Quiz 4

Question 1

What is the first goal of therapy? What should you as a clinician do to implement this goal in cases of aphasia?

Answer 1

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.

Question 2

List 3 prognostic indicators (say whether the prognosis is better or worse) depending on the type of aphasia or area of damage.

Answer 2

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

Question 3

List 3 prognostic indicators (say whether the prognosis is better or worse) NOT related to the area of damage or type of aphasia.

Answer 3

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.

Question 4

List 3 general principles of the Stimulation Approach to aphasia therapy.

Answer 4

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.

Question 5

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.

Answer 5

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.

Question 6

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.

Answer 6

Trace or copy words, write associated word for stimulus word, Write a sentence using a particular word.

Question 7

Explain 3 of the 4 basic principles of PACE therapy.

Answer 7

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.

Question 8

Give an example of how PACE therapy works.

Answer 8

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).

Question 9

Give 3 examples of therapy for global aphasia.

Answer 9

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”

Question 10

1What does CILT stand for? Summarize how it works.

Answer 10

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.

Question 11

Choose one of the following therapy approaches and explain how it works: FCT, Programmed Instruction Therapy, or Base-Ten Programmed Stimulation Method.

Answer 11

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.

Question 12

List four “Do’s” for caretakers.

Answer 12

Keep talking to the patient, get the patients attention before speaking, and be empathetic not sympathetic.

Question 13

List four “Don’ts” for caretakers.

Answer 13

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.

Question 14

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?

Answer 14

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.

Question 15

List cranial nerves I, II, III, IV. Briefly state what they do (for what body part) and whether they are sensory, motor, or both.

Answer 15

I- Olfactory, for smell, sensory
II- Optic, for vision, sensory
III- Oculomotor, eye movement, motor
IV- Trochlear, eye movement vertical and horizontal, motor

Question 16

List cranial nerves VI, VIII, and XI. Briefly state what they do (for what body part) and whether they are sensory, motor, or both.

Answer 16

VI- Abducens, Eye movement, motor
VIII- Vestibular acoustic, hearing and balance, sensory
XI- Spinal accessory, moving the shoulder and neck, motor

Question 17

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.

Answer 17

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.

Question 18

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.

Answer 18

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.

Question 19

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.

Answer 19

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.

Question 20

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.

Answer 20

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.

Question 21

Explain what an ischemic stroke is, and explain the two main types of ischemic strokes.

Answer 21

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.

Question 22

Explain what a hemorrhagic stroke is. Explain what an aneurysm is.

Answer 22

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.

Question 23

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.

Answer 23

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.

Question 24

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.

Answer 24

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

Question 25

Explain a characteristic difference of aphasia and dysarthria. Explain a characteristic difference of aphasia and apraxia of speech. What type of aphasia does apraxia of speech commonly co-occur with?

Answer 25

A characteristic difference of aphasia and dysarthria is that aphasia is a language disorder while dysarthria speech disorder that affects the articulation of sounds
A characteristic difference of aphasia and apraxia of speech is that aphasia is a language disorder and apraxia of speech is a speech disorder that affects the programming of speech sounds. It usually co-occurs with broca’s aphasia

Question 26

Define the following: phonemic paraphasias, semantic paraphasias, neologisms, stereotypic utterances, and agrammatism. What’s another term for phonemic paraphasia and for semantic paraphasia?

Answer 26

Literal/phonemic paraphasias- part of the sound hasn’t been retrieved yet - cried beef and garbage

Semantic paraphasias- confusion of words door for window

Neologisms- meaningless made up word

Stereotypic utterances/perseverative paraphasias -repetition of a word over and over

Agrammatism- difficulty with grammar (leave out articles and propositions)