Exam 1 Study Guide Flashcards
(93 cards)
1
Q
Aphasia
A
Language disorder resulting from brain damage to brain areas that subserve the formulation and comprehension of language and its components (semantic, phonological, morphological, and syntactic knowledge)
A multimodality language disorder due to brain damage; modalities involved are auditory comprehension, reading comprehension, oral expression, and written expression
2
Q
Agnosia
A
Impairment of the ability to comprehend the meaning of a perceived stimulus;
-the inability to recognize people or objects, sounds, or voices, even when basic sensory modalities, such as vision and hearing, are intact
3
Q
Echolalia
A
Involuntary repetition of someone else’s words
4
Q
Logorrhea
A
Excessive speech output
5
Q
Fasciculus
A
A bundle of nerve fibers
6
Q
Neologisms
A
new words, phrases or sentences only understood by the speaker
new word formations that can render language unintelligible
7
Q
Jargon
A
meaningless and unintelligible speech
can be unintelligible words that usually follow the phonological rules of our language (e.g., freach) or unintelligible words that bear no relationship to the stimulus
8
Q
Semantic/Verbal paraphasias
A
the substituted word is related to the target word (i.e. fork for knife)
also called verbal paraphasia; confusion with closely associated words (e.g., driving range for parking lot)
9
Q
Phonemic/literal paraphasias
A
the substituted word differs from the target word by a phoneme (i.e. ped for bed)
also called literal paraphasia (e.g., saying corned beef and garbage, or saying fable, sable, or cable for table);
typically found in patients with conduction or Wernicke’s aphasia
10
Q
Circumlocutions:
A
talking around a topic; being able to describe but not name
can be empty speech, a description of the use or function of the item to be named, or use of a word that is correct semantically and syntactically but is not in common usage
11
Q
Hemorrhage:
A
the rupture of a blood vessel with subsequent bleeding into or around the brain
12
Q
Ischemia:
A
deficient circulation in the brain
reduction of oxygen due to an occluded vessel
13
Q
Thrombosis
A
an occlusion of an artery to the brain by a clot
plaque and fat build up at the site of blockage
14
Q
Embolism
A
Blood clot that breaks off and travels through the blood stream until it can no longer pass, occluding the vessel
15
Q
AVM
A
Arteriovenous malformation; webbing of capillaries than can cause a hemorrhage
congenital communication between arteries and veins which tend to bleed and cause subarachnoid hemorrhage
16
Q
TIA:
A
Transient Ischemic Attack; an acute neurological deficit of vascular cause that lasts less than 24 hours
While transient ischemic attack (TIA) is often labeled “mini-stroke,” it is more accurately characterized as a “warning stroke,” a warning you should take very seriously.
TIA is caused by a clot; the only difference between a stroke and TIA is that with TIA the blockage is transient (temporary). TIA symptoms occur rapidly and last a relatively short time. Most TIAs last less than five minutes; the average is about a minute. When a TIA is over, it usually causes no permanent injury to the brain.
17
Q
Aneurysm
A
ballooning or weakening of a vessel wall
18
Q
Give an example of a “neurotransmitter”.
A
Dopamine, PI (phosphatidyl-inositol), acytylcholine, serotonin, norepinephrine
19
Q
What disorders can be traced to neurotransmitters?
A
- Parkinson’s disease- Substantia Nigra; insufficient dopamine production
- Bipolar: neurotransmitter called PI (phosphatidyl-inositol)
- Alzheimer’s: neurofibrillary tangles
20
Q
What is the homunculus? What does it represent? Be able to sketch the distribution of different areas of the body as represented on the motor strip.
A
“Little man” that represents the areas of the body controlled on the motor strip. Size of the features relates to the number of neural connections
21
Q
Basal Ganglia
A
– responsible for motor control and motor integration
i. Caudate nucleus
ii. Putamen
iii. Globus pallidus
iv. Amygdala
- Consists of Caudate Nucleus, Putamen, and Globus Pallidus.
- Caudate Nucleus + Putamen – Striatum
- Basal Ganglia- acts as a filter to prevent unwanted movements
- Substantia Nigra – Lowered dopmaine levels lead to Parkinson’s disease
22
Q
• Diencephalon
Thalamus:
A
attention, memory
•Relay for sensory information toward the cerebral cortex
• Primary bridge for information from the cerebellum and globus pallidus to the cerebral cortex
– Important subcortical gray matter structure
– Doorway through which subcortical systems of nervous system communicate with cerebral cortex
– Receives neural inputs of planned motor movements from basal ganglia and cerebellum
– Sensory impulses from the body pass through thalamus on way to cortex
– Believed to use sensory information to further refine motor impulses
23
Q
What structures make up the (functional) limbic system (sometimes called the “limbic lobe”)?
A
- Uncus (on top of amygdala)
- Parahippocapal gyrus
- Cingulate gyrus
- Olfactory bulb and tract
- Hippocampal formation
- Dentate gyrus
24
Q
What areas are connected by the following fibers:
A
a. Corona Radiata: Cortex to the brainstem and spinal cord
b. Arcuate fasciculus: Broca’s area to Wernicke’s area
c. Corpus Callosum: Left and Right Hemispheres
25
The Circle of Willis is made up of what arteries?
a. Anterior Cerebral
b. Anterior Communicating Artery
c. Middle Cerebral Artery
d. Posterior Cerebral
e. Posterior Communicating
f. Sometimes: Basilar and carotid are included
26
A stroke in the superior division of the MCA could lead to what types of aphasia?
Hemisensory loss, hemineglect, weakness in the upper/lower extremities.
Could lead to Broca’s, Wernicke’s or Global, it depends where the infarct occurs
27
A stroke of the posterior division of the MCA would result in what types of deficits?
•Fluent aphasia (Wernicke's)- inability to repeat
Limb apraxia, visual loss → Fluent aphasias
28
A stroke of the anterior division of the MCA would result in what deficits?
•Non-Fluent Aphasias (Broca's)- inability to repeat
29
What is meant by the “watershed effect” of the cerebral blood supply? How does that relate to our topic of aphasia?
•When there is a clot in an artery -blood flow is interrupted for any part beyond the clot
All the areas that relate to speech production are supplied blood from the MCA. Vessels branching out from this will be affected if a clot/hemorrhage occurs in certain areas. Knowing the areas of the brain that control which types of functions is necessary when determining which parts of the brain were deprived of blood.
30
How does the Blood-Brain Barrier impact our study of CVA, particularly hemorrhages?
•The Blood-Brain Barrier is responsible for preventing harmful substances from damaging our brain while allowing the good parts (i.e., nutrients, oxygen, certain medications) in.
•Blood itself is toxic to the brain
•Hemorrhages violate the blood brain barrier
oDue to AVM or aneurysm
The Blood-Brain Barrier prevents cerebral penetration of harmful toxins, substances, etc. This also prevents the penetration of helpful items from crossing which could interfere with medicines stopping a hemorrhagic bleed. Hemorrhages also interfere with the BBB.
31
Broca’s aphasia:
-Physical: Dysarthria/apraxia, monotone speech, hemiplegia, right facial weakness, poor walking, emotionally liable
-Site of lesion: left lateral frontal, pre-Rolandic, suprasylvian region
• Brodmann’s Areas 44 and 45
• Superior division of the MCA
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-Language:
o Good auditory comprehension → the BEST of all aphasics
o Short phrase length
o Poor repetition ability
o Telegraphic speech
o Impaired reading and writing
o Distorted sounds
o Slow rate and uneven flow
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-Broca’s Aphasics can:
o Communicate, even if little information is given
o Not irrelevant in their responses
o Can produce meaningful speech
o Aware of speech difficulties
o Try to repeat or attempt to correct mistakes
o Frustrated when they fail-try hard!
o Can recite automatic information better than spontaneous (counting, Pledge of Allegiance)
32
Transcortical Motor Aphasia:
-Site of Lesion: Anterior frontal perisylvian (association pathways connecting perisylvian region with other regions)-supplementary motor areas involved
o Outside of Broca’s Area
o Looks a lot like Broca’s
-Characterized by:
o Impaired initiation of verbal output- possibly mute
o Echolalia and perseveration are common
o Little spontaneous speech
o Speech recovered is: nonfluent, paraphasic, agrammatic & telegraphic. Initiate but not finish
o Short phrase length
o Anomic: can’t name many items w/in a category
o Good auditory comprehension for simple conversations
o BUT GOOD REPETITION (repetition impaired in Broca’s)
33
Transcortical Mixed Aphasia:
-Site of Lesion: Somewhat rare, Not listed as part of the Boston Classification System (BDAE, 1983)
o Caused by hypoxia, acute carotid occlusion or stenosis, heart attacks, cerebral shock, multiple embolic strokes of the MCA branches
o Posterior parietal, temporal lobes
-Characteristics:
o A variety of sensory/physical problems: Spastic quadraplegia, Visual field defects, etc.
o Extremely limited spontaneous verbal
o Automatic unintentional and involuntary communication and automatic speech
o Parrot-like repetition, echolalia, or repeat 3-4 nonsense words
o Severe fluency and writing impairments.
o No auditory comprehension skills!
o Severe naming problems, neologisms
34
Global Aphasia:
-Site of Lesion: Effects entire perisylvian area, extending deep into the white matter (MCA area)
o Left frontal, temporal & parietal lobes
-What they can do:
o Follow whole body commands
o Distinguish meaningful vs. Non-meaningful speech
o Identify environmental sounds
o Recognize familiar faces, people, songs
o Sense of humor intact
o Interpret facial gestures and expression
o Respond to personally relevant language
o Alert, task oriented and responsive
o Socially appropriate even with one syllable!
35
Wernicke’s Aphasia:
-Site of Lesion: Posterior third of the superior temporal gyrus
-Characteristics:
o Often do not have physical limitations or hemiparesis, normal right visual function
o Sound confused, but not as frustrated as Non-fluent, Not as aware of their disorder. Acuse others of speaking in a code, mumbling, etc.
o Get depressed and socially isolated
o More severe anomia
o Prolific output (maybe even logorrhea or exhibit press of speech) Talk a lot – don’t say much!
o Rapid rate but effortless, fluent speech with good articulation and normal prosody.
o Normal phrase length with intact grammatical forms
o Poor auditory comprehension- dominant characteristic
o Poor repetition skills
o Language errors such as: paraphasias, fillers, empty speech, extra syllables, perseverations, neologisms, and jargon.
o Impaired reading and writing
-Comprehension Characteristics:
o Difficulty comprehending certain elements of spoken speech
o Extreme difficulty in understanding most
o Comprehending the names of common objects
o Greater difficulty comprehending sentences
o Difficulty distinguishing spoken words that contain minimally different phonemes
o Seem to understand conversation on a topic but not when a new topic is introduced
o Need extra time for new conversational topics
o More impairment in background noise, movements, and other conversations
o Comprehension tied to a given context
o Turn taking may be minimal
o Can’t repeat
36
Anomic aphasia:
-Site of Lesion: Angular gyrus
-Characterisitcs:
o Word-finding problems
o Auditory comprehension good- pointing OK
o Repetition is good
o Circumlocutions or vague unspecific words used to compensate
o Verbal Paraphasic errors –substitution of words
o Fluent, well-articulated speech except for word-finding pauses, syntax is normal
o Writing and oral reading are normal and comprehension good.
37
Transcortical Sensory Aphasia:
-Site of Lesion: Posterior parieto-temporal (sparing Wernicke’s area) Often posterior middle temporal gyrus, maybe angular gyrus and visual/auditory association cortex involved.
-Characterized by:
o Fluent but anomic (significant-disrupts flow of speech): semantic paraphasias, perseverations, fillers and non-specific words.
o Normal phrase length with good syntactical arrangements
o Poor auditory comprehension
o BUT GOOD REPETITION SKILLS (Wernicke’s can’t repeat) but poor comprehension of the material repeated.
o Echolalic (Wernicke’s not usually) and echo grammatically incorrect forms and nonsense syllables.
o Can’t point, follow commands, or answer yes/no questions.
o Normal automatic speech and complete songs, rhymes once started by the clinician
o Poor reading comprehension: Read aloud OK but substitute words and don’t understand it.
o Writing similar in problems to expressive skills
38
Conduction Aphasia:
Excellent chance for near-complete recovery
-Site of Lesion: Arcuate Fasciculus
-Characteristics:
o Fluent output (varies) Articulation normal
o Anomic: more on content words than on function words, speech empty because of omitted content words, can point but not name
o Good auditory comprehension
o Repetition worse than spontaneous speech-distinguishing feature! Add or delete phonemes, longer words, phrases, sentences more difficult
o Function words more difficult to repeat
o May use spontaneously but can’t repeat!
o May be comprehended but can’t repeat! Tries to correct. Better at correcting than Broca’s
o Phonemic paraphasias-(aware and self-correct) ---circumlocutions
o Reading hard to do aloud, but silently OK
o Writing a few letters, but spelling errors, letter omissions, reversals, substitutions
39
Global Aphasia: Characteristics are discouraging but what CAN they do?
* Follow whole body commands
* Distinguish meaningful vs. Non-meaningful speech
* Identify environmental sounds
* Recognize familiar faces, people, songs
* Sense of humor intact
* Interpret facial gestures and expression
* Respond to personally relevant language
* Alert, task oriented and responsive
* Socially appropriate even with one syllable!
40
Characteristics of Non-Fluent Aphasia
* Reduced speech rate (>50 wpm)
* Excessive speaking effort (struggle, facial grimace, hand gestures, etc.)
* Limited phrase length
* Abnormal prosody
* Generally depressed amount of speech
* Speech initiated with notable difficulty
* Excessive use of content words (nouns and verbs) and omission of function words (grammatic words) sounding telegraphic in nature
41
Characteristics of Fluent Aphasia
* Speech production with minimal or no effort
* Normal or even increased rate of speech
* Normal melodic properties
* Flowing speech
* Easily initiated speech
* Normal amount of speech (100-200WPM)
* Less effective or meaningful communication (in spite of fluency-jargon or paraphasias )
42
Subcortical aphasias:
Thalamic CVA – what are the general characteristics? Are they more fluent or non-fluent?
• More fluent
```
-Characteristics:
o Anomia, variable phrase length, variable auditory comprehension,
o Good repetition
o Hypophonic, paraphasic, perseverative
o Choose bizarre words in paraphasias
```
43
Subcortical aphasias:
Basal Ganglia CVA- characteristics, fluent or non-fluent?
• More non-fluent
-Characteristics:
o Anomia
o Variable Phrase Length
o Good auditory comprehension/repetition skills
o Hypophonia, dysarthria, paraphasias, strange grammatical constructions
44
Aphasia is NOT?
• It is NOT dementia, a thought disorder, a memory disorder or a motor speech disorder (articulation, apraxia of speech, dysarthria)
45
When were the first documented cases of aphasia noted in history?
1700 B.C. Edwin Smith Papyrus
• In Egypt in the Edwin Smith Papyrus (30 Centuries BC)- described a speechless patient with a lesion
46
What did Hippocrates contribute that was quite controversial in his time?
• Brain is the organ of the mind, not the heart
47
Who was Galen and what was he known for discovering?
Greek physician; first to dissect animals discovered that nerves from the brain control function and distinguished between motor and sensory nerves
* A Greek physician that developed theories of language function through the dissection of pig brains
* Form is related to function
* First to dissect animals and determined that nerves from the brain controlled functions
48
Who was Gall and what did he call his study of precise localization? What did he contribute that is important to neuroanatomy?
* ‘Phrenology” → localization of emotions and personality traits
* the first to propose a relationship between specific human behaviors and cerebral regions
* Distinguished between white and gray matter
49
. Bouilland was the first to describe_______.
anomia and apraxia of speech.
* Language is localized in the frontal lobes
* Distinguished separate faculties for memory of articulatory movements and memory for "senses" of words
* Distinguished between disorders of articulated speech and language.
* First to note difference in apraxia of speech and anomia.
50
Dax may have been the first to discover and present findings on ______although someone else got the credit.
cerebral dominance
* First description of cerebral dominance was by Dax, 6 weeks before Broca’s article. Dax was given no credit!
* Few knew of his theory of unilateral left hemisphere function for articulate speech
51
Broca: what did he get credit for discovering?
* Discovered the “Speech Center” in frontal lobe (1861)
* “We speak with the left hemisphere”
* Famous article was called the “first truly scientific paper on language-brain relationship”—but heavily influenced by predecesors
* Aphemia”: Reduced fluency; Non-grammatic telegraphic speech; Many language production errors; Only limited impairment of comprehension of language
52
Wernicke: What did he discover and what type of aphasia is credited to his work?
* First to describe sensory aphasia or Wernicke’s aphasia
* Different than Broca’s: Fluent but meaningless speech; Grammatically correct speech; Severe problems in understanding spoken language; Problems comprehending read material
53
Hughlings Jackson: What was his theory of localization vs. neural networks?
* Opposed Broca, thought that the brain worked as a whole unit in language
* Father of English neurology
54
Aleksandr Luria: Who was he and what did he add to the modern view of brain function?
* Modernist; thought that each area of the brain may have a primary function but the brain operates as a whole for production and comprehension of language
* Combines localization and Holistic view
55
CT Scan
CT Scan – Computerized tomography; x-ray pictures of slices of the brain, picture is based on how much radiation is absorbed
Pros: Good at detecting hemorrhages, show location and extent of the damage
Cons: exposure to radiation; does not show small lesions, tumors or TBI
* A set of X-ray generators and detectors rotates 360 degrees around the head and scans structures in slices as thin as 1-2 mm.
* Shows internal structures, lesions, tumors, other neuropathologies.
56
MRI
Magnetic resonance imaging (MRI) is a test that uses a magnetic field and pulses of radio wave energy to make pictures of organs and structures inside the body.
• When head placed in the strong magnetic field the hydrogen atoms align with external magnetic field. Hydrogen atoms align and a pulse is set out, image is formed based on resonance coming back
Pros: Less prone to artifact from bone tissue; clearer images of structures than CT scan; no radiation exposure
57
PET Scan
positron emission tomography (PET) scan is an imaging test that uses a radioactive substance called a tracer to look for disease in the body.
• Studies activities in brain structures.
• Differences in metabolic rates of different areas of the brain.
• Patient takes glucose mixed with positron-emitting isotope which is metabolized in the cerebral cells.
• Areas of greater metabolism suggest greater neural activity and blood flow.
• Machine detects and amplifies positrons (radiation) emitted by the isotopes.
• Computer analyzes the data to show areas of high or low metabolic activity.
• Differences in rate of activity indicate health of tissue
• Lower glucose metabolism suggests structural and functional problems in the brain.
PET Scan – Positron Emission Tomography; measures metabolic rates through the intake of glucose; areas with more activity have greater blood flow
Pros: Useful for showing tumors (tumors show increased metabolism); shows areas that are not working
Cons: Poor resolution of boundaries, expensive, subject to movement of artifact
Aphasia: PET shows focal brain damage effects elsewhere.
58
rCBF
Regional Cerebral Blood Flow (analyzed in PET scans)
• Measures amount of blood flow in different areas of the brain.
• Active cerebral region requires more blood.
• Indicates present of, increase in cerebral activity.
• Radioactive inert gas (xenon-133) injected into bloodstream or in haled.
• Gamma ray camera scans brain for radioactive materials
• Scanned information sent to computer to construct images of regions of the brain show different flood flow in different colors.
59
Angiogram
Catheter up the femoral artery to look at the arteries
Pros: detects aneurysms and hemorrhages
Cons: Can cause a stroke, only outlines main arteries
• an X-ray test that uses a special dye and camera (fluoroscopy) to take pictures of the blood flow in an artery (such as the aorta) or a vein
60
fMRI
Functional magnetic resonance imaging or functional MRI (fMRI)
• Contrast material intravenously administered before MRI.
• Detects changes in cerebral blood flow as person experiences different states of performs different activities
• Detects increased blood flow associated with cerebral activity in regions activated.
61
MRA
A magnetic resonance angiogram (MRA) is a type of magnetic resonance imaging (MRI) scan that uses a magnetic field and pulses of radio wave energy to provide pictures of blood vessels inside the body.
• Rate and velocity of blood supply to cerebral structures measured.
• Non-invasive, less risky, and more economical than cerebral angiography
• Visualizes carotid arteries and intracranial blood circulation.
62
CTA
A computerized tomography scan, or CT scan, is a type of X-ray that uses a computer to make cross-sectional images of your body. The dye injected to perform CT angiography is called a contrast material because it "lights up" blood vessels and tissues that are being studied.
• Injection of radiographic contrast materialinto the femoral artery in the groin
• Catheter guided to carotid or vertebral artery
• Radiopague material injected into artery
• Rapid series of X-rays taken, outline of major arteries on film (cerebral anterior, posterior, middle arteries visualized.)
• X-rayed material shows variations in blood circulation showing vascular occlusions.
• Can detect hemorrhages and aneuryms.
• Does not outline small arteries and can cause a stroke itself!
63
CT vs MRI
* MRI: clearer images of structures than CT Scan.
* Detects small lesions missed by CT scans as well as demyelinating and traumatic lesions.
* MRI less prone to artifacts from bone tissue
* Both grey and white matter are better contrasted in MRI vs. CT, because the gray matter contains more water.
* CT Scans not helpful first 48 hours of a stroke
* CT better for detecting cerebral hemorrhage
* Hematoma 3-4 days old better revealed by MRI than CT scan.
* CT scans sensitive to changes in tissue density, MRI sensitive to varying chemical composition of tissue.
64
When did CT Scans emerge as a neuroimaging tool?
• 1970s: Allan McLeod Cormack & Godfrey Newbold Hounsfield – Computerized axial tomography (CAT or CT Scanning).
65
When were MRIs invented?
• 1980s: Peter Mansfield and Paul Lauterbur- Magnetic Resonance imaging (MRI or MR Scanning).
66
When did fMRIs become popular?
• 1990: Functional magnetic resonance imaging fMRI could show blood flow changes. Since then fMRI has dominated the field of stroke treatment.
67
What information should be included in a thorough evaluation?
-Neurologic History
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-Case History
o Chief complaint
o Hx of illness
o Medical hx
o Family and social hx
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-Neurologic Examination and history
o General Observations and medical examination
-Neuroimaging
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-Cranial Nerve exam
o Cranial Nerves
o Motor system
o Reflexes
o Sensation
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-Aphasiological Exam
o Mental status examination
68
According to Helm-Estabrook’s flow-chart (Figure 4.5 in text) what few basic behaviors would you need to test to sort out aphasia syndromes?
* Flueny, MLU
* Auditory Comprehension
* Repetition abilities
69
Why is it important to take a thorough case history?
To determine the extent to which performance irregularities are the result of brain damage that caused the aphasia or of other variables: cultural differences, SES, substance abuse, normal aging, DLD
* Aphasia may be caused by disorders that are not readily seen on medical imaging
* Medications can cause depression affecting language output
* May have a previously existing disorder such as AIDS or dementia
70
What are some frequently assessed behaviors that seem to be used in many standardized tests for aphasia?
* Fluency of Speech
* Nonverbal communication
* Naming skills
* Speech production
* Repetition skills
* Auditory comprehension
* Writing
* Reading and reading comprehension
71
What information can you obtain from a conversational sample/discourse sample? (Helm-Estabrooks, hand-outs and class discussion)
* Phrase length
* Substantive/function word ratio
* Syntax
* Paraphasias
* Prosody
* Articulatory agility
72
What are some other informal tasks could you do initially to help direct your selection of a formal test?
* Conversational interview
* Auditory comprehension (through convo and personal info)
* Naming tasks
* Repetition of single words/phrases
* Reading
* Writing
* Limb and apraxia apraxia
* Singing (automatic tasks)
73
Why would you want to do a neurological/cognitive examination/screening before planning your treatment?
• The ability to compensate for language deficits and maximize the use of residual language depends on the extent to which all aspects of cognition can be recruited in the service of communication and other functional activities of daily living
74
Which inventors of neuroimaging techniques were awarded Nobel Prizes in Medicine?
* Allan McLeod Cormack & Godfrey Newbold Hounsfield – Computerized axial tomography (CAT or CT Scanning). 1979 Nobel Prize for Physiology and Medicine
* 1980s: Peter Mansfield and Paul Lauterbur- Magnetic Resonance imaging (MRI or MR Scanning). Nobel Prize for physiology or medicine in 2003.
75
General Diagnostic
| MTDDA – Minnesota Test of Differential Diagnosis of Aphasia Schuell, 1973
* Classic test; earliest published, used more in the past
* LONG, 47 subtests 3-6 hours
* Assesses: auditory, speech and language, visual, reading, visuomotor and writing
* May only choose certain subjects
76
General Diagnostic
| BDAE-3 – Boston Diagnostic Aphasia Examination – Third edition
* Commonly used, designed to classify a patient into one of the major aphasia types
* May not be that easy
* 27 subtests, 1-5 hours to administer, average of 2 hours
* Results suggest site of lesion as well as severity of aphasia
* Assesses most impaired skills: articulation, fluency, repetition, word-finding, paraphasia, writing and singing
77
General Diagnostic
| • The Boston Assessment of Severe Aphasia (BASA)
* 15 subtests, 61 total questions
* Takes less than 40 min, can be used at bedside, assesses gestures as well
* Assesses: auditory comprehension, repetition, social greetings and simple conversations, yes/no questions
78
General Diagnostic
| • The Western Aphasia Battery (WAB)
* Widely used test. Comprehensive 1-2 hours
* Evaluates speech, fluency, auditory comprehension, repetition, naming, reading, writing, calculation, drawing, nonverbal and performance on block designs
* Classifies into major aphasia types
* May not be consistent with other classification systems
79
General Diagnostic
| • The Porch Index of Communicative Ability (PICA-4)
* Unique test
* Earlier items are more difficult than later, uses the same stimuli in all subtests, specific instructions, specific cues
* 18 subtests, assesses many things
* Some think it may be relevant to everyday communication
* Must undergo training
* Complex response scoring system from 1-16
* PICA found useful in predicting and assessing improvement with and without treatment
80
What are some of the strengths and weaknesses of the tests ?
• Many of them take hours to administer
o Some clients take twice as long! Poor health, fatigue easily
• MDDTA: LONG. Has 47 subtests 3-6 hours.
• BDAE: 27 subtests, 1-5 hours to administer, average 2 hours.
• BASA: 15 subtests 61 items; Takes less than 40 minutes. Can be useful at bedside.
• WAB: Comprehensive, 1-2 hours.
• PICA: 18 subtests, assesses many things.
Some think it may not be relevant to everyday communication. Must undergo training. Complex response scoring system from 1-16.
81
PICA testing: why has the PICA been so popular as an evaluation and research tool?
* PICA: Unique test. Earlier items more difficult than later, uses same stimuli in all subtests, specific instructions, specific cues, 18 subtests, assesses many things. Some think it may not be relevant to everyday communication. Must undergo training. Complex response scoring system from 1-16. PICA found useful in predicting and assessing improvement with and without treatment.
* It has good reliability and validity
* Can show the family the expected progress of the patient
* PICA found useful in predicting and assessing improvement with and without treatment
82
What is the argument among researchers for testing functional communication skills such as the CADL as opposed to formal, structured testing such as the BDAE?
* Functional goals may be more important than certain skills
* To find out how their communication disorder affect their everyday communication, emphasis on evaluating how well they meet their basic communcation needs.
* Feel that standardized tests place too much emphasis on syntax, phonology, structure, etc. and the real issue is whether or not the client can make his/her needs known.
* May not be standardized and rely on observation.
* Some clients want to achieve more than the basic functional communication skills.
83
Screenings:
* Aphasia Language Performance Scales (ALPS)
| * The Boston Diagnostic Aphasia Examination (BDAE-3) 3rd Edition-Short Form
84
Auditory Comprehension
* Revised Token Test -RTT
* Auditory Comprehension Test for Sentences –(ACTS) (Shewan, 1981)
* Functional Auditory Comprehension Task (FACT) (LaPointe & Horner, 1978)
* Discourse Comprehension Test (DCT), (Brookshire & Nichols, 1993, 1997)
* Northwestern Syntax Screening Test (NSST), (Lee, 1971)
* Test for Auditory Comprehension -3rd Edition (TACL-3) (Carrow-Woodfolk, 1999)
85
Reading Skills
* Reading Comprehension Battery for Aphasia (RCBA) (LaPointe & Horner, 1998)
* Gates-MacGinitie Reading Tests, (Gates, MacGinitie, Maria, et. al. 2000)
* Adapt other reading tests for adolescents
86
What are some brief cognitive tests or screeners that could be given to determine the patient’s cognitive status and sort out aphasic symptoms from cognitive symptoms?
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o Arizona Battery for Communication Disorders of Dementia (ABCD)
o Mini Mental State Exam
o SLUMS
o Brief Interview for Mental Status
o Cognitive Linguistic Quick Test
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87
Cognitition
* Mini-mental State Exam (Folstein, Folstein, & McHugh, 1975)
* Arizona Battery for Communication Disorders of Dementia (ABCD) (Bayles & Tomoeda, 1993)
* Raven’s Colored Progressive Matrices (Raven, 1995)
* Wechsler Memory Scale-III, (Wechsler, 1975)
* Cognitive Linguistic Quick Test (CLQT), (Helm-Estabrooks, 2001)
* Boston Assessment of Severe Aphasia (BASA), (Helm-Estabrooks, et.al., 1989)
88
• Diencephalon
| Hypothalamus:
Limbic system
The hypothalamus is an area of the brain that produces hormones that control:
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Body temperature
Hunger
Moods
Release of hormones from many glands, especially the pituitary gland
Sex drive
Sleep
Thirst
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89
• Diencephalon
| Epithalamus:
pineal body (gland)
Physically, the epithalamus connects the limbic system to the basal ganglia. Chemically, the pineal gland is responsible for producing melatonin, a substance that regulates sleep. It is also true that the epithalamus plays a role in emotions and motor function.
90
Non-Fluent Aphasias
Broca’s
Transcortical Motor Aphasia
Mixed Transcortical Aphasia
Global Aphasia
91
Fluent Aphasias
Wernicke’s
Transcortical Sensory Aphasia
Conduction Aphasia
Anomic Aphasia
92
The PICA uses a 16-point scoring system. Which is a better response?
• Goes from a score of 1 (no response) when a patient exhibits no awareness of the test item to a score of 16 (complex) when the patient gives an accurate, responsive, complex, immediate, elaborative response to the test item
93
Cerebellum
* Takes rough motor impulses from the association cortex, refines them, coordinates them, and send them (via thalamus) up to primary motor cortex
* It is attached to the back of the brainstem and lies just below of the cerebrum
* Helps to regulate muscle tone, maintain balance, and coordinate skilled motor movements.
* Damage to the cerebellum – variety of disorders
* Ataxia – speed, range, and direction of movements are affected. The gait is affected (drunken character).
* Intention tremor-only during voluntary movements.
