Nonfluent Aphasias Flashcards
1
Q
Nonfluent Aphasias
A
may be referred to as: expressive aphasia, motor aphasia, or anterior aphasia
2
Q
Major characteristics of nonfluent aphasias
A
- major symptoms characteristic of nonfluent syndromes of aphasia (generalities)
1. decreased rate of speech
2. decreased phrase length
3. decreased prosody
4. decreased initiation of speech
5. decreased talking in general
6. increased effort
3
Q
Four types of nonfluent aphasias
A
broca’s aphasia
global aphasia
transcortical motor aphasia
mixed aphasia
4
Q
Broca’s Aphasia
A
- first described in 1861
- associated w/damage to the cerebral language areas surrounding the sylvian fissure but not extending to Wernicke’s area
5
Q
Neuroanatomical bases of Broca’s Aphasia
A
- 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
6
Q
General Characteristics of Broca’s Aphasia
A
- 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
7
Q
Language Characteristics of Broca’s
A
- nonfluent and effortful speech
- agrammatic speech
- impaired repetition of words/sentences
- impaired naming
- questionable auditory comprehension
- oral reading
- writing problems
8
Q
Broca’s Aphasia:
- Lesion site
- Verbal expression
- Auditory comprehension
- Naming
A
- posterior-inferior frontal gyrus of the left hemisphere
- severely impaired; agrammatic; telegraphic; dysprosodic; possible AOS; minimal paraphasias
- better than expression; some degree of deficiency in some pts; essentially intact for most
- impaired (anomia)
9
Q
Broca’s Aphasia:
- Repetition
- Oral Reading
- Reading Comprehension
- Writing
A
- impaired; especially for grammatical features
- impaired; similar to oral expression
- impaired to some extent
- impaired
10
Q
Transcortical Motor Aphasia (TCM)
A
- extrasylvian aphasic syndrome; lies outside of the perisylvian language zones
- nonfluent aphasia w/good repetition skills
11
Q
TCM Neuroanatomical bases
A
- 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
12
Q
General Characteristics of TCM
A
- 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
13
Q
TCM Language Characteristics
A
- 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
- essentially mute, motor prompts may help them
14
Q
TCM Aphasia
- Lesion site
- Vertical expression
- Auditory comprehension
- Naming
A
- deep portions of left frontal lobe below or above Broca’s area
- impaired; initially mute; paraphasic; agrammatic; telegraphic; limited word fluency; pt will have no apraxia of speech
- intact for simple; subtle problems w/complex material
- mildly impaired; better for confrontational naming
15
Q
TCM Aphasia
- Repetition
- Oral Reading
- Reading comprehension
- Writing
A
- intact; may demonstrate echolalic and perseverative speech
- Impaired
- good except for syntactically complex material
- impaired
16
Q
Mixed “Transcortical” Aphasia
A
- rare nonfluent aphasia type
- combine TMA and TSA
- language impairment is severe and extensive
- pts retain repetition skills
- has been labeled isolation aphasia
17
Q
Neuroanatomical Bases of Mixed Transcortical
A
- 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
18
Q
General characteristics of Mixed Transcortical Aphasia
A
- 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
19
Q
Language Characteristics of Mixed Transcortical Aphasia
A
- 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
20
Q
Mixed Transcortical Aphasia
- Lesion site
- Verbal Expression
- Auditory Comprehension
- Naming
A
- watershed area; pg 113
- often severely impaired; agrammatic w/paraphasias
- often severely impaired
- Impaired
21
Q
Mixed Transcortical Aphasia
- Repetition
- Oral Reading
- Reading Comprehension
- Writing
- Additional Information
A
- good but parrot-like; nonfunctional repetition
- often severely impaired
- often severely impaired
- impaired
- Broca’s aphasia with decreased auditory comprehension
22
Q
Global Aphasia
A
- 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
23
Q
Neuroanatomical Bases of Global Aphasia
A
- 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
24
Q
General Characteristics of Global Aphasia
A
- 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
25
Language Characteristics of Global Aphasia
- globally impaired communication skills
- severely impaired fluency
- impaired repetition, naming, reading, writing
- impaired auditory comprehension
26
Global Aphasia
1. Lesion site
2. Verbal expression
3. Auditory comprehension
4. Naming
1. widespread damage; left fronto-temporo-parietal regions
2. severely impaired; minimal vocalizations
3. impaired; maybe personally relevant information; some y/n’s (need 100% accuracy)
4. impaired
27
Global Aphasia
1. repetition
2. oral reading
3. reading comprehension
4. writing
1. impaired
2. impaired
3. impaired
4. impaired; not meaningful; may copy letters and/or write name
28
General nonfluent aphasia treatment 1
1. coarticulated speech
- build on level of success (syllables, words, phrases…)
2. auditory comprehension
- point, follow commands, understand complex material
3. oral expression tasks may range from:
- oral-motor skills, automatic sequences, repetition, answering questions, naming, and word fluency to reading words and sentences aloud
29
General nonfluent aphasia treatment 2
1. understanding written language (reading)
- identify letters, words, match words and pictures, read sentences and paragraphs
2. writing
- improve mechanics for writing basic information, the alphabet, numbers, writing to dictation, writing names, and writing about a picture or event
30
Nonfluent Treatment Strategies
- consider spared abilities and functional levels:
1. good writing: apply directly to communication
2. some writing: consider a writing/spelling therapy program
3. no writing, some drawing: consider a communicative drawing therapy program
4. no writing, some gesturing: consider a communicative gesturing therapy program
5. gestural-verbal training increases naming for some people with aphasia
31
Pace treatment approach
- PACE (Prompting Aphasics’ Communicative Effectiveness)
- Pulvermuller & Volkbert, 1991
- uses compensatory strategies to facilitate communicate
- can be used with wernicke's
---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
32
Mapping Treatment
- mapping tx for agrammatism (Byng, 1988)
- targets sentence structure and thematic roles by identifying the subject and object of sentences
- uses pictures
33
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
34
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.
35
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
- elicit spontaneous response to picture
- model and reinforce patient’s response
- provide ‘wh’ cues for patient to elaborate
- reinforce elaboration and model the sentence
- repeat and have patient repeat
- reinforce and provide another model
36
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
---is your name _____?
---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
37
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
38
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
39
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
40
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
41
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
42
Functional AAC Considerations 1:
- 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)
43
Functional AAC Considerations 2:
- 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
