Quiz 2 Flashcards
Transcortical Motor Aphasia Breakdown
1) Non-fluent
2) Good auditory comprehension
3) Good repetition
*Motor area, anterior superior areas to Broca’s area, and cingulate gyrus
Pure alexia
marked impairment
of reading or spelling, but relatively preserved
speech production and comprehension
Deep alexia
SEVERE phonological impairment + impaired access to semantics
*Large left perisylvian damage
Transcortical sensory
evolves to Anomic
Transcortical motor
evolves to Anomic
3 methods for repairing or preventing stroke damage
1) Take advantage of cerebral plasticity (SLP)
2) Reorganization of neurons
3) Thrombolysis
Assessment for Living with Aphasia (ALA-2)
- A pictographic self-report measure of aphasia related to quality of life
- Psychometrically based profile with respect to:
- Language impairment
- Life participation
- Psychosocial factors
- Environmental areas
Transcortical Sensory Aphasia Breakdown
1) Fluent
2) Poor auditory comprehension
3) Good repetition
*Temporopariet-occipital area or deep to Wernicke’s area
Stuck-in-set perseveration
Inappropriate maintenance of a category or framework of responses
*drawing money from previous copying task during new picture description task
Implications of cognitive impairments in aphasia with attention
- More prone to distraction
- This intensifies language difficulty
Global alexia
Severe damage to phonology, orthography, and semantics
*Large left perisylvian damage
Phonological agraphia
When spelling real words is better than spelling nonwords
Global
evolves to Broca’s
Lesions away from the Sylvian fissure _______ repetition
disrupt or preserve
preserve
Quality of Communication Life (QCL)
- Stimuli for people with aphasia
- Self report style
Aphasia Framework for Outcome Measurement (A-FROM) includes these four sections
1) Participation in life situations
2) Communication and language environment
3) Language and related impairments
4) Personal identity, attitudes, and feelings
Neologistic paraphasia
a neologism substituted for a real word
Recurrent perseveration
Inappropriate production of a previous response (an action, word, sound, etc.)
following intervening presentation of a new stimulus, or after giving a different intervening response
- Carrying forward a response (pupper, toothbrush ect.)
Broca’s
evolves to Anomic
PPA is different from stroke induced aphasia but these measures
1) Neuronal destruction can be selectively targeted (rarely complete destruction)
2) Gradual loss allows for reorganization
3) Damages areas that CVA don’t usually hit (e.g. anterior temporal lobes)
To assess phonology, we can use ______.
Non-words
3 Types of memory
1) Working memory (task)
2) Episodic memory (exp.)
3) Semantic memory (facts)
Implications of cognitive impairments in aphasia with memory
- Smaller WM
- WM is slower and less efficient
Life Participation Approach to Aphasia (LPAA) is best described as
A more holistic approach to living with aphasia. Focuses on participation in life and the identity of a person living with aphasia
First stage of dementia progression
Anomia (naming objects)
“I know what it is but can’t find the word.”
Western Aphasia Battery
- Functions much like the test for 518 and the other child language assessments for different aspects of speech and language
Functional reorganization
Activation or non traditional speech areas
Semantic (verbal) paraphasia
errors in word choice
girl —> boy girl —> house
End stage dementia
Mutism
Conduction Aphasia Breakdown
1) Fluent
2) Good auditory comprehension
3) Poor repetition
*Arcuate fasciculus and supramarginal gyrus
Mixed Transcortical Aphasia Breakdown
1) Non-fluent
2) Poor auditory comprehension
3) Good repetition
*Diffuse or multifocal lesions isolating perisylvian language area
Primary Progressive Aphasia (PPA) Definition
Aphasia due to a progressive disease or dementia, in which language processes are affected first
Atrophy of the brain is common
Anomic Aphasia Breakdown
1) Fluent
2) Good auditory comprehension
3) Good repetition
*Inferior temporal region and posterior temporo-parietal region
Semantic PPA characteristics
1) Naming and single word comprehension severely impaired
2) Surface dyslexia/dysgraphia
3) Grammar is spared
4) Loss of conceptual knowledge in addition to words and their meanings
e.g. “ship and tomb, do these words mean the same thing?” (will answer wrongly)
Central agraphia
Can result in an inability to spell
Logopenic PPA region affected
Left temporo-parietal area
posterior temporal, supramarginal gyri, and angular gyri
Logopenic PPA characteristics
(Must haves)
1) Impaired single word retrieval (anomia)
2) Impaired repetition of sentences and phrases
(At least 3)
1) Phonological errors
2) Spared single-word comprehension
3) Spared motor speech
4) Preservation of grammar
Communication Outcomes After Stroke (COAST)
- Measurements for the actual functional outcomes like phone calls and other situations like that
- Free
Agraphia
An acquired impairment of writing/spelling
*usually comes with aphasia and alexia
Phonological alexia
Phonological impairment of reading where reading real
words is significantly better than reading nonwords
*Perisylvian damage
Alexia
Acquired impairment of reading
*sometimes referred to as acquired dyslexia
Melodic Intonation Therapy (MIT)
Patient imitates intoned speech modelled by a clinician
Is phonology perisylvian or extrasylvian?
Perisylvian
*Broca’s area, the precentral gyrus, the insular cortex, the Wernicke area, and the supramarginal gyrus
Functional reactivation
Greater reliance on preserved language areas
The hallmark characteristic of aphasia, anomia, can be identified by:
1) Pauses and hesitation
2) Self-correction
3) Circumlocution
4) Word choice errors (paraphasia)
Reading and spelling rely on these 3 central processing components
1) Sounds (phonology)
2) Meanings (semantics)
3) Visual representations (orthography)
4 Types of attention
1) Sustained
2) Selective (prioritizing)
3) Alternating (switching)
4) Divided (more than one at a time)
Lesions near the Sylvian fissure _______ repetition
disrupt or preserve
disrupt
SOAP format
1) Subjective: comments, non-measurable observations
2) Objective: data from assessment activities / session (no interpretation)
3) Assessment: clinical interpretation of assessment findings
4) Plan: direction for future treatment or assessment
What causes dementia?
1) 60%-70% Froto-temporal lobar degeneration (FTLD)
2) 30%-40% Alzheimer disease
Regularity effect
Can spell regular things, but not irregulars (can get a close sound like chore for choir)
Peripheral agraphia
Can result in an inability to write
Broca’s Aphasia Breakdown
1) Non-fluent
2) Good auditory comprehension
3) Poor repetition
*Broca’s area, insula, anterior parietal lobe
Raven’s Colored Progressive Matrices
- Measures fluid intelligence (interaction with the novel)
- Examines focal brain damage
- Colored pieces scored as either pass or fail
Thrombolysis and Tissue Plasminogen Activator (tPA) is used for what type of stroke within what time frame?
Ischemic stroke within 4.5 hour time slot
Non-fluent / agrammatic PPA neural region affected
Anterior perisylvian area
What is dementia?
It is a syndrome caused by an underlying disease process. It is diffuse (widespread) damage.
4 Cognitive domains
1) Attention
2) Memory
3) Executive functions
4) Visuospatial skills
Non-fluent APHASIA characteristics
1) Impaired prosody
2) Short (<4 words) utterances
3) Articulatory struggle
4) Reduced grammatical complexity (telegraphic speech)
- Dysarthria and AOS may also be present
Hallmark features of aphasia
1) Anomia
2) Perseveration
3) Errors in speech or circumlocution
Main inhibitory neurotransmitter
GABA
Gamma Aminobutyric Acid
Perseveration
Inappropriate repetition of continuation of an earlier response or behavior
- Can occur with writing, speaking, auditory comphrenesion, and gesturing
Phonemic (literal) paraphasia
errors in sound selection or substitution
1) single sound boat —> boap
2) multi sound yes —> kleeza
Surface alexia features
Damage to orthographic REPRESENTATIONS
1) Can spell REGULAR but not irregular words
2) Tends to resolve
3) Non-words are correct because sound to letter is preserved
e. g. phonologically plausible reading errors (chore for choir)
* Anterior temporal lobe damage (extrasylvian)
Non-fluent / agrammatic PPA characteristics
1) Effortful, halting speech
2) Poor sentence construction (mostly nouns)
3) Reduced utterance length (less that 4 words)
Main excitatory neurotransmitter
Glutamate
Continuous perseveration
Inappropriate prolongation or continuation of a behavior without an intervening response or stimulus
*Drawing of extra loops or putting more hands on a clock
Quick Aphasia Battery (QAB)
- Language function test that resembles the WAB at least a little
- Targets different domains of language
- Gives a multidimensional profile of language function
Implications of cognitive impairments in aphasia with executive functions
- Decreased insight, awareness, organization
- Cognitive inflexibility
Boston Naming Test
- A naming vocabulary test
- Multiple choice format with pictures (bed, pencil, whistle)
- 60 questions from easiest to most difficult
Is semantics perisylvian or extrasylvian?
Extrasylvian
*angular gyrus
What percentage of strokes are ischemic versus hemorrhagic?
Ischemic 80%
Hemorrhagic 20%
(12% intracerebral, and 8% subarachnoid)
Criteria for PPA
1) At least 2 years of isolated language impairment
2) Memory problems, visuospatial deficits, and behavior/personality change not present at this time
3) No focal lesion that could have caused language problem
Fluent APHASIA characteristics
1) Normal prosody
2) MLU more than 4 words
3) Insubstantive speech
4) Semantic and phonemic paraphasia common
Cognition definition
refers to the processes we use to make sense of the sensory information in our environment in order to interact with that environment
Definition of paraphasia and its 3 types
Paraphasia = error in naming
1) Semantic (verbal)
2) Phonemic (literal)
3) Neologistic
Wernicke’s Aphasia Breakdown
1) Fluent
2) Poor auditory comprehension
3) Poor repetition
*Large posterior perisylvian lesions
Semantic PPA neural region affected
Bilateral anterior temporal lobes
*Left more affected
Wernicke’s
evolves to Conduction
Global Aphasia Breakdown
1) Non-fluent
2) Poor auditory comprehension
3) Poor repetition
*Extensive damage, involves entire perisylvian area
Conduction
evolves to Anomic
Stuck-in-set perseveration is associated with lesions in what area?
frontal lobe
Continuous perseveration is associated with lesions in what area?
right hemisphere
Recurrent perseveration is associated with lesions in what area?
temporal lobe
CART stands for
Copy and recall treatment
This type of aphasia has difficulty initiating speech
Transcortical motor aphasia
We use the Stroop test to examine which part of cognition?
Executive function
Late stage dementia can result in which type of aphasia?
Transcortical sensory
A-FROM assessment purpose + example of standardized assessment
1) Identifies impairment
2) Communication activities of daily living (CADL-3) (menu reading)
A-FROM assessment purpose + example of interviewing
1) Participation goals
2) interviewing and coaching
A-FROM assessment purpose + example of self-report
1) Personal identity
2) ALA-2
A-FROM assessment purpose + example of contextual assessment
1) Environmental factors
2) Real life task assessment in natural context
A-FROM assessment purpose + example of dynamic assessment
1) Communication strategies
2) Interprofessional team meeting
Process for formulating goals in treatment
1) Strengths and challenges
2) Measuring outcomes (measurable changes)
3) Functional outcome measures (life changes)
Elements required for evaluation report
1) Background information
2) Assessment results
3) Summary and recommendations
4) Avoid jargon
5) Provide verbal account to patient and family
