Quiz 4 Flashcards
What is the first goal of therapy? What should you as a clinician do to implement this goal in cases of aphasia?
Inform the patient and the caregiver about the nature and the consequences of the disorder.
As a clinician, in the case of aphasia, I should inform the patient and caregiver about the specific type of aphasia the patient has. I should then inform them of all the possible symptoms that may be present or may become present overtime and the most likely recovery and prognosis associated with the specific aphasia based on the time it was diagnosed and the age of the patient.
List 3 prognostic indicators (say whether the prognosis is better or worse) depending on the type of aphasia or area of damage.
Borderzone and subcortical lesions offer a better prognosis than parasylvian lesions
Brocas, conduction, transcortical, and anomic aphasias have better prognosis than wernikes or global aphasia
hemorrhagic stroke has a better prognosis than ischemic stroke
List 3 prognostic indicators (say whether the prognosis is better or worse) NOT related to the area of damage or type of aphasia.
The younger the patient the better the prognosis, the sooner the therapy begins after the onset of aphasia the better the prognosis, and when the patient with aphasia has the will to improve and accept limitations the better the prognosis.
List 3 general principles of the Stimulation Approach to aphasia therapy.
Intensive auditory stimulation should be used in conjunction with other modalities, the stimulus must be adequate and get to the brain, repetitive sensory stimulation should be used.
Give three specific examples of the implementation of the Stimulation Approach. At least one of these three examples should be for single word comprehension, and at least one example for sentence comprehension.
Read a simple phrase and complete (ex. Cats and ? [ocean, dogs, lamps]) Listen to a short or long story and retell it. Point to a printed word.
Give 3 examples of the Stimulation Approach to aphasia therapy for reading/writing. These 3 examples should all be at different levels of complexity (e.g., “WED 1,” “WED 2,” and “WED 3” or something like that). You don’t have to say what “WED” level, but just give examples at different levels.
Trace or copy words, write associated word for stimulus word, Write a sentence using a particular word.
Explain 3 of the 4 basic principles of PACE therapy.
The SLP and patient participate equally as senders and receivers of information where they take turns in selecting information and communicating messages. The SLP and patient exchange new information. The patient may use both verbal and nonverbal modalities of communication to send messages.
Give an example of how PACE therapy works.
The clinician picks up a card that was face down, the clinician then describes the picture (this can be done verbally or nonverbally), the patient then needs to receive the information and communicate that they understand the information. Next, the patient takes their turn at choosing a card that is face down. Now the patient describes it to the clinician (again, can be verbal or nonverbal).
Give 3 examples of therapy for global aphasia.
Patients can trace, copy, and write forms, numbers, letters and words.
Clinician can and should use stimuli that offers the best chances for a correct response from the patient like automatic speech, singing and repetition.
Auditory comprehension of body commands like “stand up” “look up” “turn off the light”
1What does CILT stand for? Summarize how it works.
Constraint-induced language therapy. CILT focuses on tasks and forces the focus to that task and nothing else. For example, enforcing only verbal responses and suppressing any other means of compensating communication such as gesturing or writing.
Choose one of the following therapy approaches and explain how it works: FCT, Programmed Instruction Therapy, or Base-Ten Programmed Stimulation Method.
Programmed instruction therapy is a therapy approach that uses shaping and reinforcement. The shaping is taking small, controlled steps in order to get closer to the wanted behavior. Reinforcement is the affirmative statements to responses and the progression through the program based on responses.
List four “Do’s” for caretakers.
Keep talking to the patient, get the patients attention before speaking, and be empathetic not sympathetic.
List four “Don’ts” for caretakers.
Don’t cut the patient off or interrupt while they are speaking, Don’t fill in the silence, don’t allow the patient to become isolated.
List the two incoming pairs of arteries to the circle of Willis. List the 3 pairs going to the cerebrum coming out of the circle of Willis. Which artery did I say feeds most of the area for language?
Incoming: Internal carotid arteries & Vertebral artery.
To the cerebrum: Anterior cerebral arteries, Middle cerebral arteries, & posterior cerebral arteries
The middle artery going to the left hemisphere feeds most of the area for language.
List cranial nerves I, II, III, IV. Briefly state what they do (for what body part) and whether they are sensory, motor, or both.
I- Olfactory, for smell, sensory
II- Optic, for vision, sensory
III- Oculomotor, eye movement, motor
IV- Trochlear, eye movement vertical and horizontal, motor
List cranial nerves VI, VIII, and XI. Briefly state what they do (for what body part) and whether they are sensory, motor, or both.
VI- Abducens, Eye movement, motor
VIII- Vestibular acoustic, hearing and balance, sensory
XI- Spinal accessory, moving the shoulder and neck, motor
Name CN V, VII, and IX. Say whether they are motor, sensory, or both. Say what they are for, and how you would evaluate their functioning.
V- Trigeminal, motor and sensory, motor for jaw opening and closing, sensory for the face. Is the jaw loose? Can they open and close it or move it laterally?
VII- Facial, sensory and motor, sensory for the tongue, Motor for the face especially the lips. Ask them to pucker, smile and retract the lips on the left then the right.
IX- Glossopharyngeal, sensory and motor, sensory for the tongue and pharynx, motor for the pharynx. Test the gag reflex. You can also listen for hypernasality but this could be from damage to another nerve as well.
Name CN X and XII. Say whether they are motor, sensory, or both. Say what they are for, and how you would evaluate their functioning.
X- Vagus, Sensory and motor, Sensory in the abdominal cavity, Motor to help lift the soft palate and helps the larynx go down. Say “ah” in quick succession and prolonged, check to see if the velum is reacting properly.
XII- Hypoglossal, Motor, for tongue movement, look to see if the tongue can move laterally, protrude and elevate. Check for involuntary contractions of the tongue or atrophy.
Explain the connectionist theory as to how the brain performs auditory comprehension. Where does the signal start? Explain the steps—where it goes and what this part does. Don’t forget for sarcasm/humor.
Starts at the thalamus and is sent to the temporal lobe, goes to Herschel’s gyrus, there it is separated by whether it is linguistic or not, if it is linguistic it is sent to Wernicke’s area, here it tries to figure out the meaning/syntax, it is then communicated with Broca’s area where more complex syntax is figured out. The information is also sent to the right hemisphere from Wernicke’s area through the corpus collosum to figure out the pragmatics i.e., sarcasm and humor.
Nonlinguistic goes to the right hemisphere.
Explain the connectionist theory as to how the brain performs speech. Where does the signal start? Explain the steps—where it goes and what this part does. Don’t forget for sarcasm/humor. Include all the way to self-monitoring.
It starts in Wernicke’s area for semantics and to figure out what you will say, communicates with the corpus collosum for the pragmatics of your intended speech, the signal is sent from Wernicke’s area through the arcuate fasciculus to Broca’s area, Broca’s area helps to form the sentence and put the syntax together, the signal is then sent to the premotor cortex, the premotor cortex starts to plan the motor movements needed and puts the program in the right order, the signal then goes to the motor strip which sends the motor information to the subcortical area, to the brain stem, out the cranial nerves which cross over to the muscles for speech. Once the speech happens the signal is sent back to Wernicke’s area to moderate output and adjust if something is wrong.
Explain what an ischemic stroke is, and explain the two main types of ischemic strokes.
When an artery that is delivering blood to the brain is occluded. The two main types are Thrombotic, buildup over time causing occlusion, and Embolic, artery is suddenly occluded because something was dislodged and blocks the artery.
Explain what a hemorrhagic stroke is. Explain what an aneurysm is.
A hemorrhagic stroke is when a blood vessel ruptures and breaks. Blood spews out and kills neurons. Often due to high blood pressure.
An aneurism is when the blood pressure causes an artery to balloon out and puts the artery in danger of bursting but there is a chance it will never burst.
List 4 risk factors for stroke. Explain the FAST acronym and what you are to do to check if someone may be having a stroke.
F- Face, ask the person to smile and see if one side of the face is drooping
A- Arm weakness, Ask the person to raise both arms
S- Speech difficulty, Ask the person to repeat a simple sentence
T- Time, time is very important, the faster the person is treated the better the prognosis. Call 911 right away.
Explain the major differences in characteristics of aphasia and dementia. What is the prognosis for each? Explain the major differences in characteristics of aphasia and confused language. Explain a difference in characteristic of aphasia and schizophrenia.
Dementia is typically gradual and progressing while aphasia is usually sudden onset
With dementia, syntax is usually fine while there are semantic deficits. Aphasia on the other hand usually affects syntax
Prognosis is better with aphasia, as you can typically improve with therapy. With dementia, they typically don’t get better with therapy.
With confused language, patients can be disoriented, they may not know where they are or what year it is; this is not usually seen with aphasia
With confused language, speech is usually syntactically correct while with aphasia there are problems with syntax
Schizophrenia is a psychological disorder that typically happens at a younger age then aphasia,
aphasia is a language disorder
