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Aphasia > Test 3 > Flashcards

Test 3 Flashcards

1
Q

“compensatory or functional communication” target

A

day-to day- communication abilities

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2
Q

“compensatory or functional communication” goal

A

improving functional communication and quality of life> reducing impairment

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3
Q

“impairment-based” or “restorative” target

A

language impairment/processes (phonological)

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4
Q

“impairment-based” or “restorative” goal

A

generalisation beyond trained items/tasks, and to the communicative environment of the person
- reducing impairment> improving success of communication

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5
Q

Compensatory approach Pros

A
  • focus on functional strategies for daily life
  • easy for client to see impact
  • easier for clinician to administer
  • fit into limited number of sessions
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6
Q

compensatory approach cons

A
  • functional strategies often limited in their overall impact on impairment
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7
Q

Impairment-based pros

A

greater improvement on overall language processes (generalisation)

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8
Q

impairment-based cons

A
  • less immediate impact for client
  • more difficult for clinician to administer
  • may require more treatment sessions (potentially exceeding what insurance will cover)
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9
Q

generalization

A

the transfer of treatment gains to untreated items and every day, non-clinical environments
- ultimate treatment goal

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10
Q

Neuroplasticity

A
  1. use, improve, or lose it
  2. specificity rebuilds targeted networks
  3. salience is essential
  4. repetition and intensity promote learning and consolidation
  5. promote generalisation; avoid interference
  6. complexity enhances learning and generalisation
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11
Q

Models of language processing

A
  • classic model of language processing
  • modern models of language processing
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12
Q

Classic Model hypothesis

A

brain mechanisms are involved in word access/storage

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13
Q

Wernicke-Geschwind- repetition of spoken words

A

auditory cortex-> Wernickes area-> arcuate fasciculus-> Brocades area-> motor cortex

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14
Q

Wernicke-Geschwind- reading aloud of written text

A

visual signals-> angular gyrus-> Wernicke’s area-> arcuate fasciculus-> Broca’s area-> motor cortex

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15
Q

Strengths of Wernicke-Geschwind model

A
  • aid framework for modern models
  • started our thinking about pathways involved in comprehension and production of speech and language
  • comprehension: acoustic-> concept
  • spontaneous speech: concept-> motor
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16
Q

Problems with Wernicke-Geschwind model

A
  • too simplistic
  • only models lexical processing, not language processing
  • many aphasias don’t fall into these categories
  • single lesion sites don’t correspond to single deficits
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17
Q
A
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18
Q

functional anatomical model

A
  • model (typical speaker) of two auditory speech processing networks, connected to BOTH motor and conceptual systems
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19
Q

functional anatomical model- dorsal stream

A

mapping sound onto sub-lexical and articulatory-based representations
- ex. speech perception and production

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20
Q

functional anatomical model- ventral stream

A

mapping sound onto meaning
- speech recognition

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21
Q

speech perception (dorsal stream)

A
  • activate and maintain sub lexical items such as phonemes and related articulation
  • perceiving speech sounds
  • ex. “rhughet” I perceive speech sounds (they are familiar)
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22
Q

speech recognition (ventral stream)

A
  • access the lexicon/stored words
  • recognising words
  • ex. “rhubarb” “I recognise that word”
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23
Q

Dorsal stream

A
  • left-hemisphere dominant
    -acoustic information received
  • auditory sensory/phonological + motor interface
  • articulatory network
  • measures of speech motor impairment
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24
Q

Ventral stream

A
  • bilateral
  • acoustic information received
  • phonological + semantic-> lexical
  • higher-level syntax/ combinatinatorial network;
    … before moving on to articulation…
  • measures of impaired speech comprehension
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25
Q

representation

A

how language is represented- phoneme, morpheme, grapheme/letter, lemma/word form, lexical item/word, concept

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26
Q

process

A

how language is activated/accessed

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27
Q

modular language models

A
  • also called box-and-arrow, local, or discrete
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28
Q

modular language models representation

A
  • language units are stored locally (together)
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29
Q

modular language models processing

A
  • language units are processed serially (one at a time, in order)
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30
Q

Distributed language models

A

also called connectionist
Two connectionist models:
1. parallel distributed processing (PDP)
2. interactive activation

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31
Q

Distributed language models representation

A

language is represented in terms of learned patterns/networks of activation between different knowledge units

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32
Q

Distributed language models processing

A

knowledge is processed in an interactive manner; not sequential, serial manner

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33
Q

Basic connectionist model principles

A
  • knowledge (language) can be described by interconnected networks of units
  • these networks or patterns of units are activated depending on the strength of the network/patterns
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34
Q

Basic connectionist model principles- spreading activation

A
  • when a neutron/unit is activated, it spreads to other neuron’s/units connected to it
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35
Q

Basic connectionist model principles- learning

A
  • ex. speech therapy
  • learning is modifying the connections between units
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36
Q

Parallel Distributed Processing- Connectionism

A

-interconnected networks> representation
- language must me PROCESSED (not just retrieved)

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37
Q

Parallel Distributed Processing

A
  • strength of representation depends on network strength
  • more experience/familiarity with representation = greater network strength (connection weight)
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38
Q

Highlight of lecture 9

A
  • aphasia is an impairment of language processing
  • models help us understand the specifics of impairments and support clinical decision-making
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39
Q

Modular Models highlight

A
  • localised representations, serial processing
  • useful to consider some speech/language phenomena
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40
Q

Connectionist Models highlight

A
  • interactive networks of sub lexical units
  • networks connect with and between modalities
  • strength of networks based on experience (learning)
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41
Q

Aphasia and Learning

A
  1. principles of neuroplasticity
  2. Learning in aphasia rehabilitation
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42
Q

Learning in aphasia rehabilitation

A
  • errorless learning
  • knowledge of results vs performance
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43
Q

Treatment/rehabilitation is learning, learning requires:

A
  • attention
  • memory
  • executive function
    -language
  • visuospatial skills
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44
Q

attention

A

attend to treatment tasks

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45
Q

memory

A

remember instructions

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46
Q

executive functions

A

work towards a goal

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47
Q

visuospatial skills

A

to attend to visual stim, facial expression, gesture

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48
Q

important learning components

A
  • multimodal approach to more richly encode info
  • intentional cueing framework
  • metalinguistic instruction
    Feedback: presence, absence, timing
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49
Q

low frequency feedback

A

may promote learning better than high frequency feedback in many context

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50
Q

high frequency feedback

A

may promote learning when training complex skills

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51
Q

Performance

A
  • feedback about performance/process
  • helpful during training on specifics of performance
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52
Q

Results

A
  • feedback about correctness of response
  • helpful in retention of trained skills
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53
Q

retrieval practice

A

self generated picture name with correct response feedback provided
- best to strengthen semantic-lexical connections

54
Q

errorless learning

A

repeated exposure to the stimuli and its name before naming attempted
- networks tapped: lexical and phonological
- best to strengthen lexical-phonological connections

55
Q

Picture Naming Task- Stage 1

A

meaning to a word
- required to name a picture

56
Q

Picture naming task- stage 2

A

Word to phonology
- required to name a picture and repeat a word

57
Q

Aphasia Therapy- Prior approach

A

focus primarily on language impairment

58
Q

Aphasia Therapy- emerging approach

A

focus on the language impairment (restorative) and overall life satisfaction and participation (compensatory)

59
Q

Aphasia Therapy- common approach

A

focus on life satisfaction and participation (compensatory)

60
Q

Aphasia Therapy- Goal

A

generalization of the targeted language skills to a) untrained items and b) functional communication in the real-world
- selecting appropriate/adequate stimuli
- involving the patient and family/caregivers in treatment planning
- extending treatment outside the clinic

61
Q

Who is the target of therapy?

A
  • the person with aphasia is the central focus of the rehabilitation process
  • family members, friends, colleagues, and health-care workers that need to be able to communicate with patient are involved
62
Q

Who decides what therapy to give?

A
  • predominant/traditional paradigm is SLP as expert; therapist-led approach
  • emerging trend as expert; client-led approach
63
Q

Therapy considerations- client

A
  • profile of impairment
  • priorities for improvement
  • insurance, access to therapy, motivation, more
64
Q

Therapy considerations- clinicians

A
  • knowledge/training
  • environment
  • perspectives on spontaneous recovery
65
Q

spontaneous recovery

A
  • relatively rapid recovery in the weeks and months after stroke
  • 3-6 months; some consider up to 12 months post CVA
  • recovery is never limited
66
Q

RTSS Significance to SLP

A

treatments may be modified or administered differently than developed or tested-> impact not treatment outcomes

67
Q

RTSS Purpose- active ingredients

A
  • what the clinician does to evoke change
68
Q

RTSS Purpose: Mechanisms of Actions

A

how the treatment works

69
Q

RTSS Purpose: Treatment targets

A

the aspect of functioning targeted for change

70
Q

Aphasia is an impairment of language ____

A

processing

71
Q

attention =

A

-processing resource
- variable cognitive resources for processing
- language networks require resources or “fuel” (attention) to boost activation of target items and inhibit distractions

72
Q

allocating attention means:

A

more fuel and therefore more activation to target or process or items

73
Q

short term memory

A

items temporarily activated from long-term memory/sensory input
Tasks: simple serial recall

74
Q

more attention is required for _______ tasks than for ______ tasks.

A

working memory tasks
short term memory tasks

75
Q

PWA with stronger semantic processing better

A
  • at the first words
  • primary bias
76
Q

PWA with stronger phonological processing better

A
  • last word
  • recency bias
77
Q

working memory

A

ability to maintain and manipulate items for more complex cognitive tasks (like language)
- ex. in conversation, remembering what your partner said a few moments ago

78
Q

Attention with distraction

A
  • the more prominent the accompanying distraction, the more attention is required for the task
79
Q

Attention with task complexity

A
  • greater the task complexity, the more attention is required for the task
80
Q

Suppressing distractions

A

many believe inhibition (suppressing distractions) requires attention
- inhibition is essential of language processes

81
Q

continuity hypothesis

A
  • neurologically healthy adults appear to have aphasia If certain factors are manipulated
  • diminished or misallocated attention may account for the variability, stimulability, multimodality, and transience observed in aphasia
82
Q

Language Processing requires:

A

Attention+ short term memory+ working memory

83
Q

Cognitive Linguistic Quick Test

A
  • sustained attention/vigilance (also hemianopia/ visual attention
  • examinee scans a printed page of symbols that includes target symptoms and foil symptoms
84
Q

Cueing hierarchies

A
  • a structured approach to supporting response selection
  • may straighten semantic, phonological networks
  • some evidence of generalization
  • a good learning tool for considering impairment, language processes
85
Q

phonological cueing

A
  • therapy uses a phonological hierarchy of least to most cues
  • Picture (cake)
  • rhymes with “zake”
  • model
86
Q

semantic cueing

A
  • picture (duck)
    “swimming bird, wide beak”
  • “he carved a wooden duck”
87
Q

Aphasia is a disorder of:

A
  • linguistic access
  • lexical retrieval is a variable in aphasia
  • representations are not gone, just inaccessible
  • other cognitive processes necessary for retrieval
88
Q

Connectionist models can

A
  • help us characterise the impairment
  • emphasise processing over-representation
  • help identify treatment stimuli and approaches
89
Q

Lexical-semantic word Error types

A
  • semantic substitutions
  • mixed errors/formal errors
90
Q

semantic substitution example

A
  • cat for dog
  • knife for fork
91
Q

mixed errors/formal errors

A
  • (lexical+phono)
  • cat (for) rat
92
Q

Characteristics of the stimuli

A
  • word frequency
  • word imageability
  • word length
    -lexicality
93
Q

word frequency and word imageability

A
  • tap more into lexical and lexical-semantic properties
94
Q

word length and lexicality

A
  • tap more into lexical and phonological properties
95
Q

Phonomotor Treatment

A
  • by straightening phonological level representations, bidirectional spread of activation:
  • bottom up to conceptual semantics
  • topdown: when a word is activated, previously weak phonological representations will not be stronger and more easily accessible
96
Q

Developmental connection between phonology, orthography, and reading

A
  • first, semantics -> phonology for communication
  • later, phonology-> orthography
97
Q

Word

A

a pattern of activity distributed over a set of orthographic units, phonological units, semantic units

98
Q

Alexia

A

acquired difficulty with reading

99
Q

2 types of Alexia

A
  • Peripheral Alexias
  • Central Alexias
100
Q

Peripheral Alexia

A
  • visual/perceptual; not aphasia
101
Q

Central Alexias

A

often associated with aphasia
- step from linguistic processing impairment; difficulty deriving sounds and/or meaning from print

102
Q

Surface Alexia

A

-impaired reading of irregularly spelled words
- regularisation error: “pint” rhymes with “mint” when read aloud
- BUT relatively intact reading of regularly spelled words and pseudo words
-Good grapheme to phoneme conversation

103
Q

Phonological Alexia

A
  • impairment in pseudoword reading
  • no semantic reading errors
  • lexicaliztation errors (flig-> fig)
  • visual errors (signal-> single)
    Morphological errors (baked-> baking)
    Rely on sight word reading/whole word recognition- poor grapheme to phoneme conversion
    -imageability effects: highly imageable words better than abstract words
104
Q

Deep Alexia

A
  • severly impaired pseudoword reading
  • semantic errors in oral reading (semantic paralexia- (boot->shoe)
  • lexicaliztation errors
  • visual errors
  • morphological errors
  • imageability effects:highly imageable words better than abstract words
105
Q

How Alexia Types are Classified

A
  1. locus of impairment
  2. Relative processing strengths/reliance
  3. Accuracy and Error Features
106
Q

Duel Route Model

A
  • reading invoices with several independent components and two separate processing routes (lexical and sub-lexical)
107
Q

Use sub-lexical route with

A

-unfamiliar or nonwords
-identify and parse graphemes
-grapheme to phoneme rules
-blending of graphemes

108
Q

use lexical route with

A

-stored word knowledge
-familiar real words

109
Q

a person with surface alexia relies on…

A

-sublexical route
-grapheme to phoneme rules

110
Q

a person with phonological alexia relies on…

A

-lexical route
-stored word knowledge
-familiar real words- regular and irregular

111
Q

a person with deep alexia relies on…

A

-lexical route
- Some stored word knowledge (highly imageable words)
- makes semantic errors

112
Q

A likely underlying contributor to reading difficulty in aphasia…

A
  • general impairment in phonology
  • break down in connection between the letters and their corresponding sounds
113
Q

successful audition of language

A

-stimulus detection
-discrimination of stimuli
-retention
-categorization
-sequential retention

114
Q

stimulus detection

A

awareness and attention

115
Q

discrimination of stimuli

A

recognising minimal differences

116
Q

retention

A

short and long term storage

117
Q

categorisation

A

comparing stimulus to storage

118
Q

sequential retention

A

organizing stimuli over time

119
Q

Mortons Logogen Model

A
  1. Hear Word (spoken word)
    ->
  2. Auditory phonological analysis (analysis of the sound wave and phonological elements)
    ->
  3. Phonological input lexicon (access storage of known spoken words)
  4. Semantic system (access of word meaning)
120
Q

Dell’s Spreading Activation Model- Heard Word

A
  1. Auditory/speech level: (pre lexical): spoken word is heard, phonological aspects analysed
  2. Lexical level: (Phonological in put lexicon): access store of known words
  3. Semantic level: (meaning) access semantic knowledge, combined features
121
Q

Auditory speech level (pre-lexical) processing

A
  • auditory analysis carried out bilaterally
    -left lateralized speech-specific processing
  • Imaging studies show: activation of primary auditory cortex during auditory comprehension
    -Lip reading has been shown to be integrated with auditory information
122
Q

Mirror neurons

A

-motor theory of speech perception:
- speech production and speech perception processes overlap
-activation of the primary motor cortex during auditory comprehension
-auditory input: phonological perception is linked to phonological production

123
Q

lexical level

A

-phonemes detected have a spread of activation upward to lexical level
-activate the lexical node/knowledge
-activated only words previously learned

124
Q

semantic level

A
  • the lexemes detected have an upward spread of activation to semantics
    -activate the correct word for comprehension of meaning
    -heavily dependent on verbal short-term and working memory
125
Q

Assessment of comprehension

A
  • first consider hearing impairment
    -WAB
    -CAT
126
Q

Auditory Comprehension General treatment considerations

A

-patients will moderate-sever e auditory comprehension deficits may be more difficult to engage in therapy
- may not be able to perform more structured tasks

127
Q

Marshall reccomends…

A

-context based approach
-clinician must be flexible
-focus on overall successes in communication, rather than what the person says or how he/she says it
-experiment with different strategies and strategy combinations to improve message comprehension and exchange

128
Q

Maximizing auditory comprehension: communication strategies:

A
  • consider extralinguistic variables
  • body and face orientation
    -environment: other auditory and visual inputs
    -facial expresssion
    -gesture
    -visual aids (key words, symbols, pictures)
    -Manipulate linguistic variables
  • manipulate timing variables
129
Q

maintain communication flow

A
  • if there is excessive flow:
  • utilise stop strategy to improve patient’s ability to recognise and repair errors
  • interpret and translate patient’s errored utterances
130
Q
A

Aphasia (2 decks)

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