Test #1 Flashcards
What does the propositional definition of aphasia say?
an affected person can’t formulate goal directed utterances, can’t convey intent
When was the majority of Paul Broca’s work done?
1860s
What do the cognitive theorists of aphasia believe?
there is some intellectual problems with aphasia
What do localizationist theorists say about aphasia?
affected individuals have difficulty naming and disassociation between a label and a concept
What does the concrete-abstract definition of aphasia say?
abstract language is more propositional and that is the deficit in aphasia
What does the uni-dimensional theory of aphasia say?
aphasia is a single disorder, you don’t differentiate between different types of aphasia
- all modalities of language are impaired to some extent
- should find the relative strengths within the language system to rebuild the weaknesses
What does the multi-dimensional theory of aphasia say?
- there is differential diagnosis
- different types of aphasia based on the site of lesion and the clients behaviors
What does the microgenetic theory of aphasia say?
lesions in certain areas lead to specific deficits
-the older you are, the more localized your functions are
What does the thought process theory of aphasia say?
there is an impairment in semantic expression due to a deficit in thought processes
What does the psycholinguistic theory of aphasia say?
separates aspects of language into cognitive (what we know about the world), linguistic (form and content), and communicative (pragmatics)
-aphasia causes a problem with the content, form, use, and knowledge about the world
What is the definition for aphasia used in class?
an acquired communication disorder caused by brain damage characterized by an impairment of language modalities (not a sensory, intellectual or psychological deficit)
Explain short term memory
might be the three items you need to pick up from the grocery store
-don’t need to commit that to long term memory
Explain long term memory
can be broken down into semantic memory and lexical memory
What is semantic memory
deals with concepts
What is lexical memory?
the labels that are applied to concepts
What MUST someone with have to be considered aphasic?
anomia
What kinds of things will people with aphasia do to indicate that they know a concept?
- gesture
- point
- circumlocute
What is working memory?
a subset of short term memory
-almost like a rehearsal space; helps you manipulate the concepts that are present so you can infer meaning
What is episodic memory?
memory for episodes (what you did that day, or something longterm that is more memorable)
-can be short term or long term
What is procedural memory?
memory for sequences or how to do things
i.e. how to make a peanut butter and jelly sandwich
What is topographic memory?
memory of how things relate in space
How do we formulate things?
- first concepts
- then propositions
- then schemata (schemata ties propositions together with with procedural and episodic memory
- finally incorporate all schemata to create a schema
What is a paraphasia?
when someone substitutes a word for a related word
What is agnosia?
lack of recognition from a certain sensory modality
i.e. not recognizing that sirens mean there is an emergency
What does apraxia cause problems with?
sequencing and motor planning
What does apraxia often co-occur with
aphasia
-especially non fluent aphasias
How many words per utterances does a non fluent aphasia have?
1-3 words on average
is apraxia related to more anterior or posterior lesions of the brain?
anterior lesions
What are some symptoms of apraxia of speech?
- poor programming/sequencing of speech
- oral groping
What kind of tasks are easier for patients with apraxia?
automatic tasks
What kind of impairment is dementia?
intellectual
What does dementia impair first, language or cognition?
cognition, then it affects language
What is primary progressive aphasia?
the midway diagnosis between dementia and aphasia
What generally happens with primary progressive aphasia?
starts like an aphasia, but overtime where most aphasias recover, the person will decline overtime and their cognition will later be affected as well
What is right hemisphere disorder or non dominant hemisphere disorder?
when there is a stroke or injury to the right/non dominant side of the brain that causes pragmatic and attention issues
What percentage of left handed people will have language in their left hemispheres?
60-70%
meaning the other 40-60% will have language in their right hemispheres
What is the number one symptoms of aphasia?
anomia (word finding problems)
What kind of memory will someone with aphasia have?
semantic memory
lexical memory is impaired
What is circumlocuting?
talking around the word and providing semantic information
What types of paraphasia are there?
- literal/phonemic paraphasia
- verbal paraphasia
- unrelated paraphasia
What is phonemic paraphasia?
phoneme substitute within the work
When are you more likely to recognize your error/deficits, an anterior or posterior lesion?
anterior lesion
What is verbal paraphasia?
substitute a word with a related word
What is unrelated paraphasia?
a real word is substituted, but it isn’t related to the context
Are you more likely to hear paraphasias with lesions more anterior or posterior?
posterior (because they are more fluent)
What is a neologism?
a totally made up word
What is it called when someone uses one neologism after another?
jargon/word salad
What is “press for speech”?
when a patient isn’t able to monitor when to stop speaking
What is the rule of thumb for phonemic paraphasias?
if 50% or more of the target phonemes are there, it’s phonemic paraphasia
What is agrammatism/telegraphic speech?
when you leave grammatical markers out and content/function words are left in
What kind of lesion do you tend to hear telegraphic speech in?
anterior lesions or Broca’s aphasia
What is a stereotypy?
when one person says one word or phrase a lot
What kind of stereotypys are there?
dictionary form and non dictionary
What are some comprehension characteristics of aphasia?
- better understand shorter utterances
- better comprehension of nouns
- may exhibit slow rise time
- noise build up
- intermittent imperception
What is noise build up?
- point of overload
- patient may be comprehending for a while but eventually hit a point of overload and won’t comprehend beyond that point
What is intermittent imperception?
- shutter effect
- similar to noise build up, but will intermittently comprehend
What are written symptoms of aphasia?
- agraphia
- paragraphia
- jargongraphia
What is agraphia?
written errors; tend to mirror spoken/verbal errors and vice versa
What is paragraphia?
written equivalent of paraphasia
what is jargongraphia?
written equivalent of jargon
-string of neologims
What is perseveration?
when a patient continues to go back to the same things
What is the difference between perseveration and sterotypy?
- stereptype=the only thing the patient can say
- perseveration=patient may have more words but continue to go back to the same topic or words
Is a person with anterior lesions likely to realize their deficits?
yes
Is a person with a posterior lesion likely to realize their deficits?
no
What does it mean to get a client in set?
get them prepared for an activity
i.e. model, or thoroughly explain directions
What is the first thing needed to do when diagnosing aphasia?
confirm the presence of anomia
What are ways to test naming?
- confrontation naming
- generative/categorical naming
- phonemic naming
- story retell
- describe a procedural sequence
How do you assess fluency?
take the patient’s three longest utterances and average them
How many average words must a person have per utterance to be considered fluent?
9 or more
How many average words per utterance does a person need to have to be considered non fluent
5 or less
How many average words per utterance is considered borderline fluent?
6-8 words
What ar the best ways to assess fluency?
- ask open ended questions
- wh- questions
- picture description
- ask about an emotional topic
How can you assess auditory comprehension?
- yes/no questions
- pointing tasks
- following directions
- comprehension of narratives
What is Broca’s aphasia?
a non fluent, effortful, and agrammatic type of language production
What are some symptoms of Broca’s aphasia?
- telegraphic speech
- difficulty initiating speech
- preserved auditory comprehension
- impaired repetition
- impaired naming
Where is the lesion in Broca’s aphasia?
inferior frontal gyrus of the frontal lobe (broca’s area)
Do patients with Broca’s aphasia tend to recognize their deficits?
yes
What are some comorbidities of Broca’s aphasia?
- right hemiparesis
- apraxia of speech
- swallowing difficulties
What is Wernicke’s aphasia?
a fluent aphasia with sometimes excessive verbal expressions that are full of paraphasias and neologisms
Where is the lesion with Wernicke’s aphasia?
just under the sylvian fissure on the superior temporal gyrus (wernicke’s area)
What are some symptoms of Wernicke’s aphasia?
- fluent speech
- meaningless speech
- paraphasias
- poor AC
- poo repetition
Do you see hemiparesis with Wernicke’s aphasia?
not usually
What does it mean if Wernicke’s aphasia doesn’t improve and becomes chronic?
the lesion extends beyond Wernicke’s area (BA 22)
What is often the most debilitating symptom of Wernicke’s aphasia?
poor auditory comprehension
Which type of aphasia do you tend to hear a lot of press for speech?
Wernicke’s
Which other type of aphasia is similar to wernicke’s aphasia with very poor repetition skills?
conduction aphasia
Do patients with conduction aphasia have good or poor comprehension skills?
better comprehension skills compared to wernicke
What are some symptoms of conduction aphasia?
- paraphasias
- anomia
- sometimes patients recognize errors
- fluent
Where is the lesion for conduction aphasia?
in the left hemisphere usually around the supramarginal gyrus
(the bundle of fibers that connects wernicke’s and broca’s area)
What does the bimodal distribution theory say?
that the patients level of fluency depends on where the lesion is on the arcuate fasciculus
Do patients with conduction aphasia try and self correct?
sometimes
What type of aphasia looks like Broca’s but with spared repetition?
transcortical motor (TCM)
does TCM aphasia have a more anterior or posterior lesion?
anterior
Where is the lesion for TCM aphasia?
around but spares broca’s areas
What are some comorbidities of TCM aphasia?
- transient incontinence
- rigidity of the upper extremities
- hemiparesis more in the leg than arm
- problems initiating speech
- may see bradykinesia
What is bradykinesia?
slow movement
What other type of aphasia looks like wernicke’s aphasia but with spared repetition?
transcortical sensory (TCS)
Will a patient with TCS aphasia comprehend something they repeat?
no
What kind of mediation is someone with transcortical sensory aphasia missing?
semantic mediation
Where is the lesion for transcortical sensory aphasia?
surrounding but sparing wernicke’s area
What other aphasia does mixed transcortical aphasia look like?
global aphasia
what is the lesion like with mixed transcortical aphasia?
very large, but spares the perisylvian
What aphasia has good repetition skills but all other areas are poor?
mixed transcortical aphasia
What does palilalia mean?
compulsively repeating yourself
What is a letter representation system?
what assigns a grapheme (written letter) to each word
what is graphemic input lexicon?
what will recognize a string of letters by sight
graphemic input lexicon has to go through what so you can comprehend a word?
semantic representation system
explain the lexical semantic route
looks at the features of words
- processed through letter representation system
- then perceived graphemes go through the graphemic input lexicon
- then the graphemic input lexicon goes through a semantic representation system so you can comprehend
- if you read aloud you then assign a grapheme to a phoneme
What is the non lexical route?
unfamiliar words don’t need semantic mediation
- often go from grapheme to phoneme conversion
- considered a sublexical route or phonological route
does newer reading require more or less attention?
more attention
Is reading a left hemisphere or right hemisphere process for most people?
left hemisphere proces
Explain how reading involves all the lobes of the brain
occipital: vision
temporo-parietal and occipito-parietal: word identification
inferior frontal gyrus: semantic processing of words
-more anterior: semantic processing of words
-more posterior: phonologic processing of words
what is surface dyslexia?
no access to meaning
-must sound it out
Can someone with surface dyslexia read?
yes, but they probably aren’t comprehending it
What is phonologic dyslexia?
person cannot read non words
-has difficulty with low frequency words
What is deep dyslexia?
when a person exhibits semantic errors for the target
- will not be able to read non words
- will do better with high frequency words
What kind of impairments will someone with deep dyslexia have?
grapheme to phoneme conversions
what is pure alexia?
- no co-occuring agraphia
- impaired access to graphemic input
How do you look at assessment for dyslexia?
- obtain literacy history
- look at ability to inference from written material
- look at various word frequencies
- look at different regularities of spelling
- look at different levels of concreteness
- look at word lengths
What do you look at in error type analysis?
- visual confusions
- semantic confusions
- derivation errors
- regulation errors
- phoneme to grapheme conversion errors
During paragraph reading with someone with alexia or dyslexia, how many words should you ignore before you start counting errors?
200
What kind of paragraphs should you have someone with alexia/dyslexia read when assessing?
- novel (new)
- strong in theme
What things should you focus on in treatment with alexia?
- focusing attention
- lexical decision making
- limiting letter by letter reading
- survival reading
What does agraphia often co-occur with?
aphasia
What are some characteristics of agraphia?
- paraphasias (written)
- neologisms
- agrammatism
What are the three types of agraphia?
- lexical (surface): doesn’t access semantic route well
- phonologic: doesn’t access phonologic route well
- deep agraphia: a little of both lexical and phonologic
What are some treatment targets with agraphia?
- assess ability to write automatic things
- assess ability to copy
- asses spelling and diction
- written naming
- written narrative
What is CART?
copy and recall treatment
-pick 10 functional words and copy it over and over
What are two screenings for aphasia?
- Bedside Evaluation Screening Test (BEST)
- Aphasia Language Performance Scales (ALPS)
Explain the ALPS
- has 4 scales: listening, reading, speaking, and writing
- provides graphs for progress
- has a system of cueing to give 1/2 credit
- each scale is out of 10 points
What are some benefits of standardized aphasia tests?
- provide norms
- valid measure of performance
- invariable adminstration
What are some common comprehensive standardized test?
- Boston Diagnostic Aphasia Examination-3 (BDAE-3)
- Western Aphasia Battery-Revised (WAB-R)
What are some functional assessments?
- Communication Activities of Daily Living-2 (CADL-2)
- Functional Assessment of Communication Skills (ASHA-FACS)
What are some tests for severe/global aphasia?
Boston Assessment for Severe Aphasia
What is one of the most standardized assessments out there?
Porch Index of Communication Abilities (PICA)
What kind of scoring system does the PICA use?
multi-dimensional scoring system
The PICA is considered to be the best prognostic test for aphasia if it is given when?
1-5 months post stroke (preferably in the first month)
What kind of subtests does the PICA have?
the typical ones + pantomime and drawing
What PICA score has really good predictive value?
the “peak mean difference” score
>500 = great prognosis
<200 = plateau, limited ability to change
What does the HOAP score on the PICA provide?
the number where we think the client will end up 6 months post injury
What are some things you want to assess in an informal beside eval?
- conversation
- discourse (phrase length, substantive/functor ratio, syntax, paraphasias)
- auditory comprehension
- naming
- repetition
- reading and writing
- praxis
What are some ways to assess auditory comprehension?
- come up with 5 one-step, two-step, and three-step directions
- yes/no questions
- pointing tasks
- money
How can you assess naming?
- confrontation naming (“what is that?”)
- responsive naming (naming to description)
- generative naming/word fluency (categories or phonemic fluency)
How do you assess repetition?
start with single syllables and then moves to phrases
How do you assess praxis?
use automatic lists
Who is a cognitive eval done by?
a neuropsychologist or SLP or OT
What should you include when obtaining a case history for cognitive eval?
- premorbid cognitive level
- considerations
- neuropsychiatric behaviors (caused by brain damage)
