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Flashcards in Aphasia Deck (507):
1

What is aphasia?

an impairment of language function caused by brain damage (includes multiplicity of deficits involving one ore more aspects of language use)

2

What is meant by multiplicity of deficits?

it is multi-modal

3

Aphasia is neuro-muscular. T/F

False

4

When you have language problem that is motor driven it is what? 2

1 dysarthria
2 apraxia

5

Aphasia is neurogenic and acquired. T/F

Ture

6

Aphasia is developmental. T/F

False

7

Does aphasia involve only a few parts of language?

no, it often involves all aspects of language

8

___ % of patients with L hemisphere strokes develop aphasia.

30

9

___ new cases of aphasia are reported in the US each year.

80,000

10

What do you need to know to work with an aphasia client? 9

1 cause/etiology/severity
2 Hx - behavior, past treatment and response
3 TPO - evolution
4 Impact - social/family structure
5 Interaction and support preferred
6 Dx - aphasia, interpret, classify
7 Rehab/TX - evidence based practice
8 Lesion - neuro
9 Hearing status

11

___ is using a system to allow a PWA to adapt to his/her new life.

paradigm mapping

12

__ is when the PWA goes into sudden state of extreme negativity, appropriate reaction to frustration and fear but the intensity is out of proportion.

catastrophic reaction

13

What goes into stroke prevention?

smoking
alcohol overuse
drug use
health/fitness

14

What groups are higher risk for stroke? 4

African American
Elderly
Type A
Diet and Exercise

15

How do different aphasia's happen in similar stroke profiles?

though two different pts can have strokes affecting the same hemisphere (left) they can have different manifestations

16

How do we know about Broca's and Wernicke's area?

oblation paradigm: remove a particular area and see affects

17

Where is Broca's area?

inferior third convolution of the frontal lobe on the left hemisphere (includes pars opercularis and pars triangularis)

18

Where is Wernicke's area?

posterior third of the superior temporal gyrus of the temporal lobe on the left hemisphere; the temporo-parietal junction

19

How are Broca's and Wernicke's areas connected?

arcuate fasciculus

20

What happens if the connections (arcuate fasciculus) between Broca's and Wernicke's areas is broken?

conduction aphasia, trouble at producing speech, good comprehension, cannot repeat what they hear

21

_____ are the coordinates of brain structures based on cytoarchitecture.

Brodmann's area

22

Brodmann used ___ to map the brain, not based on function.

cytoarchitecture

23

Each hemisphere is broken into lobes or segments and they are interconnect, but have major roles: ____ is ____, _____ is ____, _____ is ____, and ____ is ____.

frontal is executive function
parietal is sensory and proprioception
temporal lobe is hearing
occipital lobe is vision

24

The largest connection between hemispheres is ____

.corpus callosum

25

What are connections between hemispheres called? What are connections within hemsipheres called? What are connections up and down hemispheres called?

callosal fiber tracts
association fiber tracts
projection fiber tracts

26

What is BA 4 in the frontal lobe?

primary motor cortex/pre-central gyrus

27

What BA has voluntary control of motor behavior? What kinds of muscles does it control?

4; striated muscles

28

___ means a section doesn't move at all.

hemiaplegia

29

___ means that a section is impaired.

hemiparesis

30

What is BA6 in the frontal lobe?

premotor cortex and supplementary motor area

31

What BA provides the prepares complex and skilled movement? "Get ready to move" signal

6

32

What disorder is associated with lesions of the pre-motor cortex and supplementary motor area?

(limb) apraxia; they can repeat, but cannot initiate their own response

33

What is controlled in the prefrontal cortex?

goal oriented behavior, abstract reasoning, decision making, planning; appropriate behavior

34

What is the most complicated movement you can do?

speech

35

What are the 3 sections of the inferior frontal gyrus?

1 pars opercularis (operculum is an overhang/awning)
2 pars triangularis
3 pars orbitalis

36

What are the pars opercularis, pars triangularis, and pars orbitalis part of?

inferior frontal gyrus

37

What is Broca's areas BA? What does it do?

44 & 45; motor speech production

38

What kind of aphasia did Tan have?

global aphasia

39

What are the symptoms of Broca's aphasia? 4

1 distorted sounding speech
2 automatic speech
3 halting, with equal stress, poor prosody
4 agrammatism (trouble with grammatical aspects of speech)

40

From the mesial surface of the frontal lobe we can see the ___, which is involved in initiation and preparation.

supplementary motor area

41

What are the three primary gyri of the temporal lobe?

inferior, middle and superior

42

What does the temporal lobe do? 2

auditory comprehension, word retrieval, memory (storage of words are verbal memories), limbic system

43

What is Heschel's gyri BA?

41, 42

44

What is the the opercular region of the temporal lobe called?

planum temporale - it is where Heschel's gyri is located

45

Where is Wernicke's area? BA?

posterior 1/3 of superior temporal gyrus; 22

46

What does Wernicke's area do?

phonemic decoding and encoding; putting the sounds in the right order;

47

If you have an inferior or middle temporal lesion, what could you have?

anomia (word retrieval)

48

Why do memory impairments go hand and hand with TBIs?

because the temporal pole is an important

49

What is embedded in the temporal lobe? memory

amygdala (temporal pole); hippocampus

50

What does the limbic system do? 3

1 emotions/motivations
2 survival functions - eating
3 survival functions - sex

51

What is the basal ganglia?

group of nuclei in the subcortex, imp for smooth movement and coordination

52

What is the basal ganglia composed of? 4

1 caudate nucleus
2 putamen
3 globus pallidus
4 claustrum (a subcortical gray structure)

53

What is the thalamus?

the relay station (everything going in goes through it, and everything going out)

54

What are the ventricles?

holes in the brain the create and store CSF

55

What is in the parietal lobe? 3

primary sensory cortex; superior parietal lobule; inferior parietal lobule (supramarginal and angular gyrus)

56

What BA is the primary sensory cortex?

2,1,3

57

What does the superior parietal lobule do? 2

1 body awareness position (proprioception)
2 reciprocal connections with motor cortex

58

What does the inferior parietal lobule do? What is it made up of? 2

language, what you know about things comes together here; angular and supramarginal gyrus

59

What BA is the angular gyrus?

39

60

What BA is the supramarginal gyrus? What is it imp for?

40; writing, analysis and integration of sensory input

61

What is imp about the occipital lobe?

primary visual cortex; visual association cortex

62

What BA is the primary visual cortex? What's another name for it?

17; striate or calcarine cortex

63

What is in the middle of the primary visual cortex?

calcarine fissure

64

What BA is the visual association cortex? What is it associated with in another lobe?

18, 19; posterior inferior and middle temporal gyri BA 37

65

What are the two kinds of association cortices?

uni-modal association (can only handle 1 type of input) and multi-modal association

66

What is meant by uni-modal association cortex?

it is modality specific: neurons respond exclusively to 1 type of neuron; damage only affects that modality

67

What are examples of uni-modal association cortices? 5

1 audition: posterior superior temporal gyrus BA 22
2 vision: extrastriate BA 18&19
3 inferior temporal gyrus BA 20
4 somatosensory: superior parital lobule BA 5 &7
5 motor: pre-motor cortex BA 6 & 8

68

What is meant multi-modal association cortex?

it is not limited to one sense modality; receive input from different uni-modal or heteromodal areas (may contain convergence neurons) mixtures of different sense neurons

69

Where are the multimodal association corteices that we know so far? 3

1 prefrontal regions (9,10,11)
2 inferior parietal lobule (39,40)
3 middle (21) and posterior ventral temporal lobe (37)

70

What is the insula and what does it do?

it is a cortex beneath the frontal, temporal and parietal opercula; motor control and other tasks

71

What are the principles of brain organization?

laterality of function, interconnectivity

72

What is the principle of laterality?

language function and praxis is lateralized to the left hemisphere; attention, emotion and gestalt are lateralized to the right hemisphere

73

___% of left handed individuals have bilateral language.

60

74

What are physical differences between the hemispheres? 3

1right frontal pole is wider and extends more
2left parieto-occipital lobe is wider and extends longer
3 Sylvian fissure and auditory association cortex is greater on the left

75

Is lateralization always relative?

yes, it is not absolute

76

What are the important components of the language hearing network? 3

1 Heschel's gyrus (speech worth processing more)
Inferior Parietal Lobule, Wernicke's gyrus, Auditory 2 Association Cortex - Multi Modal Areas (what is the speech saying)
3 Temporal Lobe IPL (Semantics memory, what does it mean?)

77

What goes in to the language speaking network? 5

1 Should I speek? Pre-frontal
2 Semantics? IPL; Inf and middle temporal
3 How to say it? Order? Code? Wernicke's area
4 Pgm speech output? Broca's area
5 Move the speech musculature? Primary motor strip

78

What difference does it make if the lesion is in the Peri-sylvian language zone or the extra-peri-sylvian (borderzone)?

Perisylvian lz- means prim aud cortex, inf frontal lobe and connex btw (may not include Wernicke's) - interferes with repetition
Extra-perisylvian lz - they can repeat even though they cannot comprehend (spare perisylvian)

79

If pt cannot repeat it means ___

there lesion is at least perisylvian

80

What difference between anterior/posterior lesion (central sulcus, relatively anterior or posterior)?

anterior damage tends to be nonfluent
posterior damage tends to be fluent

81

The more anterior the damage is the more likely the person is to be ____

non fluent

82

The anterior/posterior is ___ dichotomy and the perisylvian and extra-perisylvian is a ____ dichotomy.

fluency and comprehension; repetition

83

In aphasia terminology, fluency means what? 5

1 amount/sentence length
2 morphological omissions
3 flattened prosody
4 struggle iniitiating articulation
5 lack of spontaneous utterances

84

Dysfluent adults must be less than or equal to ___ words per utterance or less than ___ words/minute.

4; 100

85

What is the comprehension dichotomy for anterior/posterior?

posterior - impaired comprehension
anterior - relatively preserved auditory comprehension (exception asyntactic comprehension - impairment of comprehension when it is dependent on syntax)

86

What is auditory comprehension?

understanding words, phrases, sentences, discourse; specifics differ based on the demand

87

Where is alexia without agraphia take place?

primary visual cortex, splenium of the corpus callosum, inferior temporal lobe; IPL spared; can recognize the letters and name them out loud, but can't read what they have just written

88

What are "letter by letter" readers?

pts with alexia

89

Which groups are higher risk for stroke? 4

men
african americans
asians
heredity

90

What can you do to prevent stroke?

stop smoking
eat healthier
drink only in moderation

91

What does the stroke warning FAST mean?

Face (one sided drooping/loss of sensitivity)
Arms (difficulty raising one arm)
Speech (trouble speaking)
Time (time is a factor)

92

What is the LPA? What is it also called?

Life Participation Approach to aphasia; social appraoch

93

___ includes the PWA as the primary person, who has intelligence and are competant.

Life Participation Approach/social approach

94

What is meant by "supported communication"?

an increase in "communicative access"

95

What are the principles of the social approach? 5

1 address both info exchange and social needs as dual goals of communication
2 authentic, relevant, and natural contexts
3 communication as dynamic, flexible, and multidimensional
4 communication is collaborative
5 focus on natural interaction: conversation
6 focus on adaptations and enablement rather than impairment and disability

96

What is the goal of the social approach?

Enhancement of Life through Participation (Quality of Life, which is difficult to measure)

97

What can you do with supported conversation? 4

1 write the question down
2 give choices
3 use gestures
4 use a communication book

98

Should you pretend you understand a PWA?

NO! Show that you don't understand and acknowledge the participant's frustrations and fears "I know you know"

99

What goes in to having a clear message for a PWA?

1 shorten phrases (plenty of pause between phrases)
2 write topic at the top of the page and clinician and PWA key words as you go

100

What do you do to support for output?

provide pen and paper and ask "is there anything you can do to show me?"

101

What is meant by written choice?

multiple choice, always include an "other"

102

What is important of verification of understanding?

are we still talking about ___ (topic)

103

Brain uses ____ of O2 consumed by the adult body. How much does children under 4yrs brains use?

20%; 50%

104

Brain cannot ___ O2.

store; needs a constant supply

105

When you deprive the brain of O2, it is called ___.

ischemia

106

Consciousness can be lost in less than ____. Brain damage occurs in ____ in loss of O2 supply.

10 seconds, 3-5 minutes

107

Which type of stroke to we see most often?

middle cerebral artery (on left side)

108

What carotid artery supplies the brain?

internal carotid artery (supplies almost all mesial surface of the brain)

109

What does the posterior cerebral artery supply?

mesial surface fo the occipital and temporal lobe, lateral occipital love

110

What does the middle cerebral artery supply?

almost all of the lateral cerebrum

111

What does the anterior cerebral artery supply?

mesial surface of the frontal and parietal lobes

112

How doe you explain variety of deficits?

variety of branches of each cerebral artery

113

What is the watershed region?

the overlap of the MCA and ACA where they finger together (this is vulnerable to hyperperfusion or drops in BP - skinny arteries are like this)

114

The two circulation routes to the brain are ___ and ___.

anterior and posterior.

115

Both circulation routes to the brain arise from ___.

aorta

116

The aorta bifurcates into the ____ and ___

common carotid (anterior); subclavian (posterior)

117

___ provides blood supply to the face.

External carotid

118

____ provides blood supply to the brain.

Internal carotid

119

What is the anterior circulation?

bifurcation of internal carotid (middle cerebral and anterior cerebral)

120

____ arise from the subclavian arteries and joint to form ______.

verterbral arteries; basilar artery

121

The vertebral arteries supply _____ then combine to form basilar artery which then suplies ___.

Posterior Inferior Cerebellar Artery & Anterior Inferior Cerebellar Artery; Superior cerebellar artery

122

After the AICA, the basilar continues to form ____ and then finally ___.

Superior cerebellar artery; posterior cerebral artery

123

What does the posterior cerebral artery supply?

posterior inferior temporal lobe and posterior occipital lobe

124

The area around the sylvian fissure where the middle cerebral artery comes out is called the ___.

Perisylvian cortex or the Perisylvian Language Zone

125

The edges (terminal arteries) of each territory is the watershed region and is ____ _____ (dual blood supply, but vulnerable to hypoperfusion)

extra peri-sylvian

126

The ___ arteries of each territory is the watershed region and is extra perisylvian (dual blood supply, but vulnerable to hypoperfusion)

terminal

127

____ strokes that we see are often damage located in the small penetrating arteries off the MCA.

lacunar

128

Lacunar strokes affect the _____.

terminal/penetrating arteries

129

____ is a sudden interruption in blood flow the brain.

Stroke

130

_____ results in more distal area strokes and ___ results in more proximal area strokes. ___ results in watershed areas strokes.

Hypertension; hypotension; hypotension

131

What are the two major kinds of stroke?

blockage - ischemic; hemorrhagic

132

____ new strokes in the US per year.

400,000

133

___ of new cases of aphasia are from stroke.

50%

134

What are the two types of hemorrhagic stroke?

thrombus - progressive narrowing in brain
embolus - clot from elsewhere

135

___ is the permanent damage as a result of ischemia.

Infarction

136

What is a TIA?

transient ischemic attack - temporary blockage for less than 24 hours.

137

What is the emergency tx for ischemic stroke? How soon must be administered?

clot-buster - rT-PA; must be given w/in 3 hours

138

How can the doctor manage hemorrhagic strokes?

controlling high blood pressures
bleeding
edema (swelling of brain)

139

How is a hemorrhagic stroke different than ischemic?

the damage is more diffuse and has a high fatality rate; better prognosis (generally) depending on location

140

___ is a tangle of arteries and veins which are vulnerable to rupture.

AV malformation

141

___ is a ballooning/weakening of the wall of an artery.

Aneurysm

142

What are other types of brain damage that can cause aphasia? 6

penetrating wound, head injury, anoxia, degenerative diseases, tumors, infections

143

The type of injury is less important than ___ and ___.

location of damage; extent/size of lesion

144

Aphasia is not a disease, it is a ____.

symptom

145

What are the different ways that we can image the brain? 3

1 structural vs. functional
2 contrast vs. non-contrast
3 x-ray vs magnetic vs. biochemical spectral analysis

146

___ is a type of imaging developed in the late 60's that uses radiation measures how much radiation has been absorbed in different densities. Many x-rays from multiple directions.

Computerized Tomography (CT)

147

What are CT scans good for?

can use contrasts - can enhance the margins of the lesion; good for viewing infarction, not so good at acute or subacute infarctions, good at detecting hemorrhages;

148

____ uses large superconducting magnet with strong external magnetic field (sets nuclei with odd # of protons spinning and they match up and then relax resultingin a magnetic moment).

Magnetic Resonance Imagining

149

What are MRI scans good for?

discriminating normal tissue for tumor or infections in water content (ignores bones) can take pictures at different time points (T1 (anatomical) vs. T2 (pathological/physiological))

150

In MRIs, the lesion shows up as ____.

white (liquidiy, soft, tissue)

151

MRI can detect changes that occuring during ____ (breakdown of the blood-brain barrier, which is sooner than CT).

first few hours

152

Which imaging is better at seeing the lesion?

CT over time, MRI early on

153

What is encephalomalacia?

"soft brain" secondary to increased water content is bright white on T2 MRI

154

What is fMRI?

using MRI technology to measure change in signal right after brain activity

155

What is PET?

positron emission technology - scanner detects radioactive material that is added to brain, highlights brain activity (metabolically)

156

What are the advantage and disadvantages for PET?

adv - image of brain activity
disadv - expensive; radioactive; not great resolution

157

What is MEG?

magnetoencaphalography - meas magnetic field produced by electrical activity in brain; uses SQUIDs (superconducting quantum interference devices)

158

What is MEG good for? 3

localizing a pathology
research brain function
TEMPORAL resolution good but not spatial

159

What is Diffusion-Weighted Imaging?

measures the diffusion of water molecules over short distances

160

What is good about DWI?

can detect ischemic strokes when MRI sometimes cannot

161

What is Perfusion Imaging?

can show which areas of the brain are not getting blood (they are not functioning) done by injecting a contrast agent then performing RMI using ultrafast techniques

162

____ refers to the potential of the nervous system to be modified in response to stimulation and activation, it is experience-dependent, cortical reorganization.

Neuroplasticity

163

What is neuroplasticity?

the potential of the nervous system to be modified in response to stimulation and activation

164

What are the two types of neuroplasticity? (little/big)

1 micro level - neurophysiologic (cellular/network)
2 macro level - behavioral (beh./system)

165

How is recovery defined?

any and all behavioral changes

166

What is recovery at the behavioral level?

perform the task in the same manner as it was previously

167

What is recovery at the micro level?

restoration of function w/in the area of cortex damage

168

What are the primary changes of brain damage?

acute (first few days) necrosis, inflammation, retrograde cell degen, anterograde cell degen

169

What are the secondary changes of brain damage?

over time (subacute and chronic), transneuronal degen, denervation supersensitivity, diaschisis, vascular disruption and collateral sprouting

170

What is diaschisis?

regions connected to the damage area shut down, not b/c their damage, but b/c of their connection

171

What is regression of diaschisis?

distant FX of brain lesions subside; structurally unaffected brain regions recover function

172

What is restoration in brain damage?

reactivation of brain areas w/ neural connex

173

What is recruitment in brain damage?

a.k.a functional takeover, enlisting other brain areas not normally involved to contribute to beh (right hemisphere; the homologue to broca's area)

174

What is retraining in brain damage?

brain areas perform novel or additional functions as a result of rehabilitation

175

What is a return of behavior supported by the same premorbid functional system?

restitution-restoration-reactivation (repetition)

176

What is rerouting parts of the functional system w/o changing the whole system?

reorganization-reconstruction-substituion w/in functional system (vicariative Tx - melodic intonation therapy)

177

What is an example of relearning?

grapheme-phoneme correspondences

178

What is improving access to preserved function?

facilitation

179

What are compensatory approaches?

functional substitution (write instead of say it, gestures, etc.)

180

What are the two types of neuroplasticity? (+/-)

adaptive or maladaptive

181

What are maladaptive neuroplasticity?

less successful changes that spins the wheels

182

What are the 10 principles of neuroplasticiy? very important!

Kleim and Jones
1 use it or lose it - degeneration w/o use
2 use it or improve it - make growth better through use
3 specificity - growth specific areas that are most relevant (why luminosity/oral motor exercises don't work)
4 repetition matters - overtraining
5 intensity matters - more is better (mostly)
6 time matters - the earlier to the stroke, the better, effects taper
7 salience matters - put it in a context
8 age matters - younger people tend to recover
9 transference - "wax on" / "wax off"
10 interference - learning of one behavior interferes

183

What are the three models of language representation? 3

1 neuroanatomical model - lesion analysis/ablation
2 cognitive neuropsychological model - functional (stepwise) architecture of beh
3 distributed networks - parallel distributed beh (across the network)

184

____ correlates behavior with localization of anatomical lesion. All that can be said is that the damaged area was somehow involved.

neuroanatomical model

185

Frontal operculum is important for ___

speech output, reading (esp reading aloud) also syntax

186

Left posterior ventral temporal lobe is imporatnt for ___

word/lexical retreival

187

Inferior temporal lobe is imp for ___

cateory specific retreival

188

What are shortcomings of n.a. model?

some cases contradict lcoalization and doesn't take into effect diaschisis

189

___ takes into account the processes involved in functional characteristics of brain activity.

cognitive neuropsychological model

190

____ is active for naming objecting and reading words aloud; shared functions for word retrieval: translating word form to articulatory sequences.

Frontal operculum

191

___ is critical for lexical retrieval and is in the BA 37.

Left posterior ventral temporal lobe/inferior temporal and fusiform gyri

192

What are the neural correlates of sentence processing?

1 Bilateral recruitment of Broca's and Wernicke's
2 Left angular gyrus
3 Bilateral temporal sulcus

193

Perfusion imaging is a form of (structural/functional) imagining.

functional

194

Perfusion imaging is a form of (structural/functional) imagining.

functional

195

___ is involved in programing writing output. It is located in pre-frontal area.

Exner's area

196

What does a differential Aphasia diagnosis tell you?

the cluster of symptoms, but it doesn't tell you why; the cognitive neuropsychological model provides this

197

Anomia is both a sign/symptom and ___.

a diagnosis/syndrome

198

Can a SLP make a dx of Broca's aphasia?

yes! it is based on the signs and symptoms that we observe

199

Is it w/in an SLP's scope of practice to make a dx of a left hemisphere CVA?

no! that's a medical diagnosis

200

What is a sign?

observable trait

201

What is a symptom?

patient complaint

202

Can you have the same syndrome from multiple different etiologies?

Yes, doesn't even have to be a focal lesion for some of the more "focal" aphasias

203

Anomia is a syndrome, when?

when it is the only problem.

204

Does prompting help a person with anomic aphasia?

no, and may refuse to accept the name when provided

205

What are anomic aphasia characterized by? 3

1 word fiinding difficulties
2 circumlocutions/empty speech
3 nouns more difficult than verbs

206

We must distinguish anomic aphasia from _____ or failure to recognize objects.

agnosia

207

What parts of the brain does acute anomic aphasia typically affect?

left-temporal-occipital junction or thalamus

208

What parts of the brain does chronic anomic aphasia typically affect?

difficult to localize; inferior/middle temporal gyri

209

Acute anomia has a ___ prognosis.

very good

210

Chronic anomia has a ___ prognosis.

not very good

211

___ is when the words bear meaningful relationship to the target.

semantic paraphasia

212

___ is when the words are phonlogical similar or nonwords.

phonemic paraphasia

213

___ is when a nonsense word or phrase bearing no apparent relationship to the target.

Neologism

214

____ is when a meaningful description of the intended word.

meaningful description of the intended word

215

___ is repeated abberrant response from the target.

Peseveration

216

____ is when there is a failure to give any response ("I don't know").

No response

217

___ is mimicking exactly what the examiner says.

echolalia

218

___ is verbal responses limited to common phrases or expletives.

automatisms

219

___ is recurrent nonsensical response; perhaps related to prosody.

stereotypies

220

___ is utterances with grammatical elements omitted.

Agrammatism

221

What are the stages of naming objects?

1 perceptual processing (visualize input/primary processing)
2 recognition
3 meaning (semantics; central representation)
4 form (frequency sensitive)
5 output (motor system)

222

What is the role of the input lexicon?

recognition of the object (part of info processing when a stimulus becomes uniquely distinguishable from other physically similar stimuli)

223

Is the input lexicon dependent on modality?

no, it is thought to be mode and modality indepenedent

224

What does full recognition in the input lexicon access?

semantic system

225

A problem with recognition in failure/input lexicon is called ____.

an agnosia

226

What is achromatopsia?

color recognition failure

227

What is prosopagnosia?

face recognition failure

228

What is visual object agnosia?

object recognition failure

229

What are the two classes of agnosia?

1 apperceptive
2 associative

230

___ is a final stage of purely perceptual processing (cannot even copy a seen object).

Apperceptive agnosia

231

___ is when you gives the percept meaning by linking it to previous experience.

Associative agnosia

232

What is the importance of agnosia?

determining if the person has it, before calling them anomic

233

What are semantic features?

conceptually related components (if you see a lion and the next picture is tiger, you've already activated a semantically related idea, this is called semantic priming)

234

If you use a related semantic feature to activate an idea, this is called _____.

semantic priming

235

The contraversy over the semantic system is whether it is ___ or ____ (i.e. category specific or not).

unitary or specific

236

____ is store phonologic representation is another form of lexical knowledge.

Phonologic form (output lexicon)

237

Phonologic output lexicon is sensitive to ___ and ____.

word class (nouns easier than verbs)
frequency (high easier than low)

238

Phonlogical form must be coded for ___ and ___.

what and where (does the /b/ go at the beginning middle or end)

239

____ is an abstraction representation of what the word means/is related to.

Lemma (this is also where rhymes are stored)

240

What are the 3 things that need to be considered in assessing word retrieval?

1 task
2 cahracteristics of words being probed
3 levels of processing involved in the performance

241

What are the different methods of levels of processing involved in the performance of the task? 4

1 lexical-semantic, phonological encoding
2 semantic, lexical, phonological
3 coneceptual-semantic, lexical semantic, lexical-form, phonological encoding, articulation
4 word sleection (conceptual-semantic feature-lexical network-phonological network), and phonological encoding (phonological newtowrk-phonological encoding-articulation)

242

What goes in the cognitive neuropsychological models? 5

1 based upon theory of normal processes
2 model of functional architecture for the beh of interest
3 asses specific component of the beh based on pt characteristics
4 ID locus of impairment
5 target tx to address or compensate impairments

243

What tasks for word retrieval are available? 2+

1 picture naming/naming to definition
2 repetition of words and non-words
(also, word recognition, lexical decision, phoneme discrimination and semantic association)

244

What are different kinds of stimuli that are available for word probes? 4+

1 word frequency
2 word imageability
3 word length
4 lexicality
(also category, part of speech, etc.)

245

___ means better performance of on high frequency words than low frequency words.

"frequency effect"

246

What does a frequency effect in word rpoduction indicates difficulty ____; but in in repetition indicates ______.

somewhere in the lexical semantic processing; a deficit in phonological representations

247

___ is how "picturable" something is (concrete v. abstract)

Imageability

248

How does the imageability effect affect word retrieval?

suggests deficit in spread of activation in semantic-lexical network

249

How does the imageability effect affect repetition?

reveals dependency on lexical-semantic processing for repetition

250

The ___ is that shorter words are produced more easily than longer words.

word length effect

251

A ___ is more difficulty with short words.

reverse length effect

252

Word length effect in word retrieval and repetition suggests what?

a deficit in phonological processing regardless of the kind of word production task

253

What does a reverse length effect signify?

difficulty with input processing, more competition for shorter words (more words similar to them, longer words are more unique)

254

___ is better performance for real words versus pseudowords.

Lexicality effect

255

What does pseudoword repetition rely on? How do you demonstrate damage to this route?

non-lexical route (if they cannot be repeated suggests damage to this route)

256

If the replaced word in a non-word tasks is a related non word, what does that mean?1
if the replaced word in a non-word task is a real world, what does that mean?2

1 ouput processing is impaired
2 lexicalization error; input processing is impaired and partial reliance on lexical-semantic route

257

____ is different types of stimuli for naming (nouns v. verbs, high v. low freq, and different modalities).

Confrontational naming

258

____ is asking a pt to come up with as many as you can in a category (semantic or phonological).

Generative naming (verbal fluency)

259

____ is a naming task that involced word retrieval during connected speech.

discourse naming

260

___ is difficulty seeing more than one point in a space at the same time.

Simultanagnosia

261

What are the steps of auditory comprehension? 4

1 heard word
2 auditory phonological analysis
3 phonological input lexicon
4 semantic system

262

____ is difficulty repeating, poor minimal pairs or choosing the word when their is a phonological distractors. Improves with lip-reading/written input. Usually caused by bilateral damage and has a good prognosis.

pure word deafness/word sound deafness

263

What is pure word deafness marked by?

poor repetition, poor recognition of sounds

264

____ happens when the ycan process input enough to distinguish minimal pairs but still have auditory input deficits, auditory lexical decisions (meaning) are impaired

word form deafness (lexical level)

265

___ can descriminate minimal pairs, make auditory lexical decisions (real v. non-real words), and repeat, but cannot comprehend (access word meaning). May understand written and provide definitions to written words. Abstract words are more difficult to concrete.

word meaning deafness

266

Issues in perceptual analysis are __1___, issues with recognition are ___2___ and issues with meaning are ____3___.

1 word sound deafness
2 word form deafness
3 word meaning deafness

267

____ is the system of rules for the modification of word forms to signify their relationships to other words in the sentence is the morphology of the language.

Morphology

268

____ creates differences of meaning within the word class (stays a verb, noun or adjective).

Inflectional morphological processes; walk -> walks; round -> rounded

269

___ creas a new categories of words from existing owrds, changes the cateogry of the root.

Derivational affixes; destroy -> destruction; conserve -> conservation

270

____ need to be attached to word to have meaning.

bound morphemes

271

____ can be free-standing words or attached to other morphemes.

free-standing morphemes

272

____ is the SVO structure.

canonical (basic) word order

273

____ is the non-SVO structure, like passive voice OVS or object cleft is OSV

uncanonical word order

274

Word order is important for assignment of thematic roles in ____ sentences.

reversible

275

___ is a syndrome marked by morphological and word order comprehension deficits.

Agrammatism

276

If there is a difficulty with idea, pt may have ___

cognitivie deficit

277

If there is a difficulty with thematic roles, there could be a problem with ___

functional level of representation

278

___ has been historically viewed as part of the syndrome of Broca's aphasia, characterized by halting and effortful fragmented language production,, the syntactic complexity of sentecnes is reduced, content words are used more than grammatical words, and marked by telegraphic speech.

Agrammatism

279

What are the 4 commonly occuring (but dissociable) symptoms of agrammatism? !!! exam question !!!

1 morphologic impairment
2 syntax production deficit (word order)
3 asyntactic comprehension
4 verb retrieval deficit

280

___ is when comprehension is dependent on syntax.

Asyntactic comprehension

281

If person is tested as Broca's aphasia, what's the next steps? 6

1. assess thematic role assignment/sentence production
2 assess verb retrieval
3 assess morphology
4 assess syntax comprehension
5 assess word retrieval
6 assess discourse

282

What assessment will help with specifying sub-syndromes with Broca's (or other) aphasias? 6

Action Naming Test
Object/Action Naming Test
Pyscho Linguistic Assessment of Language Performance in Aphasia (PALPA)
Circles and Squares Test
Quantitative Production Analysis

283

What behaviors do we look at for diagnosis of aphasia using the neuroanatomical approach? 4

1 fluency
2 naming
3 auditory comprehension
4 repetition

284

What are the behaviors of Broca's?

nonfluent, impaired naming, impaired repetition, imparied auditory comprehension

285

What are the behaviors of Wernicke's?

fluent, impaired naming, impaired repetitions, impaired auditory comprehension

286

What are the behaviors of conduction aphasia?

fluent (sometimes not), impaired naming, impaired repetition, preserved auditory comprehension (sometimes not)

287

What are the behaviors of transcortical motor aphasia?

nonfluent, impaired naming, preserved repetition, preserved auditory comprehension

288

What are the behaviors of transcortical sensory aphasia?

fluent, impaired naming, preserved repetition, impaired auditory comprehension

289

What are the behaviors of transcortical mixed aphasia?

nonfluent, impaired naming, preserved repetition, impaired auditory comprehension

290

What are the behaviors of anomic aphasia?

fluent (some deficits), impaired naming, preserved repetition, preserved auditory comprehension

291

What are the behaviors of global aphasia?

nonfluent, impaired naming, impaired repetition, impaired auditory comprehension

292

____ % of patients with aphasia are "unclassifiable"

45-60

293

What leads to a PWA getting the "unclassifiable" label? 5

1 atypical cerebral dominance
2 bilateral damage
3 multiple lesions
4 progressive neurologic disease
5 premorbid deficits (e.g. substance abuse, learning disabilities)

294

What is the point of diagnostics in aphasia? 5

1 severity
2 assess so that you can find strengths and weakness
3 where to start
4 inform PWA w/ progrnosis
5 type - fluent/nonfluent

295

PWA who have Broca's be better with ____ than spontaneous speech.

visual confrontational naming

296

What does poor repetition reflect in Broca's?

difficulty with verbal output

297

What are the components of agrammatism? 4

Bad with
1 verbs
2 morphology (endings)
3 word order
4 understanding form

298

___ basically means articulatory effort and is a characteristic of Broca's.

Apraxia of speech

299

____ generally parallels impairments in auditory comprehension, but in Broca's aphasia, it is typically impaired.

Reading aloud

300

What are two impairments that typically go along with auditory comprehension deficits? Which one is found in Broca's?

reading aloud, writing. Writing only

301

What is meant by apraxic and linguistic agraphia?

the signals in the sentence that tell you to change the words and create a new meaning; more than just semantics, also effects prepositions, passive sentences

302

____ is when it is difficult to sound out graphemes, phonemes, and/or conversational speech.

Phoneme dyslexia

303

If the lesion is not ____ it is usually NOT Broca's aphasia.

just located in Broca's area (i.e. if the lesion is above Broca's often results minor Broca's aphasia and apraxia of speech)

304

Where is lesion localization for Broca's?

superior branch of the MCA (lg portions of frontal and parietal lobes, caused by an embolus)

305

What are associated defictis with Broca's? 3

1 Buccofacial apraxia (non-verbal oral apraxia)
2 Ideomotor limb apraxia
3 Right hemiplegia

306

____ is lesions that are confined to ONLY Broca's area (third frontal convolution). Starts a mutism and generally resolves to a mild verbal dyspraxia (phonetic disintegration).

Minor Broca's

307

____ is often called "paying by the letter" or telegraphic speech.

Agrammatism

308

Patients with agrammatism are characterized by what? 4

1 halting and effortful lang production
2 reduced syntactic complexity
3 content words (n. & v.) used more than grammatical owrds (art., prep., and aux. v.)
4 telegraphic

309

What is the prognosis for recovery from Broca's?

intermediate, highest rate of recovery, but no full recovery b/c of regression from diaschisis (also different symptoms may occur)

310

If a PW Broca's recovers fluency and repetition their dx may change to ___

Anomic aphasia

311

If a PW Broca's recovers repetition their dx may change to ___.

transcortical motor aphasia

312

Wernicke's aphasia is/isn't usually hemiparetic.

isn't

313

Where is the lesion typically for Wernicke's?

peri-sylvian posterior

314

What are the major encoding/decoding symptoms of Wernicke's?

can't encode or decode (sounds like people are speaking a foreign language to them and they think the problem is with your listening when you don't understand)

315

In Wernicke's, auditory comprehension is ___.

severely impaired (often cannot follow simple, single step commands w/ out significant context)

316

Where is the deficit in auditory comprehension in Wernicke's?

phonemic processing

317

What does impaired repetition in Wernicke's result in?

phonemic and semantic paraphasias

318

What is the characteristics of spontaneous speech in Wernicke's?

paraphasic fluent output - semantic, phonemic, both, approaching neologistic jargon. Prosodically accurate and with paragrammatism

319

___ may yield more phonemic paraphasias than seen in spontaneous speech in Wernicke's.

Visual confrontational naming tasks

320

What is the reading status in Wernicke's?

usually severely impaired (equal to spontaneous speech), but a subtype that has limited damage to the IPL has better reading

321

What is the writing status in Wernicke's?

usually severely impaired (equal to spontaneous speech) linguistic agraphia, with handwriting preserved, can make letters, not words

322

What are the psychosocial aspects of Wernicke's? 2

Ansognosic for speech
Alienation and suicide common due to misdiagnosis of psychosis/dementia

323

Where is the lesion localized for Wernickes?

classically: posterior/superior temporal lobe of left; can extend superiorly and/or posteriorly with greater, more persistent deficits

324

What types of word retrieval errors are seen in Wernickes? 3

neologisms (degraded word)
semantic (real related words)
phonemic (part of the word is degraded)

325

What is recovery like for Wernicke's? 2 options

1 some retain their fluent jargon under pressure for many months. Over time, phonemic paraphasias resolve and they are left with semantic paraphasia and persistent anomia.
2 if they have less jargon initially, they can demonstrate better recovery and resolve more quickly in the direction of anomic aphasia, demonstrating gains in comprehension and repetition

326

What is acute Wernicke's aphasia look like?

patient may be euphoric and gesturally hyperactive; later developing paranoia

327

What are prognositic indicators for Wernicke's? 4

1 age (WEAK)
2 lesion size (strong)
3 initial severity of aud comp
4 proportion of jargon

328

What is conduction aphasia's speech characterized by? 2

1 trouble with repetition
2 constant revisions

329

What is the auditory comprehension status in conduction aphasia?

relatively intact, especially if not syntactically complex

330

What is naming like for conduction aphasia?

almost always anomic from phonemic paraphasias to inability to retrieve the word

331

What is repetition like for conduction aphasia?

marked by deficit in repetition, especially for phrases or sentences, or unfamiliar words and nonsense words

332

What does conduit d'approche mean?

getting close to the target

333

What does conduit d'ecart mean?

very far from the target

334

____ is marked by a deficit in auditory short-term memory characterized by disturbance in only verbal repettion tasks.

Repetition conduction aphasia

335

____ is marked by phonological output processes in general (have difficulty with word production across output tasks).

Reproduction conduction aphasia

336

What region may be critical for repetition?

RIGHT peri-sylvian region (left may not be critical)

337

What deficits are associated with conduction aphasia? 3

1 buccofacial apraxia (non speech sound repetition impaired) and limb apraxia
2 some arm hemiparesis
3 impaired reading aloud and writing (misspellings to profound paragraphia

338

What is lesion localization for conduction aphasia? (2 distinct sites)

1 arcuate fasciculus of the dominant hemisphere (disconnect btw Wernicke's and Broca's)
2 Wernicke's area to parietal lobe (phonological short term memory)

339

What is the prognosis for conduction aphasia?

positive- many cases demonstrate excellent recovery, can also be a phase of Wernicke's recovery,
highest rate of recovery (along with Broca's) but better in the first three months post onset

340

What is acute conduction aphasia characterized by?

paraphasias decrease b/c pt becomes less fluent b/c anticipates errors and attempts to self-correct

341

Don't confuse ___ with syndromes/symptoms.

etiology

342

____ is a severe disruption of all aspects of speech and language with grossly nonfluent verbal output. Less likely to respond at all unlike Wernicke's.

Global aphasia (total aphasia)

343

What are the characteristics of fluency in global aphasia? 4

1 typically only a few words, stereotyped, repetitive utterance
2 emotionally charged phrases may be produced fluently spontaneously (god damnit - uninhibited by frontal lobe)
3 series speech is severely limited (may only be able to being a series): counting, days of week,etc.
4 prosody also impaired

344

What are the characteristics of auditory comprehension in global aphasia? 3

1 severe impairment; variable performance on simple commands, pt may refuse to participate
2 in context MAY be better than formal testing
3 MAY follow some gross midline commands (stand up, stick out your tongue; the more distal of your arm from midline, the more difficult)

345

In global aphasia naming is ___.

severely impaired

346

What are associated characteristics for global aphasia?5

1 praxis is usually severely involved
2 hemiplegia (lack of movement)
3 hemianesthesia (lack of senses)
4 homonymoushemianopsia (half of visual field deficit)
5 right sided neglect

347

What is the lesion localization for global aphasia?

extensive lesion in the territory of the left MCA, large peri-sylvian lesion (pre/post rolandic)

348

When we say that the global aphasia lesion is often pre- and post-rolandic, what do we mean? 3

fronto-temporo-parietal cortex, basal ganglia, also motor strip usually.

349

Global aphasia can also feature isolated ____ lesions.

subcortical

350

Global aphasia has generally a ____ prognosis especially if ___ improvement is/is not seen w/in ___.

poor; significant; is not; first few weeks

351

Many pts with global aphasia will make a ____ change to severe Broca's aphasia.

slow, gradual

352

Many pts with global aphasia will gradually change to ___ over time.

severe Broca's aphasia

353

____ improves more than ___ (especially for social communication) for global aphasia.

Comprehension; speech output

354

What can global aphasia resolve to? 4

1 Broca's
2 TCM
3 Anomic
4 Conduction
(or remain global)

355

With global aphasia, there is a ___ window, around that time some patients will show improvements.

6 month window

356

Around 6 months, some global aphasia patients will show improvements in ___, ____, and ___.

nonverbal communication; praxis; alertness and responsiveness

357

____ is a system for learning skilled movement (scissors).

Praxis

358

_____ results from a lesion in watershed region anterior to perisylvian area.

Transcortical motor aphasia

359

What are the characteristics of fluency in transcortical motor aphasia? 5

non fluent:
1 may initially present as mute
2 stumbling spontaneous speech; repetitive, even stuttering-like
3 syntax, highly simplified, may be classified as agrammatic
4 reduction in the amount and complexity of spontaneous speech despite retained ability to repeat
5 differences in output with exo-evoked vs. endo-evoked responses

360

____ is a type of output that is a response to stimulus that comes from outside (show pic, you name it).

exo-evoked

361

___ is a type of output that is self-generating.

endo-evoked

362

What are the characteristics of repetition in TCM? 2

can be:
- relatively well-preserved (can repeat full sentences, correct grammatically incorrect statements, and reject nonsense words when they repeat)
- greater difficulty repeating longer sentences, closed class items (functors, prepositions), low probability words/sentences

363

___ are a way of describing functors and prepositions.

Closed class items

364

___ is when you "close" the end of a task. Can change behaviors.

Completion phenomenon

365

What are the statuses of naming and auditory comprehension in TCM?

naming: impaired (may pair output w/ another motor response to help initiate; prompting with phonemic clues may help or may lead to erroneous response)
auditory comprehension: relatively spared (may have difficulty with syntax-dependent comprehension)

366

What are the statuses of reading and writing in TCM?

reading could be preserved or alexia
writing usually impaired; apraxic agraphia

367

What are associated signs of TCM? 7

1 hemiparesis of leg more than arm
2 initial muteness
3 bilateral ideomotor apraxia
4 akinesia (paucity of movement) or bradykinesia (slowness of movement)
5 transient urinary incontinence
6 contralateral grasp reflex
7 upper extremity rigidity

368

Where the lesion located for TCM? 3 opts

1 lg lesion in left anterior watershed (borderzone) region which spares Broca's area
2 infarction in the ACA resulting in damage to the SMA and its limbic connections
3 isolated lesion to Broca's area: rare cause

369

What is prognosis for TCM?

variable, some recover to anomic or Broca's, some recover completely, some remain moderately to severely impaired

370

What is perseveration?

unintentionally repeating the same behavior

371

What are the types of perseveration?3

1 stuck-in-set perseveration
2 recurrent perseveration
3 continuous perseveration

372

___ is the inappropriate prolongation or repetition of a behavior without interruption (worst kind) (involves a deficit in motor output and most common in patients with damage to the basal ganglia)

Continuous perseveration

373

___ is the unintentional repetition of a previous response to a subsequent stimulus. (involves an abnormal post-facilitation of memory traces and related neuroanatomically to posterior left hemisphere dmaage)

Recurrent perseveration

374

___ is the inappropriate maintenance of a current category or framework. (involves an underlying process deficit in executive function and is related neuroanatomically to frontal lobe damage)

Stuck-in-set perseveration

375

What is necessary to lok at for differential diagnosis in TCM?

1 repetition ability distinguishes it from Broca's
2 look for repetition compared to spontaneous speech
3 can possible exist free of perseveration and with a great deal of interference of preseveration

376

What are the characteristics for auditory comprehension and naming of Transcortical Sensory aphasia?

aud comp - severely impaired (deficit at the level of connecting sound to meaning; phonemic processing is intact for both input and output; comprehension may be slightly better than in Wernicke's)
naming - severely impaired

377

Where is lesion located for TCS?

posterior watershed lesion (in the temporo-parieto-occipital region or posterior and deep to Wernicke's area), but not a lot of data;

378

What are the characteristics for reading and writing for TCS?

reading aloud may be possible, but reading comprehension is even more impaired than audition
writing is also severely impaired at least as bad as spoken output

379

What are associated deficits for TCS? 5

1 not usually hemiparetic, so often misdiagnosed as psychotic
2 constructional apraxia
3 ideational apraxia
4 anosognosia
5 elements of Gerstmann syndrome (co-occurence common)- agraphia, left-right confusion, finger-ID, acalculia, limb apraxia

380

What is recovery like for TCS?

it caused by etiologies other than dementia usually good: quickly evolves to anomia
dementia: deteriorates

381

What are the characteristics of Mixed Transcortical Aphasia? 5

1 rare syndrome
2 severely impaired aud comprehension
3 limited or absent meaningful spontaneous speech
4 preserved repetition
5 either multi-focal or diffuse with perisylvian spared

382

What are the fluency and auditory comprehension characteristics of Mixed transcortical?

nonfluent (no speech initiation, short meaningless responses, series speech may be preserved once initiated)
severely impaired aud comp (echolalic)

383

What are the characteristics of repetition, naming, reading and writing for mixed transcortical?

repetition - not normal, but better than other attributes
naming - severely impaired with semantic paraphasias, neologisms, or no response
reading and writing are also poor

384

What are associated signs of mixed transcortical? 3

1 hemiplegia
2 hemianesthesia
3 homonymous hemianopsia

385

Where is the lesion localized for mixed transcortical?

watershed areas of the cortex, resulting from occlusion of the carotid artery, trauma, or diffuse encephalopathy

386

What is prognosis for mixed transcortical?

may recover some, but not like TCS or TCM, may resolve to severe anomic

387

____ is a common disorder characterized by fluent, often circumlocutory speech, preserved repetition and comprehension and impaired naming.

Anomic aphasia

388

What are the characteristics of anomic aphasia?

anomia is their only problem (fluent, preserved repetition and auditory comprehension)

389

What are the characteristics of reading and writing in anomic aphasia?

may be preserved or impaired

390

What are the clinical symptoms of naming in anomic aphasia?

visual confrontation naming is poor (some only have difficulty with low frequency words)
circumlocution (inability to inhibit active words that they want,structure but not content around a word)

391

Prompting usually does/does not help in anomic aphasia.

does not

392

In anomic aphasia, pt may _____ the name when provided.

refuse to accept

393

It is important to differentiate anomic aphasia from ___ (failure to recognize).

agnosia

394

Where is lesion localized in anomic aphasia?

in acute it is left themoral-occipital junction or thalamus
in chronic it may be difficult to lcalize (inferior/middle temporal gyri)

395

Why should we treat people with aphasia?

although most recover occurs in the first 6-12 mos, evidence has shown that most individuals benefit from therapy and can show a slow rate of recovery

396

____ is modifying the individual's environment to accommodate their deficit: decision based on etiology, TPO, immediate needs, etc.

Management

397

____ is direct application of aid to deficient behaviors.

Treatment

398

_____ is when the effect is to speed up or embellish the recovery ultimately governed by the physiology of the nervous system.

Restitutive tx

399

____ aims to achieve the behavioral goals in a new way.

Substitutive tx

400

___ is a type of substitutive tx that ulimately removes the substitutive cue in hopes that the behavioral goal may still be supported (facilitative; temporarily aids a permanent strategy).

Vicariative

401

___ is altering the task strategy so that the behavioral goal thereafter would be achieved using new functions in a manner different from normal performance.

Compensatory

402

What are the different nonfluent tx methods? 6

1 Melodic intonation tx
2 Constraint induced language tx
3 Syntax- Mapping
4 Syntax Tx of Underlying forms
5 Word-retrieval- Semantic Feature Analysis
6 Word-retrieval- Cuing hierarchies

403

What are the different fluent tx methods? 3

1 Schuell's stimulation approach
2 Direct Tx for comprehension
3 Attention training

404

What are compensatory methods? 8

1 pantomime
2 gestural codes (ASL, others)
3 facial expression
4 writing
5 drawing
6 pointing boards/books
7 augmentative communication devices
8 computer systems (e.g. C-VIC)

405

Since naming is an issue in almost all aphasia, one possible treatment for all aphasia is ___.

word retrieval

406

____ begins with the clients error (instead of word) and highlight features that are different (including draw describe, list, etc. (LOTS of Different names for this one)

Semantic Features tx or Semantic Distinctive treatment or Semantic Complexity theory or Atypical naming

407

___ is that that network is not as strong as it need to be . A matrix or cuing hierarchy which helps to fill lacking semantic representations which may be missing. Clinician chooses words and you test the client's word retrieval to the related network. (don't start necessarily with an error)

Semantic feature analysis (SFA)

408

____ is a common approach, that involves category sorting and word-picture matching with closer cateogries and more related distracters, yes/no semantic questions etc.

Semantic comprehension treatment

409

____ is a treatment which read aloud/name aloud.

Phonological treatments

410

____ is focused on the name or sound of the word (initial phoneme, rhyme, word repetition).

Phonological cueing hierarchy

411

____ is like SFA but with phonological form of the word.

Phonologic component analysis

412

____ specifically targets verbs.

Verb training

413

___ targets the specific pairings that a verb can take and strengthens verbs.

V-nest

414

____ and ___ works under the principle that it is the same form regardless of which intake method is used.

Verbal + Gestural Reorganization;
Writing/reading cues

415

____ take automatic words and write it down and try to make it volitional rather than automatic. Take control of words.

Voluntary Control of Involuntary Utterances

416

___ is an approach to excessive perseveration, by writing down the extra word, tearing it up and throwing it away.

Treatment of Aphasic Perseveration

417

____ is a combination of both semantic nd phonologic in a least potent to most potent (increasing the cues).

Traditional cuing hierarchies

418

What is a reverse cuing hierarchy?

Beginning with the most potent cues and progressively decreasing the cues - called Errorless learning

419

___ is a form of inter-systemic reorganization where the right hand is moved it activates the left hemisphere.

Intention Manipulation

420

___ is a logical tx when comprehension is impaired. 1. reduce response length (shut up therapy), 2 attend to alerting signals, 3. establish reliable yes/no response
4 manipulate the signal/task in command following

Auditory comprehension

421

What are the steps of auditory comprehension tx? 4

1. reduce response length (shut up therapy)
2 attend to alerting signals
3. establish reliable yes/no response
4 manipulate the signal/task in command following

422

What goes into a task hierarchy for stimulation of auditory comprehension? 3

1 stepwise increase in task demands (or decrease in task demands)
2 steps could vary in many ways
3 vary the nature of the signal (point to common objects by function/name, point two common obj by function/name, point to one object describe by 3 descriptors)

423

What is a task hierarchy?

systematic steps you are going to use (assuming decreasing) from easy to harder, but could reverse
(e.g. follow one-verb commands, point to 3 common objs, point to 3 obj. by function, two obj location instruction, etc.)

424

What are factors that may be manipulated in an auditory comprehension stimulation task hierarchies? 6

1 # of choices
2 relatedness of foils
3 length
4 paralinguistics (rate/pauses, delays, stress)
5 redundancy
6 syntactic complexity

425

What are stimulus factors for auditory comprehension task hierarchies? 7

1 familiarity and relevance
2 frequency
3 semantic category
4 phonological similarity
5 manipulability
6 emotionality
7 concreteness

426

____ is that words and sentences in discourse may be easier to understand than in isolations (redundancy of language, context clues, etc.)

Discourse comprehension

427

___ argues that context may aid communication, target functional communication, clinciian manipulateds the linguistic and timing variables in a controlled communication setting: loose training approach.

Contextualized approach

428

____ is a strong controlled, intensive auditory stimulation of the impaired symbol system

Stimulation approach

429

____ is a stimulation of the correct response w/ direct tx, uses a story completion format. formally called the HELPSS.

Sentence Production Program for Aphasia

430

____ is a modified version, which focuses on who does what to whom to improve sentence comprehension and production. Color coded pictures for roles.

Mapping treatment

431

______ is another linguistic syntactic approach that takes advantage of positional level of the sentence - production of complex, non-canonical sentences also produces the deep structure. Left branching/object cleft sentences

Treatment of Underlying Forms

432

____ is to repeat and tap intoned phrases of increasing length, to improve someones output. Nonfluent aphasia; relatively preserved auditory comprehension.

Melodic Intonation Therapy

433

What does PACE stand for? Communicate your idea anyway you can

Promoting Aphasic Communication Effectiveness

434

___ is a type of therapy good for severe nonfluent forms of aphasia, that works on the first few conversational turns

Script therapy

435

___ was based on a movement-based therapy, based on forcing individuals not to use compensatory strategies. They used their impaired brain areas more

Constraint Induced Language Therapy

436

What was the first introduced CILT's rules? 3

1 all approx relevant utterances could be used
2 certain verbalized social conventions may be added such as names of co-players, gratitude, etc.
3 standard phrasal structures or novel sentence frame may be required depending upon participant ability

437

Patients with severe/global aphasia may ___ tests and may even ____.

fail most; refuse to be tested

438

What can you do initially to test severe/global aphasia?

bedside testing: look for behaviors to monitor improvement;

439

What approach should you use when testing severe aphasia?

process approach

440

Using a ____, testing severe aphasia where you record not only a score but how the patient performs.

process approach

441

What is the main goal of Tx of severe aphasia?

establish a small basic core of communication intentions conveyed through any and all input modalities

442

____ is called the old brain or historic brain and is the home for the limbic system and other impulsive parts of the brain.

Subcortex (basal ganglia, thalamus and hypothalamus)

443

Subcortical aphasia usually results from a lesion in ___ or ___.

basal ganglia; thalamus

444

Why is subcortical aphasia contraversal?

some of them are the result of cortical lesions we couldn't see

445

______ is marked by symptoms that don't fit other classic symptoms. Trouble with lexical-semantic access.

Thalamic aphasia

446

Two regions implicated for language for thalamic aphasia are ____ (executive functions) and ____ (semantic/lexical processing)

dorsalmedial nucleus; pulvinar

447

Thalamic aphasia a problem with _____ mechanism also known trouble with ____.

gating; access

448

___ is marked by anomia in spontaneous speech, normal grammar, normal artic, normal repetition, possible comprehension impairment, light tough interpreted as burning and inappropriate laughing and crying.

Aphasia from thalamic lesions

449

What is a good treatment for thalamic aphasia?

intersystemic reorganization

450

____ is a type of subcortical aphasi with invisible cortical damage associated with the vascular event and is not fundamentally different from cortical aphasia.

Aphasia from basal ganglia

451

____ is when their aphasia symptoms continue to worsen (at first their aphasia are their only symptoms).

Primary Progressive Aphasia

452

What are the 3 variants of Primary Progressive Aphasia?

1 Progressive Nonfluent aphasia (PNFA)
2 Semantic (fluent) dementia
3 Social Comportment and Executive Function Disorder/Logopenic

453

____ is a type of primary progressive aphais athat is marked by agrammatism, decreased MLU and WPM and decreased complexity. Poorly formed sentenceswith phonemic paraphasias and "frontal" deficits and maybe apraxia of speech.

Progressive nonfluent aphasia

454

____ is makred by a naming impairment, semantic paraphasias and comprehension also impaired (word and object meaning), but reversal of the concreteness effect (greater difficulty with concrete rather than abstract). Temporal lobe atrophy.

Semantic (fluent) dementia

455

____ is relatively preserved semantic knowledge, marked word retrieval definition spontaneous speech, good motor control for speech and paucity of verbal output and fluency is between semantic and nonfluent subtypes.

Logopenic

456

___ is marked by disinhibition, agitation, impulsivity, apathy, hyper-oral, and hyper-sexual. It can be independent or related to logopenic.

Social comportment and Executive function disorder

457

Why do we care about alexia and agraphia? 2

1 associated deficits contribute to the overall profile
2 may be the residual deficits following recovery of language and can be used for rehabilitation or compensation

458

What are the basic task for assessing reading in aphasia? 7

1 single word reading aloud
2 word-picture matching
3 lexical decision
4 letter identification
5 cross-case matching
6 sentence and paragraph reading
7 reading comprehension

459

______ getting the input in to the CNS (Reading)

Peripheral alexia

460

_____ is impairment with the central processing system (Reading)

Central alexia

461

____ has a word length effect when reading. They can typically write.

Pure alexia

462

What does MOR stand for/mean?

Multiple Oral Rereading - it is more reading which capitalizes on knowledge of language system itself (with inhibition of letter naming strategy)

463

What is "Implicit Semantic Access"?

Also known as "brief exposure", it involves presenting the stimulus so fast, they can't recognize the word (limits letter-by-letter strategy) and shows better than chance understanding of word meaning

464

____ is increase of access to input lexicon, especially for non letter-by-letter readers. They write what they see.

Cross-modal cuing

465

____ is when a person reads at the sublexical route, converting letters to sounds.

Surface alexia

466

What do you do to treat surface alexia? 3

retraining irregular words; can teach them to self-cue with phonology; teach contrasting homophones

467

What does deep alexia mean?

when you depend on trained lexical route; impaired grapheme-phoneme conversion; semantic paralexias

468

If you can't tell if is deep alexia or phonologic alexia, you need to test _____.

non-words!!

469

How do you treat deep alexia?

work on mapping pictures to the written word (strengthen association)

470

_____ is reliance on lexical routes and creates problems with novel words.

Phonologic alexia

471

How do you treat phonologic alexia? 3 steps

1 teach letter-to-sound correspondences
2 teach pt to sound out words
3 teach pt to sound and blend words
(teach irregular words likes yacht)

472

What are some basic parts of agraphia? 4

1 sound letter conversion (graphemic output lexicon
2 output store/what the word writes like (motor program)
3 where you keep the letters as you write (graphemic buffer)
4 adjusting for writing styles, upper case or cursive (allographic conversion)

473

What are some tasks for assessing writing/agraphia? 9

1 spontaneous writing
2 written naming
3 writing to dictation
4 spelling to dictation
5 copying
6 typing
7 anagrams
8 visual imagery
9 picture description

474

___ is marked by comparable rates and types of errors across all lexical tasks (written naming, oral naming, spelling to dictation, etc.) and semantic paragraphias

Semantic system deficit

475

___ is marked by a sublexical route impairment, with highly familiar words spelled correctly and impaired spelling of novel or nonwords.

Phoneme to grapheme conversion deficit

476

___ is marked by a semantic impairment and grapheme-phoneme conversion impairment.

Deep agraphia

477

In the ___, you retrain writing through key words and checking practice against a target.

Lexical relay cueing hierarchy

478

___ is marked by a deficit in word form, but retained word phoneme conversion. Frequent homophone confusions: rain for reign or possibly rane for reign if the phoneme to grapheme conversion is preserved.

Graphemic output lexicon deficit

479

_____ is reliance on phoneme-grapheme conversion and regularization of irregular words.

Surface alexia

480

___ is marked by a loss of retrieved word form, observed letter omissions, substitutions, transpositions & insertions and observed length effect.

Grapheme buffer (memory store) impairment

481

What can you do to treat graphemic buffer deficit? 2

1 use intact PGC mechanism for self-monitoring and self-correcting
2 breaking a larger word into smaller "words": target becomes tar get

482

____ is marked by errors in cAsE, written spelling substitution, difficulty changing case, with well formed letters, and intact oral spelling. In context of good oral skill.

Allographic conversion

483

____ is marked by poorly formed letters, with copying impaired and no case effect, with intact oral spelling. Common in Broca's, but can occur in isolation.

Apraxic agraphia

484

____ is marked by poor spacing on page consistently on one side or the other and could omit beginning or ends of words.

Spatial agraphia

485

What is a very popular agraphia approach?

Copy and Recall Treatment (CART) can be done as a home program, choose meaningful words, and make them copy 5 times, if the get it write can move on if not, repeat. can practice prompts at home.

486

____ means that it doesn't have to have a recipient of the gesture (learned movement). (Salute, hitchhike, wave goodbye). Less degrees of freedom, but more abstract. Some evidence this is easier for individuals with limb apraxia.

Intransitive gestures

487

What is the best way to test for limb apraxia?

ask for pantomime use of tools in absence of tool

488

Name 3 are some limb apraxia testing tasks:

wave goodbye, hitchhike, salute, use a saw, use a toothbrush, drink from a cup, put salt on food, use a key to open a door, use a screwdriver, shoot a gun, use a comb, drink from a glass, use scissors, flip a coin

489

____ means that it doesn't have to have a recipient of the gesture (learned movement). (Salute, hitchhike, wave goodbye). Less degrees of freedom, but more abstract. Some evidence this is easier for individuals with limb apraxia.

Intransitive gestures

490

What is the best way to test for limb apraxia?

ask for pantomime use of tools in absence of tool

491

Name 3 are some limb apraxia testing tasks:

wave goodbye, hitchhike, salute, use a saw, use a toothbrush, drink from a cup, put salt on food, use a key to open a door, use a screwdriver, shoot a gun, use a comb, drink from a glass, use scissors, flip a coin

492

What should the clinician remember when testing a patient with suspected limb apraxia with objects?

be as non-directive as possible:don't hand them the handle first or put them in the hand as if to use, let them locate the useful part

493

Just like with speech, individuals can repeat gestures without meaning. T/F

true

494

_____ has been definied as a disorder of skilled movement that cannot be attributed to other causes of motor impairment, intellectual impairment, impaired comprehension, inattention or uncooperativeness.

Limb apraxia

495

Why should we care about limb apraxia? 3

1 it's common
2 it's persistent
3 it's problematic (Difficulty with tools - how can the pt cook?)

496

How does semantics work with limb apraxia?

need to understand action semantics: how we use tools

497

What are the different inputs for the action output system? 4

audiotry/verbal
visual/gestural
visual/object
tactile

498

What is the difference between transitive and intransitive gestures?

transitive gestures require a direct object (hammer, scissors, etc.)

499

What do you need to assess besides pantomime-to-command with limb apraxia? 3

visual tool use
imitation tool use
tool object or tool gesture association

500

___ is a loss of deftness or fine motor control; inability to connect innervations of independent units. Cannot pick up the penny off of the table.(Type of Limb Apraxia)

Limb kinetic apraxia

501

____ is a failure with the "production" aspects of skilled movement: selection, sequencing and spatial organization of movements. (Most common form of limb apraxia)

Ideomotor Apraxia

502

Name 3 spatial production errors that could be found in limb apraxia

wrong limb/joint movement; external configuration; internal configuration; body part as tool; concrete object

503

Name 3 temporal production errors that could vbe found in limb apraxia.

amplitude; sequencing; occurence; delay

504

____ is a deficit in higher order abstract actio nand goal planning.

Ideational apraxia

505

____is a deficit in conceptual knowledge associated with tool or object use.

Conceptual apraxia

506

What type of content errors might be found in limb apraxia? 4

1 no content
2 related content
3 unrelated content
4 perseveration

507

What are methods for rehabilitation of limb apraxia? 2

Management through accommmodation
Treatment though direct application of aid to the deficient behaviors (Better with practice, train with gestures, self-verbalization, provide as much contextual information as possible)