COMD 500 Ch. 8 – Flashcards
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Aphasia
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A language disorder that is acquired sometimes after an individual has developed language competence -"absence of language" -"without language"
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Comprehensive Definition of Aphasia
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-A disturbance in the language system after language has been established or learned -Results from neurological injury to the language-dominant hemisphere of the brain -Included disturbances of receptive or expressive abilities for spoken and written language
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Considerations of Aphasia
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-Not a developmental disorder -Not a psychiatric problem -Not a motor speech disorder
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Ischemic Strokes
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Happen when the blood supply to the brain is blocked because of an occlusion somewhere in the artery -Thrombosis -Embolism
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Hemorrhagic Strokes
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Result when a blood vessel or artery ruptures and excessive amounts of blood enter the brain
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Risk Factors for Aphasia
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Uncontrollable: -Age -Gender -Racial or ethnic background -Family history Controllable: -Hypertension -Diabetes -Tobacco smoking -Alcohol use
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How is aphasia classified?
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-The classification system for the aphasia subtypes is known for taxonomy -It draws upon those characteristics of aphasia that most differentiate disorders from one another
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Behavioral symptoms of Aphasia
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-Some persons with aphasia are unable to initiate speech at all or struggle to get out more than one word at a time -Others can initiate speech well but produce meaningless utterances -Language deficits seen in aphasia are differentiated by their impact on: (1) fluency, (2) comprehension, (3) repetition, (4) naming, (5) reading and writing
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Subtypes of Aphasia
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-Global aphasia -Broca's aphasia -Wernicke's aphasia -Conduction aphasia -Anomic aphasia -Transcortical motor aphasia -Transcortical sensory aphasia
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Global Aphasia
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-Occurs as a result of a large region of brain damage or multiple sites of brain injury in the language-dominant hemispheres -This aphasia syndrome results in deficits across all language modalities, a person is likely to be non-fluent and have poor language comprehension
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Broca's Aphasia
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-Results from damage to the frontal lobe of the brain -Typically produces slowed, halting, and labored speech, yielding what some describe as a telegraphic or robot-like quality -Person exhibits mild to moderate auditory comprehension problems, particularly when messages increase in length and complexity or when contextual cues are removed
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Wernike's Aphasia
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-Results form brain injury to the superior and posterior regions of the temporal lobe, possibly reaching to the parietal lobe of the language-dominant hemisphere -Person produces spontaneous speech that flows well with normal prosody: (1) prosody, (2) logorrhea, (3) neologisms, and (4) jargon
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Conduction Aphasia
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-Results from injury to the temporal-parietal region of the brain, typically a connecting pathway called the arcuate fasciculus -Hallmarks include difficulties with repetition and reading aloud
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Anomic Aphasia
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-Not identified with a specific area of the brain or a site of lesion -Person is fluent and expressive with relatively few deficits in language expression and comprehension with the exception of naming -Most pervasive type of chronic condition, even after treatment, and is the MOST common of aphasia profiles
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Transcortical Motor Aphasia
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-Results from damage to the frontal lobe, typically the superior and anterior portions -Symptoms are similar to Broca's aphasia EXCEPT that these individuals have repetition skills that are far better than their spontaneous speech -Most clients with this syndrome also demonstrate strong performance in oral reading
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Transcortical Sensory Aphasia
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-Results from injuries to the language-dominant hemisphere at the border of the temporal and occipital lobes or the superior region of the parietal lobe -Demonstrate classic symptoms of Wernicke's profile EXCEPT they have stellar repeptition skills -Echolalia
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How is Aphasia Identified and Treated?
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Assessment Process: -Requires a multidisciplinary team -Spontaneous recovery SLP seeks to answer these questions: -Is aphasia present? -What type and where is the site of injury? -What treatment plan should be used? -What is the prognosis? -Any referrals?
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Prognostic Indicators
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Those variables that assist in predicting recovery -Site of the brain injury -Type and size of the injury -Type and severity of aphasia -Handedness -Age -Pre-morbid health -Motivation for treatment Often, prognostic indicators are used to specify treatment
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Treatment of Aphasia in Evidence-Based Practice
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The goal of aphasia treatment is to correct or compensate for speech language deficits so that individuals can communicate functionally in their daily routines -Evidence-based practice
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Determining the Treatment Setting
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-Aphasia therapy is not limited to the speech-language pathologist and client working in a clinic or office setting -Therapies should encompass other environments to facilitate carryover and generalization of progress to different settings -A group approach is another consideration for treating aphasia
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Measuring Outcome
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Effective language treatment for persons with aphasia should be measured based on their ability to communicate in real-world situations -Real world communication (i.e. discourse) -Functional outcomes
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Fluency
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A qualitative aspect of communication and speech that is used to describe its forward flow, including its phrasing, intonation, and rate -Fluent speech -Non-fluent speech *Short, choppy phrases *Slow, labored production of speech *Grammatical errors *Telegraphic quality
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Auditory Comprehension
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-The ability to understand spoken language -Can be referred to as language comprehension -Aphasia characterized by comprehension problems can be referred to as receptive aphasia
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Repetition
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The ability to accurately reproduce verbal stimuli on demand -Major factor that differentiates between some aphasia subtypes -Can be seriously compromised
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Naming
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-The ability to retrieve and produce a targeted word during conversation or more structured tasks (aka word retrieval/finding) -Anomia: term used to describe word-finding problems or the inability to retrieve a word -Paraphasia: errors in naming *Semantic (cat->dog) *Phonemic (cat->car) *Neologism (skrit->dog)
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Reading and Writing
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-Involves the comprehension and expression of written language -Reading and writing deficits often parallel verbal language deficits *occasionally, reading and/or writing are relatively spared, providing an important path for communication to occur
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Right-hemisphere Dysfuntion
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Definition: results from neurological damage to the right cerebral hemisphere -Aphasia can result with left-hemisphere damage -When damage affects the right hemisphere, language and cognition may be impacted, but the symptoms are quite different form those seen with aphasia (cognitive-linguistic disorder)
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Characteristics of RHD
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-Anosagnosia -Unilateral neglect -Prosopagnosia -Flat affect -Compromised pragmatics: difficulty understanding jokes/humor; impaired prosody and intonation -A tendency toward using wordy expressions, providing tangential or inaccurate info (may include confabulation) -Difficulty understanding or using higher-level cognitive-linguistic skills -Dysarthria or dysphagia (when neuromuscular systems are compromised)
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Anosagnosia
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Lack of awareness of cognitive-linguistic deficits and possible denial of problem areas
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Unilateral Neglect
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Lack of awareness of the left side of the body and external stimuli to the left side
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Prosopagnosia
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Difficulty recognizing faces
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Identification of RHD
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-Like left-hemisphere injury, right-hemisphere damage requires a comprehensive speech-language assessment as part of an interdisciplinary team assessment -Specialized batteries are available specifically for the RHD population, such as the Mini Inventory or Right Brain Injury (MIRBI) -Can be more difficult to identify, because deficits are less obvious
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Treatment of RHD in Evidence-Based Practive
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-Knowledge of treatments for RHD is more limited than that for left-hemisphere damage and aphasia -Initial therapy for RHD targets the management of attention and visual disruptions, since these impact productive treatment activities -Therapy also targets higher-level cognitive-linguistic tasks, such as thinking through functional problems
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Traumatic Brain Injury
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Definition: refers to neurological damage to the brain resulting form the impact of external forces -Epidemiology studies show that TBI is a leading cause of death and disability in the US -Given the frequent long-term medical, vocational, and social needs of affected individuals, TBI represents a substantial health care issue in the US
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Characteristics of Traumatic Brain Injury
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-Open head: occurs when the skull and the meninges have been penetrated -Closed head injuries: the brain is jostled within the skull, yielding diffuse brain injury -Polytrauma: mixture of open and closed head injury, multiple medical concerns, and post traumatic stress disorder
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Identification of TBI
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-The SLP works as a member of an interdisciplinary rehabilitation team to plan for treatment following a TBI -The Glasgow Coma Scale (GCS) rates the best-observed response for eye opening, verbal response, and motor response to characterize an individual's functioning form severe to mild TBI 1. eye opening response 2. best verbal response 3. best motor response *Totals score
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Sports Related TBI
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CDC estimates 300,000 sports related TBIs each year -Only included TBIs with loss of consiousness -LoC only account for 8-19.2% of sports related TBIs -Therefore, ~1.6-3.8 million sports related TBIs each year -Athletes tend to under-report: even this estimate may be low!
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Chronic Traumatic Encephalopathy
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"Punch drunk syndrome" "Dementia Pugilistica" CTE (Modern) -Professional US football conservatively 3.7% incidence (some evidence for wrestling & hockey) -Main symptoms typically years after career -Histological signs can be seen early in life (i.e. University player Owen Thomas who committed suicide at 21) -Seen in animals and humans with single blast exposure
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TBI Communication: Discourse Impairment
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Macro-linguistic Deficits -Reduced cohesion and coherences -Impaired organization -Problems with story components and grammar Difficulty with Inference -Impaired social cognition Reduced Info and Efficiency -Tangential language -Difficulty identifying communication breakdowns and repairing -Shorter and less complex utterances Reduced initiation and maintenance -Dependent on others to maintain the flow of conversation Micro-linguistic deficits -Meaning within words, phrases, or sentences
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TBI and Communication: EBP
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EBP: cognitive-linguistic therapy (acute, post-acute); intervention to improve social communication skills *Practice guidelines: -Intervention for specific areas of deficit (i.e. reading, word-finding, narrative production) -Treatment intensity is a key factor *Practice options: -Group based intervention for language and social communication deficits -Computer based interventions as an adjunct to clinician guided treatment *Treatment interventions will vary according to an individual's level of impairment as reflected by the Rancho scales -Levels I to III: severe -Levels IV to VI: middle -Levels VII to X: mild
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TBI and Communication: Treatment
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Types of tasks *Social skills training -Pragmatic communication behaviors (listening/starting a convo) -Social perception of emotions and social inferences -Psychotherapy for emotional adjustment -Self instructional training strategies for emotion perception deficits *Narrative/conversation
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Dementia
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Definition: a chronic and progressive decline in memory, cognition, language, and personality resulting from CNS dysfunction -The diagnostic criteria of the American Psychiatric Association identify 3 defining traits: (1) Memory impairment (2) Impairment in cognition skills (3) Presence of aphasia, apraxia, or agnosia
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Causes of Dementia
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-Loss of neurons -Loss of function/communication between neurons -Build up of protein deposits
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Types of Dementia
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-Alzheimer's disease -Vascular dementia -Lewy body dementia -Fronto-temporal dementia -Parkinson's disease -Primary progressive aphasia
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Identification of Dementia
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-A team of professionals evaluates suspected dementia to verify its presence, cause, and course of intervention -Medical testing will rule out other treatable illness that may appear like dementia -More comprehensive testing by the SLP typically involves the complete Arizona Battery for Communication Disorders of Dementia
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Treatment of Dementia
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-Research continue to develop more effective pharmacological treatments to combat degenerative changes associated with dementia -The majority of medications currently approved by the FDA for dementia target those individuals in mild to moderate stages -SLPs often focus on compensatory strategies
