Neurological Communication Disorders Exam 2

Western Aphasia Battery (WAB)

consists of four language domains and three performance domain subtests; assess following linguistic tasks - content, fluency, auditory comprehension, repetition and naming, naming; assesses non-linguistic skills such as drawing, calculation, block design, praxis; diagnosis is based on criterion cut scores from quotient systems - helps determine type of aphasia, which may change based on their performance; possible 8 subtypes - global, conduction, wernicke's, broca's, anomic, transcortical motor, transcortical sensory, and isolation aphasia; bedside version is available; provides information about linguistic and nonlinguistic skills and differential diagnosis information

Relatively preserved repetition abilities

Transcortical sensory and anomic aphasias are distinguished from Wernicke's and conduction aphasias by...

Life Participation Approach to Aphasia (LPAA)

Treatment approach that we use which focuses on helping individuals with aphasia and others affected by it in achieving their immediate and long-term life goals - spouses, children, frineds; immediate goals could be going back home; long term could be communicating wants and needs, call family members

syndrome-based, or model-based

Treatment approaches may be classified as ______-based approaches or ______- based approaches.

True

True or false. Brain damage may cause changes in personality and emotions.

False

True or false. Damage specific to Broca's area always produces Broca's aphasia.

Transcortical motor aphasia

Which aphasia may be associated with dysexecutive aphasia?

1. case history; 2. neuroimaging findings; 3. aphasia testing; 4. Rule out presence of comorbidities

What is included in the assessment protocols for aphasia?

30-35%

What is the prevalence of depression in people with aphasia?

anomic and conduction --> transcortical sensory aphasia --> wernicke's aphasia

What is the prognosis of each receptive aphasia from better to worse?

Mini Mental State Examination (MMSE), Montreal Cognitive assessment (MoCA), 7-minute screener, CLIQT

What tests can be used for determining mental status?

Catastrophic reaction

a form of massive denial where a person is unable to maintain a biologic homeostasis; typically seen in Broca's or global aphasia; can range from turning away from communication partner to reacting violently; may not have a lot of control over these reactions; could be temporary or long lasting

afferent conduction aphasia

damage in temporal lobes leading to impaired repetition and memory deficits

Why Transcortical Motor Aphasia may be considered an executive dysfunction

damage to extra-sylvian areas leads to deficits in verbal initiatives rather than deficits in language knowledge - problems with higher level processing; shares features with prefrontal syndrome but specifically with regard to verbal processes; damage to extra-sylvian areas does not affect language comprehension but rather affects meta-cognition; prefrontal cortex is associated with metacognition rather than pure cognitive abilities

Wernicke's aphasia

deficits in understanding individual isolated spoken words, but deficits in understanding words in context; more posterior lesions can cause deficits in vision (written language)

Melodic Intonation Therapy (MIT)

designed for individuals with nonfluent aphasia; MIT combines several techniques including intoned speech, unison production with the clinician, and lip-reading; utilizes right hemisphere skills to help with language; simple 2-3 syllable phrases, to speaking 5+-syllable phrases, across 3 levels of treatment

Transcortical Motor Aphasia

different views exist regarding whether this is a language disorder or an executive dysfunction; some may consider it to be a secondary and not primary aphasia syndrome; some may refer to it as "dysexecutive aphasia"

Primary Progressive Aphasia (PPA)

a neurological disorder that begins with a left hemispheric lesion followed by damage to right hemisphere; all 3 subtypes have been associated with neuropsychiatric features including depression, anxiety, irritability, disinhibition, and apathy; aphasia but no stroke; left hemisphere degeneration followed by right hemisphere degeneration followed by right hemisphere degeneration; considered a cognitive communication disorder

Striato-capsular aphasias

affecting structures of basal ganglia; includes anterior damage to internal capsule and putamen, posterior capsular-putamen damage, and anterior and posterior damage of the basal ganglia

Stroke Impact Scale (SIS)

assesses a person's difficulty in general domain such as mobility, physical health, and communication domains

Language Modalities Test for Aphasia (LMTA)

emphasizes on role of auditory and visual inputs and outputs on language task; responses are scored on a scale; 5 possible types of aphasia subtypes - semantic, syntactic, pragmatic or expressive, jargon, and global aphasia; allowed a differential scoring system for errors (rather than just pass/fail); allowed a detailed description of an individual's errors from a psycholinguistic perspective

Mixed Transcortical Aphasia (MTA)

extremely rare; presence of both transcortical motor and transcortical sensory aphasias; lesions may include isolation of perisylvian areas, frontoparietal areas, or left thalamic areas; sometimes may include hemianopia (blindness in half of visual field); sometimes occurs in viral diseases and after drug overdose

Features of conduction aphasia

fluent verbal expression including normal average phrase length along with pauses; characterized by expressive language deficits that exceed the level of auditory comprehension deficits; speech production includes errors in sound selection and sequencing followed by self-correction attempts; more speech errors during repetition tasks compared to spontaneous speech tasks

Anomic aphasia syndrome based approach

goal is improvement of word retrieval; tasks may include variety of confrontational naming and nonconfrontational naming such as object and picture naming, priming, recall of category members, word associations, antonym and synonym production, description of busy pictures; programs focusing on improvement of phonological mapping such as oral reading with phonological cues

Functional assessment

goal is to evaluate a person's performance on everyday functional communication behaviors in structured role-playing scenarios; includes encouragement of use of any response modality (verbal, non-verbal, gestural); more ecologically valid of assessment compared to standardized tests; may include use of quality of life instruments, rating scales, and questionnaires

Semantic Feature Analysis (SFA)

goal is to improve ability to retrieve target vocabulary; used with patients with anomic aphasia; client produces words semantically related to the target word; may use chart with conceptual associations - semantic networks

Transcortical sensory aphasia syndrome based approach

goal is to improve auditory-verbal comprehension; errors are due to disconnect between the cognitive system and the input and output lexicons, impairment of the cognitive system, or due evolution from Wernicke's aphasia over time; program involving pairing of auditory input with another modality and reconstruction of semantic relationships is often helpful - using headphones for auditory direction along with a written script

Cognitive Approach to treatment of Auditory Comprehension

goal is to improve comprehension for spoken language in natural and everyday situations; used for fluent aphasics; patients need to have relatively good graphomotor skills and adequate alertness - give them things in a written manner rather than having them listen

Visual Action Therapy (VAT)

goal is to improve the use of communicative gestures, facilitate improved verbal expression; useful for individuals with non-fluent aphasia and minimal output

Phonologic Component Analysis

goal is to improve word finding/naming skills, it helps to strengthen activation of lexical networks; typically used with individuals with anomic aphasia; borrows some concepts from SFA; helps with naming; words beginning with a particular letter or phoneme or containing specific letters --> words that end with -ed, or words that start with Te- etc.

Wernicke's syndrome based approach

goal is to reduce severity of auditory comprehension defictis; stimulation procedures to facilitate a structured content and carefully controlled difficulty levels and administered with picture matching, word recognition, item sequencing, answering questions, and following directions

Voluntary Control of Involuntary Utterances (VICU)

goal is to stimulate the use of propositional speech for functional communication among individuals with non-fluent aphasia; useful for individuals with relatively spared abilities to repeat printed words

treatment considerations for receptive aphasias

goal of treatment is to improve the individual's communication in functional or social settings by either facilitating the accuracy of language responses, exploit residual linguistic and nonlinguistic cognitive skills, or developing use of new strategies for increasing effectiveness of individuals' communicative attempts; treatment may include stimulation of auditory-verbal associations; treatment for less severe aphasias focus more on remediation of expressive deficits such as paraphasias and word retrieval failure

Typical features of Transcortical Motor Aphasia

impaired initiation of verbal output, anomia, short phrase length (0-5 words per breath), good auditory comprehension, good repetition

Intensive Comprehension Aphasia Program (ICAP)

intensive treatment focusing on neuroplasticity; based on an ICF model; living with aphasia includes consideration of the following factors: severity of aphasia, participation in life situations, communication and language environment, personal identity, attitudes, and feelings - focus more on the person and less on the diagnosis

Intensive Language Action Therapy (CILT)

introduced in 2001 based on motor rehabilitation, includes 2 major principles: forced use of affected domains (verbal language) and mass practice leads to functional gains in communication; only verbal mode is accepted, forcing clients to use their affected domains; language treatment activities focus on constraining other possible modalities and restrict the client to only spoken modality

Functional Assessment of Communication Skills for Adults (ASHA FACS)

it does not measure impairment, rather it aims to measure how specific speech, language, hearing, and/or cognitive deficits affect a person's performance on daily life activities; consists of 43 items and four domains - social communication, communication of basic needs, reading, writing, and number concepts, and daily planning; subdivided into 2 scales - communicative independence and qualitative dimensions of communication - lower scores indicate greater deficits; items are rated after observing functional communication on the 2 scales; recommended to do 3 observational sessions before ratings are made

Paraphasias

language errors

Mental status examination

look at their mental function (awakeness, alertness, orientation); memory (immediate recall - digit span, recent memory, remote memory, short and long term); language (spontaneous speech, naming, repetition, writing, reading), visuospatial functions (copying figures, spatial orientation); manipulation of acquired knowledge (problem solving, abstract language)

Circumlocution

may be able to describe it but can't find the word itself; "you write with it" = pencil

Conduction aphasia

may be caused either due to isolated lesions in alternative white matter bundle in inferior parieta lobe or due to a combination lesion affecting the left primary auditory cortex, insula, and underlying white matter; may be classified into 2 types: afferent and efferent

Anterior damage to internal capsule and putamen

may cause symptoms similar to Broca's aphasia; a transcortical aphasia or a dysarthric aphemia disorder; severe form of dysarthric articulation; mild repetition problems; moderate naming or word-fining problems; some auditory comprehension problems; severe writing and moderate reading problems

Anterior and posterior damage of the basal ganglia

may cause symptoms similar to global aphasia at onset; nonfluent and extremely limited spontaneous speech; severely impaired auditory comprehension; significant reading, writing, repetition, and naming problems

Posterior capsular-putamen damage

may cause symptoms similar to wernicke's aphasia; severe auditory comprehension deficits; fluent speech; significant naming and word-finding problems

phonological paraphasias

miss some letters, mispronounce, flip letters in the word; "spoon" = "stoon"; more likely to see these in Broca's aphasia

Conduction aphasia syndrome based approach

programs emphasize repetition training to provide a transition to spontaneous speech production; oral reading helps with improvement of speech production abilities but with minimal generalization to other forms of language expression; sentence production tasks - rehearsal theoretically strengthens the auditory representation of the target in working memory which increases opportunities for accurate motor programming; repeptition improved by focusing on improving auditory and oral word sequencing.

Features of Wernicke's aphasia

poor auditory comprehension, poor repetition, anomia, verbal expression consisting of well-articulated prosodic speech with paraphasias and perseverations, neologisms are common, rapid rate of speech, discourse includes macrolinguistic deficts (excessive comments and irrelevant utterances)

Mixed nonfluent aphasia

presence of Broca's and global aphasia; associated with considerable comprehension impairment for content words; presence of agrammatism; may occur with one or more CVAs; may be associated with right sided hemiparesis and right sided facial paralysis

Transcortical Sensory Aphasia

can often coexist with Alzheimer's disease; fluent but empty and paraphasic spontaneous speech; impaired auditory comprehension in the presence of relatively sparing repetition; naming is often but not always impaired; impaired confrontation naming; sometimes confrontation naming (of visual objects) is intact and may be better than comprehension of spoken and written words

Anomic aphasia

caused due to lesions of angular gyrus or second temporal gyrus; damage to the left inferior frontal region results in deficits in action naming; damage to the left temporal region results in deficits in nouns; word retrieval problems may occur due to a loss of word knowledge, impaired access to such knowledge, or due to the difficulty with mapping such knowledge into phonological forms that represent the corresponding words

Fluent (or receptive) aphasias

characterized by easily articulated speech output with relatively normal phrase length and speech prosody

Alternative Reading and Constrained Summarisation (ARCS)

cognitive-linguistic discourse treatment focusing on attention during reading aloud and orally summarizing text while constraining from non-specific language use; evidence of improvements for lexical retrieval during discourse with possibility of generalization to confrontation naming in clients with moderate Wernicke's aphasia after 10 weeks of treatment

Functional communication profile (FCP)

consists of 45 common communication behaviors, each rated on a 9 point scale; overall score indicates an individual's ability to effectively communicate in daily life

Semantic paraphasias

pick another word that belongs to the same semantic category; instead of "fork" they may say "knife"; "dog" --> "cat"

Minnesota Test of Differential Diagnosis (MTDDA)

5 sections - auditory comprehension, visual and reading, speech and language, visuomotor and writing, and numerical relations; client is categorized into one of 7 aphasia diagnostic categories

Typical features of broca's aphasia

Anomia, short phrase length, relatively good auditory comprehension, relatively poor ability to repeat words and phrases, agrammatisms, effortful articulation with errors at the level of phoneme and syllable, phonemic or phonological paraphasias, circumlocution

Porch Index of Communicative Ability (PICA)

Consists of 18 subtests related to performance in verbal, gestural, and graphic modalities; includes a multidimensional scoring system to capture response elements of accuracy, responsiveness, completeness, promptness, and efficiency; includes a 16-point scale with additional markings (such as perseveration) to reflect response modality and quality; allows multidimensional scoring, allows to see progress over time; requires extensive clinician training, complex scoring system

treatment for wernicke's is aimed at reestablishment of sound structure of words, while treatment for conduction aphasia focuses on stimulation of selection and sequencing of speech sounds

Difference between treatment for wernicke's and treatment for conduction aphasia?

Boston Diagnostic Aphasia Examination (BDAE)

Includes 5 language-related sections and one praxis section; aphasia classification is based on a z-score profile and a 5-point severity rating scale; possible 8 subtypes of aphasias - global, Broca's, conduction, Wernicke's, anomic, Transcortical motor, Transcortical sensory, mixed aphasia

mildly non-fluent speech, relatively short sentences, mild agrammatisms, presence of phonetic deviations and few phonological paraphasias, some presence of foreign accent

What does minor Broca's aphasia result in?

presence of relatively severe auditory comprehension deficits

Wernicke's and Transcortical sensory types are distinguished from conduction and anomic aphasias by...

large portions of the left fronto-parieto-temporal zone of language

What are common sites of damage for global aphasia?

unable to speak spontaneously; language comprehension deficits; reading skills intact including reading aloud and long sentences; intact confrontation naming with pictures; repetition occurs without access to meaning of what is being repeated

What are features of Mixed Transcortical Aphasia (MTA)?

it allows multidimensional progress, allowing you to see progress over time, but requires extensive training before administration and has a complex scoring system

What are some advantages and limitations to the PICA?

allowed a differential scoring system for errors (rather than just pass/fail); allowed a detailed description of an individual's errors from a psycholinguistic perspective

What are some advantages to the LMTA?

hearing loss, vision changes, apraxia (Broca's), dysarthria, dementia, depression, behavior problems

What are some co-morbidities often seen with aphasia?

Minnesota Test of Differential Diagnosis of Aphasia (MTDDA); Language Modalities Test for Aphasia (LMTA); Porch Index of Communicative Ability (PICA); Boston Diagnostic Aphasia Examination (BDAE); Western Aphasia Battery (WAB)

What are some commonly used aphasia test batteries?

constraint induced language therapy (CILT), PACE, SFA, LPAA, and HELPSS

What are some commonly used treatment programs for subcortical aphasias?

PACE, SFA, Phonologic Component Analysis, Cognitive Approach to treatment of Auditory Comprehension

What are some of the commonly used programs for fluent aphasias?

1. Promoting Aphasics' Communicative Effectiveness (PACE); 2. Intensive Language Action Therapy (CILT); 3. The Intensive Comprehensive Aphasia Program; 4. Melodic Intonation Therapy (MIT); 5. Helm Elicited Language Program for Syntax Stimulation (HELPSS); 6. Computer based training programs; 7. Transcranial magnetic stimulation (tCS)

What are some of the commonly used programs to treat expressive aphasias?

differences - broca's is non-fluent, while wernicke's is fluent; broca's has better comprehension than wernicke's; broca's is frontal lobe damage (anterior) while wernicke's is more posterior damage (temporal), Broca's is more common; Similarities - both include problems with naming; both due to left hemisphere damage; both language disorders; similar causes; both have sudden onset

What are some similarities and differences between Broca's and Wernicke's aphasia?

Visual Action Therapy (VAT), Voluntary Control of Involuntary Utterances (VICU)

What are some treatment considerations for mixed aphasias?

limited spontaneous speech, although once initiated, syntax is intact; naming errors including semantic and phonemic paraphasias; neologisms; circumlocutions; relatively intact repetition; some level of auditory and reading comprehension deficits; impaired writing; hypophonia; fluctuating performance

What are symptoms associated with acute thalamic aphasia?

patient may be mute and/or have fluctuating state of consciousness; language functions may be intact when alert; patient may show an aphasic disorder when alert; severity of thalamic aphasia may fluctuate independent of patient's alertness

What are symptoms associated with thalamic CVA?

relatively fluent expressive language along with naming deficits; writing and spelling errors; mild auditory comprehension deficits

What are symptoms of chronic thalamic aphasia?

motor component (lack of fluency, apraxia of speech), and agrammatisms

What are the 2 major symptoms of Broca's Aphasia?

posterior parieto-temporal, sparing wernicke's area, bilateral lesions, middle and inferior temporal gyri, and occipitotemporal areas

What are the most commonly affected areas in Transcortical Sensory Aphasia?

posterior third of superior temporal gyrus

What are the most commonly affected areas in Wernicke's aphasia?

angular gyrus, second temporal gyrus

What are the most commonly affected areas in anomic aphasia?

supramarginal gyrus, underlying white matter pathways, wernicke's area, left insula, and auditory cortex

What are the most commonly affected areas of conduction aphasia?

BDAE and WAB

What are the most commonly used aphasia tests that have a common goal of classifying an individual into classical aphasia subtypes and rating severity of aphasia based on performance on several subtests?

Global Aphasia

most severe form of language impairment following focal brain damage; global impairment in all modalities (comprehension, expression, reading, writing); speech is minimal and/or lacking in content; language comprehension is severely limited; sometimes milder versions of this may be called "mixed aphasias"; prognosis is often considered poor

Broca's aphasia

motor component (lack of fluency, verbal-articulatory impairment - AOS) and agrammatisms; Damage specific to Broca's area does not produce this aphasia; results from damage to Broca's area as well as insula, lower motor cortex, subadjacent subcortical and periventricular white matter

Transcranial direct stimulation

non-invasive and inexpensive method aimed at direct activation of affected brain areas; can be simultaneously used with speech therapy; one of newest ways of treatment for aphasia; electrical stimulation to affected areas (broca's or wernicke's) - when used along with speech therapy, may show a lot of improvements

Unawareness of deficit

not even aware something is wrong; associated with posterior lesions; most likely in wernicke's aphasia, maybe TSA; in some cases, suspiciousness and frank paranoia may also occur

General observations and medical examination

observation of behaviors including the level and type of social interaction; any abnormalities in different body regions; spontaneous movements (asterisix, tremor, choreiform movements)

Denial of illness

one of the symptoms that often happens following a brain injury; any type - TBI, stroke, etc.; deny any sort of problems

Efferent conduction aphasia

parietal and insular lesions causing phonemic deficits

National Aphasia Association (NAA)

provides information about aphasia for individuals with aphasia and their family members; also offers information about ongoing research projects and resources for patients and family members

Forced hyperplasia

refers to odd behaviors due to frontal lobe deficits such that patients are pulled to stimuli in the environment and seem compelled to act on those stimuli even after when told not to or when they acknowledge they are not supposed to;

Indifference

related to having no interest in communicating; more likely to develop if the frontal lesions extend beyond the prefrontal regions; more common in those with a diagnosis of both aphasia and TBI; may be aware of the problem but don't want to do anything about it

Depression

some clinicians believe that this and catastrophic reactions may have overlapping clinical and neural biological features; non-fluent aphasics more likely; anti-depressants may give some relief; can lead to a lot of barriers in speech therapy; chronic accumulation of small macrovascular and microvascular lesions may contribute to development

Fluent aphasias

spoken languages of fluent aphasias are characterized by variable amounts of information and paraphasias; in addition, individuals with fluent aphasias demonstrate deficits in reading and writing that commensurate with their speaking and listening skills; poor reading and writing occurs with poor speaking and listening skills and vice versa

Communication Activities of Daily Living (CADL)

test items are based on daily functional situations; responses are scored on a 3-point scale and voerall score can be compared with corresponding scores on standardized tests; reported to have strong psychometric properties (validity and reliability)

Model based approaches

these programs are used when the pattern of deficits do not conform to the characteristics of traditional aphasia syndromes; these programs target specific deficits and include use of any one of the multiple modalities (oral vs. written naming, oral repetition, vs. writing to dictation)

Promoting Aphasics' Communicative Effectiveness (PACE)

to improve pragmatic skills by teaching them to differentiate between relevant and irrelevant stimuli, use of contextual cues, follow conversational rules, and avoid confabulation; identify themes or main ideas from reading stimuli; help the client to order the information form least to most important; work on turn taking, topic maintenance, and other pragmatic skills - trying to make them as effective communicators as possible using whatever may help them

Syndrome based approaches

treatment approaches based on the individual syndrome present in the individual.

Helm Elicited Language Program for Syntax Stimulation (HELPSS)

used for adolescents and adults with agrammatical speech; based on a syntactic hierarchy of difficulty shown by agrammatic clients; uses 11 sentence types - imperative intransitive, imperative transitive, Wh- interrogative, declarative transitive, declarative intransitive, comparative, passive, yes-no questions, direct-indirect object, embedded sentences, and future; helps with incorporating grammatical elements

Thalamic aphasia

usually occurs with damage to certain thalamic nuclei on the dominant side; sometimes may also occur with damage in the non-dominant hemisphere

chief complaint, history of present illness, review of neurological complaints, review of other organ systems, medical history, psychiatric history, drug history, allergies, family history, social history

what are the features of a neurological history?