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