Non-Fluent Aphasia

Question 1

Non-Fluent Aphasias

Answer 1

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

Question 2

What are the Non-fluent Aphasia

Answer 2

broca’s aphasia

global aphasia

transcortical motor aphasia

mixed aphasia

Question 3

Broca’s Aphasia

Answer 3

first described in 1861

associated w/damage to the cerebral language areas surrounding the sylvian fissure but not extending to Wernicke’s area

Question 4

Broca’s Aphasia Neuroanatomical Bases

Answer 4

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

Question 5

Broca’s Aphasia General Characteristics

Answer 5

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

Question 6

Broca’s Aphasia Language Characteristics

Answer 6

nonfluent and effortful speech
agrammatic speech
impaired repetition of words/sentences
impaired naming
questionable auditory comprehension
oral reading
writing problems

Question 7

Broca’s Aphasia 8 must knows chart

Answer 7

Look at power point

Question 8

Transcortical Motor Aphasia (TMA)

Answer 8

extrasylvian aphasic syndrome; lies outside of the perisylvian language zones

nonfluent aphasia w/good repetition skills

Question 9

TMA Neuroanatomical Bases

Answer 9

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

Question 10

TMA General Characteristics

Answer 10

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

Question 11

TMA Language Characteristics

Answer 11

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

Question 12

TMA 8 Must Knows Chart

Answer 12

Look at powerpoint

Question 13

Mixed “Transcortical” Aphasia

Answer 13

rare nonfluent aphasia type

combine TMA and TSA

language impairment is severe and extensive

pts retain repetition skills

has been labeled isolation aphasia

Question 14

Mixed Neuroanatomical Bases

Answer 14

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

Question 15

Mixed General Characteristics

Answer 15

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

Question 16

Mixed Language Characteristics

Answer 16

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

Question 17

Mixed 8 Must Know Chart

Answer 17

Look at powerpoint

Question 18

Global Aphasia

Answer 18

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

Question 19

Global Neuroanatomical Bases

Answer 19

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

Question 20

Global General Characteristics

Answer 20

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

Question 21

Global Language Characteristics

Answer 21

globally impaired communication skills

severely impaired fluency

impaired repetition, naming, reading, writing

impaired auditory comprehension

Question 22

Global 8 Must Knows Chart

Answer 22

Look a powerpoint

Question 23

General NonFluent Aphasia TX

Answer 23

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

Question 24

TX Strategies

Answer 24

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

Question 25

PACE Approach

Answer 25

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

Question 26

Mapping TX

Answer 26

mapping tx for agrammatism (Byng, 1988) targets sentence structure and thematic roles by identifying the subject and object of sentences uses pictures

Question 27

SPPA

Answer 27

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

Question 28

MIT

Answer 28

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.

Question 29

RET

Answer 29

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

Question 30

TX for Equivocal Responses

Answer 30

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

Question 31

Gestural Response TX

Answer 31

- 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

Question 32

Card TX

Answer 32

(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

Question 33

Writing Hierarchy

Answer 33

- 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

Question 34

Communication Boards

Answer 34

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

Question 35

Using AAC

Answer 35

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

Question 36

Functional AAC Considerations | How functionally can the pt.:

Answer 36

``` 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 ```