA Language Characteristics
muteness, echolalic, reduced spontaneous speech
agrammatic speech, paraphasic
impaired naming w/intact repetition
intact serial speech (relatively)
intact knowledge of grammar/meaningfulness
limited naming; may use motor prompts
better comprehension than production
TMA 8 Must Knows Chart
Look at powerpoint
Mixed “Transcortical” Aphasia
rare nonfluent aphasia type
combine TMA and TSA
language impairment is severe and extensive
pts retain repetition skills
has been labeled isolation aphasia
Mixed Neuroanatomical Bases
caused by various conditions that decrease blood flow throughout the cerebral arteries
- hypoxia of various origins
- cardiac arrest
- cerebral edema
- multiple embolic strokes
supplied by the middle cerebral artery, and the anterior/posterior cerebral arteries
Broca’s, Wernicke’s and the arcuate fasciculus are spared
Mixed General Characteristics
varied clinical picture
bilateral UMN paralysis
severe spastic quadriparesis (weakness of all 4 limbs)
visual field deficits (typical problem is right hemianopia)
weakness in hip/shoulder muscles
severe brain damage
Mixed Language Characteristics
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
Mixed 8 Must Know Chart
Look at powerpoint
Global Aphasia
may account for 30-55% of pts w/aphasia
most severe form of aphasia; has a generalized effect on communication skills
impacts all modes of communication and spares no particular skill
possible for global aphasia to evolve into another type of aphasia
be careful of prognosis
Global Neuroanatomical Bases
lesion likely involve the entire perisylvian region affecting both Broca’s and Wernick’e areas
subcortical areas may even be impacted
more common sites are impacted by the middle cerebral artery
pg 148 (text; has good picture…figure 5-3)
widespread destruction of the left fronto-temporo-parietal regions
Global General Characteristics
presence of strong neurological symptoms; weakeness, paralysis, sensory loss
apraxia including both verbal and oral types
hemi-neglect: left neglect is common in right hemisphere damage
Global Language Characteristics
globally impaired communication skills
severely impaired fluency
impaired repetition, naming, reading, writing
impaired auditory comprehension
Global 8 Must Knows Chart
Look a powerpoint
General NonFluent Aphasia TX
Coarticulated speech:
-build on level of success (syllables, words, phrases…)
Auditory comprehension:
-point, follow commands, understand complex material
Oral expression tasks may range from:
-oral-motor skills, automatic sequences, repetition, answering questions, naming, and word fluency to reading words and sentences aloud
Understanding written language (reading):
-identify letters, words, match words and pictures, read sentences and paragraphs
Writing:
-improve mechanics for writing basic information, the alphabet, numbers, writing to dictation, writing names, and writing about a picture or event
TX Strategies
Consider spared abilities and functional levels:
-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
PACE Approach
PACE (Prompting Aphasics’ Communicative Effectiveness)
Pulvermuller & Volkbert, 1991
Uses compensatory strategies to facilitate communicate
- this approach encourages the exchange of information
- provide a stimuli picture face down between patient and clinician and the patient must look at it and use any available means to communicate the message (similar to charades but this uses any and all communication modalities and methods)
- SLP guesses and provides feedback
Mapping TX
mapping tx for agrammatism (Byng, 1988)
targets sentence structure and thematic roles by identifying the subject and object of sentences
uses pictures
SPPA
Sentence Production Program for Aphasia (SPPA)
Helm-Estabrooks & Nicholas, 2000
program is used to improve conversation with pts who have nonfluent aphasia and who are agrammatic speakers
attempts to increase phrase length, content, and grammar
SPPA focuses on eight (8) sentence types using a thematic base
MIT
Melodic Intonation Therapy (MIT)
Sparks & Deck, 1986
MIT is an approach that uses melodies and intonation patterns of the intact right hemisphere
Four levels of MIT:
(1) intoning a melodic line,
(2) hand tapping saying syllables,
(3) answering questions, and
(4) practice with drilled phrases & sentences
pictures are used initially and later program cues are reduced.
RET
Response Elaboration Training (RET)
Kearns, 1991
RET is a program using loose training with patient-initiated responses (without restrictions)
-approach uses simple line drawn picture stimuli requiring personal interpretation
-SLP scaffolds responses (does not provide correction to pt responses)
Six steps
1. elicit spontaneous response to picture
2. model and reinforce patient’s response
3. provide ‘wh’ cues for patient to elaborate
4. reinforce elaboration and model the sentence
5. repeat and have patient repeat
6. reinforce and provide another model
TX for Equivocal Responses
equivocal (vague, ambiguous, confusing)
- use two 3x5 cards with “yes” and “no” (one on each)
- pt repeats each word 5 times while looking at the cards
- assist the pt to say the word and nod “yes” and then “no” when given a cue
- present yes-no questions for the pt’s responses
- request responses to simple questions
1. is your name _____?
2. did you have a stroke? - establish a baseline and begin treatment with personal, environmental and informational questions
- use pictures to help the pt understand questions
- chart responses
Gestural Response TX
- core vocabulary is chosen based upon pt needs (begin with 5-10 words)
- clinician makes a gesture while saying a word
- clinician repeats the word with the patient
- pt imitates the gesture immediately and then after a brief delay
- pt gestures after the clinician says the and writes the word
- pt writes the word if possible when seeing the gesture
Card TX
(deck of cards)
improve sequencing of numbers on cards by putting them in order
match cards according to suit and number (use 2 decks)
respond to commands using cards
-pick up the ace
Writing Hierarchy
- trace a word
- copy the word
- say the word for the patient to identify in writing
- ask the pt to write the word to dictation
- ask the pt to write the word given a picture
- ask the pt to write the word in response to a question
Communication Boards
Use communication boards with pictures and words
-alphabet and word boards are usually ineffective for individuals with global aphasia
Include pictures of people & familiar objects
Use pictures of real objects, actions, and places
Teach the pt to use the communication board
-point when an item is named (immediate then with a delay)
-keep the board visually simple at first and then expose more items with time when success is achieved
-consider a more high-tech AAC (augmentative alternative communication) device if possible and financially feasible
Using AAC
When introducing an AAC device, assess the device’s communicative capabilities and compare it with the client’s needs
-consider operational demands regarding the client’s motor, sensory, and cognitive skills
Adapt the device to the client’s situations and available support
Train the client and family how to use the device
Monitor its use for functional language
Functional AAC Considerations
How functionally can the pt.:
get someone’s attention give yes/no answers call for help indicate understanding of what is being said respond without words say the name of a person nearby communicate their needs, wants, pain (if any) have social time with friends and family understand written communication communicate their emotions describe something have a one-on-one conversation get involved in group talk about self participate in a group conversation
