Acquired Neurogenic Communication Disorders

Question 1

What do SLPs do?

Answer 1

diagnose and treat communication, swallowing, and related disorders of the oropharyngeal mechanism

Question 2

SLP settings:

Answer 2

schools
SNF
private practices
hospitals
NICU
acute care

Question 3

Neurological Processes of Communication:

Answer 3

Cognitive – linguistic processes

Motor speech programming

Neuromuscular execution

Question 4

Aphasia =

Answer 4

acquired communication disorder caused by brain damage

characterized by an
impairment of language modalities: speaking,
listening, reading and writing

not the result of a
sensory deficit, a general intellectual deficit, or a
psychiatric disorder

Question 5

Multimodality Deficit
Language is a Central Process

Answer 5

3 levels:
1) word
2) sentence
3) discourse

comprehension:
> listening
> reading

production:
> speaking
> writing

Question 6

word:

Answer 6

comprehension:
> listening: listen to word & point to object/picture

> reading: read work & point to object/picture

production:
> speaking: name objects/pictures

> writing: write names of objects/pictures

Question 7

sentence:

Answer 7

comprehension:
> listening: follow command
> reading: follow instruction

production:
> speaking: describe actions
> writing: describe actions

Question 8

discourse:

Answer 8

comprehension:
> listening: listen to story & answer questions

> reading: read paragraph & answer questions

production:
> speaking: describe complex picture

> writing: write letter/story

Question 9

Aphasia multimodal language problem

Answer 9

Basic pattern of relative intact function / deficit

listening comprehension is the most preserved function

writing is the most impaired

auditory comprehension (listening) is relatively intact compared to expressive language functions (speaking and writing), especially in cases of more severe impairment

Question 10

Aphasia is an acquired impairment of the cognitive
system specialized for:

Answer 10

comprehending and formulating
language, leaving other systems relatively intact

Question 11

Aphasia Symptoms - Expression

Answer 11

anomia
non-fluent aphasia
telegraphic speech
agrammatism
telegraphic speech
paraphasia
neologism
jargon

Question 12

anomia =

Answer 12

Having difficulty finding words

Question 13

non-fluent aphasia =

Answer 13

Speaking haltingly or with effort

Question 14

telegraphic speech =

Answer 14

names of objects

Speaking in single words

Question 15

agrammatism =

Answer 15

Speaking in short, fragmented phrases

Making grammatical error

Question 16

telegraphic speech =

Answer 16

Omitting smaller words like the, of, and was

Question 17

paraphasia =

Answer 17

Substituting sounds or words

semantic word level
paraphasia “table” for bed

phonemic sound level paraphasia
“wishdasher” for dishwasher

Question 18

neologism =

Answer 18

Making up words

Question 19

jargon =

Answer 19

Fluently stringing together nonsense words and real words, but leaving
out or including an insufficient amount of relevant content (e.g., fluent
aphasia with empty speech, paucity of content

Question 20

Aphasia Symptoms - Comprehension

Answer 20

difficulty understanding
spoken utterances

Requiring extra time to
understand spoken messages

Providing unreliable answers to “yes/no” questions

Failing to understand complex grammar

Finding it very hard to follow fast speech (e.g., radio or television news)

Misinterpreting subtleties of
language (e.g., taking the literal meaning of figurative speech such as “It’s raining cats and dogs.”)

Lacking awareness of errors (e.g., anosognosia)

Question 21

classification of aphasia:

Answer 21

nonfluent = speech production is halting and effortful, grammar is impaired, content words may be preserved

fluent = person is able to produce connected speech, sentence structure is relatively intact but lacks meaning

Question 22

nonfluent aphasia:

Answer 22

language comprehension relatively intact -> broca’s aphasia & transcortical motor aphasia

language comprehension impaired -> global aphasia

Question 23

broca’s aphasia =

Answer 23

repetition of words/phrases poor

Question 24

transcortical motor aphasia =

Answer 24

strong repetition skills

may have difficulty spontaneously answering questions

Question 25

global aphasia =

Answer 25

severe expressive and receptive language impairment may be able to communicate using facial expression, intonation, and gestures

Question 26

fluent aphasia:

Answer 26

language comprehension relatively intact -> conduction aphasia & anomic aphasia language comprehension impaired -> wernicke's aphasia & transcortical sensory aphasia

Question 27

conduction aphasia =

Answer 27

word finding difficulties, difficulty repeating phrases

Question 28

anomic aphasia =

Answer 28

repetition of words/phrases good word finding difficulties uses generic fillers ("thing") or circumlocution

Question 29

wernicke's aphasia =

Answer 29

repetition of words/phrases poor

Question 30

transcortical sensory aphasia =

Answer 30

repetition of words/phrases good may repeat questions rather than answering them "echolalia"

Question 31

Characterize the communication output?

Answer 31

Non-fluent – Speech production is halting and effortful *grammar is impaired, content words may be relatively preserved Fluent - produces connected speech *sentence structure is relatively intact, but lacks meaning

Question 32

Characterize the auditory comprehension?

Answer 32

Language comprehension relatively intact Language comprehension relatively impaired

Question 33

If the repetition abilities were good, what type of aphasia do you think this person has? a) Broca’s b) Transcortical motor c) Conduction d) Global

Answer 33

b) Transcortical motor pattern of relatively preserved listening ability, but impaired speaking and writing, along with moderate difficulties in reading, fits with transcortical motor aphasia anomia (difficulty finding words) and agrammatism (telegraphic speech with missing function words) are common Paraphasias (word substitutions) might be minimal or absent argon or neologisms (nonsense words) are typically not prominent

Question 34

If the repetition abilities were poor, what type of aphasia do you think this person has? a) Broca’s b) Transcortical motor c) Conduction d) Global

Answer 34

c) Conduction (listening) is relatively intact Fluent speech but with frequent phonemic paraphasias (word or sound substitutions) Anomia (difficulty finding words) is present, but agrammatism is less common compared to Broca’s or transcortical motor aphasia no jargon or neologisms

Question 35

Broca’s aphasia also involves poor repetition, but the speech is typically ____

Answer 35

non-fluent, and the graph shows moderate to severe impairments across

Question 36

Transcortical motor aphasia is characterized by ___

Answer 36

good repetition

Question 37

Global aphasia involves severe deficits across ____

Answer 37

all modalities, including listening including listening, speaking, reading, and writing, with very little preserved ability

Question 38

If the repetition abilities were poor, what type of aphasia do you think this person has? a) Wernicke's b) Transcortical sensory c) Anomic d) Global

Answer 38

a) Wernicke's Listening comprehension is typically significantly impaired in Wernicke's aphasia Fluent speech is common, but it often includes paraphasias (word substitutions), jargon, and neologisms (nonsense words) Anomia (difficulty finding the right words) is also typica

Question 39

Transcortical sensory aphasia would involve good ___ despite poor ___

Answer 39

repetition comprehension

Question 40

Anomic aphasia is primarily characterized by ____

Answer 40

word-finding difficulties (anomia) but good comprehension and good repetition

Question 41

If the repetition abilities were good, what type of aphasia do you think this person has? a) Wernicke's b) Transcortical sensory c) Anomic d) Global

Answer 41

b) Transcortical sensory typically have poor comprehension Fluent speech is common, but often filled with paraphasias (word substitutions) or even neologisms (made-up words) Anomia (difficulty finding words) is present

Question 42

Wernicke's aphasia typically involves:

Answer 42

poor repetition, despite fluent speech and poor comprehension

Question 43

Anomic aphasia involves:

Answer 43

good comprehension and good repetition, but it is primarily characterized by word-finding difficulties

Question 44

Screening tool for aphasia

Answer 44

Language Screening Test

Question 45

Motor Speech Disorders

Answer 45

Dysarthria(s) Communication through vocal symbols = Speech

Question 46

Speech =

Answer 46

embodies language into the physical (acoustic) properties for the purposes of recognition and interpretation

Question 47

Motor Speech Disorders – Dysarthria(s)

Answer 47

group of neurogenic speech disorders characterized by "abnormalities in the strength, speed, range, steadiness, tone, or accuracy of movements required for breathing, phonatory, resonatory, articulatory, or prosodic aspects of speech production

Question 48

abnormalities are due to one or more sensorimotor problems—

Answer 48

weakness or paralysis incoordination involuntary movements excessive, reduced, or variable muscle tone

Question 49

predominant framework for differentially diagnosing dysarthria is based on ___

Answer 49

a perceptual method of classification

Question 50

perceptual method of classification relies on _____

Answer 50

auditory perceptual attributes of speech that point to the underlying pathophysiology perceptual attributes are used to characterize the dysarthrias and, along with pathophysiological information, can help identify underlying neurologic illness

Question 51

Motor Speech Disorders: Dysarthria types

Answer 51

congenital degenerative diseases demyelinating and inflammatory diseases infectious diseases neoplastic diseases toxic/metabolic diseases trauma vascular diseases

Question 52

congenital =

Answer 52

cerebral palsy, chiari malformation

Question 53

degenerative diseases =

Question 54

demyelinating and inflammatory diseases =

Answer 54

multiple sclerosis, encephalitis

Question 55

infectious diseases =

Answer 55

acquired immune deficiency syndrome (AIDS), herpes zoster

Question 56

neoplastic diseases =

Answer 56

CNS tumours, cerebral, cerebellar, or brainstem tumours

Question 57

toxic/metabolic diseases =

Answer 57

botulism, carbon monoxide posioning

Question 58

trauma =

Answer 58

traumatic brain injury chronic traumatic encephalopathy

Question 59

vascular diseases =

Answer 59

stroke (hemorrhagic or ischemic)

Question 60

flaccid =

Answer 60

associated with disorders of the lower motor neuron system and/or muscle Weakness, flaccidity, atrophy, fasciculations, hypoactive gag reflex, facial myokymia (involuntary, spontaneous, localized quivering of a few muscles), nasal backflow while swallowing

Question 61

Spastic =

Answer 61

associated with bilateral disorders of the upper motor neuron system Pathologic oral reflexes (sucking reflex; snout reflex; jaw jerk reflex), lability of affect, hypertonia, hyperactive gag reflex

Question 62

Ataxic =

Answer 62

associated with disorders of the cerebellar control circuit dysmetric jaw, face, and tongue AMRs, head tremor

Question 63

Hypokinetic =

Answer 63

associated with disorders of the basal ganglia control circuit Masked facial expression, tremulous jaw, lips, tongue, reduced range of motion on AMR tasks, resting tremor, rigidity

Question 64

Hyperkinetic =

Answer 64

associated with disorders of the basal ganglia control circuit Involuntary head, jaw, face, tongue, velar, laryngeal, and respiratory movements, relatively sustained deviation of head position, multiple motor tics, myoclonus of palate, pharynx, larynx, lips, nares, tongue, or respiratory muscles

Question 65

Traumatic Brin Injury - Cognitive-Communicative Disorders

Answer 65

form of nondegenerative acquired brain injury, resulting from an external physical force to the head (e.g., fall) or other mechanisms of displacement of the brain within the skull (e.g., blast injuries)

Question 66

Traumatic Brin Injury - Cognitive-Communicative Disorders: symptoms

Answer 66

Changes in levels of consciousness Memory disturbances Changes in cognitive function (e.g., attention, memory, executive function) Disturbances of sensory & motor function Confusion associated with deficits in orientation Neurological signs, such as brain injury observable on neuroimaging, new onset or worsening of seizure disorder, visual field deficits, hemiparesis, etc.

Question 67

TBIs can result in focal damage =

Answer 67

(e.g., gunshot wound) or be more diffuse in nature (e.g., diffuse axonal injury) symptoms can vary depending on the site of lesion and extent of damage to the brain TBI is often associated with polytrauma (injury to the brain in addition to one or more other body systems)

Question 68

TBI can be categorized as:

Answer 68

mild, moderate, or severe based on the extent and nature of injury, duration of loss of consciousness, post- traumatic amnesia, and the severity of confusion at initial assessment during the acute phase of the injury

Question 69

Potential Consequences/Impact of Cognitive-Communication Impairment Can Include:

Answer 69

Reduced ability to effectively communicate needs Reduced awareness of impairment and its degree Reduced memory, judgment, and ability to initiate and effectively exchange routine information Difficulty performing personal lifestyle management activities (i.e., pay bills) Reduced ability to anticipate potential consequences, lack of judgment and problem solving Reduced social communication skills and/or ability to manage emotions

Question 70

Cognitive-Communicative Disorders – Potential Impact on Everyday Function

Answer 70

Difficulty anticipating consequences of own actions Poor organization, with limited problem solving and judgment Difficulty with concepts of time and money Difficulty self-disciplining and self-monitoring to follow rules; exhibits socially inappropriate behavior Difficulty changing routine or schedule; difficulty learning new rules

Question 71

Limited communication:

Answer 71

difficulty selecting appropriate words and remembering names limited memory and/or knowledge of current events and/or personal history responses in conversation may be verbose, redundant, or tangential missing or misunderstanding humor difficulty understanding nonverbal communication (i.e., facial expressions and/or body language) difficulty understanding abstract information

Question 72

Difficulty managing home or maintaining a job or business due to:

Answer 72

Difficulty following directions Difficulty comprehending or applying abstract written information Difficulty analyzing personal and/or business problems, identifying and applying solutions Difficulty assessing own strengths and weaknesses, developing effective plans to improve weaknesses Difficulty managing multiple responsibilities simultaneously Difficulty managing emotions (especially anxiety, frustration, or anger) related to performance difficulties Difficulty making, following, and modifying plans as needed Difficulty effectively communicating with colleagues and/or customers

Question 73

Traumatic Brin Injury – Observations: Cognition

Answer 73

Orientation Attention Learning & Memory Recognition, prosopagnosia, gnosis, etc. Executive/Goal directed behavior Self-Awareness

Question 74

Traumatic Brin Injury – Observations: Language & Communication

Answer 74

* Verbose * Tangential * Paucity of thought * Slow processing speed * Word finding * Expressive impairments * Receptive impairments * Dysarthria

Question 75

Traumatic Brin Injury – Observations: Behavioral Regulation

Answer 75

* Affect * Agitation * Lability * Sensitivity * Impulsivity

Question 76

Traumatic Brin Injury - Neurocognitive Effects

Answer 76

Deficits in shifting attention between tasks Difficulty with selective attention Impaired sustained attention (e.g., for task completion) Increased response latencies Reduced processing speed Impaired goal directed behavior Deficits in short-term memory that negatively affect new learning or planned tasks Post-traumatic amnesia (retrograde) Lack of insight for monitoring one's strengths, weaknesses, functional abilities, problem situations, and so forth Reduced awareness of deficits (anosagnosia) Impaired goal directed behavior Deficits in orientation to self, situation, location, and/or time Impaired spatial cognition that can affect ability to navigate and ambulate

Question 76

Traumatic Brin Injury - Language & Communication Effects

Answer 76

* Pragmatic/Social Communication * Spoken Language

Question 76

Traumatic Brin Injury - Neurobehavioral Effects

Answer 76

Affective changes, including over-emotional or over-reactive affect or flat (i.e., emotionless) affect Agitation and/or combativeness Anxiety disorder, depression Difficulty identifying emotions in others (alexithymia) Emotional lability and mood changes or mood swings Excessive drowsiness and changes in sleep patterns, including difficulty falling or staying asleep (insomnia), excessive sleepiness (hypersomnia) Feeling of disorientation or fogginess Increased state of sensory sensitivity accompanied by exaggerated response to perceived threats (hypervigilance) Impulsivity, irritability and reduced frustration tolerance Stress disorders

Question 77

Pragmatic/Social Communication

Answer 77

Conversational turns marked by verbosity Difficulty initiating conversation and maintaining topic Difficulty inhibiting inappropriate language or behavior Impaired ability to use nonverbal communication effectively (e.g., tone of voice, facial expression, body language) Impaired social cognition skills (e.g., regulating emotion; expressing emotion and perceiving emotion of others; ability to take the perspective of others and to modify language accordingly) Tendency to be tangential

Question 78

Spoken Language =

Answer 78

Anomia or word retrieval deficits Decreased ability to formulate organized discourse or conversation Difficulty following directions Difficulty understanding abstract language/concepts Difficulty making inferences Tendency to perseverate in verbal responses Use of incoherent or confabulatory speech

Question 79

Difficulty functioning independently due to:

Answer 79

unresponsiveness to all external stimuli may open eyes, suck, and/or yawn does not attend to others no purposeful speech extremely impaired attention and memory with impulsivity extremely limited communication:

Question 80

extremely limited communication:

Answer 80

difficulty responding to and/or saying name difficulty expressing basic needs to others using simple words and/or gestures (i.e., yes/no difficulty saying greetings (i.e., "hi" and "bye") on own