Ch.4 The Aphasias

What are three cognitive and three motor deficits than can co-occur with aphasia?

-Cognitive defects that can co-occur include deficits in arousal, attention, and short term memory. -Motor deficits that can co-occur are the dysarthrias, apraxia of speech, and dysphagia.

How are phonemic, neologistic, semantic, and unrelated verbal paraphasias different from one another?

-Phonemic paraphasias occur when the word produced is mostly correct except for a phoneme-level mistake. -Neologistic paraphasias occur when an individual produces a word that is entirely different from the intended word and is mostly unintelligible. -Semantic paraphasias occur when one word is substituted for another word that is similar in meaning. -Unrelated verbal paraphasias occur when an individual substitutes a word that is unrelated in meaning to the intended word.

The four cortical fluent aphasias

-Wernicke's Aphasia -Transcortical Sensory Aphasia -Conduction Aphasia -Anomic Aphasia

What are three categories of aphasia therapy?

-restorative therapy (constraint-induced aphasia therapy) -compensatory therapy (AAC) -social therapy (communication partner training.

Subcortical structures

-thalamus -striatocapsular region (area within the basal ganglia)

Receptive language deficit

A deficit in the ability to derive meaning from language.

How might a lesion at the striatum be associated with aphasia?

A lesion at the striatum might be associated with aphasia because infarcts that damage the striatum can also disrupt blood flow to the primary language cortices that are enough to create an aphasia but not enough for the immediate cell death to show up on neuroimaging studies used in hospitals.

Logorrhea

A near nonstop, usually meaningless and tangential, output of speech.

Anomic Aphasia lesion area

Anomic aphasia may occur when there is damage anywhere within the language areas.

Lesion location of Broca's Aphasia?

Broca's aphasia occurs from damage to the inferior posterior frontal lobe of the left hemisphere that may be restricted to Broca's area or extend adjacent to Broca's area.

Why is communication partner training important?

Communication partner training is important because the spouses or caregivers who communicate the most with the individual with aphasia do not realize how best to communicate or facilitate overall communication with their partner.

Conduction Aphasia lesion location

Conduction Aphasia occurs when there is a lesion on the supra marginal gyrus of the parietal lobe, posterior to the primary sensory cortex, above Wernicke's area that damages the arcuate fasciculus.

How does constraint-induced therapy differ from errorless learning?

Constraint-induced therapy differs from errorless learning because constraint induced therapy constrains a patient's ability to compensate for deficits and forces the person to use the weakened skills to exercise and improve the areas of weakness. Errorless learning focuses on reducing the number of errors produced by patients by setting the difficulty level of tasks very low so the client can succeed.

Expressive language deficit

Difficulty in formulation and production of language to communicate an intended meaning.

What should be included during an aphasia assessment?

During an aphasia assessment the following should be included: case history, assessment of functional communication and connected speech, administration of a standardized test of aphasia, and evaluation of cognition.

Motor deficits arise with damage to the ______ lobes, which are responsible for initiating and gross planning of movements.

Frontal

Lesions of Global Aphasia?

Global Aphasia occurs when the zone of language (Broca's, Wernicke's and arcuate fasiculus) is damaged.

How does group therapy facilitate hope and recovery?

Group therapy facilitates hope and recovery because it promotes hope, psychosocial emotional support, pragmatics, self-confidence, and carryover from individual therapy sessions.

Why is neuroplasticity important to aphasia rehabilitation?

It is important to aphasia rehabilitation because it is central to the concept of restorative therapy since neuroplasticity allows a part of the brain to change its previous function to take on and learn a new and previously unknown role.

Why is it important to recognize crossed aphasia?

It is important to recognize crossed aphasia because it means that an individual has preserved motor abilities in their writing hand when a left hemisphere stroke renders them aphasic. The intact writing hand gives potential for use in therapy as a way to reclaim language or establish a compensatory communication strategy.

Why is it useful to use a classification system for the aphasias?

It is useful to use a classification system for aphasia because it allows a reference point for professionals to communicate information about patients by enabling standardization of knowledge and language about language deficits. Another reason to classify the aphasias is for the purpose of lesion localization which helps identify aphasia symptoms based on specific lesion locations.

How might learned nonuse inhibit rehabilitation?

Learned nonuse might inhibit rehabilitation because the individual learns to compensate for a deficit by employing other intact abilities and in doing so, ceases to exercise the physical or intellectual ability in which the deficit is present.

How does Schuell's stimulation therapy differ from melodic intonation therapy?

Schuell's stimulation therapy is different from MIT therapy because Shuell's stimulation therapy is the re-establishing of lost language abilities through the use of auditory stimuli to evoke a response. Melodic intonation therapy is the use of intact melodic/prosodic processing of the right hemisphere to cue word retrieval and production in the left hemisphere.

Striatocapsular aphasia symptoms

Signs and symptoms include loss of fluency, rare phonemic paraphasias, and preserved repetition.

Anomic aphasia symptoms

Signs and symptoms include: fluent speech; intact receptive language; severe word naming deficit.

Conduction Aphasia symptoms

Signs and symptoms include: fluent speech; phonemic paraphasias; anomia; relatively intact auditory comprehension; significant deficits in repetition; can paraphrase.

Wernicke's Aphasia symptoms

Signs and symptoms include: significantly impaired receptive language deficits; repetition deficits; anosognosia; fluent speech filled with neologisms, empty speech, and paraphasias; deficits in pragmatic skills.

Transcortical Sensory Aphasia symptoms

Signs and symptoms of this aphasia include: poor auditory comprehension; relatively intact repetition; fluent speech with semantic paraphasias.

Striatocapsular Aphasia lesion location

Striatocapsular Aphasia occurs when there is an ischemic stroke within a part of the basal ganglia known as the striatum. This lesion leads to damage at the striatum but also reduces blood flow to cortical language areas. It is reduction of blood flow to the language areas which can create any profile of cortical aphasia based on site of lesion and personal anatomy.

Symptoms of Global Aphasia?

Symptoms include little to no receptive language or expressive language; most of their preserved and automatic language is lost; can produce one or two odd words/neologisms; intact prosody; fluent speech if able to produce word; cognitive deficits; hemiplegia; severe dysarthria; bucco-facial oral apraxia; apraxia of speech; swallow problems.

Thalamic aphasia lesion location

Thalamic Aphasia occurs due to lesion within the left or dominant side of the thalamus.

Crossed aphasia

The condition of having aphasia in right handed individuals arising from right cerebral hemisphere lesion.

Explain the role of the arcuate fasciculus in conduction aphasia.

The role of the arcuate fasciculus in is to connect Broca's area and Wernicke's area to transfer information from the temporal lobe language heard to the frontal lobe for direct repetition. In conduction aphasia this pathway is damaged thereby disconnection posterior areas of the brain from more anterior areas which inhibits repetition abilities.

Thalamic aphasia symptoms

The signs and symptoms include almost fluent speech, significant anomia in spontaneous speech that is not as significant in confrontational naming tasks, impaired receptive language, perseverative semantic paraphasias, normal articulation, hypophonic voice, intact repetition, and intact grammar.

Symptoms of Broca's Aphasia?

The symptoms of Broca's aphasia include halting, effortful, agrammatic, and telegraphic speech that are mostly content words; disfluent speech due to circumlocution and anomia; impaired prosody due to shortened length of utterances and the self-repairs; deficits in written language that are similar to their verbal output which may be further hindered by hemiplegia or hemiparesis; deficits in repetition. Those with Broca's aphasia usually have intact receptive language abilities with deficits in higher-level receptive language tasks.

Symptoms of Transcortical Motor Aphasia?

The symptoms of Transcortical Motor Aphasia are similar to those in Broca's aphasia except in Transcortical Motor Aphasia, repetition abilities are preserved; articulation may be unaffected unless the lesion reaches the primary motor cortex; writing abilities mirror verbal output abilities.

What are the three cortical nonfluent aphasias?

The three cortical nonfluent aphasias include: Broca's Aphasia, Transcortical Motor Aphasia, and Global Aphasia.

Two subcortical aphasias

The two subcortical aphasias are Thalamic Aphasia and Striatocapsular Aphasia.

How does aphasia therapy facilitate spontaneous recovery?

Therapy for aphasia during the time of spontaneous recovery facilitates even greater levels of recovery and cues further improvement past the level achieved with spontaneous recovery alone.

How might self-repairs produced by a person with aphasia reduce fluency?

Too many unsuccessful self-repairs break up fluency of an utterance and do not contribute to appropriate communication.

Lesions of Transcortical Motor Aphasia?

Transcortical Motor Aphasia occurs from damage to the supplementary motor cortex or the area anterior to Broca's area.

Transcortical Sensory Aphasia lesion location

Transcortical Sensory Aphasia occurs when there is a lesion posterior to Wernicke's area at the temporo-occipital-parietal junction.

Paraphasias

are errors in expressive language that are not related to motor deficits but that are linked to higher-level language deficits associated with aphasia.

Subcortical aphasias

arise as a result of damage to subcortical structures.

Cortical aphasias

arise as a result of damage to the cortex.

Administration of a standardized test

assesses multiple modalities of language including verbal reception of language, verbal expression, reading, and writing that allows for confirmation, refutation, and triangulation of preliminary conclusions to set goals and prognosis.

An evaluation of cognition is important because

cognition, language, and communication are intimately intertwined. Some level of cognition deficits is almost universally present in those with aphasia.

Anomia is a deficit of

expressive language

Aphasia

is a deficit in language abilities resulting from damage to the brain. Aphasia results in difficulty with language production, language comprehension, or both that may occur in any or all modalities (spoken, written).

Anomia

is a deficit in word finding ability.

Agraphia

is an acquired impairment in the ability to form letters or form words using letters.

Alexia

is an acquired impairment of reading, and there are many subtypes.

Agrammatism

is lack of appropriate grammatical construction of language individuals with aphasia display.

Lesion localizaition

is the practice of identifying the location of pathology in the brain based on the profile of deficits the individual displays.

Perseverate

is to do something repeatedly, redundantly, and, more often than not, inappropriately.

Assessment of functional communication and connected speech that is obtained through a patient and family interview are also important because

it gives the SLP the opportunity to assess the patient's residual language abilities to communicate in functional situations that could be later used as a baseline.

The case history is important because

it has the basic demographics, medial history, and social history of the patient which sets the context for interpreting all other information gathered.

A person with anomia

knows the meaning they want to communicate but cannot find the word or words to do so.

Alexia and agraphia are often the result of

lesions to the language-dominant hemisphere of the angular gyrus.

Perseverative paraphasia

occurs when a word produced earlier is repeatedly and inadvertently produced by an individual instead of the intended word.

Verbal comprehension deficit

refers specifically to an inability to comprehend the spoken language others produce.

Expressive language deficits usually arise from lesions in

the anterior portion of the left cerebral hemisphere at or near Broca's area. However, lesions almost anywhere in the anterior portion of the left hemisphere are likely to produce some expressive deficits.

Anosognosia

the pathological condition of having a deficit and being unable to recognize that the deficit exists or denying that the deficit exists despite evidence indicating otherwise.

Empty speech

vocalized communication often produced by those with fluent aphasia that is abundant yet lacking in meaning.

Neologistic paraphasias occur

when an individual produces a word that is entirely different from the intended word and is mostly unintelligible.

Unrelated verbal paraphasias occur

when an individual substitutes a word that is unrelated in meaning to the intended word.

Semantic paraphasias occur

when one word is substituted for another word that is similar in meaning.

Phonemic paraphasias occur

when the word produced is mostly correct except for a phoneme-level mistake.

Receptive language deficits include problems

with verbal or written language and usually arise from lesions in the posterior portion of the left hemisphere at or near Wernicke's area.

Wernicke's Aphasia lesion area

Wernicke's Aphasia occurs when there is a lesion in Wernicke's area in the left hemisphere. If the lesion reaches posteriorly toward the angular gyrus and into the visual association cortex, there may be reading deficits.