Weeks 4-7 Flashcards
Anomia: S/S
impairment in naming; universal impairment in aphasia; deficits can occur in both semantic processing and phonological processing
Anomia: Assessments - formal
Formal: BNT, expressive vocab test, PPVT-II; error analysis: compare error patterns across different tasks to determine level of semantic error
Anomia: Assessments - informal
Informal: language samples, conversation, S/A, sentence completion; naming body parts
Anomia: Assessments - structured vs naturalistic
structured: confrontation naming tasks pressure of naming in the moment like picture or object naming;
naturalistic: word finding during conversation
Anomia: phonological input vs output
Input triggers output
lexical input: visual object or written word recognition system; rhyming judgments will be difficult b/c harder to make judgment about two things that sound similar
lexical output - retrieving name in written or spoken form;
Anomia: semantic input vs output
Input triggers output
lexical input - written word, picture; category sorting for closely related semantic categories
lexical output: speaking word or writing word;
Anomia: neural structures
diffuse LH both perisylvian and extrasylvian;
left-inferior temporal for semantic naming (lexical input)
Anomia: two stages for input and output mechanisms
Semantic
Phonological
Anomia: informal methods
responsive naming, convergent naming, divergent naming, verbal fluency;
responsive naming: Provide name of something when given a description
convergent naming: SLP different examples within category and patient gives category eg: banana, apple, pear → fruit
divergent naming: SLP gives category and patient gives different examples within category eg: name 3 round objects
verbal fluency: when SLP asks patient to name as many things within a category within 1 min (divergent naming with time limit)
Anomia: naming assessment
Why consider different characteristics of stimulus
Important to vary complexity to test where breakdown is occuring
Nouns vs verbs Semantic categories Length Familiarity/frequency Age of acquisition
Anomia: naming assessment
Semantic error analysis
Error Patterns:
Comprehension errors
Naming errors
Oral word reading and writing may NOT be affected
Difficulty interpreting meaning of gesture and objects/pictures
Banana vs pear → same semantic category
Banana vs hammer → higher level error at semantic level
Anomia: treatment for lexical retrieval
Goal: restore function and compensatory strategies
Restore function - tasks focusing on accessing semantic and phonological word retrieval
Compensatory - gesturing, writing, circumlocution (talk around target word)
Cueing hierarchies → semantic cues → phonemic cues → different modality (eg written form)
true/false
If spelling knowledge is preserved in anomia, then spelling knowledge may facilitate word retrieval through phonemic self-cueing
true
Sentence level Auditory Comprehension:
Determine sentence complexity
2 things can affect sentence complexity –> reversibility and complexity
Semantic reversibility → semantically reversible sentences are MORE difficult to understand → Nonreversible are easier b/c we rely on word meaning to interpret if we don’t understand syntax
Sentence structure → more complex is more difficult → the more verbs the more complex
Single Word Auditory Comprehension:
Determine sentence complexity
Examples of semantic reversibility
More complex –> more verbs and passive
Reversible → The girl hugged the boy (more complex and difficult)
Nonreversible → The girl hugged the doll
Single Word Auditory Comprehension:
Determine sentence complexity - canonical vs noncanonical
Simple: SVO = canonical word order (active sentence)
Complex: noncanonical word order = deviations from SVO structure eg OVS (passive sentence)
“The doll/boy was hugged by the girl”
SW - Auditory Comprehension:
describe
inability to understand the meaning of the word despite correct repetition
SW - pointing to a named object, following directions like “jump”
SW - Auditory Comprehension:
treatment
Based on stimulation approach → system is uncoordinated/reduced efficiency
Pointing drills
Following directions
Y/N questions
Sentence level comprehension:
treatment
Sentence completion: “cloze procedure”
open-ended questions and storytelling
Mapping therapy for Broca’s
Verb-centered treatment
Sentence level comprehension:
Informal vs formal treatment
Informal: spontaneous speech → cookie-theft picture
Formal: aphasia batteries like PAL subtest
Sentence level comprehension:
Mapping therapy treatment
Therapy specifically for Broca’s asyntactic comprehension impairments
Goal: map syntactic and semantic levels of sentence representation
Syntactically Oriented Treatment
Type of sentence-level treatment
SPPA → improves naturalism of context and interaction
Treatment for underlying forms - ID action, agent, theme
What is Auditory Comprehension
Ability to understand spoken language
When assessing comprehension remove expression
Single Word Auditory Comprehension:
Formal vs informal assessments
Formal: aphasia batteries, BDAE (or BNT subtest)
Informal: pointing, simple y/n responses, matching
Sentence level Auditory Comprehension
Formal vs informal assessments
Formal: aphasia batteries typically have sentence level comprehension sub-tests
Informal: 1-3 step directions (very functional); simple/complex Y/N questions; answering open ended questions
Sentence level Auditory Comprehension
describe
Common among severe aphasia types
Stages based in SW comprehension BUT word meaning alone is not the “whole” meaning
Broca’s aphasia → asyntactic comprehension → difficulty comprehending noncanonical sentences that are semantically reversible (mapping breakdown)
“The boy was hugged by the girl”
Pure Alexia: S/S
Marked impairment of reading or spelling with preserved verbal language comprehension & production
Letter-by-letter reading
Word-length effect: as word gets longer, becomes more difficult
Global/Deep Alexia: S/S
<30% correct on single-word or reading tasks
spelling typically more impaired
Phonological Alexia/Agraphia: S/S
Struggle to map sound system with writing system; phonological system is impaired; semantic system is intact
Lexicality effect – better at real words than non-words;
morphologic errors in reading (drive, driven), spelling errors in similar words (bird, bride)
Impairment noted at text level
Surface Alexia/Agraphia: S/S
semantic system is impaired; phonological system intact
Regularity effect – phonological approach good for regularly spelled words/non-words but breaks down for irregularly spelling (e.g., phone = fone)
Spelling worse than reading
Allographic Agraphia: S/S
Impairment converting graphemes to letter shapes (can’t write lowercase when given uppercase)
Apraxic Agraphia: S/S
Motor programming of handwriting impaired – falls more in domain of OT
Global/Deep Alexia: treatment
Treatment often lexical in nature to retrain specific words
CART (copy and recall treatment)
Phonological Alexia/Agraphia: treatment
Strengthen mapping
Strengthen phonological skills with “key word” approach
Reading and spelling treatment
Surface Alexia/Agraphia: treatment
Retraining irregular orthographic representations
Problem solving
surface aka semantic
Allographic Agraphia: treatment
Lexical spelling treatment – repeated copying of letters
Using alphabet card
Apraxic Agraphia: treatment
Drilling or refer to OT
Alexia/agraphia: semantic vs phonological
Individual variation counts → S/S are important not categorizing
Central processing: Phonological and Semantic
Phonological → perisylvian
Semantic → extrasylvian
Orthographic → extrasylvian
If phonological is impaired…
Lexicality effect → better at real words than non-words; morphologic errors in reading (drive, driven)
Semantics are intact → phonological system is impaired
Syntactic impairments evident at text-level
Damage to perisylvian
If surface (semantics) is impaired…
Regularity effect → phonological approach good for regularly spelled words/non-words but breaks down for irregularly spelling (e.g., phone = fone)
Phonological system intact → semantic system is impaired
How do you assess phonological alexia/agraphia
Lexicality effect
Reading errors
Spelling errors
Minor errors at SW level → errors occur at text-level (longer length sentences)
How do assess surface (semantics) alexia/agraphia
Overeliance on sublexical processing - C-A-T
Good phonological ability → poor semantic ability
Spelling is worse than reading
Regularity effect
Damage to extrasylvian
Regularity effect
Occurs in surface (semantic) alexia agraphia
Phonological approach works well for regularly spelled words and nonwords → breakdown occurs with irregular words
phone → fone; choir → kwire; circuit → serquit
How to treat reading and writing impairments
All the ways to treat Alexia and agraphia
So like Pure Alexia would be:
Brief Exposure to written words & Multiple Oral Re-Reading
Global & Deep Alexia & Agraphia:
CART (call & recall therapy)
Phonological Alexia & Agraphia:
Strengthening Phonological Skills (key word approach)
Sentence & paragraph level reading treatment
Surface Alexia & Agraphia:
CART again
Problem Solving with an electronic speller
Allographic Agraphia:
Lexical Spelling Treatment (practice writing the letters from a model)
Alphabet card (to compensate)
Apraxic Agraphia:
Practice copying written words with extensive feedback
In severe cases, treatment won’t help
Phonological alexia/agraphia: grammatical class effects
Nouns (easy) → verbs → function words (hard)
Pure alexia: treatment
Goal is to increase speed of word recognition and accuracy
Brief exposure to written word → forces them to focus on holistic word recognition
Multiple oral rereading -> top-down approach; not SW → text level (longer strings of text) is more functional
Form → content → use
Structure → semantics → pragmatics
What is pragmatics
Branch of linguistics with the way language is used
Social aspect of language
The use of abstract symbols that are ruled based to convey meaning in a social context
Pragmatic competence
The ability to understand the speaker's intended meaning Read nonverbal cues Not overly stating Theory of mind Idiom, sarcasm (nonliteral)
Pragmatic behavior difficult for brain injury
self-correction/self-monitoring
Have difficulty using contextual info to generate inferences
Pragmatic: informal vs formal assessment
Informal: narrative, interviews, observe behavior
Formal: rating scales, checklists, standard assessments → CADL
Pragmatic: treatment
PACE
More naturalistic context; also used for word finding
What is discourse
Any form of communication
Can be monologue or dialogue
Discourse genres
Narrative
Procedural
Expository
Conversation
Discourse: analysis: psycholinguistic and sociolinguistic
Psycholinguistic: Focus on form and connected discourse
Sociolinguistic: focus on use; examined in context
Discourse: treatment
Based on principles of experience-based neuroplasticity nowadays utilized computerized technology
not easily identified by traditional aphasia batteries b/c we are looking at larger units of language
Discourse: treatment
Discourse level and social skills
Discourse level treatments - hierarchical discourse therapy: focus on relevant responses, increased production and abstractions
Social skills treatment: focus on quantity of info, clarity of expression, style of interaction
Formulaic language - define
Overlearned words, phrases or longer linguistic units that are: Known to native seeker Occur naturally in discourse - important of social interaction Eg sentence starters
Formulaic language: 3 types
Automatic speech → counting
Recited speech → humpty dumpty
Formulaic expressions→ idioms, pause fillers, lexical bundles
Formulaic language: t/f
Neural underpinnings of formulaic language are different compared to novel language production
True
formulaic language → RH
Formulaic language is preserved when novel language (LH) is not
Formulaic language can be used to elicit language “salt and ____” “mary had a little ___”
GRICES maxims
For pragmatics
quantity, quality, relation, and manner
Name a few pragmatic behaviors
Turn taking
conversational skills,
the use of our non-verbal communication skills,
understanding non-literal language, interpreting and expressing emotions
Politeness markers
Pragmatics competences: what is the best informal assessment
narrative analysis (storytelling, interview, etc) is best informal assessment
Anomia: phonological error patterns
Error Patterns: Comprehension preserved Errors in oral naming and word reading Difficulty activating output lexicon Disturbance in internal structure of phonological representation
