Weeks 1-3 Flashcards
What is language
An abstract system of symbols combined by the use of grammatical rules that allows for the sharing of meaning within a social context
What is communication
The transmission of info between 2 beings (human or nonhuman); can include verbal, body lang, gestures, nonverbal noises and linguistic or non linguistic factors
What is speech and is it the same as language
Speech is NOT the same as language
Speech: motoric verbal means of communicating (articulation, voice, fluency)
True or false: acquired language and cognitive-communicative disorders may arise from injury to brain
true
True or false: acquired speech disorders occur to damage below level of cortex - spinal cord, cranial nerves, spinal nerves and peripheral body
true
What are the 2 cell types of nervous system
neurons : dendrites, cell body, axon, terminal ending and synapse; “communication cell”
Glial cells: provide axon myelination; “helper cells”
Gray matter: ______
White matter: _______
Gray matter = cell bodies and dendrites
White matter = myelinated axons
In CNS: nuclei is _______, except basal ganglia
In CNS: tracts, fasciculi are ______
Nuclei = gray matter
Tracts & fasciculi = white matter
Why is myelination important for axons
Myelination on axon carries the signal with rapid speed
Demyelinated axons lead to MS
Name the 4 lobes of cortex and which are more important for language
Frontal*
Parietal*
Temporal*
Occipital
Language is housed in which hemisphere
Left
right hemisphere = melody, intonation
What is the cortex
the cerebral cortex is the outermost layer of the brain, made up primarily of gray matter. It is the most prominent visible feature of the human brain → the cortex is the wrinkled convoluted surface of cerebrum
What are Brodmann’s areas
The structural differences of the cortex correlate to functional differences
Language → phonological and grammatical processing → housed in 44 and 45
Association cortex vs primary cortex
Primary Cortex:
direct processing of primary sensory or motor info.
Performs the actual task of the region.
Association cortex:
Most of brain made up of association cortex
Where modifications occur → analyze, recognize and act on sensory input
Usually positioned adjacent to primary cortex
plans & integrates info for the primary area.
Info is received from sensory cortex → then to primary cortex for perception → then to association cortex to ID whatever that we’ve perceived
Where is the first cortical location where sensory experience is received
Primary auditory cortex
Where in the primary cortex is motor command initiated
Primary motor cortex
Unimodal vs multimodal
Unimodal: usually adjacent to primary area; recognition using one sense
Multimodal: integrating senses
Name the 3 white matter tracts and their purpose
Projection tracts: interconnect primary cortical areas (primary motor and primary sensory) to deeper structures
Association tracts: are the most numerous and interconnect regions of the cortex within the same hemisphere
Commissural tracts: interconnect homologous (having the same relation, relative position) areas in the left and right hemispheres; tracts crossing b/w left and right hemis
Name the association tract connecting Broca’s and Wernicke’s areas
Arcuate fasciculus
What is decussation
Term used to describe a crossing of information at the midline
Why is continuous blood supply important for the brain
Must have continuous flow of blood → neural cells die quickly without
Once neural cell die, they are not regenerated
What are the 3 cerebral arteries providing blood to cortex (language and cognition are cortical functions)
Anterior cerebral artery (ACA)
Middle cerebral artery (MCA)
Posterior cerebral artery (PCA)
Which 2 cerebral arteries are important for language and cognitive communicative functioning
ACA and MCA
MCA provides blood supply to specialized language center of the brain in left hemisphere → Broca’s and Wernicke’s
ACA provides blood to prefrontal area → judgment, inhibition, high level cognitive processes, problem solving, planning
What is watershed zone
Areas b/w 2 cerebral arteries in the cortex
What is an ischemic stroke and the 4 types
Ischemic stroke = insufficient blood supply caused by blood clots
4 types:
Thrombosis: localized buildup of fatty plaques/platelets causing occlusion
Embolism: blockage in blood vessel caused by traveling clot, air bubble, etc.
Transient ischemic attack (TIA): “mini stroke”; stroke symptoms resolve → blood flow returns causing no cell death
Lacunar strokes: small blockages of blood vessels occurring in thalamus or basal ganglia; causes cell death appearing as tiny dots on scan; causes motor sensory deficits
What is the penumbra
Surrounding area of living tissue next to cell death caused by CVA
Tx goal → increase blood flow to area to form new connections that were lost
What is hemorrhagic stroke and the 3 types
Hemorrhagic stroke = brainbleed
3 types:
Intracerebral: common cause high blood pressure; occurs in cranial tissue
Extracerebral: related to aneurysm; occurs in meningeal tissue
space-occupying lesions: squeeze neural tissue against cranium; common cause aneurysm
Short term and long term treatments for stroke
ST: goal is to save tissue of penumbra with medical treatment to restore brain function
LT: rehab
What is tPA and when is it used
Tissue plasminogen activator (tPA) is administered for occlusive ischemic strokes (blood clots)
It breaks down clots
What is perisylvian
Area of brain responsible for language
What are the perisylvian language areas of brain
Broca’s area (BA 44, 45; frontal lobe): expressive language —> language production and structure of language: like MLU, fluency, phonology, syntax, grammar, etc
Wernicke’s area (BA 22; temporal lobe): (auditory) receptive language —> language comprehension and understanding
Angular and supramarginal gyri: implications for reading and writing and spelling
Superior longitudinal fasciculus and arcuate fasciculus: white matter association tracts interconnecting the 4 cortical lobes
The patient has difficulty with _____ when the arcuate fasciculus is damaged
Repetition tasks
Neuroimaging allows for visualization of structure aka _______ and function aka ________
Structure → anatomy
Function → physiology
Location of Broca’s area
Inferior frontal gyrus
Location of Wernicke’s area
Posterior superior temporal gyrus
3 types of structural neuroimaging
CT
Cerebral angiography
MRI
These have good spatial resolution but not temporal
Identifies anatomical difference in healthy brains vs patients
2 types of functional neuroimaging
PET
fMRI
(EEG)
(MEG)
Identifies brain functioning during activity
Has good spatial AND temporal resolution
Pros and cons of structural neuroimaging: CT
CT scans: High spatial resolution allows us to see details of brain structure
Pros: able to distinguish between ischemic (blockage) or hemorrhagic stroke (bleed) Widely available; less expensive Cons: high radiation exposure Poorer spatial resolution than MRI
CT research results
Aphasia and patients with RH and LH damage were more severely affected than those with unilateral LH damage
Damage associated with Broca’s → transient speech impairment (not as severe, more easily changing)
Broca’s area and white matter → chronic nonfluent speech following stroke (more severe, more chronic long-term impairment)
Pros and cons of structural neuroimaging: Cerebral angiography
Able to view vascular abnormalities in cerebral blood vessels
Pros: detects hemorrhage, aneurysm, gives indication of stroke risk
Cons: radioactive dye, invasive, x-ray exposure
Pros and cons of structural neuroimaging: MRI
Better spatial resolution than CT
Water concentration varies depending on tissue type (gray vs white)
MRI can distinguish between tissue densities based on water concentration
Pros: excellent spatial resolution; no radiation; abel to see areas of cortical thickness
Cons: expensive, not appropriate for all patients
MRI research findings
LH stroke → with MRI lesions in anterior portion of insula is a predictor of verbal apraxia (motor planning)→ concluded it was NOT Broca’s area
MRI found structural damage or decreased blood flow in Broca’s area is best predictor of speech/lang production
Spontaneous aphasia recovery immediately following injury is related to increased brain function in areas surrounding acute lesion
Pros and cons of structural neuroimaging: DTI
Tractography technique with MRI: diffusion tensor imaging
Water moves freely along axon than across axon
DTI results show: damage to both anterior and posterior language zones may result in conduction aphasia → not just damage to AF
What is functional neuroimaging
Seeks to understand the location or timing of task-dependent neural activity in the brain
Looks at changes over time → temporal resolution
Pros and cons of functional neuroimaging: PET
Positron emission tomography (PET)
Pros: method of viewing neural regions during tasks with decent spatial resolution
Cons: radioactive tracer; reduced temporal resolution
PET research findings
A study to determine hemispheric activity/compensation during language task found LH “activation” in preserved regions among stroke pts was very similar to that observed in healthy individuals (
RH brocea’s area homologue inactivation was related to poorer language performance
Pros and cons of functional neuroimaging: fMRI
Functional magnetic resonance imaging
Measures change in magnetic field within brain during rest as compared with during task
Increased firing of neurons during task is related to need for more oxygen and glucose
Pros: no radioactive tracer, good spatial resolution
Cons: not a direct measure of neural activity, reduced temporal resolution, not appropriate for all pts
PET research findings
Like PET, fMRI studies in aphasia focus on cortical reorganization after injury suggesting both RH and LH are important
Stroke is a leading cause of serious ________ disability
long term
Those who arrive at the hospital within _____ hours of first symptoms have less disability than those with delayed care
3 hours
___% that fully recover after stroke
30%
What populations are at high risk of TBI
Children and older adults with falls as the leading cause
Stroke, TBI and AD have both ______ and _____ impact
Societal and personal impact → personal being the largest impact
Therapy goal of neurogenic communication disorders and what two aspects need to be considered when planning treatment
Goal: Maintain worthwhile quality of life
Treatment: social context and clinical aspects
Define impairment
Pathology; can be easily identified through testing
Define disability
The consequences of the impairment on everyday life
Define handicap
Value that the individual, family, community places on disability and the degree to which the individual is disadvantaged
Differences in individuals’ perception of disability and handicap should be identified and considered during assessment and intervention planning
Name a few psychosocial barriers that may impact person’s life and recovery
Mood and personality Perceived support Perception of stigma Emotional turmoil Self-esteem and identity
Name a few common themes and stages of individuals with illness
Coping strategies Social support Participant involvement in treatment decisions Strain of trying to endure Shock of institutionalization Suffering and uncertainty of illness
It’s important to try to understand what the patient is going through
What are some ways to practice a patient-centered approach
Inform → assessment
Respect -> patient preferences
Ask → goals of therapy; QoL
Educate → patients’ role and condition
True/false: depression is a barrier to rehabilitation
TRUE
Stages of emotional reaction to chronicity of illness
Shock Realization Denial Mourning Adaptation
Quality of life incorporates
Physical health Psychological health Independence Social relationships Personal beliefs
What is aphasia
Acquired neurogenic language disorder due to damage to left hemisphere
Language difficulty is primary
What is pure aphasia
Can hear but can’t understand (poor auditory comprehension)
No motor planning/coordination difficulty
Not a change in cognition
Aphasia may co-occur with sensory, motor and cognitive impairment
What is sensory aphasia
Deficits in language comprehension (receptive language)
Posterior injury
What is motor aphasia
Deficits in language production (expressive language)
Not motoric physical production
Anterior injury
What is crossed aphasia
Language impairment due to damage to nondominant hemisphere → typically right hemisphere in most people
true/false - there is only one theory of aphasia
False - there are many - no single unifying theory of aphasia
theory vs model
Theory - statement/idea
Model - tests the theory’s statement
What is the goal of aphasia theories and models
To further understand aphasia and language by studying pathology
Theory: classical associative connectionist paradigm
define
Dominant theory for assessments
Discrete centers of brain (anatomy) responsible for language (physiology) interconnected by pathways to facilitate info flow b/w areas
Theory: classical associative connectionist paradigm
What is the anatomy and connecting physiology
Posterior language center: Wernicke’s area → language comprehension (receptive language)
Anterior language center: Broca’s area → language production → expressive language
Name the pathway between posterior and anterior centers
Arcuate fasciculus
Theory: classical associative connectionist paradigm
What are the limitations
Links broad aphasic symptoms to discrete structures → doesn’t’ always match up through observations
Gave rise to “cognitive neuropsychological models” for understanding aphasia however these models are based on function and do not attach function to specific neural regions
What are two commonly used assessments for aphasia
Boston Diagnostic Aphasia Classification (BDAE)
Western Aphasia Battery (WAB)
Agreement b/w these two assessments is 27%
What are the two main classification criteria for aphasia
Fluency (utterance length)
Comprehension
Helps to drive treatment methods
Pros and cons for aphasia classification
Pros
Pattern of brain injury and behavioral effects
Helps to drive treatment
Cons
Doesn’t account for individual variation
Brain functions as holistic integrated unit → no discrete language centers
Ability to do or not do a task is more meaningful than classification
S/S of aphasia: Paraphasias (word choice errors)
Verbal/semantic
Word errors semantically related to target word
“Cup” → “bowl” (similar meaning)
S/S of aphasia: Paraphasias (word choice errors)
Literal/phonemic
Word errors phonemically related to target word
“Cup” → “Cat” (/k/ word initial)
Words are related in production
S/S of aphasia: Paraphasias (word choice errors)
Neologism and jargon
Newly created made up words with no content eg “slunker” “glimpop”
Jargon is neologism at conversational level
S/S of aphasia: Paraphasias (word choice errors)
Stereotypies and recurrent utterances
Stereotypies: non-propositional, not novel; ;produced constant repetition of sound segment “toe-no”; produced with correct prosody
Recurrent utterances: “ya know” repeated
Sometimes there’s a bust of in freq in emotional settings
S/S of aphasia: Paraphasias (word choice errors)
Perseveration: Atypical repetition of words, topics after that stimulus has ceased
When patient hears and produces target word and then used that target word for all following answer; knows they are saying incorrect word
First said banana and now calls all breakfast items banana
Define agrammatism
Reduced function words, reliance on content words
Typically seen in impaired fluency
What is BDAC
Boston Diagnostic Aphasia Classification
Based on classical associative connectionist theory with modifications
8 parameters of speech and lang production
Classifies 7 types of aphasia
30-80% of patients are easily placed into classifications
Describe the classifications of Werncikes and Brocas according to BDAC
Wernickes:
Higher score: articulation, phrase length(fluency), prosody
Lower score: paraphasias (word errors), anomia (word finding), sentence repetition, comprehension
Brocas:
Higher score: paraphasias (word errors), anomia (word finding), sentence repetition, comprehension
Lower score:articulation, phrase length (fluency), grammatical form, prosody
What is anomia
Common throughout all types of aphasia
Impairment in lexical retrieval (naming)
Use of pause filled reducing fluency
According to BDAE which aphasia type has low comprehension - Wernickes and conduction aphasia
Wernickes
However these 2 conditions have very different underlying biological mechanisms and patterns of language and communication so the fact that this test is only saying that auditory comprehension scores differentiate b/w the 2 is a limitation
What is WAB
Western Aphasia Battery
Aphasia assessment informed by BDAE
8 aphasia classifications based on performance on 4 parameters
What are the 4 parameters of WAB
Fluency
Auditory verbal comprehension
Repetition ability
Naming/word finding
What are the pros and cons of WAB
Pro:
Classifies nearly 100%
Increased reliability of testing due to direct instruction in scoring and test administration (test/retest)
Cons:
Based on same framework as BDAE but has different parameters adn classifications
Agreement in classification between BDAE and WAB is 27%
What is fluent aphasia
Posterior injury (wernickes)
Poor auditory comprehension
Speech is naturalistic and fluent
Normal utterance length
Lack of agrammatism (reduced function words)
What is non-fluent aphasia
Anterior injury (Brocas)
Good auditory comprehension reduced fluency (Utterance length is short and lots of pausing) Agrammatism (reduced function words)
True or false: some studies show damage to Broca’s is not a requirement for non-fluency
true
What is best approach for classifying aphasia (3 approaches)
Describe signs and symptoms of that particular individuals language impairment
Describe the impact on the different language domains (phonology, morphology, syntax, semantic, pragmatics)
Describe co-occurring impairments that may impact rehab
what is cognitive neuropsychological models and the 4 stages
single word processing studies help identify where the breakdown is in auditory and visual word processing by examining different stages of language comprehension and production.
Not representing regions of brain —> instead there are cognitive modules.
the independent stages help us to study disorders at various stages of impairment
4 stages:
- phonological (hearing) and orthographic (seeing) input lexicon
- semantic system –> gives meaning and context
- phonologic (spoken) and orthographic (written) output lexicon –> finding phonemic meaning
- written or spoken form —> cueing with phonemic cue can help with this stage
cognitive neuropsychological models
pros and cons
pro: help inform clinical intervention with model based theory; provide cognitive baseline for observations
cons:
- are modules truly independent or is there overlap?
- often based on single studies –> is it able to generalize
- doesn’t relate info back to neurobiology and regions of brain
