L6: Classification Systems for Aphasia Flashcards by Julia Kuzmich

what are classification systems?

correlations bw groups of behaviours (symps) and sites of lesions determined by autopsy or neuroradiology studies

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what are the benefits of classification systems?

provide a common language amongst clinicians

presume lesion localization and most likely etiology

highlight exceptionalities

however…. correlations do not supprt conclusively simplistic brain behaviour relationships

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what are the risks of classification system usage?

classifying can cast a person into preconceived set of behaviours

ignoring critical assessment in areas the classification system does not cover

w/i group variance often is larger than bw group variance for dimensions on which treatment may be being based

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what are the 3 non-fluent aphasias

broca’s
global
transcortical motor (TCM)

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what are the 3 fluent aphasias

wernicke’s
transcortical sensory
conduction
anomic

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what are the 6 categorization parameters for boston classification?

spontaneous language (fluent vs non)

repetition

auditory comp

reading comp/matching

reading aloud

writing

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what are the categorization paramaters of spontaneous language? (non fluent vs fluent )

content (morphosyntactic, semantic and pragmatic considerations)

naming - confrontation (object, picture, action) vs generative vs responsive

error analyses

paraphasias (type and proportion of occurence)

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what are the categorization paramaters of repetition?

single words

phrases

real vs non words

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what are the categorization paramaters of auditory comp?

sound, word, sentence, paragraph

concrete vs abstract

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what are the categorization paramaters of reading comp and matching?

letter, syllable, word, clause, sentence paragraph

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what are the categorization paramaters of reading aloud?

single word and phrases

real vs nonwords

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what are the categorization paramaters of writing?

spontaneous (letter, syllable, word, clause, sentence, paragraph)

copying

spelling and dictation

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what are the 5 main parameters of nonfluent vs fluent speech? (first 3 being most distinctive)

articulatory agility

grammatical form

melodic line

average phrase length

anomia

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articulatory agility refers to (nonfluent vs fluent speech)

distinguished from motor speech production (ex. dysarthria) on basis of variability of performances

inc effort to speak

mispronunciations at phoneme and syllable levels (ex. phonemic paraphasias)

self corrections, restarts and reformulations, sound and syllable reps

inc effort aggravates inaccuracies

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grammatical form refers to (nonfluent vs fluent speech)

do they have their grammatical markers?

agrammatism = absent or incorrect use of grammatical structures, non-meaningful filler words or phrases

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melodic line refers to (nonfluent vs fluent speech)

prosodic features (duration, rate, loudness, pitch, contours, stress patterns)

pauses/hesitations (filled - ex. um, unfilled - periods of silence), rhythm disrupted

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average phrase length refers to (nonfluent vs fluent speech)

of words in a breath group or w/i sig pause

average 3 longest utterances produced under 3 conditions

words produced in a specified time period

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what are the 3 conditions for average 3 longest utterances? (aka # of words in a phrase that determine nonfluent vs fluent speech)

all correct and incorrect words that are articulated clearly enough for transcription

9 or > = fluent
0-5 = non-fluent
6-8= borderline fluent

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anomia refers to (nonfluent vs fluent speech)

paraphasic errors

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anterior (non-fluent) refers to lesions that are …

anterior to central sulcus, superior to sylvian fissure

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posterior (fluent) refers to lesions that are …

posterior to the central sulcus, inferior to sylvian fissure

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What are some of the main characteristics of anterior/non-fluent aphasia?
(consider: phrase length, content vs functor words, words per min, vocab, forms, auditory comp)

short phrases (2-3 words)

high % content words rather than functor (ex. articles)

low words per min

restricted vocab

retains overlearned forms and serial items

fairly good auditory comp by poorer performance on longer, more complex structures

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What are some of the main characteristics of anterior/non-fluent aphasia?
(consider: writing, reading, co-morbidities, effort, syntax) PART 2

impairment in spoken language mirrors writing impairment

mild reading comp disturbances

oral and verbal apraxias often co-existing

w recovery, more effortful productions

syntax impaired

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What are some of the main characteristics of posterior/fluent aphasia?
(consider: phrase length, articulation, word classes, expressive vocab, word associations, comp skills)

normal phrase lengths

facility of articulation

use of all word classes but fewer substantives

may or may not have semantically empty expressive language, sometimes filled w jargon and paraphasias (phonemic, verbal, and semantic)

general word associations are poor or bizarre

mildly impaired or poor comp skills

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What are some of the main characteristics of posterior/fluent aphasia? (consider: reading, writing, rep tasks, melody, awareness) PART 2

reading aloud, reading comp, and writing impaired paraphasic errors on rep tasks normal melody and rhythm can be generally unaware of errors

Broca's aphasia is a type of

anterior/nonfluent aphasia

What are the spoken language characteristics (neurolinguistic) of Broca's aphasia? (8 of them)

verbal output laboured, sparse and halting poorly articulated utterances, misarticulations prominent short phrases (telegraphic, text like) agrammatic output (functor missing/restricted vocab/grammar) dysprosodic AOS During recovery: effortful/short phrases confrontation naming mildy impaired (aided by phonemic cueing)

agrammatic output refers to

functor words missing, utterances primarily substantive restricted vocab and grammatical forms (verbs omitted more than nouns, that is nouns more freq than verbs)

agrammatism is present ____ language domains/models, associated with ______ output (_____ words/min)

across slow, efffortful reduced

agrammatic spoken language may be _______ in fluency, BUT _____ nonfluent language is agrammatic

reduced not all aka not all nonfluent aphasias show agrammatism

agrammatism often shows _____ of verbs, ______ proportion of verbs to nouns (type token ratio)

omission declining

type-token ratio =

discourse measure that takes a ratio of one word class and compares it to another word class (ex. Verbs vs nouns)

agrammatism often involves omission of function words such as...

prepositions, articles, and conjunctions

agrammatism: verbs are typically _____ or in ____ form

inflected or ing form

agrammatism: ______ of bound morphemes often occurs

omission

agrammatism: word order may be ______ in production even in the presence of _____ issues

preserved comprehension

agrammatism: sentence comprehension is impaired in speech and/or accuracy and usually shows....

non-canonical sentences (ex. negs or passives) longer sentences (typically more propositions/ideas) sentences requiring wh- phrase movements (Broca's)

What are the repetition characteristics (neurolinguistic) of Broca's aphasia? (5 of them)

rep almost always abnormal less abnormal than fluency but still abnormal omits functor words difficulty repeating same syntactical wording know they are not repeating same words in same order

in Broca's aphasia comprehension is distinctly ____ than expression

better

What are auditory comp characteristics (neurolinguistic) of Broca's aphasia? (4 of them)

*Im pretty sure these are things where their auditory comp is weaker but double check* complex sentences: one independent cause plus 1+ dependent clause multiple concepts: compound sentences w 2+ independent clauses reversible sentences: reversible implausible better understood than reversible plausible processing word order (rely on syntax)

in Broca's aphasia (nonfluent/posterior) reading comprehension is...

less impaired than verbal and writing skills but still impaired

in Broca's aphasia (nonfluent/posterior) reading aloud is...

impaired bc of probs w verbal expression and phonemic programming

in Broca's aphasia (nonfluent/anterior) writing is...

poor and matches verbal output letters are formed poorly/oversized ... and telegraphic

Where is the site of the lesion for Broca's aphasia?

L-lateral frontal love, posterior/inferior portions of F3 IFG, extending t adjacent subcortical white matter

80% of Broca's aphasia patients exhibit ______ because of proximity to precentral motor strip

R-hemiplegia (more sig for arm than leg, leg is more medial on homunculus) hemiparesis = muscular weakness on one side of the body

Broca's aphasia may be correlated with ____ due to involvement of association area for sequenced actions

ideomotor apraxia inability to carry out command or act that can be performed spontaneously Limb or bucco-facial/nonverbal apraxia

Patients w Broca's aphasia may exhibit personality changes due to...

disturbances to frontal lobe and the afferent and efferent connections to the limbic system (hypothalamus, amygdala, thalamus, hippocampus etc)

Transcortical motor aphasia resembles Broca's aphasia but ... (hallmark feature!!!)

repetition is robust

transcortical motor aphasia is a type of

non fluent/anterior aphasia

describe the spoke language symptoms of transcortical motor aphasia

nonfluent spontaneous spoken output agrammatic verbal output telegraphic/text like mostly content/substantives and few functors serial spoken language is robust

in transcortical motor aphasia, confrontation naming is usually defective bc of ______, however this is inconsistent

word finding problems

in transcortical motor aphasia, contextual cues and semantic cues helpful, but _____ cues not helpful

phonemic

auditory comp in transcortical motor aphasia is

minimally impaired, approaches normal

reading comp in transcortical motor aphasia is _____, reading aloud is ...

good poor bc of articulation and agrammatic, nonfluent output

writing in transcortical motor aphasia ...

poor graphics (misshapen letters, especially large ones) spelling is also poor

site of lesion for transcortical motor aphasia is

middle and anterior portions of 2nd and 3rd frontal gyri and sometimes anterior portion of 1st frontal gyrus can affect motor and premotor cortex, anterior and superior to broca's

transcortical motor aphasia involves the following neurobehavioral correlates...

personality changes and emotional lability broad spectrum of motor changes (paralysis or paresis) depending on sites and extent of lesion

global aphasia is a type of

non-fluent/anterior aphasia

global aphasia involves severe reduction in...

ALL language modalities minimal verbal output may be limited to 1-2 word utterances including stereotypes, serial forms, automatic utterances

global aphasia may involve ______ utterances, _____ and _____ paraphasic errors

nonsense neologisms jargon

in global aphasia, _____ output may be severely compromised

nonverbal, i.e. gestures

stereotypical response =

involuntary utterance that is routinely used in replace of a propositional utterance (which is voluntary and novel in meaning)

in global aphasia they may respond to _____ communication or ____ systems but prognosis is _____

augmetative gesture poor

in global aphasia: repetition = auditory and reading comp= reading aloud = writing =

sig impaired severely impaired severely impaired writing usually w non-dom hand, agraphic and linguistic disturbances

site of lesion of global aphasia is

variations in regions involved but primarily extensive distribution thru L hemisphere large perisylvian, extending into subadjacent white matter

what are the neurobehavioural correlates of global aphasia?

associated w neuropsychological disturbances (agnosias, emotional lability, parietal lobe symps, attention deficits) neurological deficits (paralysis - upper and lower limbs, incontinence, visual field probs)

agnosia

inability to process sensory info lack of knowing, lack of recognizing people, lack of recognizing objects