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Aphasia > Non-Fluent Aphasia > Flashcards

Non-Fluent Aphasia Flashcards

1
Q

Non-Fluent Aphasias

A

may be referred to as: expressive aphasia, motor aphasia, or anterior aphasia

major symptoms characteristic of nonfluent syndromes of aphasia (generalities)

  • decreased rate of speech
  • decreased phrase length
  • decreased prosody
  • decreased initiation of speech
  • decreased talking in general
  • increased effort
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2
Q

What are the Non-fluent Aphasia

A

broca’s aphasia

global aphasia

transcortical motor aphasia

mixed aphasia

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3
Q

Broca’s Aphasia

A

first described in 1861

associated w/damage to the cerebral language areas surrounding the sylvian fissure but not extending to Wernicke’s area

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4
Q

Broca’s Aphasia Neuroanatomical Bases

A

posterior-inferior (third) frontal gyrus of the left hemisphere is known as Broca’s area (Brodmann’s areas 44 and part of 45)

area known as the anterior language cortex

middle cerebral artery blood supply

lower part of the premotor cortex

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5
Q

Broca’s Aphasia General Characteristics

A

more easily recognized than Wernicke’s pts

typically present w/contralateral hemiplegia or hemiparesis

weakness of [r] side facial muscles

most motor problems improve over time

pts are often very depressed; catastrophic reactions refusing to cooperate or continue testing

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6
Q

Broca’s Aphasia Language Characteristics

A 
nonfluent and effortful speech
agrammatic speech
impaired repetition of words/sentences
impaired naming
questionable auditory comprehension
oral reading
writing problems
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7
Q

Broca’s Aphasia 8 must knows chart

A

Look at power point

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8
Q

Transcortical Motor Aphasia (TMA)

A

extrasylvian aphasic syndrome; lies outside of the perisylvian language zones

nonfluent aphasia w/good repetition skills

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9
Q

TMA Neuroanatomical Bases

A

anterior superior frontal lobe

usually above or below Broca’s area

lesions often impact association pathways

impacts supplemental motor area

supplied by the anterior cerebral artery

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10
Q

TMA General Characteristics

A

similar to Broca’s aphasia

motor disorders: rigidity of UE, akinesia, bradykinesia

hemiparesis

pts may demonstrate apathy or behavioral withdrawal
exhibit little to no interest in using language

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11
Q

TMA Language Characteristics

A

muteness, echolalic, reduced spontaneous speech
agrammatic speech, paraphasic
impaired naming w/intact repetition
intact serial speech (relatively)
intact knowledge of grammar/meaningfulness
limited naming; may use motor prompts
better comprehension than production

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12
Q

TMA 8 Must Knows Chart

A

Look at powerpoint

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13
Q

Mixed “Transcortical” Aphasia

A

rare nonfluent aphasia type

combine TMA and TSA

language impairment is severe and extensive

pts retain repetition skills

has been labeled isolation aphasia

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14
Q

Mixed Neuroanatomical Bases

A

caused by various conditions that decrease blood flow throughout the cerebral arteries

  • hypoxia of various origins
  • cardiac arrest
  • cerebral edema
  • multiple embolic strokes

supplied by the middle cerebral artery, and the anterior/posterior cerebral arteries

Broca’s, Wernicke’s and the arcuate fasciculus are spared

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15
Q

Mixed General Characteristics

A

varied clinical picture

bilateral UMN paralysis

severe spastic quadriparesis (weakness of all 4 limbs)

visual field deficits (typical problem is right hemianopia)

weakness in hip/shoulder muscles

severe brain damage

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16
Q

Mixed Language Characteristics

A 
extremely limited spontaneous verbal expression, echolalic
severely impaired fluency
severely impaired auditory comprehension
marked naming difficulty
unimpaired automatic speech
normal articulation
severe reading deficits
severe writing impairments
17
Q

Mixed 8 Must Know Chart

A

Look at powerpoint

18
Q

Global Aphasia

A

may account for 30-55% of pts w/aphasia

most severe form of aphasia; has a generalized effect on communication skills

impacts all modes of communication and spares no particular skill

possible for global aphasia to evolve into another type of aphasia

be careful of prognosis

19
Q

Global Neuroanatomical Bases

A

lesion likely involve the entire perisylvian region affecting both Broca’s and Wernick’e areas

subcortical areas may even be impacted

more common sites are impacted by the middle cerebral artery

pg 148 (text; has good picture…figure 5-3)

widespread destruction of the left fronto-temporo-parietal regions

20
Q

Global General Characteristics

A

presence of strong neurological symptoms; weakeness, paralysis, sensory loss

apraxia including both verbal and oral types

hemi-neglect: left neglect is common in right hemisphere damage

21
Q

Global Language Characteristics

A

globally impaired communication skills

severely impaired fluency

impaired repetition, naming, reading, writing

impaired auditory comprehension

22
Q

Global 8 Must Knows Chart

A

Look a powerpoint

23
Q

General NonFluent Aphasia TX

A

Coarticulated speech:
-build on level of success (syllables, words, phrases…)
Auditory comprehension:
-point, follow commands, understand complex material
Oral expression tasks may range from:
-oral-motor skills, automatic sequences, repetition, answering questions, naming, and word fluency to reading words and sentences aloud
Understanding written language (reading):
-identify letters, words, match words and pictures, read sentences and paragraphs
Writing:
-improve mechanics for writing basic information, the alphabet, numbers, writing to dictation, writing names, and writing about a picture or event

24
Q

TX Strategies

A

Consider spared abilities and functional levels:
-good writing: apply directly to communication

  • some writing: consider a writing/spelling therapy program
  • no writing, some drawing: consider a communicative drawing therapy program
  • no writing, some gesturing: consider a communicative gesturing therapy program
  • gestural-verbal training increases naming for some people with aphasia
25
Q

PACE Approach

A

PACE (Prompting Aphasics’ Communicative Effectiveness)
Pulvermuller & Volkbert, 1991

Uses compensatory strategies to facilitate communicate

  • this approach encourages the exchange of information
  • provide a stimuli picture face down between patient and clinician and the patient must look at it and use any available means to communicate the message (similar to charades but this uses any and all communication modalities and methods)
  • SLP guesses and provides feedback
26
Q

Mapping TX

A

mapping tx for agrammatism (Byng, 1988)

targets sentence structure and thematic roles by identifying the subject and object of sentences

uses pictures

27
Q

SPPA

A

Sentence Production Program for Aphasia (SPPA)
Helm-Estabrooks & Nicholas, 2000

program is used to improve conversation with pts who have nonfluent aphasia and who are agrammatic speakers

attempts to increase phrase length, content, and grammar

SPPA focuses on eight (8) sentence types using a thematic base

28
Q

MIT

A

Melodic Intonation Therapy (MIT)
Sparks & Deck, 1986
MIT is an approach that uses melodies and intonation patterns of the intact right hemisphere
Four levels of MIT:
(1) intoning a melodic line,
(2) hand tapping saying syllables,
(3) answering questions, and
(4) practice with drilled phrases & sentences
pictures are used initially and later program cues are reduced.

29
Q

RET

A

Response Elaboration Training (RET)
Kearns, 1991
RET is a program using loose training with patient-initiated responses (without restrictions)
-approach uses simple line drawn picture stimuli requiring personal interpretation
-SLP scaffolds responses (does not provide correction to pt responses)
Six steps
1. elicit spontaneous response to picture
2. model and reinforce patient’s response
3. provide ‘wh’ cues for patient to elaborate
4. reinforce elaboration and model the sentence
5. repeat and have patient repeat
6. reinforce and provide another model

30
Q

TX for Equivocal Responses

A

equivocal (vague, ambiguous, confusing)

  • use two 3x5 cards with “yes” and “no” (one on each)
  • pt repeats each word 5 times while looking at the cards
  • assist the pt to say the word and nod “yes” and then “no” when given a cue
  • present yes-no questions for the pt’s responses
  • request responses to simple questions
    1. is your name _____?
    2. did you have a stroke?
  • establish a baseline and begin treatment with personal, environmental and informational questions
  • use pictures to help the pt understand questions
  • chart responses
31
Q

Gestural Response TX

A
  • core vocabulary is chosen based upon pt needs (begin with 5-10 words)
  • clinician makes a gesture while saying a word
  • clinician repeats the word with the patient
  • pt imitates the gesture immediately and then after a brief delay
  • pt gestures after the clinician says the and writes the word
  • pt writes the word if possible when seeing the gesture
32
Q

Card TX

A

(deck of cards)
improve sequencing of numbers on cards by putting them in order

match cards according to suit and number (use 2 decks)

respond to commands using cards
-pick up the ace

33
Q

Writing Hierarchy

A
  • trace a word
  • copy the word
  • say the word for the patient to identify in writing
  • ask the pt to write the word to dictation
  • ask the pt to write the word given a picture
  • ask the pt to write the word in response to a question
34
Q

Communication Boards

A

Use communication boards with pictures and words
-alphabet and word boards are usually ineffective for individuals with global aphasia
Include pictures of people & familiar objects
Use pictures of real objects, actions, and places
Teach the pt to use the communication board
-point when an item is named (immediate then with a delay)
-keep the board visually simple at first and then expose more items with time when success is achieved
-consider a more high-tech AAC (augmentative alternative communication) device if possible and financially feasible

35
Q

Using AAC

A

When introducing an AAC device, assess the device’s communicative capabilities and compare it with the client’s needs
-consider operational demands regarding the client’s motor, sensory, and cognitive skills

Adapt the device to the client’s situations and available support

Train the client and family how to use the device

Monitor its use for functional language

36
Q

Functional AAC Considerations

How functionally can the pt.:

A 
get someone’s attention 
give yes/no answers 
call for help
indicate understanding of what is being said
respond without words
say the name of a person nearby
communicate their needs, wants, pain (if any)
have social time with friends and family
understand written communication
communicate their emotions 
describe something
have a one-on-one conversation
get involved in group talk about self
participate in a group conversation

Aphasia (7 decks)

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