Chapter 8: Neurologically Based Communication Disorders

Question 1

Ishemic Strokes vs Hemorrhagic Stroke

Answer 1

Ischemic: Causes by a blocked or interrupted blood supply to the brain
1. Thrombotic Strokw: A blood clot (thrombus) in an artery
2. Embolic Stroke: A wandering clot (embolus)
Hemorrhagic: Caused by bleeding in the brain due to ruptured blood vessels
1. Intracerebral Hemorrhages (most common type): Blood vessel bleeds or ruptures into the tissue deep witin the brain
2. Extracerebral Hemorrhages: Ruptures within the meninges
- Blood flow is interrupted to the brain
- Blood pools and damange the cells

Question 2

Major Symtoms of Aphasia

Answer 2

Paraphasia
Repitition
Logorrhea
Empty Speech
Agarmmatic Speech
Anomia
Circumlocution
Others

Question 3

Paraphasia

Answer 3

An expressive lnaugage eorror unrelated to motor deficits
Semantic: substitution of one word for another; may be related in meaning (marker for pencil)
Phonemic: Errors at the sound level; phonemes may be substitudes, ommited, or transposed (tup for cup)
Neologistic (neologism): nonword a person creates; they are unintelligible, unrelated to the intended word (skeen for pencil)

Question 4

Logorrhea

Answer 4

Excessive and inappropirate prodution of speech, often tangential and meaningless

Question 5

Empty Speech

Answer 5

Substitution of such general words as this, that, stuff, and thing in place of more specific words

Question 6

Agrammatic speech

Answer 6

Omission of grammatic features in speech; speech that consists mostly of content words (nouns, verbs, etc) and lacks function words (articles, conjunctions, prepositions, etc)

Question 7

Anomia

Answer 7

Naming difficulty or wordfinding deficit with varying severity
Confrontation naming is especially difficult

Question 9

Circumlocution

Answer 9

Production of nonspecific words and “beating around the bush” often due to word finiding problems

Question 10

Broca’s Aphasia Language Impairment characteristics

Answer 10

• Non-fluent and effortful speech- frequent pauses, interjected sounds (um, uh), revisions, repetitions, etc.
• Agrammatic, limited speech- “telegraphic speech”
• Impaired repetition (words and sentences)
• Impaired confrontational naming
• Some impairment in auditory comprehension (complex information)
• Alexia (difficulty reading)
• Agraphia (difficulty writing)- slow, agrammatic, many spelling errors

Question 11

Site of Lesion for Broca’s Aphasia

Answer 11

• Posterior- inferior portion of frontal lobe
• 3rd frontal convolution
• Broca’s area

Question 12

Blood supply for for Broca’s Aphasia

Answer 12

Middle Cerebral Artery (MCA)

Question 13

Transcortical Motor Aphasia Language Impairment characteristics

Answer 13

• Muteness- possibly due to akinesia
• Echolalia and perseverative speech
• Reduced spontaneous speech
• Non-fluent, paraphasic, agrammatic, and telegraphic speech
• Confrontational naming deficits
• Intact repetition
• Relatively intact automatic speech (days, months, numbers)
• Intact knowledge of grammar- can correct others
• Limited word fluency
• Use of motor prompts to initiate speech
• Comprehension > Production
• Alexia
• Agraphia

Question 14

Site of Lesion for Transcortical Motor Aphasia

Answer 14

• Anterior lesions of left frontal lobe
• Subcortical areas of left frontal lobe in the watershed areas
• Below or above Broca’s Area

Question 15

Blood Supply for Transcortical Motor Aphasia

Answer 15

• ACA
• Watershed region between ACA and MCA

Question 16

Global Aphasia Language Impairment characteristics

Answer 16

• Globally impaired communication skills- verbal + non-verbal
• Severely reduced fluency
• Extremely limited verbal expression- few recognizable or unrecognizable words
• Impaired Repetition
• Impaired Naming
• Impaired Auditory Comprehension
• Alexia + Agraphia

Question 17

Site of Lesion for Global Aphasia

Answer 17

• Diffuse left hemispheric damage
• Can have bilateral damage
• Lesion can extend subcortically

Question 18

Blood Supply for Global Aphasia

Answer 18

Typically MCA but can involve any or all arteries

Question 19

What is the most severe type of nonfluent Aphasia? and why??

Answer 19

Global Aphasia
Due to extensive lesions that affect all language areas

Question 20

What are the types of non-fluent aphasia?

Answer 20

Broca’s Aphasia
Transcortical Motor Aphasia
Mixed Transcortical Aphasia
Global Aphasia

Question 21

Wernicke’s Aphasia Language Impairment characteristics

Answer 21

• Normal or even abnormal speech fluency (logorrhea or press of speech)
• Rapid rate of speech
• Normal prosodic features
• Good articulation
• Normal phrase lengths
• Generally intact grammatical forms
• Severe word-finding problems
• Empty speech
• Poor auditory comprehension
• Impaired conversational skills
• Impaired repetition
• Impaired reading comprehension
• Alexia

Question 22

Site of Lesion for Wernicke’s Aphasia

Answer 22

Posterior portion of the Superior temporal gyrus in the left

Question 23

Bloody supply for Wernicke’s Aphasia

Answer 23

MCA

Question 24

Transcortical Sensory Aphasia Language Impairment characteristics

Answer 24

• Fluent speech- good articulation, normal phrase length
• Good syntactic skills
• Paraphasia- semantic and neologistic
• Empty speech
• Impaired naming
• Good repetition
• Echolalia
• Impaired auditory comprehension
• Once initiated, normal automatic speech
• Sentence completion intact
• Poor reading comprehension
• Relatively preserved oral reading skills
• Agraphia

Question 25

Site of Lesions for Transcortical Sensory Aphasia

Answer 25

- Inferior left temporoparietal region - Can be a bilateral lesion - Middle temporal gyrus - Occipital lobe could be involved - Can include angular gyrus, visual and auditory association areas

Question 26

Bloody supply for Transcortical Sensory Aphasia

Answer 26

PCA

Question 27

Conduction Aphasia Language Impairment characteristics

Answer 27

- Impaired repetition - Varied speech fluency - Paraphasia - Word finding deficits - Recognition of errors - Good syntax and prosodic features - Normal speech articulation - Naming deficits (object identification intact) - Intact auditory comprehension - Variable alexia - Agraphia

Question 28

Site of Lesions for Conduction Aphasia

Answer 28

- The region between Broca's area and Wernicke's area - Supramarginal Gyrus in the inferior parietal lobe and the aecuate fasciculus - Left parietal or temporal lobe and the insula

Question 29

Blood supply for conduction Aphasia

Answer 29

MCA

Question 30

Anomic Aphasia Language Impairment characteristics

Answer 30

- Word finding difficulty- debilitating and pervasive - Object identification intact (can point to object when named) - Fluent speech - Normal syntax - Verbal paraphasia (word substitutions) - Intact auditory comprehension - Intact repetition - Articulation intact - Relatively normal oral reading and writing

Question 31

Site of Lesions for Animic Aphasia

Answer 31

- Varies (causes this to be controversal) - Many times lesions in parietal-temporal region involving angular gyrus - Inferior temporal gyrus

Question 32

Blood supply for Anomic Aphasia

Answer 32

MCA

Question 33

Types of Fluent Aphasia

Answer 33

Anomic Aphasia Conduction Aphasia Transcortical Sensory Aphasia Wernicke's Aphasia

Question 34

Outline of Aphasia Assessment

Answer 34

Assessment of Repetition Skills Naming Skills Sentence Production, narration, and discourse Speech Fluency Functional Communcation Skills Auditory Comprehension Reading and Writing Skills Gestures and Pantomime Automated Speech and Singing Bilingual Speakers with Aphasia

Question 35

Alexia vs Dyslexia

Answer 35

Alexia: Loss of previously acquired reading skills due to recent brain damage Dyslexia: Children's difficulty learning to read (possibly genentically based)

Question 36

Agnosia

Answer 36

Impaired understnading of meaing cartain stimuli, without peripheral sensory impairment 4 types 1. auditory agnosia: difficulty in matching objects with their sound, and normal visual recognition of objects 2. auditory verbal agnosia: impaired understanding of spoken words 3. visual agnosia: impaired visual recognition of objects, which may be intermittent 4. tactile agnosia: impaired tactile recognitionof objects when visual feedback is blocked and impaired naming and description of objects clients can feel in their hands

Question 37

Assessment of Dementia overview

Answer 37

1. Case history 2. Clinicial examination 3. Interview of family and other caregivers 4. Neurological assessment 5. Communication assessment 6. Assessment of intellectual function

Question 38

What domains or skills should be sampled when assessing dementia?

Answer 38

- Awareness or orientation to surrounding - Mood and affect - Speech and language skills - Storytelling while looking at sequenced pictures - Storytelling (spontaneous) or retellling the one clinicians tells - Give a discourse on a current topic - Abstract language comprehension - Cognitive tasks (memory and executive function) - Abnormal thinking (hallucination or delusions) - Visuospatial skills (replicating a blocked design)