LCD 323: Exam 1

Aphasia Therapy Online: Reading Exercises

- single words and short phrases - matching upper/lower case letters - answering simple, written Y/N questions - auditory letter discrimination

Right Hemisphere Brain Damage (RHBD): Symptoms

- Cognitive deficits (problem-solving, reasoning) - Neglect (visual, like they can't see and don't consider things on the side they have visual neglect on) - Constructional impairment (writing is impaired) - Limb apraxia (motor planning problem, groping and awkward movements) - Anosognosia (lack of awareness of disorder) and Prosopagnosia (can't recognize faces) - Confabulation (tells a story that starts off as true but then becomes more made-up) - Communication deficits

Assessment is conducted to identify and describe

- Communication performance in the 4 modalities (comp and expression in verbal and written lang) - Effect of the disorder on the person's everyday (i.e. everyday activities and employment) (are they planning to go back to work?) - Contextual factors that serve either as barriers or facilitators of successful communication (what resources are in place) - The impact on Quality of Life for the individual

Specific Treatments

- Computer based treatment - Melodic Intonation Therapy - Reading treatment - Syntax treatment - Word finding - Augmentative and Alternative Communication - Script training - Semantic Feature Analysis

What types of material should be included in a comprehensive aphasia exam?

- Conversation (you try to engage person in conversation) - Open ended description (cookie theft pic, they can say whatever) - Word comprehension (need to understand single words) - Following commands (are they able to?) (hierarchy, 1 step directions to 5 step) - Listening comprehension for lengthy material - Automatic speech including rhythm and singing - Repetition (see if they can imitate) - Confrontational naming (can they label a picture for you?) - Word and sentence reading (decoding/comprehension) (starts easy and gets harder, hierarchy) - Writing mechanics, spelling dictation

Assessment may result in

- Diagnosis - Description of the characteristics of the disorder - Recommendations for intervention (therapy and goals of therapy) and support - Referrals for other assessments/services

Alexia

- Difficulty comprehending written material - Difficulty recognizing words - Difficulty decoding - Substituting associated words - Difficulty reading non-content words (i.e. to, from, the)

Agraphia

- Difficulty copying letters, words, sentences - Writing only single words (Broca's) - Substituting incorrect letters or words - Spelling or writing nonsense syllables (Wernicke's) - Writing run-on sentences that do not make sense (Wernicke's) - Writing agrammatical sentences

Auditory Comprehension Impairments

- Difficulty understanding spoken utterances - Unreliable answers to Yes/No questions - Failing to understand complex grammar structures (like passive: "Sarah was pushed by John") - Needing extra processing time - Misinterpreting figurative language (like metaphors, similes, poems, idioms) - Lacking awareness of errors

How could Therapy address Pragmatic impairment in a person with RHBD?

- Discuss the importance of turn0taking during conversation - Use simple articles from magazines and newspapers to stimulate conversation and work on topic maintenance

How could Therapy address Constructional impairment in a person with RHBD?

- Draw lines from A to B to C etc. (or play Dots) - Copy simple drawings - Use graph paper for writing words (sometimes they write very slanted, so this can help)

Classifying Aphasia: What ways are there to classify Aphasia?

- Expressive and Receptive - Non-fluent and Fluent - Motor and Sensory - Location of brain damage -- Broca's or Wernicke's Aphasia

Wernicke's Aphasia

- Fluent and well articulated, jargon and empty of content - Poor auditory comprehension

Conduction Aphasia

- Fluent verbal, paraphasic speech (may ask for the table when they want something on the table, semantic or phonetic switch-ups, neologisms/made-up words) - Auditory and visual comprehension relatively good - Writing skills are poor

Transcortical Motor Aphasia

- Good ability to repeat long utterances - Difficulty spontaneously answering questions - Mildly impaired auditory comprehension - Same symptoms as Broca's, but can repeat/imitate - Non-Fluent

How to Diagnose RHBD

- Interview (med chart and records, radiology results) - Informal tests (cognitive tasks and aphasia subtests) - Formal tests given by multiple professionals -- neurologist, neuropsychologist, occupational therapist and SLP

Cerebrum

- Largest part of the human brain - Associated with higher brain function, such as thought and action - Functions are contralateral (right hemisphere to left side of body, left hemisphere to right side) - Outer layer of the cerebrum is the cerebral cortex

Cerebrovascular Accident (CVA) or Stroke

- Most common cause of aphasia - Two types: Ischemic and Hemorrhagic

Transcortical Sensory Aphasia

- Similar to Wernicke's -- impaired auditory comprehension and verbal expression - Good ability to repeat words and phrases - May repeat questions rather than answer them (echolalia)

Etiologies of Aphasia

- Stroke/CVA (ischemic or hemorrhagic) - TBI - Brain tumor (infringes on areas of the brain, puts pressure on them) - Brain surgery - Brain infections (meningitis) - Other neurological diseases (degenerative diseases like Dementia)

Aphasia: Signs and Symptoms

- Verbal expression impairments - Auditory comprehension impairments - Written language impairments (agraphia or dysgraphia) - Reading comprehension impairments (alexia or dyslexia)

How could Therapy address Integrating information in a person with RHBD?

- Verbal sequencing tasks of everyday activities (like how you brush your teeth) - Verbal sequencing of cooking activities (like how to read a recipe) - Using scripts for simple conversation - Practice using the calendar, making charts, graphing items - Explain metaphors and similes - Read a short story and discuss, including inferencing - Verbalize directions to familiar places - Work on analogies (verbal puzzles)

Aphasia Therapy Online

- Website - Has Listening, Reading, Spelling, and Picture naming exercises

Aphasia Therapy Online: Listening Exercises

- auditory/word matching - auditory/picture matching - spell a spoken word - auditory letter discrimination

Aphasia Therapy Online: Spelling Exercises

- picture naming - spelling spoken words

Aphasia Incidence and Prevalence: Prevalence of aphasia is about ________________ people or _/______

1 million people or 1/250

Acquired Impairments

Aphasia, RHBD, TBI, Degenerative neurological conditions

Aphasia Incidence and Prevalence: ___% of individuals under 65 suffer aphasia after their first ischemic stroke

15%

Increases to ___% for individuals 85 and older

43%

Right Hemisphere Brain Damage (RHBD)

A group of neuromuscular, perceptual, and/or linguistic deficits that result from damage to the right hemisphere of the brain (and may include epilepsy, hemisensory impairment, and hemiparesis or hemiplegia)

Aphasia

A neurogenic language impairment due to localized brain injury that affects understanding, retrieving, and formulating meaningful and sequential elements of language

is aphasia acquired or congenital?

Acquired -- usually results from an injury to the brain

What specific language modalities does Aphasia affect?

All of them - Spoken language expression - Spoken/Auditory language comprehension - Written expression - Reading comprehension

Traumatic Brain Injury

Damage to the brain that results from bruising and lacerating caused by forceful contact (hitting their head or their head getting hit by something) that causes a disruption in its normal functioning

Prevalence

Cases that have occurred in a specific time period, people living with a condition in a specific time period

Ischemic Stroke (aka Occlusive Stroke)

Caused by complete or partial blockage (clot) of the arteries transporting blood to the brain, causing neurons to suffocate

Types of Ischemic Strokes

Cerebral arteriosclerosis, Embolism, Thrombosis, Transient Ischemic Attack (TIA)

Ischemic Strokes: Embolism

Fragment of material (that was already in the circulatory system) traveling through circulatory system hits a small brain artery and blocks the blood cells from getting to the brain

Non-fluent Aphasia

Has trouble formulating sentences and stuff

Time

If the other three things are happening (affected Face, Arm, and Speech) then it's time to call 911

F.A.S.T.

Face, Arm, Speech, Time

Degenerative Neurological Conditions

Dementia (and the many diseases under it, like Alzheimer's)

Alexia or Dyslexia

Difficulty with reading comprehension

Agraphia or Dysgraphia

Difficulty with writing

Fluent Aphasia

No trouble stringing sounds and words together, but it may not make sense

All the aphasias in which people have an ability to imitate or repeat (Transcortical Motor, Mixed, Transcortical Sensory, Anomic), what area of the brain must have been unaffected?

Perisylvian Area, that allows you to imitate

Hemorrhagic Strokes: Arteriovenous malformation

Poorly formed tangles of arteries and veins; arterial walls may be weak and give way under pressure and cause a hemorrhage in the brain

What is Broca's Area next to in the brain?

Premotor Area and Lateral Fissure

Arthrosclerosis

Pretty sure it's actually called atherosclerosis Too much traffic for the ambulance to get through I think it's an ischemic kind of stroke, because plaque gets into the inner walls of the arteries

What type of Dementia starts with word problems, and is a big thing with neurological degenerative diseases that cause Aphasia?

Progressive Aphasia

Temporal lobe functions

Smell and hearing; balance and equilibrium; emotion and motivation; some language comprehension; complex visual processing and face recognition

Occipital Lobe functions

Receives and processes visual information

Parietal Lobe functions

Receives sensory information; visual/spatial abilities

Global Aphasia

Severe impairment (I believe it's when both Broca's and Wernicke's areas are affected? Basically the worst of both worlds?)

Face

Is the face twitching? Drooping?

Speech

Is their speech slurred? Does it sound strange?

How do we detect a stroke?

We use F.A.S.T.

Types of Fluent Aphasia

Wernicke's, Transcortical Sensory, Conduction, Anomic

Thrombolysis

When clot-reducing medication is used to remove a clot that could/would/is cause/ing a stroke

What is a good way to work on Language expression through speaking and writing in a therapy session?

Speaking - saying "Good morning" or "How are you?" Writing - shopping list, posting on a blog, schedule

Broca's Aphasia

Telegraphic speech, comprehension better than expression

BDAE 1982

The Boston Diagnostic Aphasia Exam (looks like it also helps diagnose related disorders? says that on the book in the pic)

What kind of formal tests could an SLP give someone with suspected RHBD?

The Ross Information Processing Assessment (1996) and The mini-inventory of Right Brain Injury

Hemorrhagic Stroke

The weakened arterial wall bursts under pressure -- dangerous and often fatal

The cerebral cortex is divided into four sections, called "lobes": the __________ lobe, _________ lobe, ____________ lobe, and ____________ lobe

frontal, parietal, occipital, and temporal

Broca's Aphasia is in the _______________ or _________ of the brain, specifically the __________ lobe, whereas Wernicke's Aphasia is ________________ or ________ of the brain, specifically the ___________ lobe

anterior or front of the brain, specifically the frontal lobe posterior or back of the brain, specifically the temporal lobe

Aphasia: The localized brain injury is usually on the _______ side of the brain

left

RHBD: A right hemisphere brain injury usually affects the _______ side of the body because of ________________

left side because of lateralization

The Brain can be divided into 3 main parts: the ___________, the ___________, and the ___________

the Cerebrum, the Cerebellum, and the Brainstem

Arm

Can they raise their arms? Is one weak? Are their arms/wrists/hands tightening and curling upwards?

What is a good way to work on Language comprehension through listening and reading in a therapy session?

Listening - listening to a lecture or showtune, watching TV, listening to a podcast (podcasts are harder because there's no visual, may wanna give patient an outline before listening)

How could Therapy address Attention, Perception, and Neglect in a person with RHBD?

- Pointing to objects in the room in the left and right fields of vision - Listen to a bell rung in different fields - Identify the voice and clothing of those in the left field - Work simple to complex puzzles (must be language AND cognition based) - Read text and try to cue patient to look to the left margin - Scan or sort alphabet tiles - Answer questions about a calendar (especially on left)

How could Therapy address Reality orientation in a person with RHBD?

- Practice answers to the question of person, place, time, and purpose - Use strategies of cue cards, pictures, calendar - Pneumonics for memory

How could Therapy address Emotional and prosodic impairment in a person with RHBD?

- Practicing facial expressions - Repetition of sentences difference ways (with diff stresses) - Use of the same sentence with different emotive prosodic characteristics

Anomic Aphasia

- Primary difficulty is word finding - Can repeat - There's a range for this, some people are worse than others

Aphasia Incidence and Prevalence: Estimated that there are _______________ new cases of aphasia in the US each year

180,000

____% of individuals are LEFT hemisphere dominant for language

98% -- so a lot of people, but not everyone

Types of Non-Fluent Aphasia

Broca's, Transcortical Motor, Global, and Mixed (isolation syndrome)

Ischemic Strokes: Cerebral arteriosclerosis

Buildup, characterized by thickening/hardening of arterial walls as a result of plaque

Cerebellum functions

Motor learning and some language (processing, higher level cognitive and affective/emotional functions)

Aphasia Therapy Online: Picture Naming Exercises

Written and spoken picture naming

Ischemic Strokes: Transient Ischemic Attack

TIA or mini stroke -- usually all functioning resolves in 24 hrs, resolves pretty quickly

Verbal Expression Impairments

- Anomia - Effortful or halting speech - Telegraphic speech (single words, short fragmented phrases) - Syntax errors - Jargon - Fluently stringing together nonsense words together and real words, but leaving out relevant content

What areas would an SLP test in someone with suspected RHBD?

- Appreciation of humor - Comprehension of idioms and/or metaphors - Production of appropriate stress of intonation - Problem solving - Narratives and discourse - 4 Lang Modalities

Treatment Techniques for RHBD: What should Therapy address?

- Attention, Perception, and Neglect - Constructional impairment (due to left side neglect) - Reality Orientation - Integrating information - Pragmatic impairment - Emotional and prosodic impairment

RHBD Communication Deficits

- Prosody (aprosodia, may speak monotone without much expression) - Figurative language - Pragmatics including discourse and topic maintenance - Turn taking - Semantics dependent on prosody (happy "content" vs. stuff "content") - Drawing inferences (cognitive) - Ability to use and define abstract words ("justice" and "peace") - Story arrangement/ability to tell a story in a certain order - Comprehension of spoken narratives - Comprehension and expression of emotive speech - Comprehension and expression of linguistic information (being able to give info expressively and understand what people are saying)

Stroke Prevention: What can someone do to reduce their risk of having a stroke

- Quit smoking - Limit or eliminate alcohol - Keep a healthy diet - Maintain healthy weight - Exercise and Physical activity - Be proactive (educate yourself and go to the hospital if you have a TIA and get checked out regularly)

Treatment (of Aphasia?)

- Restoring language abilities - Strengthening intact modalities - Compensating for impairment - Training family and caregivers - Facilitating generalization of skills - Education

What connects Broca's and Wernicke's Area?

Arcuate Fasciculus (looks like an arc)

Ischemic Strokes: Thrombosis

Artery gets gradually blocked by debris in the blood over the course decades

Incidence

Brand new cases identified in a period of time

How much farther can we break down the Cerebrum?

Divided into right and left hemispheres, 4 lobes in each hemisphere

Frontal Lobe functions

Goal-directed behaviors; concentration; emotional control and temperament; voluntary movements; coordinates messages from other lobes; complex problem solving; involved in many aspects of personality

How can we further break down the Brain Stem?

It's got the Midbrain, Pons, and Medulla (and the Basilar artery and Vertebral arteries?)

What is Wernicke's Area next to in the brain?

Lateral Fissure

Receptive Aphasia

More difficulty with comprehension of language than expressing language through speaking and writing

Expressive Aphasia

More difficulty with speaking/verbal expression and writing than comprehension Writing comprehension should mirror speaking

Brain Stem functions

Provides the main motor and sensory innervation to the face and neck via the cranial nerves

Hemorrhagic Strokes: Aneurism

Sac-like bulging of the arterial wall, can rupture causing a cerebral hemorrhage

Mixed (isolation syndrome) Aphasia

Same as Global, but can repeat