Aphasia and Related Disorders

What are the 5 most frequently seen types of agnosia?

1. auditory agnosia-impairment in the ability to differentiate sounds. 2. auditory verbal agnosia-impairment In the ability to differentiate spoken words. 3. visual agnosia-impairment in the ability to differentiate visual stimuli. 4. visual verbal agnosia-impairment in the ability to differentiate written words. 5. tactile agnosia-impairment in the ability to differentiate objects through the sense of touch

What is the highest possible aphasia quotient?

100

What term refers to a loss of mathematic ability or the impairment of the ability to manipulate numerical symbols due to brain damage?

Acalculia; dyscalculia

Aphasia is...

Acquired, neurogenic, unidimensional, multimodality

What term refers to an impairment of sensory recognition or the impairment of the ability to perceive and differentiate stimulus patterns, although the sensory mechanism is intact?

Agnosia

What term refers to a loss of writing ability or an impairment of the ability to express oneself through writing due to brain damage and not as a result of neuromuscular impairment?

Agraphia; dysgraphia

What term refers to a loss of reading ability or an impairment of the ability to comprehend written verbal stimuli due to brain damage. ______ is used to denote complete impairment, the term ______ usually reserved for partial impairment

Alexia; Dyslexia

What term refers to a loss of memory?

Amnesia

Which limbic structure is associated with "fight or flight" emotional responses and has been associated with stuttering?

Amygdala

Activities must be _____ & ______.

Controlled and incremental (increasing in difficulty)

What fibers join the left and right hemispheres?

Corpus callosum

Give 2 examples of serial speech tasks.

Counting 1-10 ABC's

Which researcher argued against the use of adjectives to describe different types of aphasia?

Darley

What term refers to the process of obtaining meaning from visual and auditory stimuli?

Decoding

What is meant by 'descriptive feedback'?

Details of the response - explaining WHY response was good/bad

How does direct measurement differ from probe measurement?

Direct -measurement during the therapy session; specific to activity Probe -measurement of a set of words/skills that is not practiced; untrained targets (looking for generalization)

What term is used to denote an impairment of articulation or of speech production on the basis of a central or peripheral nervous system lesion. Weakness, paralysis, sensory loss, or incoordination of the speech musculature may exist. One or more acoustic features of speech may reflect impairment: articulation, respiration, volume, rate, voice quality, stress and intonation.

Dysarthria

What term refers to an impairment of swallowing?

Dysphagia

What term refers to an impairment of the ability to carry out voluntary motor acts such as tying shoes, fastening buttons, etc?

Motor apraxia

If the patient says 'furbis' for toothbrush, what type of paraphasia is this?

Neologism

What term is used to describe a made up word; an expected word is replaced by a new one, the meaning of which is not apparent in the utterance.

Neologism

What term describes a language impairment that is characterized by speech that is generally slow, laborious, amelodic, awkwardly articulated and Interrupted. Vocabulary is reduced and grammar is restricted to the simplest over-learned forms. Comprehension in relation to output may be well preserved.

Non-fluent aphasia

In which lobe of the brain is the primary visual cortex located?

Occipital lobe

Which treatment requires a 40 hour "short" course?

PICA

List 3 examples of a norm-referenced aphasia test. Which 2 aphasia tests are not norm-referenced?

PICA Boston CADL-2 Minnesota & Western are not

What term refers to impaired syntax characterized by errors or omissions in the use of functional words-articles, prepositions and conjunctions-which serve to establish contextual relationships of spoken and written content, e.g. ''Book is in the shelf. "

Paragrammatism

What is the general term for word substitution?

Paraphasia

What term refers to the production of unintended syllables, words, or phrases during an effort to speak?

Paraphasia

In which lobe of the brain is the sensory strip located?

Parietal lobe

Repeated productions of a previous incorrect response are called _________

Perseveration

What term refers to inappropriate oral or graphic repetition of a response or the production of a response that may have been previously appropriate when it is no longer appropriate?

Perseveration

Typical Criteria:

Plan Input Prognosis Document Progress

Which linguistic subsystem is associated with rules governing language use?

Pragmatics

What are the 5 language subsystems?

Pragmatics, semantics, syntax, morphology, phonology

What term refers to the meaningfulness of a message or utterance, or its informational-content?

Propositionality

What are the 2 language channels?

Receptive and Expressive

What term refers to paralysis of the right half of the body?

Right hemiplegia

Prognosis MUST show that the patient is making...

SIGNIFICANT PRACTICAL IMPROVEMENT

Which linguistic subsystem is associated with language content?

Semantics

Short-term objectives must be ______ & ______.

Sequenced and obtainable

What term refers to the repetition of speech which has been memorized previously such as counting, and days of the week?

Serial speech

Affective frame of reference includes:

Social issues & support Emotional issues

What does the term 'malinger' refer to?

Someone pretending to have an illness/disease, potentially for monetary gain

What term refers to complete or partial recovery of functions without treatment; usually occurs during the first six months following cerebral insult.

Spontaneous recovery

What is meant by 'facilitation'?

Strategies that make something easier for the person

Which major landmark separates the temporal lobe from the frontal and parietal lobe?

Sylvian fissure/Lateral sulcus

What is a 'task analysis'?

Taking a complex behavior modification task and breaking it down into smaller tasks that can be addressed during treatment

In which lobe of the brain is Wernicke's area and the primary auditory cortex located?

Temporal lobe

Which structure of the diencephalon is an important relay center?

Thalamus

What is the advantage of the team approach?

The team leader takes the individual approaches and findings from each member and puts them all together to come up with a general treatment plan and then the team members put it into action

Goals and objectives are important because...

They document treatment priorities, provide an overview of the treatment sequence, describe measurement conditions and specify criteria for judging success in intervention

What is meant by 'functional' in relation to aphasia goals and objectives?

Things they can use in everyday life

What term refers to a clot formation due to coagulation?

Thrombosis

What does TBI stand for?

Traumatic brain injury

Antecedent Events

Type of stimulus that comes before the response

What is meant by 'compensation'?

Using another means of expression to bypass that skill Example: If unable to write, teach another skill to bypass that modality; gestures to help with communication

What term refers to hollow areas of the brain that are filled with cerebrospinal fluid?

Ventricles

What term refers to an impairment of integrative control of the speech apparatus with associated impairment of the ability to produce phonemes accurately: caused by brain damage.

Verbal apraxia

What are the 3 language mediums?

Verbal, written, gesture

What term refers to a loss of vision in one part of the visual field?

Visual field deficit

Serial speech tasks include ______ language.

Volitional

Which aphasia tests yields an aphasia quotient?

WAB

Who developed the ICF?

WHO - World Health Organization

List 4 examples of a functional aphasia test

CADL-2 = Communication Abilities of Daily Living-2 FCP = Functional Communication Profile CETI = The Communication Effectiveness Index ASHA FACS = Functional Assessment of Communication Skills for Adults

What does the CADL assess?

CADL-2: Communication Abilities of Daily Living-2 Assess: Activities of daily life, functional language, participation, handicap

What term refers to a stroke or lesion of the brain resulting from internally caused blockage of or damage to the blood vessels supplying it?

Cerebrovascular Accident

What does CVA stand for?

Cerebrovascular accident

What is the name given to the system of inner joined blood vessels at the base of the brain?

Circle of Willis

You should capitalize upon strengths so that you can...

Compensate for the weaknesses

What is a probe?

Measurement used to monitor progression and generalization Helps to determine if therapy is working

Which artery is responsible for carrying blood to Broca's and Wernicke's?

Middle cerebral artery

Which aphasia battery was developed by an SLP?

Minnesota (Schuell)

What terms refers to a type of speech impairment whereby the client emits a profusion of utterance most of which is incomprehensible to the listener, though perhaps not to the speaker. In the severest form the words which were produced would bear little relationship to real words.

Jargon

Which researcher argued that labeling is essential for diagnosis and treatment?

Kertesz

What term refers to inappropriate laughing or crying: associated with brain damage?

Lability

What term refers to the amount of time elapsing between the presentation of a stimulus and the emission of a response?

Latency of response

3 PROGRAMS AVAILABLE FOR VISUAL ACTION THERAPY:

- Distal (wrist and hand usage) - Proximal (whole arm usage) - Bucco-facial (using cheeks and face)

Which cerebral hemisphere is usually dominant for language?

Left hemisphere

PACE THERAPY IS:

- A Pragmatic Based Treatment - More of a philosophy of treatment - Used for treatment on an individual with pragmatic impairment - Patient should be motivated, functional, attentive & alert

AMER-IND GESTURAL CODE IS :

- A compensatory approach - NOT A LANGUAGE - it is a representable code - Based on the gestural code used by American Indians from different tribes to communicate (like in trade days) - "Iconic" gestures; simpler than ASL (American Sign Language) - Grammar is verb + noun (simple) - Easy to understand without being trained in it

MELODIC INTONATION THERAPY IS:

- A facilitative approach - Based on left and right hemispheric differences - Designed for people that suffer a left CVA and are/have: o (Severely non-fluent) o (Poor repetition ) o (Strong comprehension) o (Motivated, attentive)

ETHICAL CONSIDERATIONS

- Beneficence = Guiding force behind decision should always be doing what is best for the client; client's welfare is paramount - Nonmaleficence = Do no harm - Respect = Respecting the client as well as their privacy - Integrity = Doing the right thing; being honest - Compliance = Rules in terms of documentation, paperwork, client's reimbursement for services, etc. (follow the rules) - Competence = SLP has a scope of competence and recognizes our limits - willing to refer if not competent on what client needs

PACE EVIDENCE INCLUDES:

- Descriptive - Quasi-Experimental - Group Studies

VISUAL ACTION THERAPY IS:

- Designed for severely impaired individuals that have no spontaneous means of communication - Inappropriate for a patient already using words or gestures - An entry level therapy - A compensatory approach or strategy = (Rather than trying to capitalize on residual communication methods, will teach the client a new, alternative method of communication) - Program moves slow, in very small steps

COMPONENTS or PRINCIPLES OF PACE THERAPY INCLUDE:

- Exchange = (an opportunity for each individual to exchange new information) exchange of info between clinician & client - Participate = (client AND clinician participate equally in terms of sending and receiving messages; not unidirectional) - Freedom = (client has free choice of communicative modality; can choose to provide info verbally or descriptive gesture, a mix of both, etc. - client has total freedom of communication modality) - Feedback = (feedback is naturalistic; clinician's reaction is a natural response; does not have to tell them good or wrong, etc - their response to feedback will let the client know naturally) feedback of correct response is known by communicative success - Repair = (if client gives stimulus and clinician cannot respond appropriately client is to repair)

PRINCIPLES OF MELODIC INTONATION THERAPY:

- Gradual progression - Restimulation (backup) = if you've got the right stimulus the response should be automatic; if original stimulus does not work, re-stimulate - backup to an easier step; use different stimulus - Repetition - Response latency = gradually increase latency between stimulus and response; timing between stimulus and response increases by adding pauses or time frames before patient can answer - Diverse stimuli - Restraint = clinician should be very careful and exercise restraint within their own language; monitor off-target talking because it is counter-productive - Auditory stimuli = focus on auditory stimuli, not written & picture stimuli - Frequency = MIT works best with more frequent sessions of shorter periods of time (daily therapy recommended)

MELODIC INTONATION THERAPY EVIDENCE

- Limited - Descriptive - Quasi-experimental

THERAPY SESSIONS IN VISUAL ACTION THERAPY :

- Moving from concrete level down - Trying to raise awareness that there are actions related to each object • Therapy: 1. Begin with real objects = Ex. Give patient a hammer and have them pretend they are using it 2. Next, use an action picture = Ex. Show them a picture of someone using a hammer in a situation 3. Then, a line drawing (picture) = Ex. Line drawing of a hammer (not a photograph just a line drawing of the object)

STIMULUS CONTROL IN PACE THERAPY

- Rendering (choosing stimuli -pictures- easiest to hardest; concrete to abstract, etc.) - easiest are concrete nouns, then concrete verbs - Complexity - Abstraction

Verbal Expression Therapy: Variables

-Client Variables ~Attention, fatigue, etc -Linguistic Variables ~What level are you working at? ~Determined by client --Sound level --Syllable level --Word level --Phrase level --Sentence level --Conversation Level -Paralinguistic and Extralinguistic ~Prosodic characteristics ~Gestures, body language, facial expressions

What is an omnibus battery? Give 4 examples.

-A collection of tasks that provides a multi-faceted evaluation -BDAE, WAB, MTDDA, PICA

What does the term 'basal' refer to? How is it determined?

-A suggested starting point -If patient gets 8 right, a basal limit is created, assuming that 1-7 will be easier for the patient

4 types of treatment settings

-Acute care -Rehab unit -Extended care facility (ECF) or Skilled nursing facility (SNF) -Home

Assessment vs Treatment: Antecedent Events

-Assessment: during the assessment process, it lacks cues ~Use of cues in assessment is very limited, present stimulus how it is documented in the manual and the document how they responded -Treatment: you can use lots of cues ~In treatment you are manipulating variables with the effect of improving the client's success/response

Assessment vs Treatment: Goals

-Assessment: goal is very broad, looking at a number of different behaviors and seeing where the response breaks down/threshold ~Wide → ID breakdown ~Identifying areas of breakdown -Treatment: this focuses on a very narrow range, presenting stimulus that is difficult, but has success ~Narrow → effortful success ~You've already identified areas that need help, so here you are targeting activities to help these areas using effortful success

Assessment vs Treatment: Consequent Event

-Assessment: you do NOT say whether it is right/wrong, but can acknowledge their attempts -Treatment: you DO acknowledge their success and give feedback, and tell them what process is successful/helped them achieve that success

Instruction variables you can modify:

-Attention -Rate of presentation -Complexity -Redundancy

Verbal Expression Therapy: Input

-Auditory -Visual -Both

Measurable treatment could include...

-Baseline measures -Repeated measures -Direct measurement (continual): directly related to activities -Probe measurement

Organization of treatment session:

-Beginning ~Warm up: establish rapport, patient has opportunity to tell you what their concerns are ~Warm up activity: low impact activity to prepare the patient mentally -Middle ~Bulk of session, directed at addressing the goals and objectives you set for your patient ~Order of activities: easy--harder--hardest--easy (end on positive note) -End ~Devoted to a "cool down" ~End on a favorable note ~Discuss next session & homework

Verbal Expression Therapy: Task Hierarchy

-Can include tasks related to semantics, syntax, pragmatics, morphology, phonology ~Easy --Imitation --Serial speech --Simple relations --Low propositional phrases ~Difficult --Naming --Word fluency ~~Generating a list of words that complete some sort of condition or fit into a category --High Propositional Phrases --Defining Words --Discourse --Extended Narrative

What term refers to paralysis of the left half of the body?

Left heroipleplegia

Auditory Reception Therapy

-Clients have certain differences that may impact their way of responding to auditory reception ~Client variables: variables beyond your control --Attending skills, fatigue, alertness, severity of deficit, impact of coexisting problems (like visual field cuts)---beyond your control but you have to consider as you design you therapy --Hearing loss: you don't have any control of hearing, but you still have to consider --Depression: beyond your control, but have to consider --You can't change these variables but you can try to COMPENSATE for them ~Linguistic variables: variables within your control --Level: single word stimuli, phrase, sentence, paragraph --Vocabulary - types of words that you are using --Complexity: clauses (relative, embedded), voice—what rationale are you going to choose ~~Syntax: complexity of a sentence - phrases used, are they complex (embedded clauses can make it harder) --Length - the longer, the harder --Prominence of the keywords: if you have a sentence, certain things make a word more noticeable --Redundancy: repetition of keywords, synonyms, category before stimulus; how much of this can change the difficulty of the task ~Paralinguistic variables: things that are language related, but in and of themselves are not language --Use of prosodic features, supra segmental ~~Rate will impact the difficulty ~~Use of pauses (making words more prominent) ~~Emphatic stress: sentence level stress ~~Intonation ~~Tone of voice ~Extra-linguistic: features beyond language

Explain nonstandard assessments.

-Clinician can make up commands for descriptive purposes if you suspect problems in one area or want more information about a problem or modality -Clinician can use commands, questions, serial speech tasks, impromptu tasks -Probe: different aspects of communicative functioning

Behavioral observations can be taken from...

-Conversational sample -Interview with patient

What are the 4 functions of a report?

-Describes where the patient is at the moment the report is written (consider legalities) -Explains the patient's need for services (insurance) -Provides a baseline to look at effectiveness of treatment -Means of communicating with other physicians, professionals, or anyone who decides to read the report

Activity Participation

-Emphasis is on establishing functional communication ~Focus is on functional activity (STO) Makes distinction between the activity and participation (LTG)

Functional treatment emphasizes...

-Expressing basic needs -Social; quality of life -Community; survival -Vocational/Avocational

Verbal Expression Therapy: 2 types of treatment

-Facilitation ~Designed to help the individual establishing volitional control ~For patients with milder forms of aphasia ~Can teach PWA self-cueing strategies --Help them analyze what they remember about the word -Compensatory Strategies ~Used when the deficit is of a severity where the likelihood of remediating or making a lot of progress is not very likely ~Focus on an alternative means of communication ~Can include: use of gestures, letter boards, computers, and any aid that helps the person to express their needs or desires **Can combine use of facilitation and compensatory strategies **When working on facilitation, may teach PWA how to compensate when they have difficulties

Behavior Modification method

-Follows the concepts of operant conditioning - but much more behavioral in nature -We are talking about a whole approach to treatment that can be adapted for any type of goal. -Present stimulus, elicit a response, provide reinforcement. ~Goal = increase complexity of a persons language --Start by identifying a long-term (complex) goal - our goal is typically going to be generalization ~Analysis - task analysis, identifying each step for task --Steps that will help you reach the SMART goal --Task analysis: ~~Break it down to small steps which become part of your plan; each terminal objective leads to your overall goal ~Plan - develop a plan according to the steps of the task - objectives leading to long term goal and generalization ~Generalization --Typically our goal, generalization of the targeted goal to other conditions --This is very general - you can use this for reading, writing, word finding, etc --So you've identified a long term goal - but you are teaching it by steps, each step (STO) getting us closer to the LTO --You must do a task analysis by figuring out what you have to do before you get to the target behavior --More direct than stimulation-facilitation and does target generalization

5 factors involved in analysis

-Function: across modalities -Task: within modality -Item: within task -Intra-individual profile: strengths & weaknesses -Frame of reference: cognitive, psychomotor, affective

Principles of treatment

-Functional -Measurable -Capitalize upon strengths

Auditory Reception Therapy: Output (response)

-Gestural response: like pointing to a picture, commands (make a fist), manipulating different items (pick up the cup) ~With more severely impaired, start with gestural ~Start with these types of responses then move on to verbal -Verbal response - gestural response or verbal (Y/N, single word, or elaborated) ~With higher level individuals, you can probably start with verbal ~Yes/no doesn't necessarily mean they understood it, or sometimes people with aphasia will confuse yes/no (very abstract words, no inherent meaning)—did they miss in terms of their expressive problems? Or did they not understand the stimuli? 50% probability ~Levels of verbal responses: --Y/N - could flip flop, very arbitrary and culturally bound --Single word (answering simple questions - what is your favorite fruit?) --Listen to paragraph level radio broadcast and summarize it -Written types of responses - listen to something like a broadcast and then has questions---run into problems of is it auditory or reading impairments

THE PHILOSOPHY OF MELODIC INTONATION THERAPY IS TO :

...exploit the strengths of the intact right hemisphere to retrieve the information from the left (A facilitative approach) (using melodies (from right hemisphere) to exploit language (from left hemisphere)

Auditory Reception: Global and Wernicke's

-Global Aphasia: presents a challenge to find tasks that are easy enough to find that effortful success ~First step is getting a consistent response (any type of response) → then to get a differentiated response → then we want response to be appropriate → then accurate types of responses ~Like look at you and pointing to a picture consistently on command (could be therapy for expressive modalities) -Wernicke's Aphasia: difficult with auditory tasks because they are so verbal ~Important to establish some sort of context-like meaningful themes (catalogues, maps) relative to the person's interest --They may do worse if you use random words ~Think about the rate of stimulation - too quickly or too slowly will cause problems ~Need to get their attention - stop and focus them in order to get work done ~Redundancy: may have to use more demonstration, program more redundancy --May have to demonstrate or manipulate the response ~Provide treatment in places similar to where the patient will be in everyday life

Behavioral observations can be used to gather information looking at...

-How well formed and appropriate responses are -Functioning level-helps to decide what areas of the test to administer

Deblocking: Task hierarchy

-Imitation -Sentence completion -Phonemic cues -Rhyme -Semantic cues -Superordinate -Confrontation naming

Differences between Impairment Level and Activity Participation

-Impairment Level: Focuses on comprehension; not really functional; you control stimuli and work on underlying processes -Activity participation: more functional approach

Feedback variables

-Incentive: provide positive feedback to keep them engaged -Information: descriptive feedback -Delay: withhold reinforcement and encourage individual to appraise the accuracy of their own response (self appraisal) -Consistency: Be consistent with what you are accepting; intermittent feedback; want to become more variable

List 4 means of gathering information.

-Interview -Behavioral Observation -Standardized Testing -Informal Assessment

Response variables

-Length/complexity: response you are going for should be appropriate in length/complexity for the individual -Familiarity/meaningfulness: things they are interested in, may generate a better response -Delay: if you impose a delay after a response, you will change the difficulty of the task -Response redundancy: can modify the difficulty of the response by implementing redundancy

Planning therapy involves:

-Long term goals -Short-term objectives -Activities

Impairment Level Philosophy

-Looks at patterns of strengths and weaknesses ~Relative level is modified: So skills that are strongest don't change, brings middle up, and therefore the weaknesses may rise or improve some too ~Effortful success: when you chose an activity for a patient, it should be easy enough that the person can perform the activity with a good degree of accuracy (~60-80%) but effortful so something a person still has to work on ~Fundamental processes are addressed: characteristic of the work of Schuell, addresses other processes through the main one; capitalizes upon strengths to improve weaknesses

Modifying Activities/Variables

-Make it very clear that this is something new because patients with brain-damage have a difficult time switching from task to task Instruction → stimulus → response → feedback

4 types of goals (that are likely)

-Maximize the use of residual language -Compensate for language loss -Facilitate psychological and emotional adjustment -Improve role of partners to facilitate communication

Response complexity includes:

-Motor complexity: how many articulatory movements are necessary -Linguistic complexity: certain types of sentences are simpler than other types -Cognitive complexity: amount of extractions

Modality Specific Therapy

-Not unusual to have a goal for each of the modalities -It is important for us to think about what kind of variables we can modify to make a task more difficult or variable - that would impact your decision-making

What is a modality specific test? Give an example.

-One that focuses on one single aspect of communication which tends to be shorter and more focused -Reading Comprehension Battery

A rehabilitation team includes:

-Physician (physiatrist) -Nurse -SLP -Registered dietician -Occupational therapist -Physical therapist -Master's of social work (MSW) -Family -Patient -Rehabilitation Counselor (RC) -Psychologist or neuropsychologist

Auditory Reception Therapy: Task hierarchy

-Pointing to object by name or function - "point to the dog", "point to the one you eat", "point to cat and mouse (2 objects)"--Make it an easier task - choosing things that are semantically related, harder unrelated -Verbal instructions: a little more difficult: 1 verb instructions - "pick up the spoon" → 2 verb - "point to knife, turn over fork" (4 bits: point, knife, turn, fork) → 3 verb - "touch cup, turn over the penny, pick up pen" ~You can modify the difficulty by the choice of stimulus effects the difficulty -Pre-stimulation can change difficulty: can involve giving them a general cue, cue gets them in the right semantic category BEFORE/PRIOR to you giving the actual stimulus (animals, then show me the cat and the dog)

Analyzing a conversational sample can be _______ or ______. Give examples of each.

-Qualitative or Quantitative -Qualitative-document the diversity of person's communication skills -Quantitative-length of utterance; content words vs function words

What are 4 characteristics of speech associated with fluent aphasias?

1) naming difficulty 2) runs of rapid, fluently articulated speech 3) sound and word substitutions 4) inappropriate responses to questions

Stimulus-Facilitation method

-Repeated, focused stimulus facilitates retrieval of words ~Fundamental process: Schuell emphasized auditory function ~Role: not a teacher, but a facilitator --Schuell says aphasia is not so much a loss of words but being able to retrieve the words so instead of teaching the words, you should modify the stimulus and response so they are able to retrieve the words --Providing language stimulation that is focused with the idea that it is going to facilitate the language use ~Stimuli: auditory stimulus is critical and most appropriate modality for the stimulus (Schuell) --Schuell argued the auditory modality is the most appropriate modality for the stimulus - because we process language auditorily. --Says we don't have to limit it to this but the stimulus should have an auditory component --Trying to present stimuli where the patient is responding appropriately but with effort - effortful success ~Elicitation: present the stimulus in a way that elicits a response and does not force it --If it elicits the wrong target then you have to modify your stimulus ~Tasks: importance of the clinician exercising stimulus control --Modify and think carefully about the stimuli we select to do the best job eliciting responses. --If the client gives an incorrect response then re-stimulate, strengthen the stimulus, opposed to providing corrective explanations.

Challenges involved with quality of care:

-SLP limitations ~May not be enough on staff ~May have more patients during certain times of the year ~Scheduling problems -'The system' limitations ~Reimbursement: May have to take shortcuts in terms of assessments because we need to reach goals in a certain amount of time -Patient limitations ~Stamina, strength, depression, support system

Stimulus variables:

-Salience/Intensity: how prominent is the stimulus/how strong is the stimulus -Clarity/Intelligibility: stimulus needs to be recognizable, clear, and ambiguous -Redundancy/Context: give more information than is necessary/provide stimuli in a means that looks like an item in context -Novelty/Interest Value: Things that are presented in a certain way so that the picture is memorable/choose things that are more interesting to the individual -Cues:may simplify a task by giving more cues (phonemic or semantic)

Word-finding treatments: Cuing Strategies

-Sample cuing strategies ~Metaphonological: Being able to talk about phonological aspects of language --Monosyllabic ~~Long, short? ~~Vowel, consonant? ~~Rant or ridge? --Polysyllabic --Semantic cues ~~Related words ~~Related actions ~~Mixed ~~Ex. Take action and related word and use in a sentence completion task ~Getting client into phonological neighborhood increases the likelihood that they will be able to come up with the word ~Shift responsibility --ID which cues are the most helpful and discuss these cues or strategies --Develop a list and document --Practice with these cues --Fade use of question sheet and look for generalization --Can this person use these cuing strategies when presented with new pictures?

Word-finding treatments: Lexical neighborhoods

-Semantic ~Ex. Cat --Horizontal axis-felines --Vertical axis-other animals ~There are neurological connections or nets between words --If you stimulate one word, like cat, which words are connected -Phonology ~Words with the same onset, nucleus, or coda ~Organization could represent voicing differences or single phoneme changes ~Develop a model of phonological neighborhoods -Clinician can come up with neighborhoods or can have patient come up with neighborhood

Psychomotor frame of reference includes:

-Sensation & perception -Handedness & strength -(A)vocational issues (ex. did their work involve psychomotor issues; did they like to draw?)

Standardized tests have... Some are... Put more emphasis on... Look at...

-Set protocol that all professionals follow -Norm referenced, but many are not -Intra-individual comparisons -Nature and severity

Word-finding treatments: Deblocking

-Stimulation of an intact communicative channel to facilitate, ultimately, the use of the severely impaired channel -Can use a series of activities, gradually increasing in complexity, before asking PWA to name object (pre-stimulation)

Auditory Reception Therapy: Input

-Stimulus channel: has to have an auditory component, but doesn't have to be limited to auditory/may have a mix like a visual stimulus in addition to auditory (usually auditory + visual) ~Series of commands ~Answering questions ~Listening to a paragraph

Verbal Expression Therapy: Output

-Verbal response -Gestural response -Written or graphic response -Response from computer or iPad

What does the term 'ceiling' refer to?

-Where testing should stop, because it is assumed that the patient will not get items correct past the ceiling

An interview can be _____ or _____. Give examples of each.

-Written or Oral -Written interviews include a case history form and/or medical reports -Oral interviews include talking to hospital staff members or significant others to get an idea of how this person communicates

Explain aphasia/dysphasia

An acquired impairment of verbal behavior caused by brain damage which impairs the linguistic features involved in encoding or decoding language. It is characterized by a reduction and/or dysfunction in vocabulary and/or syntax in oral-aural language use. The terms expressive and/or receptive are used to indicate that the patient's aphasic impairments tend to cluster in encoding (expressive) or decoding (receptive) language skills. The term excludes irrelevant vocabulary usage without Impairment of syntax and those communication disorders due to neuromuscular impairment of the speech musculature, dysfunction of the peripheral sense organs, mental deficiency, or psychopathology. While deficiencies in writing, gesture, calculation and reading (paralanguage systems) often accompany, isolated losses in these skills without concurrent oral-aural dysfunction do not independently constitute a symptom.

What term is used to denote the inability to articulate?

Anarthria

What term refers to the total inability to produce Intelligible speech due to central nervous system lesion which has affected the innervation of the speech musculature?

Anarthria

What term refers to a ballooning of an arterial wall?

Aneurism

What term refers to a symptom of expressive aphasia, characterized by an impairment in the ability to use nouns?

Anomia

Which very small artery joins the left and right anterior cerebral arteries?

Anterior communicating artery

What term did Broca use to describe Tan's speech disorder?

Aphemia

What term refers to a loss of voice?

Aphonia

What term refers to an loss/impairment of motor programming or of the ability to carry out voluntary movements: due to brain damage and not the result of neuromuscular impairment with no impairment on the reflexive level?

Apraxia/dyspraxia

What term term refers to a loss of the intonation, stress, pitch and rhythm patterns of speech?

Aprosodia

What allows communication from Wernicke's area to Broca's area?

Arcuate fasciculus

3 steps involved in preparing for treatment

Assess Analyze results Treat

What term refers to words or phrases such as consecutive numbers, days of the week, expletives and social expressions?

Automatic speech

Which aphasia test was developed by Goodglass and Kaplan?

BDAE-3

Which structure of the diencephalon is associated with motor control?

Basal ganglia

The left and right vertebral arteries join to form which artery?

Basilar artery

Auditory Reception: Challenge

Becomes very artificial and boring and not always functional

What term refers to paralysis of both sides of the body resulting from two separate lesions occurring either simultaneously or at different times?

Bilateral hemiplegia (double hemiplegia)

Dr. Powell's Philosophy of Treatment

EFFORTFUL SUCCESS -Trying to modify variables that you have control over - so this person is continually challenged and over time you may modify the activities to increase the challenge -You are an active participant during the session - monitoring to see if task is too easy or too hard and making modifications -Providing scaffolds - as time goes by you can reduce those scaffolds -Treatment is designed to retrieve processing (ex: salt and __) the word is still in their lexicon so we need to improve the ability to retrieve that word -Repair strategies to be able to communicate ~Strategies generalize to new words - if you can't think of the word, what could you do instead to improve communication -It is not just about the activities - but how you modify and present the activities and what you do after the response You have control over: instructions you give, stimulus you give, response definition (what you expect them to say, the criteria of success), and feedback ~No control over severity or brain damage or motivation (though you can try to increase)

Cognitive frame of reference includes:

Educational level Language proficiency (A)vocational issues

What term refers to an occlusion of a vessel due to a bit of foreign matter in the blood stream?

Embolism

Which major landmark separates the frontal lobe from the parietal lobe?

Fissure of Rolando/Central sulcus

What term describes a language impairment that is generally characterized by fluent speech with normal prosody and intonation, increased rate of utterance, often containing paraphasic/paragrammatical errors and is usually accompanied by reduced auditory comprehension?

Fluent aphasias

In which lobe of the brain in Broca's area located?

Frontal lobe

Which lobe of the brain is responsible for initiation of motor sequences?

Frontal lobe

Goals must be ________.

Functional

Long-term goals must be ______ & _______.

Functional and measurable

Which phrenologist identified 27 brain centers by comparing groups with extreme abilities?

Gall

List 4 procedures used to quantify coma.

Glasgow Coma Scale Rancho Los Amigos Scale Galveston Orientation and Amnesia Test Mini-Mental State Examination

What term refers to a complete dysfunction In all language modalities. The speech of these patients Is characterized by repetition of meaningless sound combinations. In addition, there will be an Inability to respond to almost all stimuli. General comprehension will be impaired.

Global aphasia

What term refers to paralysis of one half of the body?

Hemiplegia

What term refers to cerebral bleeding, usually due to rupture of a blood vessel?

Hemorrhage

Which limbic structure is associated with formation of new memories?

Hippocampus

What is the name of the little man drawing that illustrates cortical function?

Homunculus

How might an SLP modify a stimulus?

Increase intensity, clarity, add redundancy, increase interest value

Aphasia spares ________

Intellect

What is the ICF?

International Classification of Functioning, Disability, and Health

What is a baseline?

Measurement of a skill before implementing treatment