AphasiaExam1

ICF consists of two main parts

1. The functioning or disability of the person with the health condition 2. contextual factors that can affect the person to either improve or worsen the disability a.) impairments b.)communication activity limitations (convesation difficulties, diff using the phone, diff reading a newspaper) c.) participation restrictions (employment, relationship)

Experience-Dependent Plasticity

1. Use it or lose it 2. Use it and improve it 3. Specificiity 4. Repetition Matters (find different opportunities) 5. Intensity Matters 6. Time Matters-first 7-10 days, don't want to do too much. 7. Salience matters- importance of task to them 8. Age matters 9. Transference 10. Interfere

3 other domains besides impairment to be considered by afrom

1. greater participation in life activities 2. increased feelings of confidence 3. whether environmental barriers are reduced

5 steps of therapy

1. information gathering and sharing 2. collaborative goal setting 3. pretherapy assessment 4. therapy 5. reassessment

why discourse sampling

1. not examined by many aphasia batteries 2. inofmration involving activity and participation levels 3. Turn taking and topic management only assessed thrhough this

5 theories for restoring brain function

1. regression/resolution of diachisis 2. Restoration: reactivation of brain areas 3. recruitment: using brain areas that weren't being used 4. Retraining: certain brain areas perform additional/new functions 5. functional take over: undamaged areas take over functions

4 domains of AFROM

1.Environmental barriers or aids to communication 2. personal identify, attitudes and feelings 3. severity of aphasia (language impairments from aphasia) 4. participation in life situations (activities, roles and responsibilities, relationships i.e. job)

biopsychosocial approach to therapy (ICF)

therapy should take into account the biological impairment based factors and the psycholinguistic and cognitive processes of language and communication within the social context of the person with aphasia and his/her family

supplementary motor cortex

ability to initiate spontaneous utterances impaired by lesions in this area

aphasia is

an acquired neurogenic language impairment that can result in loss of a previous held ability to understand or produce speech and/or the ability to read or write

anosognosia

unaware of their condition

occiptal lobe

vision higher order analysis takes place in the visual association cortex (medial and lateral surfaces of occiptal lobe)

temporal lesion that extends posteriorly

visual connections are disrupted, more difficulty understanding written language and language in context but relatively less difficulty with isolated words

Extrapyramidal system

voluntary control of motor behavior

Frontal Lobes

voluntary control of movement throughout the body

hemiparesis

weakeness on one side of the body

informal assessment seeks to answer

what is the extent of problem where does behavior break down what helps the behavior what are the underlying mechanisms for the behavior

conduit d' approche

when repeated attempts come closer and closer to the target word

conduit d'ecart

when repeated attempts move further from the target word

anomic aphasia

word finding problems across tasks that require retrieval of specific substantive words -average phrase length is within normal ranges auditory comprehension and repetition are relatively or entirely intact -nonspecific phrases and circumlocution -paraphasias are rare "putting my words together. I can't seem to get 'em together. I can steem to get 'em together, that's what it is. The words that dno't appear in front of em yhou know. Like the words

primarily temporal lesion produces

word-deaf variant in which reading may be less affected may have difficulty understanding individual spoken words but can understand in context

conduction aphasia

anomia fluent output with normal average phrase length but may be interrupted by word finding pauses or attempts to self correct -auditory comprehension good repetition is worse -phonemic paraphasias very obvious (which they recognize and attempt to crrect" -circumlocitions may be produced -Reading aloud is impaired -deficits in naming and writing "I know the exact pert, part of it" i had a falve, a verve ah..it was being played, placed in the orta, the ...."

Broca's aphasia

anomia short phrase length good auditory comprehension poor ability to repeat words and phrases -agrammatism -phonemic paraphasias are common -articulation is effortful -automated verbal sequences are usually preserved -right hemiplegia -writing abilities are limited - can't read aloud, but can read andu nderstand. "April...twenty four. Europe. Mymother, my father, my husband. Go to airport. I hand ticket and fall down. At airport. I fall down.. and empulin...amalance...came."

types of informal assessment

attention, writing, reading, short term memory, social diagram

subcortical aphasias

borderline fluent aphasias -hypophonia semantic paraphasic -severe reduction of spontaneous speech

transcortical motor aphasia

characterized by impaired initiation of verbal output, anomia, short phrase length, good auditory comprehension and unlike Broca's aphasia good repetition relative to speech output- short utterances with grammatical words but incomplete sentences produced without articulatory effort. Inability to generate full sentences. -good reading comprehension "cabbie...cab driver...yes...for about seven years...ahtel worki, worked with hotels..bell captain mainly.. then sales."

embolism

clost that breaks free and travels around the body

Parietal lobes

damage to this area can produce a loss of sensation of touch and an impaired recognition of one's own body (asomatognosia) and a loss of the ability to appreciate spatial concepts

a-from

diagrammatic representation of the parts of the ICF that are relevant to aphasia- therapy can intervene in any component of this process Direct therapy can achieve this by : improving language function, everyday communication activities or social participation -can also be helped by optimizing contextual factors

Lesions for transcortical motor aphasia caused by

disruption of blood flow in the anterior cerebral artery or in the anterior most branches of the middle cerebral artery -infarction in the border zone territory between the anterior and middle cerebral arteries is the most common cause

When brain damage is vascular in cause and the language problem affects written language only

distribution of posterior cerbral artery

parietal or insular lesions and conduction aphasia

efferent type of aphsai- problems with phonemic representation

personalized client-centered therapy

engaging in therapy that holds meaning for the person with aphasia

Therapy should include

error free learning, multimodal, concurrent communication

thrombosis is

formation of a blod clot in the vein that causes a blockage

Life participation

functional; social rehabiliation model -Promoting Aphasic's Comm Effectiveness -Script Training -Conversaton Partner training -Communicative drawing -treatment focuses on life participation -enhance overall quality of life

hemiplagia

half paralysis

hemianopia

half vision loss

information gathering

health condition, language impairment, everyday activities they need to or like to engage in, participation in life and the context of the person with aphasia and the family

Temporal lobes

hearing and analysis of auditory signals -posteriorportion of the superior temporal gyrus (Wernicke's) is auditory association areas- analyzes auditory stimuli to the point of comprhenesion -medial temporal lobes- important for memory

2 types of neuroplasticiity

homologous area adapatation and map extension

ideomotor apraxia

inability to imitate hand gestures and voluntarily mime tool use

Global aphasia

infarction in the territory of both divisions of the middle cerebral artery (total occlusion of the left middle cerebral artery -brain tissue destruction occurs in large portions of the left fronto-parieto-temporal zone of language -covering the perisylvian area

Infarction in the respective branches of the middle cerebral artery produce damage to the _____ and cause _______

inferior or superior bank of the sylvian fissure; aphasia with repetition defec t(broca, wernicke, conduction)

LPAA to treating clients.

interest, goal, barrier (transportation, language, confidence), access (compensate or rehabilitate)

to implement patient centered care must

involve patients in setting goals

phonemic paraphasias

it's a kammick

neologistic paraphasias

it's a sklervick

Lesion for Broca's

left lateral frontal, pre-Rolandic suprasylvian region, often extends posteriorly to include the parietal lobe -superior division of the middle cerebral artery

When both spoken and written language are affected

lesion is in the distribution of the internal carotid artery

When the langauge problem is exclusively oral

lesion usually in the distribution of the middle cerebral artery

Lesions for Wernicke's

lesions in the posterior third of the superior temporal gyrus -distribution of the inferior division of the middle cerebral artery

Reading

medial to the left occiptal lobe 1. Primary Visual Cortex 2. Visual Association Area 3. Wernicke's area 4. Broca's speech area 5. Primary motor cortex 6. Brain stem . Muscles of Larynx

Limbic system

memories, feeilngs, the desire to produce language and the emotional coloring of thought

mixed transcortical aphasia

nonfluent speech, comprehension, naming, writing and reading impaired. Preserved repetition.

Wernicke's aphasia

notable anomia, poor auditory comprehension and poor repetition, -phonemic, semantic and neologistic (neogolisms) paraphasias -information-empty words and phrases -preservations -anosognosia -ideomotor apraxia -hemianopia -naming, reading and writing impaired "on sunday i get up, i feel find, but on Monday..I have as many to ..a man who believbes to me and i am talking to him about what i am doing and this man is a new man and he says"

Transcortical Sensory aphasia caused by

posterior lesions in the border zone between the middle and posterior cerebral arteries, in parieto-occiptal regions sparing Wernicke's area' -frequently associated with bilateral lesions in the border-zone territory (often seen with alzheimers)

comprehensive exam should include

procdures for determing the integrity of other cognitive skills (attention, memory and executive functions) discourse sampling

General Aphasia Treatment Approaches: 1. Impairment level

process oriented-medical rehab model -stimulation approach -drills, such as point to, answering questions, following directions, confrontation naming -CIAT, MIT,TAP,VAT -"clinician centered" with person with aphasia being dependent, passive patient -treatment focuses on the impairment

paraphasia

production of unintended words, syllables or phrases during the effort to speak

Global aphasia symptoms

profound anomia with no speech output and very poor auditory comprehension. -stereotypic utterances are present that consist of nonsense syllables and real words "oh boy" or "no way" -overlearned, automatized sequences are sometimes preserved -visual field defects, oral, ideomotor and ideational apraxias

agrammatism

propositional speech consist primarily of substantitive words (nouns, main verbs) with few functor words

aphemia

pure word dumbness, pure motor aphasia (loss of ability to articulate words) -lesion limited to inferior pre-Rolandic motor strip (muscles controling glossopharyngeal apparatus)

the motor strip sends neural messages to muscles via

pyramidal system

client centeredness mean

respect for individuality and values, meaning of aphasia as experienced by client and provide meaningful activities, therapeutic alliance, social context and relationships, inclusive model of health and well being (a-from), expert lay knowledge (client as expert) , shared responsibility, aphasia-accessible communication, respecting autonomy of SLP, professional as person

prefrontal cortex

responsible for synthesizing sensory stimuli and coordinating them with plans for action (contributes to abstract thinking, problem solving, and judgement EF) -damage: behavior and personality changes, impaired judgement, poor strategic planning and impaired insight

Writing

Just above Broca's area and anterior to the primary motor control area

Intervention approaches that focus on social participation and connectedness

1. Life participation approach 2. Group Therapy 3. Conversation therapy 4. Working with family,friends and caregivers 5. Community engagement approaches 6. Counseling

Speech in response to hearing

1. Primary Auditory Area 2. Wernicke's 3. Broca's 4. Primary Motor Cortex 5. Brainstem 6. Muscles of Larynx

Temporal lesions and conduction aphasia

-afferent type of aphasia, in which repetition would be impaired because of defective memory

different lesion sites for anomic

-angular gyrus -second temporal gyrus -left inferior frontal area (action naming) -left temporal region (noun naming)

LPAA

-consumer driven -supports individuals and those affected by it -immediate and longer life goals -consequences of aphasia -reengagement in life -reduce the consequences of the disease and injury

Transcortical motor aphasia

-lesion that interrupts the link between the supplementary motor cortex and Broca's area, but spares Broca's area -supplementary motor cortex -white matter pathways underneath the supplementary motor area -left frontal lobe (anterior and superior to broca's area) -anterior cerebral artery

Zone of language

-located within the distribution of the middle cerebral artery -surrounds the sylvian fissure on the lateral surface of the hemisphere

Semantic paraphasias

It's a cot

Transcortical Sensory Aphasia

significant anomia poor auditory comprehension good repetition -features of fluent aphasia are present including ease of articulation, good prosody, presence of grammatical constructions) -Semantic paraphasias more common than phonemic paraphasias -perservations are common -frequent use of nonspecific words such as thing -posterior and inferior to Wernicke's area 0lesions in the parietoocciptal region "Oh for God's sake.. I mean to say for God's sake because that is a regular picture. Ok number one. I ..how can I say it. Number one is jar of ...cokies and what happens is..ah..is..the regular jar is..oh..how can i tcall it. ...

Want therapy that focuses on

social participation and connectedness

If an aphasic syndrome is presented with preserved ability to repeat, the lesion usually has

spared the cortical zone of language but involved cortical or subcortical areas bordering the language zone (border zone lesions) -transcortical aphasias, subcortical aphasias

factors that influence language recovery in aphasia

spontaenous neural regeneration site and extent of lesion age and education motivation type and amount of language treatment environment

neural plasticity and behavioral plasticity

structural changes that occur at the micro level and make it possible to learn new skills behavioral-refers to how behaviors can make changes within the brain

Lesions for conduction aphasia

supramarginal gyrus and white matter pathways (arcuate fasciculus) -lesions in an alternative white matter bundle through the inferior parietal lobule -combination lesion affecting the left primary auditory cortex, insula and underlying white matter -left tph

neuroplasticity is

the adaptation of the brain's structure and functions throughout an individuals lifespan in response to environmental pressure, experiences and challenges