Test #2 Flashcards
What is a primary aphasia tumor?
when the tumor originated at the language center
When is aphasia progressive?
when a tumor keeps growing around the language areas
When is the aphasia secondary with a tumor?
when the tumor started somewhere else but spreads to the language areas
What are some common types of brain tumors?
- glioma
- astrocytoma
- glioblastoma multiforme
- meningeoma
explain a glioblastoma mutliforme
- very malignant, person will often die within a few years
- very hard to remove the whole tumor and it will keep growing back
What will happen if the brain tumors aren’t treated?
language will get worse and worse
What is the goal of treating dementia?
make communication functional while compensating for underlying cognitive issues
What is affected first with dementia, cognition or language?
cognitive issues occur first, and then language problems start later
What is fronto-temporal dementia?
- related to present progressive aphasia
- would expect the language to be impaired first and then the cognitive symptoms begins
- attacks the language center first
What should you focus on with dementia?
manipulation of the environment
-if there is confusion, have things like signs posted to prevent the patient from getting lost
What kind of memory is a someone with dementias’ best memory?
procedural memory
what kind of aphasia has the best recovery?
hemorrhagic (although recovery is initially slower)
What is the goal for non progressive aphasia?
increase receptive/expressive communication for functional participation in activities of daily living
What modality should you treat in someone with aphasia?
whatever modality is most inhibiting functional communication
if apraxia interferes with communication, should it be treated?
yes, early treatment goals should focus on the apraxia
What are the aspects of metacognition?
- self-awareness
- motivation
- self-monitoring
- self-inititation
- goal-orientation
What are the two ways you can choose therapy targets?
the process approach or the of the deficit approach
how are therapy targets selected during the process approach?
strengths are used to improve weaknesses
What is valued in the process approach?
- standardized measures to track progress over time
- informal measures so progress can be observed in other environments
How are therapy targets selected in the deficit approach?
weaknesses are targeted and practiced many times
What must kind of goals must be set so SLPs are reimbursed?
reasonable goals that show progress
When must a patient be discharged from therapy?
if no progress is seen over a two week period
Do patients with aphasia have variable performance?
yes; because of shutter effect, noise build up, and perseveration
What is another way progress can be tracked for third party reimbursement?
family/caregiver input
How do you deblock impaired skills?
use relative strengths to improve weaknesses
What can help patients advocate for themselves?
self-cueing
What is an example of a therapy sequence?
- social greeting
- simple task that the patient is already doing well
- harder task and developing skills
- end the sessions with an activity that the patient can be successful with
What is the treatment hierarchy for nonfluent aphasia?
- establishing voluntary phonation
- verbal automatisms
- phrase/sentence completion
- word repetition
- oral word reading
- responsive naming
- word fluency (naming categories, phonemic categories, etc.)
- confrontation naming
- matrix training
- sentence formulation (higher level)
- story retelling (very high level
What is PACE?
Promoting Aphasic’s Communicative Effectiveness
explain PACE
a way to encourage patients with aphasia to convey a message with any modality necessary
what kind of activity is usually done with PACE?
picture description
What is SPPA?
Sentence Production Program for Aphasia
What is the goal for SPPA?
increase inventory of syntactic structure for nonfluent individuals with aphasia
who are candidates for SPPA?
- nonfluent individuals
- agrammatic speech
- relatively preserved auditory comprehension
- impaired access to syntactic construction
What level of success must a patient have at level B of SPPA to move on to a new syntactic structure stimulus?
85% or better
What are levels A and B of SPPA?
Level A: delayed repetition/imitation
Level B: self-formulated responses
Can patients have half credit on the SPPA?
yes
What is MIT?
melodic intonation therapy
What is the goal of MIT?
increase propositional language for individuals with nonfluent aphasia
Who are candidates for MIT?
people with nonfluent aphasia who have an intact right hemisphere (where music is processed)
- should be stimulable for for producing words when singing songs
- should have relatively impaired auditory comprehension
What are some things that clinicians should do during MIT?
- use a slow rate
- use continuous voicing
- use simple high/low note patterns designed to imitate natural prosody
Explain level one of MIT
- assisted hand tapping at all times
- steps:
1. model by humming
2. unison production
3. unison with fading
4. immediate repetition
5. response to probe (“What did you say?”)
When can someone move to level 2 of MIT?
when they are at 90% accurate or better
How is someone scored in level 1 of MIT?
0 or 1
Explain level 2 of MIT
-Add a delay between stimulus and response
Steps:
1. Introduction of target with tapping (no response)
2. Unison with fading
3. Delayed repetition (6 seconds)
4. Response to probe
How is level 2 of MIT scored?
score of 0-2
What happens if a patient fails at a level?
they must go back a step
What is the best score someone can get with MIT if they have to go back a step?
1
Explain level 3 of MIT?
-focuses on pulling some of the melody out to sound more natural
What is the technique used to focus on rhythm and stress rather than melody?
sprechgesang
What are the steps of level 3 of MIT?
- delayed repetition
- clinician uses sprechgesang
- sprechgesang with fading
- delayed spoken repeptition with no hand tapping
- response to probe question
How is level 3 of MIT scored?
0-2
What is RET?
Response Elaboration Training
Explain RET
considered “loose training”; structure is based on patient responses
how do you shape a patient’s responses with RET?
“wh” questions and indirect correction
What should you do with the content presented by the clinician in RET?
validate it and expand/indirectly correct
What is one of the protocols for anomia?
semantic feature analysis
explain semantic feature analysis
similar to matrix training or a semantic web; encourages the patient to systematically go through the web and talk about what they are trying to say (circumlocute)
what are some treatments for global aphasia?
- Equivocal Response Program (ERP)
- AAC
Explain ERP
- used to shape yes/no responses so the patient has a place to start
- find the patient’s best modality for indicating yes/no
how do you train a person to answer yes/no questions with ERP?
- ask two basic questions for which the answer is always yes
- once the yes answer is stable, invert the question to make it a no answer
- once the no answer is stable, intermix all four questions
- finally, add additional questions when appropriate
What is the treatment hierarchy for fluent aphasia?
- picture to picture matching
- picture identification by name “point to the hook”
- picture identification by function
- responding to yes/no questions (considered middle of the road task)
- following commands with visual stimuli
- following commands with body parts
- narrative comprehension
What are some other treatment ideas for fluent aphasia?
- barrier tasks
- pacing board
- use video evidence
- voluntary control of utterances
What is the goal of voluntary control of involuntary utterances?
increase propositional utterances for functional communication
who are candidates for voluntary control of involuntary utterances?
patients with aphasia who:
- have very limited verbal output with few stereotypic words
- have enough reading comprehension for single words
- can match pictures to words
What do you try and have the patient produce during voluntary control of involuntary utterances therapy?
words that are similar to words they are already producing
What kind of models should you give someone during voluntary control of involuntary utterances therapy?
visual and verbal models
What is the sequence of tasks for voluntary control of involuntary tasks?
- read aloud reliably
- use picture stimuli for target words (pair with written word only if needed)
- choose all picturable words that the patient says
- any word that the patient says reliably should become homework
What is the goal for treatment for aphasic perseveration
reduce perseveration to deblock target words or name 90% of items with <10%
Who are candidates for treatment for aphasic perseveration?
individuals with:
- relatively good auditory comprehension
- good memory
- some self-monitoring skills
- some confrontation naming
- moderate level of perseveration
how do you calculate level of perseveration?
count the # of items where perseveration occurred and divide by the total number of items
what percentage is considered a moderate-severe level of perseveration?
> 20%
What is semantic perseveration?
recurrence of a word that is still conceptually related to the current target
what is lexical perseveration?
recurrence of a word that is not semantically related to the target
what is phonemic carryover perseveration?
when a phoneme from the previous target is used in the new target
What targets does the treatment for aphasic perseveration use?
the BDAE targets
How do you order the categories for the treatment for aphasic perseveration?
strongest to weakest
-the strongest category is the highest level of naming with the lowest level of perseveration
Who are candidates for the visual action therapy?
people with aphasia who have very limited speech
What is the goal for visual action therapy?
increase the use of representational gestures for functional communication
What is treated first in visual action therapy: distal, oral, or proximal gestures?
First proximal
Then distal
Last oral
What is anagram copy and recall therapy?
a protocol for writing
-used for enhancing written expression
What kinds of words should you start with in anagram copy and recall therapy?
short words that have the most regular spelling
What are the therapy techniques you can use nonfluent aphasia?
- Promoting Aphasic’s Communicative Effectiveness (PACE)
- Sentence Production Program for Aphasia (SPPA)
- Melodic Intonation Therapy (MIT)
What is a treatment strategy for anomia?
semantic feature analysis (similar to a semantic web)
what are some treatment strategies for global aphasia?
- Equivocal Response Training (ERP)
- Augmentative and Alternative Communication (AAC)
What kind of AAC often yields the best output for people with aphasia?
visual scenes
What are some treatment ideas for fluent aphasia?
- barrier tasks
- pacing board
- video evidence
