Unit 4_Aphasia and Dysphagia Flashcards
What is an acquired language disorder after a brain injury?
Aphasia
What is an acquired swallowing disorder after a brain injury?
Dysphagia
About how many patients after a stroke has a language disorder (aphasia)?
About every third patient
About how many patients after a stroke has a swallowing disorder (dysphasia)?
About every second, 80% (*depending on how it’s measured)
What is the recovery time for patients initially diagnosed with swallowing disorders (dysphagia) following a stroke?
Within the first week
50% do not improve
What injury is tough to recover from following a stroke?
UE and language disorders (aphasia)
Following a stroke, what injury is represented bilaterally and easier to recover from?
Swallowing disorders (dysphagia)
Following a stroke, what injury is represented unilaterally and harder to recover from?
Language disorders (aphasia)
Following a stroke, what is the timing of chronic aphasia (language disorders)?
A year after a stroke
In order to define which aphasia (language disorder) type, what should you look for?
Do they comprehend/understand
Can they produce fluent speech
What is the following:
-Acquired
-Neurological
-Language (not sensory, motor, psychiatric, or intellectual disorder)
-Multimodal, affecting reception and production
-Processing of the language
-Not a speech impediment
Aphasia (language disorder)
What is caused by neurological illnesses / injury affecting language-critical brain areas?
For example:
- Stroke
- Traumatic Brain Injury
- Brain Tumors
- Progressive Pathologies, e.g., Alzheimer’s, Primary
- Progressive Aphasia
- Epilepsy
- Infections / Inflammations
Etc.
Aphasia (language disorder)
What is the most common cause for Aphasia (language disorder)?
Stroke
Language is strongly what?
Lateralized
Approximately what percentage of right-hand dominant individuals have left hemisphere lateralization?
> 93% of individuals
Approximately what percentage of left-hand dominant individuals have left hemisphere control?
78%
Where does visual processing occur in the brain?
Occipital lobe
Where does lexical-semantic retrieval and selection occur in the brain?
Frontal Temporal lobe
Where does lexical-phonological retrieval and selection occur in the brain and phonetic encoding and articulation occur in the brain?
Sensory-motor portion of the brain
Lexical-semantic retrieval and lexical-phonological retrieval can be affected by what disorder?
Aphasia (language disorder)
Where is Broca’s area (aphasia) found in the brain (difficulty producing speech)?
Frontal lobe
Where is Wernicke’s area (aphasia) found in the brain (difficulty comprehending speech)?
Posterior Temporal lobe
Which of the following about swallowing recovery is true?
- Majority of patients with stroke recover swallowing function
- Very few patients with stroke recover swallowing function
- Patients with stroke do not experience a loss or change in swallowing function
- Swallowing and language dysfunction always occur after a stroke
Majority of patients with stroke recover swallowing function
Which of the following is a component of the definition for aphasia?
- A loss of coordination of vocal cords
- A developmental inability to learn new sounds
- A loss of hearing sensation
- An acquired loss of language comprehension or production
An acquired loss of language comprehension or production
Which hemisphere is more likely to be responsible for speech and language?
Left
Which of the following is the first to occur when patients name an object?
- Selecting the correct name for an object
- Selecting the correct phenome to pronounce the name
- Visualization and conceptualization of the object
- Verbalizing the name
Visualization and conceptualization of the object
What is a connection or list of regions of white matter that work together to achieve a specific function?
Stream
What are the 2 streams that make up the Dual Stream Models for vision and hearing?
Where (dorsal: sublexical, unilateral, (“perception”)) and What (ventral: lexical, bilateral (“recognition”)
Which of the following “streams” or neural pathways helps us to understand the “what” of language processing?
- The posterior stream to the occipital lobe
- The dorsal stream to the parietal lobe
- The ventral stream to the inferior temporal lobe
- The anterior stream to the frontal lobe
The ventral stream to the inferior temporal lobe
Why do different groups of aphasia presentations exist after a stroke?
Stroke locations are not random: vascular territories dictate their location
Why do we have arteries in our brain?
Oxygen and nutrients (glucose) to keep neurons alive and functioning
What artery is responsible for aphasia (language disorder) if impacted by a stroke?
M1 (middle cerebral artery, lower stem)
What artery is responsible for dysphasia (swallowing disorder) if impacted by a stroke?
PICA
What strategies do you use as an OT if communication is difficult?
- Wait for better “connection” / attention
- Give feedback if you did not understand
- Simple sentences / avoid “or” questions
- (Let) repeat
- Speak slowly and clear, allow time
- Use / offer other mediums (gestures, writing, …)
- Use / offer mouth / face reading
How many times a day do people swallow?
~600 swallows / day
How long does it take to move food/liquid from mouth to esophagus?
1-2s from mouth to esophagus
How many cranial nerves and muscle pairs are involved in swallowing?
5 CNs
>30 muscles/pairs
What is the gold standard for assessing swallowing function?
Modified Barium Swallow Study (MBSS)
What occurs when a person swallows and residue enters the trachea but there are no visible symptoms from the individual?
Silent aspiration
What consequences can dysphagia have?
- Choking, asphyxiation
- Aspiration, pneumonia
- Malnutrition, dehydration
- Reduced quality of life
- Death
What is the most common consequence of dysphagia and also the most feared?
pneumonia
What neurological diseases can cause dysphagia?
- Stroke, TBI
- Parkinson, ALS, Myasthenia Gravis, Multiple Sclerosis
- Dementia
What developmental diseases/ syndromes can cause dysphagia?
- Genetic mutations, e.g. down syndrome
- Structural anomalies, e.g. tracheomalazia
What ENT / GI / Ortho diseases can cause dysphagia?
Reflux, stenosis, osteophytes
Why can head and neck cancer diseases cause dysphagia?
tumor itself; resection of structures, damage due to surgery / Rx
Which cranial nerves are involved in swallowing?
- Trigeminal (CNV)
- Facial (CNVII)
- Glossopharyngeal (CNIX)
- Vagus (CNX)
- Hypoglossal (CNXII)
Where in the brain can dysphagia occur?
Anywhere - not just in both hemispheres
Where is swallowing controlled in the brain?
Bilaterally, but have one dominant hemisphere
Overall, what hemisphere in the brain is crucial for swallowing?
The right hemisphere
What nerve is the most important nerve for larynx for swallowing?
Vagus (CNX)
Why do many individuals with cortical lesions (strokes) often recover swallowing function?
Both hemispheres are involved in swallowing
Swallowing is controlled by what that spans from cortex, subcortex, to brainstem and cerebellum?
broad bilateral neural network
Up to ___% have dysphagia after stroke; half recover within first week
80%
