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CDIS 5153 > Final Exam- Study Guide > Flashcards

Final Exam- Study Guide Flashcards

1
Q

Why does Rosenbek say that auditory comprehension is sometimes called the “veiled disorder” of aphasia?

A

“A deficiency in the ability to process or understand spoken language that cannot be accounted for by peripheral sensory deficit, generalized cognitive deficit, or primary disturbances in attention or arousal.”

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2
Q

Where on the cortex is auditory comprehension localized?

A

Posterior superior aspect of the left temporal lobe and its posterior extension

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3
Q

PST lesion =

Absence of PST lesion =

A

poor prognosis for aud. comp.

good prognosis (even if initially more severe)

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4
Q

The most severe have lesions in

A

PST extending into infrasylvian portion of the supramarginal gyrus

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5
Q

What are the key components of comprehension (according to Rosenbek?)

A
  1. Stimulus detection
  2. Discrimination of stimuli
  3. Retention
  4. Categorization
  5. Sequential retention
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6
Q

What are some specific tests for Auditory Comprehension?

A

The Proust-Lichtheim Test

Liepmann

Pierre Marie – Three Papers Test

Coin and Bowl Test, Hand, Eye, and Ear Test, Man, cat and Dog test.

Goldstein (1948) – contextual basis

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7
Q

1872: The Proust-Lichtheim Test:

Liepmann:

Pierre Marie:

Goldstein:

A

Raise Fingers, squeeze hands, blink, etc.

nodding agreement test
yes/no questions

“Here are three pieces of paper of different sizes, give the largest one to me, crumple the middle one and throw it on the floor and as for the smallest one- put it in your pocket.” Relies on MEMORY, PRODUCTION and EDUCATION to some extent

1st to stress context and pragmatics- everyday questions related to personal interests

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8
Q

What are some activities within general aphasia tests that assess auditory comprehension skills?

A

Minn. Test for the Differential Dx of Aphasia (MTDDA)

Token Test

Revised Token Test

Aud. Comp. Test for Sentences (ACTS)

Functional Auditory Comprehension Task (FACT)

Yes/no questions

1,2,&3 step commands

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9
Q

What are some of the basic tenets of the following treatment approaches that address auditory comprehension issues?

Linguistic Stimulation approach:

A

Pointing to objects by name

Following Commands

Answering questions

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10
Q

What are some of the basic tenets of the following treatment approaches that address auditory comprehension issues?

A

VAT:

VIC:

CAIAC:

PACE:

TWA:

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11
Q

CAIAC:

A

Goal: “To improve the understanding of spoken messages in natural settings and everyday situations.” (pg. 335)
Candidates: (Table 23.1, pg. 346)
Alert, little fatigue
Moderate to severe auditory comprehension deficits
Moderate non-linguistic cognitive problems
Good visual perceptual skills
Basic graphomotor skills
Ability to complete homework
Nonlinguistic variables can influence performance on tasks requiring comprehension of spoken messages.
Experience that employing drills of verbally presented linguistic stimuli have questionable effectiveness.
None of CAIAC tasks require obvious processing of verbal stimuli or any verbal output.
All tasks require attention and conceptual knowledge of shape and size.
Attention Tasks:
Abstract design cancellation (pg. 348-349)
Alternating graphomotor patterns (pg. 351)
Symbol trails task (pg. 352-353)
Conceptual Knowledge tasks:
Odd-man out designs (what doesn’t belong) (pg. 35)
Actual size/weight judgments(pg. 356)
Sorting semantically related pictured objects (pg. 357)
Odd man out pictured objects (pg. 358)

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12
Q

TWA:

A

Goal: “To improve ability of individuals with moderate to severe Wernicke’s aphasia to understand spoken messages in everyday settings and situations”

Candidates: Moderate to severe Wernicke’s aphasia
Severely-moderately impaired single word comprehension
Severely-moderately impaired repeating of single words, phrases and sentences
Relatively preserved single-word reading comprehension

Some ability to read aloud a few single words with high emotional value
Based upon theory of “re-auditorizaton”
Pre-test: must be able to read 4/15 single words from ADP.
Baseline Step

Treatment Steps:
Reading comprehension-match printed to pictorial
Oral Reading-read word aloud
Repetition-repeat with only picture
Auditory Comprehension-select from field of 6

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13
Q

Can sub-cortical lesions alone cause aphasia?

A

Yes, severe aphasia because everything goes through the thalamus

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14
Q

If damage to a sub-cortical structure causes aphasia, does that mean that these structures have language functions?

A

No, its function is to relay the information from the cortex. The relay station is damaged, therefore aphasia is likely to occur

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15
Q

Are all deep structures sub-cortical and not cortical? What about the insula?

A

No, the insula has lead us to believe it is more of a cortical structure

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16
Q

What are the characteristics of cortical versus sub-cortical aphasias?

A

“Characteristics have not been defined yet.”

They have a greater variability in number of words/breath

Great variability in number of words uttered in one breath unit

Hypophonia or low speech volume distinguishes subcortical from cortical aphasia.

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17
Q

What does Help-Estabrooks call sub-cortical aphasics?

A

Borderline fluent

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18
Q

What are the symptoms of thalamic lesions?

A

Auditory Comprehension skills:
Highly variable

Repetition skills
Good

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19
Q

What are more symptoms of thalamic lesions?

A

Hemiplegia, hemisensory loss, right-visual field problems, maybe coma

Mutism initially or hypophonic (low volume)

Eventually variable phrase length and paraphasic and perseverative with bizarre word choices

Severe anomia (naming problems)

Variable auditory comprehension for conversational speech but poor for complex material

Relatively good repetition

Decreased paraphasia while repeating

Impaired reading and writing

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20
Q

What are the symptoms of anterior damage to the internal capsule and putamen of the basal ganglia?

A

Auditory Comprehension skills:Relatively good

Repetition Skills: Good

Dysarthria, hypophonia, imprecise articulation

Variable phrase length from 4-6 word phrases to nearly normal

Semantic & phonemic paraphasias with a range of grammatical constructions.

Mild or no repetition problems

Anomia: Moderate naming or word-finding problems

Mild auditory comprehension problems
	
Moderate reading problems
	
Severe writing problems
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21
Q

What are the symptoms of damage to the posterior capsular-putamenal lesions?

A

Auditory Comprehension skills: Poor

Repetition Skills: Poor

Hypophonic, well-articulated, grammatical speech

Semantic, phonemic and neologistic paraphasias
	
Fluent speech, variable phrase length
	
Severe auditory comprehension deficits
	
Anomia: severe naming and word-finding problems
	
Poor repetition problems
	
Moderate reading problems
	
Moderate writing problems
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22
Q

What happens if both anterior and posterior areas are damaged?

A 
Global aphasia
	
Non-fluent and extremely limited spontaneous speech
	
Stereotyped monosyllabic utterances or single-word productions
	
Severely dysarthric
	
Severely impaired Auditory comprehension
	
Significant naming and repetition 
	
Serious reading and writing problems.
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23
Q

How does Helm-Estabrooks recommend addressing sub-cortical lesions?

A

Mirrors the symptoms of other aphasias at this time

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24
Q

Is it common to have a bi-lateral lesion?

A

Rare to have simultaneous lesions Rare to have simultaneous lesions

(16 reported cases or 0.3% of CVAs)

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25
Where are they usually located?
Usually due to aneurysm of Anterior Communicating Artery and subarachnoid hemorrhage
26
Do bilateral CVAs generally have a positive outcome?
Often poor outcome if not fatal
27
What is meant by “alexia”?
Suffer from reading problems while other language-related skills such as naming, oral repetition, auditory comprehension or writing may still be intact.
28
What type of reading tasks should be the function of early aphasia therapy?
Target survival reading skills Reading letters, menus, checkbooks, bank statements, medicine labels, phone books calendars, maps, product labels, emergency signs, etc.
29
List some treatment considerations for working with reading with a moderate to severe aphasic.
Functional Verbal Expression is the Priority for severe aphasics Basic/Functional Reading skills may be important for mild-moderate aphasics “The first step in designing a reading treatment program is to assess the premorbid level of literacy and the current need for and interest in reading.” Silent reading comprehension more important than oral reading
30
How do writing problems differ in anterior versus posterior left hemisphere CVAs?
Anterior left: structurally poor writing: misspelling, poor letter formation Posterior left: Word order, word omission, letters formed OK
31
How do writing problems differ between left hemisphere CVAs and right hemisphere CVAs?
Left Hemisphere: More pronounced structural and syntactic writing problems than right hemi Right Hemisphere: Spatial aspects, Left neglect, Margin errors
32
What are the main types of agraphia ?
Pure Agraphia Deep Dysgraphia Phonological Dysgraphia Surface Dysgraphia
33
Pure Agraphia-
unusual syndrome agraphia without anything else going on
34
Deep Dysgraphia-
Route between word meaning and written form impaired. Spelling errors semantically related. Better at concrete nouns, greater difficulty with abstract nouns. Functor words VERY difficult. Connective pathway disorder
35
Phonological Dysgraphia-
impaired phoneme to grapheme conversion rules. Preserved ability to write real words, inability to write pseudo words. Sounding out words and thinking of the associated grapheme that goes with it
36
Surface Dysgraphia-
Phonetic errors but able to write pseudowords
37
MOTORIC ORIGINS:
Apraxic Agraphia Motor Agraphia Micrographia Hyperkinetic agraphia
38
Apraxic Agraphia-
Inability to use a writing tool to form symbols even with a model. Could be a component of ideomotor apraxia. Better ability with anagrams or typewriter or spelling aloud
39
Motor Agraphia-
paralysis of writing hand
40
Micrographia-
hypokinetic- writing is unusually small
41
Hyperkinetic agraphia-
hyperkinetic motor issues
42
Explain the basic processes that Beeson outlined in the CART and the ACRT programs. ACRT: Purpose:
TO improve spelling to use writing as a means of communication. Improve skills for everyday use.
43
Candidates:
Severely impaired writing Good grapho-motor skills Good single-word reading comprehension Some knowledge of word forms Good visual memory
44
Agnosias usually are due to damage to
the sensory areas: Posterior central gyrus
45
What does “agnosia” mean?
a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss
46
What is prosopagnosia?
Also known as '''faceblindness''' and '''facial agnosia''': Patients cannot consciously recognize familiar faces, sometimes even including their own. This is often misperceived as an inability to remember names.
47
What is Anosonosia?
This is the inability to gain feedback about one's own condition and can be confused with lack of insight but is caused by problems in the feedback mechanisms in the brain. Those with Anosognosia with multiple impairments may even be aware of some of their impairments but completely unable to perceive others.
48
What is Autotopagnosia?
Is associated with the inability to orient parts of the body, and is often caused by a lesion in the parietal lobe of the posterior thalamic radiations.
49
What is auditory agnosia?
With Auditory Agnosia there is difficulty distinguishing environmental and non-verbal auditory cues including difficulty distinguishing speech from non-speech sounds even though hearing is usually normal
50
What is phonagnosia?
Is the inability to recognize familiar voices, even though the hearer can understand the words used.
51
What is simultanagnosia?
Patients can recognize objects or details in their visual field, but only one at a time. They cannot make out the scene they belong to or make out a whole image out of the details. They literally "cannot see the forest for the trees." Simultanagnosia is a common symptom of Balint's syndrome.
52
What is asteriognosia?
Or '''Somatosensory agnosia''' is connected to tactile sense - that is, touch. Patient finds it difficult to recognize objects by touch based on its texture, size and weight. However, they may be able to describe it verbally or recognize same kind of objects from pictures or draw pictures of them. Thought to be connected to lesions or damage in somatosensory cortex.
53
What are the general functions of the right hemisphere vs. the left hemisphere?
Arousal, orientation, vigilance and selective attention Visual perception: holistic gestault-like stimuli, geometric and spatial information, facial recognition, body image Emotional experience and expressions: angry and happy emotions Perception of temporal order Perception of musical harmony Other aspects of communication…..
54
B. What are some aspects of communication attributable to the right hemisphere?
Discourse comprehension and production Complex inferences implied in verbal Communicative efficiency and specificity Understanding alternative/ambiguous meanings Understanding and expressing emotional tone Understanding and expressing prosodic aspects Prosody: intonation, rate, rhythm, pitch, intensity, etc
55
Persons with RHD usually exhibit what difficulties in these areas?
Comprehending 2-way conversation: may not take turns properly or not explain thing properly, go on and on Complex inferences implied in verbal Communicative efficiency and specificity Not specific enough or too specific Subtle inferences; overriding issues they don’t understanding Flat emotional tone when speaking; sometimes they try and miss it. They have too much emotion. R inferior frontal gyrus R posterior temporo-parietal region for understanding prosody Prosody: intonation, rate, rhythm, pitch, intensity, etc
56
C.What are some causes of communication problems in the right hemisphere?
CVA Tumors Head Trauma Alzheimer’s, Parkinson’s, other neurological diseases
57
What are some of the pragmatic problems seen in right hemisphere CVA?
turn-taking, topic maintenance, social appropriateness, eye contact
58
What is left neglect?
Failure to recognize stimuli in the left visual field "Ipsilateral"
59
Left Neglect
Damage to any lobe in either hemisphere can lead to neglect More severe and consistent, resistant to therapy People with damage to either hemi can have neglect, it is ipsilateral. Neglect can be of varying degrees. Can affect vision or can see but neglect the left side
60
What are the characteristics of left-neglect?
Right focus, don’t notice left Difficulty shifting attention from right to left Failure to perceive left-sided tactile or perceptual stimuli Failure to copy the left side of a picture of design Painting only right half of a face-ignore left Extreme right-centered attention to an array of stimuli Paying attention only to the right side of a space described from memory Bumping into things on the left Using only right-sided objects ``` Disownership of the left side of the body Denying illness (anosagnosia) ``` Auditory neglect Motor neglect Left-neglect in reading Left neglect in writing
61
Which is more commonly seen left neglect or right neglect?
Left brain damage: right-neglect = 2-15% Right brain damage: left-neglect = 31-90%
62
What attentional deficits are seen in R CVA?
Reduced state of arousal Difficulty in sustaining attention Difficulty in paying selective attention Disorientation: Topographic disorientation Geographic disorientation Reduplicative paramnesia (rare condition)-belief in the existence of multiple and identical persons, places and body parts
63
What is meant by disorientation?
Inability to recognize person, place, time, or self
64
What does “affect” mean in the context of R CVA?
expression/emotions
65
What are some affective deficits of R CVA?
Difficulty understanding emotions Difficulty stating the emotions depicted in pictures stories Problems recognizing emotions in sentences Problems understanding emotional tone of voice Difficulty in emotional expressions
66
What is “prosody”?
stress patterns, intonation rhythm, and melodious qualities of speech that convey meaning
67
How can it be impaired in R CVA?
aprosodia, auditory affective agnosia, dysprosodia Speech sounds monotonous Lacks variation: Impaired stress patterns Reduced rate Devoid of emotion Impaired in prosodic comprehension Imopaired stress patterns Devoid of emotion
68
What semantic or discourse problems are often seen in R CVA? Semantic:
Difficulty with implied, alternative or abstract meanings Failure to grasp overall meaning Difficulty with proverbs, idioms, metaphors Problems with abstract categories Difficulty with irony, humor, sarcasm Problems with logical errors in sentences
69
Discourse definition:
social communication skills, involves descriptions of events, objects, and performance, extended talk on a given topic, conversations.
70
Discourse problems:
Distinguishing significant from irrelevant info. Use tangential, inconsequential aspects of topics Conversational speech-irrelevant or tangential Understanding implied meanings, abstract words, metaphors, irony, and humor Premature incorrect inferences (jumping to conclusions) Confabulation and excessive speech Unelaborated narratives
71
Evaluation of R CVA: What behaviors should be assessed particularly in R CVA?
Discourse Pragmatic Behavior Prosody Neglect Attention Affective Processing Also: Dysarthria & Dysphagia
72
What are some of the instruments available for evaluation of communication and cognitive problems in R CVA? Know the basic uses for:
Rehab. Institute of Chicago Evaluation of communication Problems in Right Hemisphere Dysfunction (RICE) Mini –Inventory of Right Brain Injury (MIRBI), Pimental & Kinsbury, (1989) Burns Brief Inventory of Communication and Cognition, Burns (1995) Rivermead Behavioral Memory Test, Wilson, Cockburn, & Baddeley, (1991) Ross Information Processing Assessment, 2nd Ed. (RIPA-2), Ross-Swain, (1995) Woodcock-Johnson Psychoeducational Battery Revised, Woodcock & Johnson, (1989)
73
What are some published tests for visual neglect?
Test of Visual Field Attention, Coolspring software
74
What does the Stroop Test assess?
?
75
What does the Prutting Protocol assess?
?
76
In an initial screening with a person with an RHD diagnosis, what activities could you use in an initial screening?
Interview Scene Interpretation Neglect: Cancellation Drawing Line Bisection
77
Neglect: what percentages of L Brain-damaged individuals have R neglect compared to R Brain damaged individuals with L neglect?
Left brain damage: right-neglect = 2-15% Right brain damage: left-neglect = 31-90%
78
What are some facial recognition deficits found in individuals with R Hemisphere CVAs?
Difficulty recognizing familiar faces Difficulty choosing pictures of faces just shown Problems naming the pictures of faces of famous persons Capgras syndrome
79
Capgras syndrome:
: delusional belief that their friends and family members are not their real selves but imposters or doubles
80
Possible sensory issues associated with RHD that could impact treatment goals:
Achromatopsia Simultagnosia Pallinopsia Reduplicative Paramnesia
81
Achromatopsia:
Loss of Color vision
82
Simultagnosia:
inability to perceive simultaneously the multiple details of a visual display.
83
Pallinopsia:
variant of hallucination, major feature is abnormal persistence or recurrence of visual images after the stimulus has been removed.
84
Reduplicative Paramnesia:
belief in the existence of multiple and identical persons, places and body parts
85
Major Treatment Targets | Hegde, 2008
Denial and indifference issues Impaired attention Visual neglect Impulsive behavior Pragmatic language skills Impaired recognition of absurdities Impaired comprehension of metaphors and proverbs Prosody Pragmatics Affective language/emotional expression Discourse aspects: Macrostructure Agnosias: impaired facial recognition
86
Treatment of Attention Deficits Task Simple Reaction Time Tasks: Complex Reaction time Tasks: Serial tasks: Visual matching Tasks:
Arousal and sustained attention Selective attention, vigilance Arousal, vigilance Selective attention
87
Stroop-type tasks: Cancellation tasks: Alternating responses during cancellation: Dual tasks:
Vigilance, selective attention Selective attention Selective attention, flexibility, vigilance Sustained attention, flexibility
88
Treatment of Visual Neglect Strategy Verbal Reminders Salient visual and tactile cues Restructure Environment Tasks to encourage leftward search Use of contiguous stimuli
Tell them "look left"... Red line, highlighter, ruler, or Velcro strips on margins Self-care items to the left Items that encourage search More sensitive to sets
89
Treatment of Affective Deficits
Comprehension of nonverbal emotional expression- scene discussion Production of nonverbal affective expression: - not responsive to Speech Tx. May need counseling. Could use discourse treatment
90
Treatment of Prosodic Deficits Comprehension:
ID emotional prosody in sentences ID emphatic stress ID sentence stress Discriminate sentence types
91
Treatment of Prosodic Deficits Production Tasks:
Produce emotional prosody in sentences Produce emphatic stress in words Produce emphatic stress in sentences
92
Treatment of Discourse Deficits
Inference Generation Tasks Picture/story interpretation Guided inference generation Picture titles/ story headlines Story continuations Individual inferences
93
Treatment of Semantic Deficits
Alternative meanings: Activation tasks- stimulate activation of alternate meanings Homographs, word associations Resolving ambiguities, inference revision Suppression Tasks-Improve awareness and conscious control or suppression of inappropriate alternate meanings Homographs, semantic relations Sentence interpretation
94
Treatment of Pragmatic Deficits
No known treatment to address affective components Conversational Conventions: Increased conversational promoters Decreased conversational blockers Theory of Mind tasks Management of reduced sensitivity to listener needs
95
Denial and Indifference
Some consider this the most difficult aspect to treat! If in denial- less motivated to work May require delaying treatment until reduction of denial. Increase awareness of the problems Give immediate, systematic, and response-contingent corrective feedback Videotaping/audio taping Positive reinforcement of appropriate behaviors should accompany corrective feedback. Encourage self-correction- have the client chart or count errors Work closely with family or caregivers to give corrective feedback.
96
Treatment of Impaired Facial Recognition
Very little information available on tx Focus on part to whole association

CDIS 5153 (7 decks)

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