Role of Speech Pathology - Brancamp Flashcards
What capacity of the brain diminishes with age?
cerebral plasticity
Aphasia is (neurogenic/psychological)
neurogenic
Aphasia is (predisposed/acquired)
acquired
T/F: Aphasia is a problem of sensation, motor function, or intellect
false
T/F: aphasia may include all aspects of language
true
which components, specifically, of language does aphasia involve/
auditory comprehension
visual and reading comprehension
oral-expressive language
writing
Aphasia is not a disturbance of…
articulation
Are patients with mutism aphasic?
not necessarily
Does aphonia imply aphasia?
no
Can you have aphasia during an acute confusional state?
no
What is the name for speech issues caused problems with the muscular control over the speech mechanism due to CNS or PNS damage?
dysarthria
What is apraxia?
A neurogenic speech disorder resulting from impairment of the capacity to program sensorimotor commands for positioning and movement of muscles for the volitional production of speech.
Can apraxia occur without issues of conscious thought or language?
yes
What are some accompanying disorders of aphasia?
Agnosia Acalculia (dyscalculia) Alexia/dyslexia (deep and surface) Agraphia (dysgraphia) Constructional disturbance
80% of aphasia syndromes conform to (blank) schemes while 20% are due to individual differences
anatomical
Where are lesions located for Broca’s aphasia?
lateral frontal
surpasylvian
pre-Rolandic extending into adjacent subcortical periventricular white matter
Where are the lesions in Wernicke’s?
posterior third of temporal gyrus
Where are the lesions in Conduction aphasia?
Supramarginal gyrus and underlying white matter
Wernicke’s area
left insula
auditory cortex
Where are the lesions for anomic aphasia?
angular gyrus
second temporal gyrus
transcortical motor aphasia has lesions where?
anterior frontal paramedian
anterior and supeior area to broca’s
Transcortical sensory aphasia has lesions where?
posterior parieto-temporal
SPARING Wernicke’s area
Where are the lesions for global aphasia?
large perisylvian extending deep into the subjacent white matter
Where are the lesions for subcortical aphasia?
- thalamus
1. head of caudate nucleus, putamen, or internal capsule
What side of the brain does listening come in on?
left
Where is listeing processed?
on the right in Wernicke’s
How is listening and speech transferred from Wernicke’s to Broca’s centers?
arcuate fasciculus
What does the prefrontal association area do?
formulation of speech sounds
what type of aphasia is due to issues in the arcuate fasciculus?
conduction aphasia
What is the function of Broca’s aphasia?
motor programming for articulation
what is the function of the precentral gyrus?
activation of muscles for articulation
What is the function of the arcuate fasciculus?
transmission of linguistic info to anterior areas from posterior areas
what is the function of Wernicke’s area?
comprehension of oral language (posterior language zone)
what is the function of the angular gyrus?
integrates visual, auditory, and tactile info and carries out symbolic integration for reading
Left parietal though to be one of two areas associated with what? L. occipital also asscd with it
alexia
What is the function of the supramarginal gyrus?
symbolic integration for writing
What is the function of the corpus callosum?
transmission of info between hemispheres
what type of aphasia is receptive?
Wernicke’s
Expressive aphasias are due to lesions in which part of the brain?
anterior; motor lesions; aka broca’s aphasia
What are the cortical aphasias?
Cortical aphasia syndromes Broca’s aphasia Wernicke’s aphasia Conduction aphasia Anomic aphasia Transcortical motor aphasia Transcortical sensory aphasia Global aphasia Mixed nonfluent aphasia
what re the subcortical aphasias?
Subcortical aphasia syndromes Anterior capsular-putaminal aphasia Posterior capsular-putaminal aphasia Global capsular-putaminal aphasia Thalamic aphasia
Despite not being able to communicate with spoken language, how will aphasia pts try to communicate in the first few hours?
gestures or facial expression
are hemorrhagic or ischemic strokes worse?
hemorrhagic
What are the difficulties of pts with aphasia?
understanding purely verbal commands
is aware of self and environment
intent on communicating thoughts
what is fluent aphasia?
9+ words per utterance
approximates normal speech in rate of word production, length of sentences, melodic intonation
what is nonfluent aphasia?
rate is slow sentence length short melodic intonation lost production is effortful more pauses than actual words (0-5) words per utterance
what is the hallmark of aphasia?
failure to repeats words or sentences
What region of the brain is responsible for impaired repetition?
perisylvian region of dominant hemisphere
Is auditory comprehension commonly preserved in aphasia?
no, rarely
What is the issue with auditory comprehension in aphasia?
ability to decode the input
what is agrammatism?
difficulty ordering words and putting them together in a sentence.
is word content spared in agrammatism?
yes
What type of aphasia is agrammatism?
anterior aka broca’s aphasia
What are some examples of agrammatism?
may use wrong pronouns, won’t use infinitive verbs or conjugate verbs, can’t use BOUND MORPHEMES aka past tense and present progressive
If auditory comprehension is an issue, then (blank) comprehension is also an issue
reading
T/F: reading comprehension deficit can occur without auditory or writing impairment
true
T/F: in most cases of aphasia, reading, writing, and auditory comprehension are impaired to the same degree
false; all impaired to different degrees
what type of aphasia is this? Dysfluent Increased effort in speaking Speech is agrammatic, telegraphic, groping Often accompanied dysarthria and/or apraxia of speech Comprehension better than expressive Repetition abnormal Naming is poor Writing reflects spoken output
broca’s aphasia
are pts with broca’s aphasia aware of their impairments?
yes
What type of aphasia is this? Pt. usually appears normal with no dysarthria or limb weakness/paralysis. Speech is fluent but often presents with paraphasias and jargon Syntax is normal Comprehension is poor Reading is poor Repetition is poor. Word-salad
Wernicke’s aphasia
Describe the mild form of Wernicke’s
aware of errors and generally follow conversational turn taking
describe moderate wernicke’s
rarely notice errors or attempt repairs; attentive & cooperative but get off topic easily (verbal tangents)
describe severe wernicke’s
attentive, but severe comprehension deficits interfere with all communication tasks; unaware of errors and communication failure
what type of wernicke’s lacks the social pragmatic understanding?
severe
Global aphasia is a severe impairment in both (blank and blank)
comprehension and expression
T/F: pts with global aphasia have concrete understanding of symbols
true
T/F: pts with global aphasia have difficulty with abstract or inferential info
true
With respect to their understanding, describe how a pt with global aphasia understands a picture with words and symbols
understands the symbol but not the word; danger sign–understand skull and crossbones but not the word danger
Pts with global aphasia perform better with activities that are automatic or have lots of (blank) content
emotional
Speech in global aphasia is limited and replaced by…..
stereotypical sayings, overlearned phrases, or expletives
T/F: pts with global aphasia are not socially appropriate
false, they are; helps to distinguish them from the demented patient
What types of questions do pts with global aphasia tend to understand the best?
personal questions
where is the lesion in conduction aphasia?
arcuate fasciculus
temporal lobe in the audiotory association area
Conduction aphasia has (fluent/non-fluent) speech
fluent
What type of deficits are the worst in conduction aphasia?
moderate to mild
What is the hallmark of conduction aphasia?
inability to repeat long sentences; grossly repaired repetition and relatively preserved language comprehension
How does the prosody change in conduction aphasia?
pauses and hesitations
Do people with conduction aphasia attempt to make repairs to their errors?
yes
isolation syndrome is due to what type of aphasia?
transcortical aphasia
What is the hallmark of transcortical aphasia?
preserved repetition
What types of aphasias spare repetition?
Wernicke’s
Broca’s
Arcuate fasciculus
Transcortical
Lesions in transcortical aphasia are (inside/outside) the perisylvian zone
outside
What are the three types of transcortical aphasia?
motor
sensory
mixed
what is anomia?
difficulty finding words
What is anomic aphasia?
Spontaneous speech is fluent and grammatically correct, but marred with frequent word-retrieval failures. Average phrase length WNL
how is repetition in anomic aphasia?
intact
how is auditory comprehension in anomic aphasia?
intact
what is the leading cause of right hemisphere disorders?
CVA
T/F: all pts with an RHD have communicative defects
false
What percent of pts with RHD have a comm/cog deficit?
50%
prosopagnosia is an LHD or RHD?
RHD
How are RHD pts with syntax, morphology, grammar, and phonology
few if any problems
Do pts with RHD have classical aphasia?
no
The ability to come up with words that they want to say in pts with RHD is (equal/less than) age matched peers
equal
Why do pts with RHD have a hard time naming pictures or objects?
visual perceptual or visuospatial difficulties
What side of the visual field is neglected in RHD?
the left side
Where is the lesion located in neglect?
- inferior parietal lobe or parieto-temporal junction
2. inferior frontal lobe, underlying white matter, thalamus, basal ganglia
What are the four types of neglect?
visual
motor
tactile
auditory
what is the difference between a sensory deficit and tactile neglect?
tactile neglect is greater than a sensory deficit
what is the result of auditory neglect?
poor localization of sounds
What are the three zones of space that neglect can be grouped into?
personal space
peri-personal space
extra-personal space
What are examples of personal space neglect?
Neglect to shave, comb, dress on L side
What are the examples of peri-personal space neglect?
Neglect of items scanning/drawing/copying; L placed item on food tray
what are examples of extra-personal space neglect?
Neglect of people on left side of room, items on L of room
T/F: neglect is a constant issue
false; varies hour to hour and day to day
How long does it take for neglect to resolve?
within the first few weeks
What is neglect often accompanied by?
anosognosia (refusal to recognize the presence of a disorder)
What is the relationship between neglect and cog/comm defs?
presence of neglect means more likely to have cog/comm defs
what are the neglect related reading and writing issues?
neglect dyslexia and dysgraphia
What is aprosodia?
Production: flat, monotone speech, rate sounds fast
Comprehension: problems interpreting prosody
RHD possibly effects (blank) prosody more than linguistic prosody
emotional
in what RHD can we often miss a co-Dx of depression?
aprosody because of the lack of emotion
What are the biggest issues of comm in aprosodia?
emotion and nonverbal comm
describe the production in aprosodia?
Use fewer emotionally-charged words
Reduced facial expressions
Reduced animation
Flat affect – reduced animation, reduced prosody/intonation
what is the only issue with comprehension in aprosodia?
misinterpret social and emotional cues
what are some of the themes in RHD comm disorders?
problems with multiple meanings, distantly related meanings, and using context, and pragmatics
