Braincamp: After the Stroke

Question 1

Brain’s potential for reassigning to a different brain region functions that are lost when brain tissue is damaged

Answer 1

cerebral plasticity

Question 2

What happens to the brain’s ability to reassign functions served by damaged tissue with increasing age?

Answer 2

it diminishes w age

**the older a person is at the time of the brain injury, the more severe the persisting consequences of the injury are likely to be

Question 3

4 primary facts about aphasia

Answer 3

Aphasia is neurogenic
Aphasia is acquired
Aphasia involves language problems
Aphasia is not a problem of sensation, motor function or intellect

Question 4

An impairment in the ability to comprehend and formulate language; a multimodality disorder represented by a variety of impairments in auditory comprehension, visual and reading comprehension, oral-expressive language and writing.

Answer 4

aphasia

Question 5

T/F: Aphasia is a disturbance of articulation

Answer 5

false

Question 6

T/F: Patients with mutism are aphasic

Answer 6

false; pts with mutism are not necessarily aphasic

Question 7

T/F: Patients with aphonia are aphasic.

Answer 7

false

Question 8

T/F: A language disorder experienced in altered states of awareness is not considered aphasia

Answer 8

True

Question 9

A collective name for a group of speech disorders resulting from disturbances in the MUSCULAR control over the speech mechanism due to damage of the central or peripheral nervous system. It designates problems in oral communication due to paralysis, weakness or incoordination of the speech musculature.

Answer 9

Dysarthria

Question 10

A neurogenic speech disorder resulting from impairment of the capacity to program sensorimotor commands for positioning and movement of muscles for the volitional production of speech. It can occur without significant weakness or neuromuscular slowness and in the absence of disturbances of conscious thought or language.

Answer 10

apraxia

Question 11

Other accompanying disorders w stroke

Answer 11

agnosia (don't know)
acalculia
alexia/dyslexia
agraphia (impaired writing)
constructional disturbance

Question 12

About (blank) percent of the aphasia syndromes conform to a specific anatomical location

Answer 12

80%

Question 13

What is Broca’s area?

Answer 13

left inferior frontal lobe; responsible for the production of sounds

Question 14

What is Wernicke’s area?

Answer 14

left temporal lobe;
comprehension of oral language
(posterior language zone)

Question 15

How does input from Wernicke’s area connect to Broca’s area for the production of sound?

Answer 15

arcuate fasciculus

Question 16

Activation of muscles for articulation

Answer 16

precentral gyrus

Question 17

transmission of linguistic info to anterior areas from posterior areas

Answer 17

arcuate fasciculus

Question 18

transmission of information between hemispheres

Answer 18

corpus callosum

Question 19

integrates visual, auditory & tactile info and carries out symbolic integration for reading
(L parietal- thought to be one of two areas associated with alexia - also L occipital)

Answer 19

angular gyrus

Question 20

3 ways to classify aphasias (they all kind of mean the same thing…)

Answer 20

receptive vs expressive
motor vs sensory
fluent vs nonfluent

Question 21

Describe the speech of a person with aphasia

Answer 21

they produce some speech, but it does not conform to the grammatical rules of the language being used

**make errors in omission of words, weird choice of words, or errors in word order

Question 22

During the first days following a stroke, the aphasic person may not produce speech. How will they communicate?

Answer 22

gestures and facial communication

Question 23

A person w aphasia often has difficulty comprehending a purely (blank) command.

Answer 23

verbal

**Verbal messages through auditory or visual means without gestures, facial expressions or emotional intonation.

Question 24

Is a person with aphasia aware of self and environment?

Answer 24

yes, appropriate level of awareness

Question 25

T/F: A person with stroke wants to communicate thoughts regarding their condition.

Answer 25

true

Question 26

General characteristics of speech often fall into one of two categories:

Answer 26

fluent: approximates normal speech in terms of the rate of word production, length of sentences, melodic intonation, and ease in speaking [9+ words/utterance] nonfluent: rate is slow, sentence length is short, melodic contour is lost, production is effortful, may be more pauses than actual words. [0-5 words/utterance]

Question 27

This is a hallmark of aphasia

Answer 27

failure to repeat words or sentences **ability may be completely lost or characterized by phonemic paraphasias or omissions of sounds/words

Question 28

If some impaired ability to repeat words and sentences is preserved, what does this suggest?

Answer 28

perisylvian region of the dominant hemisphere is preserved

Question 29

Is auditory comprehension, the ability to decode auditory input, usu preserved in pts with aphasia?

Answer 29

no! **deficits can range from inability to understand single words, sentences, commands, narrative discourse, etc

Question 30

difficulty ordering words and putting them together in a sentence

Answer 30

agrammatism

Question 31

Agrammatic patients can use content words (nouns, pronouns, etc), but have difficulty producing (blank) words and bound morphemes (

Answer 31

function

Question 32

Patients with auditory comprehension deficits usually have some (blank) impairment

Answer 32

reading **can occur in a pure form w/o additional impairments

Question 33

T/F: In most cases of aphasia, reading, writing, and auditory comprehension are impaired together, but not to the same degree.

Answer 33

true

Question 34

``` Dysfluent **Increased effort in speaking Speech is agrammatic, telegraphic, groping Often accompanied dysarthria and/or apraxia of speech Comprehension better than expressive Repetition abnormal Naming is poor Writing reflects spoken output ```

Answer 34

Broca's aphasia * *aware of deficit, feel frustration * *ex: lady struggling to describe picture

Question 35

Are pts w Broca's aphasia usu aware of their communication impairment?

Answer 35

yes, they are usu upset by failed communication attempts

Question 36

Pt. usually appears normal with no dysarthria or limb weakness/paralysis. Speech is fluent but often presents with paraphasias and jargon Syntax is normal Comprehension is poor Reading is poor Repetition is poor. Word-salad

Answer 36

Wernicke's aphasia * *not really aware of their deficit * *ex: guy talking about baseball

Question 37

Most pts with Wernicke's are alert, attentive and task-oriented. The level of Wernicke's can vary from mild to moderate to severe. Differentiate b/w the different levels of severity.

Answer 37

Mild: aware of errors and generally follow conversational turn taking Moderate: rarely notice errors or attempt repairs, attentive and cooperative but get off track easy Severe: attentive, but severe comprehension deficits interfere with all communication tasks; unaware of errors and communication failure

Question 38

SEVERE impairment in both comprehension and expression Concrete understanding of symbols; may not fully comprehend abstract or inferential information May not understand simple words, may only understand icons or pictures Performance usually enhanced by materials or activities that are automatic or emotionally laden

Answer 38

Global aphasia

Question 39

In patient's with global aphasia, speech is severely limited and often characterized by (blank)

Answer 39

stereotypical utterances **whatawhy, how-we-do

Question 40

T/F: Most pts with global aphasia are attentive, task-oriented and socially appropriate. They occasionally comprehend personally relevant questions fairly well. Some can reliably answer yes/no questions.

Answer 40

True

Question 41

What is thought to be the sight of lesion in conduct aphasia?

Answer 41

arcuate fasciculus or temporal lobe in auditory association area

Question 42

What is the hallmark of conduct aphasia?

Answer 42

inability to repeat long sentences; grossly impaired repetition

Question 43

How is their prosody in conduct aphasia?

Answer 43

it can be affected bc they are pausing and hesitating

Question 44

What are some positive aspects of conduction aphasia?

Answer 44

fluent speech alert, attentive, task oriented aware of errors in speech and writing

Question 45

Preserved repetition is defining characteristic | Lesions are outside of the perisylvian zone

Answer 45

transcortical aphasia **not much about this

Question 46

Word finding difficulties; is common in aphasia and other neurologic disorders (dementia, encephalopathy). Often the residual impairment of a more severe aphasia

Answer 46

anomia

Question 47

Describe anomic aphasia

Answer 47

spontaneous speech is fluent and grammatically correct, but frequent word-retrieval failures; auditory comprehension intact

Question 48

What components would be included in an informal speech exam?

Answer 48

Discourse sample: "What happened to you?" Auditory comprehension skills: "Sit up and close your eyes." "Point to your nose." Assess naming skills: "What do you call this?" Assess repetition skills: "Repeat after me..." Optional tasks: Reading and writing

Question 49

Leading cause of right hemisphere disorders

Answer 49

cardiovascular accidents

Question 50

Do all adults w right hemisphere disorders have cognitive/communication deficits?

Answer 50

no **50% of all patients with RHD

Question 51

What are some deficits associated with right hemisphere damage?

Answer 51

communication deficits: facial recognition, comprehending/using facial expression (seem apathetic/uninterested), prosody deficits visuopereceptual deficits: simultagnosia, cerebral achromatopsia attentional deficits: neglect, sustained and selective attention deficits neuropsych disorders: anosognosia (lack of awareness of their deficits), Capgras delusion (think someone is impersonating the actual person) depression, visual hallucinations

Question 52

Do people with right hemisphere disorders comprehend language?

Answer 52

yes, few if any problems in comprehending or expressing language **do not have classical aphasia

Question 53

13% of patients with RHD have (blank)

Answer 53

left-sided neglect **don't pay attention to the left side of the world **may not dress the left side of their body, may only eat food on the right

Question 54

Different types of neglect?

Answer 54

motor tactile (reduced tactile stimuli on affected side) auditory

Question 55

How does neglect vary across the day?

Answer 55

can change from hour to hour, day to day

Question 56

Neglect is usu accompanied by (blank)

Answer 56

anosognosia (not being aware of their condition) **also more likely to have other communicative deficits

Question 57

Production: flat, monotone speech, rate sounds fast Comprehension: problems interpreting prosody RHD possibly effects emotional prosody more than linguistic prosody

Answer 57

aprosodia **really affects the quality of life and the family members etc, bc there is a flat affect and they seem unengaged

Question 58

These components are reduced in aprosodia

Answer 58

emotionally-charged words reduced facial expressions reduced animation flat affect

Question 59

3 themes in RHD communication disorders

Answer 59

pragmatics: eye contact, personal space multiple meanings, distantly related meanings (difficulty interpreting multiple meanings ex: pen and pen for chickens!) using context

Question 60

What is the treatment model for RHD communication disorders?

Answer 60

the medical model still prevails - identify and try to fix the impairments