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Aphasia > Lecture 4: Nonfluent Aphasias > Flashcards

Lecture 4: Nonfluent Aphasias Flashcards

1
Q

Other names for nonfluent aphasias:

A

expressive aphasia, motor aphasia, anterior aphasia

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2
Q

Major General symptoms of nonfluent aphasias:

A

Decreased rate of speech, decreased phrase length, decreased prosody, decreased initiation of speech, decreased talking in general, increased effort

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3
Q

4 Nonfluent Aphasias

A

Broca’s, global, transcortical motor, mixed

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4
Q

Broca’s Aphasia Background

A

first described in 1861
Associated with damage to the cerebral language areas surrounding the sylvian fissure but not extending to Wernicke’s area
Hallmark characteristic: fluency impairment

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5
Q

Broca’s Aphasia Neuroanatomical Bases

A

Posterior-inferior (3rd) frontal gyrus of the left hemisphere known as Broca’s area (44 and part of 45)
Area known as anterior language cortex
MCA blood supply
Lower part of the premotor cortex

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6
Q

General Characteristics of Broca’s Aphasia

A

More easily recognized than Wernicke’s
Typical present with contralateral hemiplegia or hemiparesis; weakness of (r) facial muscles
Most motor problems improve over time
Pts often very depressed; catastrophic reactions refusing to cooperate or continue testing

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7
Q

Language Characteristics of Broca’s Aphasia

A 
Nonfluent and effortful speech
Agrammatic speech
Impaired repetition of words/sentences
Impaired naming
Questionable auditory comprehension
Oral reading
Writing problems
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8
Q

Broca’s Aphasia Site of Lesion

A

Posterior-inferior central gyrus of the left hemisphere

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9
Q

Verbal Expression in Broca’s Aphasia

A

Severely impaired; agrammatic; telegraphic; dysprosodic; possible AOS; minimal paraphasias

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10
Q

Auditory Comprehension in Broca’s Aphasia

A

Better than expression; some degree of deficiency in some pts; essentially intact for most

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11
Q

Naming in Broca’s Aphasia

A

Impaired

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12
Q

Repetition in Broca’s Aphasia

A

Impaired, especially for grammatical features

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13
Q

Oral Reading in Broca’s Aphasia

A

Impaired; similar to oral expression

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14
Q

Reading Comprehension in Broca’s Aphasia

A

Impaired to some extent

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15
Q

Writing in Broca’s Aphasia

A

Impaired

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16
Q

Transcortical Motor Aphasia Background

A

Extrasylvian aphasic syndrome; lies outside of perisylvian language zones
Nonfluent aphasia with good repetition skills
Hallmark characteristic: discrepancy between language production problems (impaired) & spared repetition skills

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17
Q

Neuroanatomical Bases in TMA

A 
Anterior superior frontal lobe
Usually above or below Broca's area
Lesions often impact association pathways
Impacts supplemental motor area
Supplied by anterior cerebral artery
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18
Q

General Characteristics in TMA

A

Similar to Broca’s aphasia
Motor disorders: rigidity of UE, akinesia, bradykinesia
Hemiparesis
Pts may demonstrate apathy or behavioral withdrawal: exhibit little to no interest in using language

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19
Q

Language Characteristics of TMA

A

Muteness, echolalic, reduced spontaneous speech
Agrammatic speech, paraphasic
Impaired naming with intact repetition
Relatively intact serial speech
Intact knowledge of grammar/ meaningfulness
Limited naming; may use motor prompts (snapping, etc. to get going)
Better comprehension than production

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20
Q

TMA site of lesion

A

Deep portions of the left frontal lobe below or above Broca’s area

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21
Q

Verbal expression in TMA

A

Impaired; initially mute; paraphasic; agrammatic; telegraphic; limited word fluency; pt will have no apraxia of speech

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22
Q

Auditory Comprehension in TMA

A

Intact for simple; subtle problems with complex material

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23
Q

Naming in TMA

A

Mildly impaired; better for confrontational naming

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24
Q

Repetition in TMA

A

Intact; may demonstrate echolalic and perseverative speech

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25
Oral Reading in TMA
Impaired
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Reading Comprehension in TMA
Good except for syntactically complex material
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Writing in TMA
Impaired
28
Mixed Transcortical Aphasia (MTA) Background
Rare nonfluent aphasia type Combine TMA and TSA Language impairment is severe and extensive Pts retain repetition skills (Hallmark & distinguishing feature from global aphasia) Has been labeled isolation aphasia
29
Neuroanatomical Bases of Mixed Transcortical Aphasia
Caused by various conditions that decrease blood flow throughout cerebral arteries: hypoxia of various origins, cardiac arrest, cerebral edema, multiple embolic strokes Supplied by MCA, & anterior/posterior cerebral arteries Broca's, Wernicke's, & arcuate fasciculus are spared
30
General Characteristics of Mixed Transcortical Aphasia
Varied clinical picture Bilateral UMN paralysis Severe spastic quadriparesis (weakness of all 4 limbs) Visual field deficits (typical problems is right hemianopia) Weakness in hip/shoulder muscles Severe brain damage
31
Language Characteristics of Mixed Transcortical Aphasia
``` Extremely limited spontaneous verbal expression, echolalic Severely impaired fluency Severely impaired auditory comprehension Marked naming difficulty Unimpaired automatic speech Normal articulation Severe reading deficits Severe writing impairments ```
32
Lesion site: Mixed Transcortical Aphasia
watershed area (pg. 113)
33
Verbal expression: mixed transcortical aphasia
Often severely impaired; Agrammatic with paraphasias
34
Auditory Comprehension: Mixed Transcortical Aphasia
Often severely impaired
35
Naming: Mixed Transcortical Aphasia
Impaired
36
Repetition: Mixed Transcortical Aphasia
Good but parrot-like; nonfunctional repetition
37
Oral Reading: Mixed Transcortical Aphasia
Often severely impaired
38
Reading Comprehension: Mixed Transcortical Aphasia
Often severely impaired
39
Writing: Mixed Transcortical Aphasia
Impaired
40
Additional Info on Mixed Transcortical Aphasia
"Broca's aphasia with decreased auditory comprehension
41
Global Aphasia Background
May account for 30-55% of pts with aphasia Most severe form of aphasia; has a generalized effect on communication skills Impacts all modes of communication & spares no particular skill (which is hallmark) Possible for it to evolve into another type of aphasia Be careful of prognosis
42
Neuroanatomical Bases of Global Aphasia
Lesion likely to involve entire perisylvian region affecting both Broca's and Wernicke's areas Subcortical areas may even be impacted More common sites are impacted by MCA Widespread destruction of left fronto-temporo-parietal regions
43
General characteristics of global aphasia
Presence of strong neurological symptoms; weakness; paralysis; sensory loss Apraxia including both verbal & oral types Hemi-neglect
44
Hemi-neglect
left neglect is common in right hemisphere damage
45
Language Characteristics of Global Aphasia
Globally impaired communication skills Severely impaired fluency Impaired repetition, naming, reading, writing Impaired auditory comprehension
46
Global Aphasia Site of Lesion
Widespread damage; left fronto-temporo-parietal regions
47
Verbal expression in global aphasia
Severely impaired; minimal vocalizations
48
Auditory comprehension in global aphasia
Impaired; maybe personally relevant info; some y/n ?s
49
Naming in global aphasia
Impaired
50
Repetition in global aphasia
Impaired
51
Oral reading in global aphasia
Impaired
52
Reading comprehension in global aphasia
Impaired
53
Writing in global aphasia
Impaired; no meaningful; may copy letters &/or write name
54
General Nonfluent Aphasia Treatment
Coarticulated speech; auditory comprehension; oral expression tasks; understanding written language/reading; writing strategies
55
Coarticulated speech
Build on level of success (syllables, words, phrases...)
56
Auditory comprehension strategies
Point, follow commands, understand complex material
57
Oral expression tasks may range from:
Oral-motor skills, automatic sequences, repetition, answering questions, naming, & word fluency to reading words & sentences aloud
58
Understanding written language (reading)
Identify letters, words, match words and pictures, read sentences and paragraphs
59
Writing Treatment
Improve mechanics for writing basic info, the alphabet, numbers, writing to dictation, writing names, & writing about a picture or event
60
Treatment Strategies: Consider spared abilities/functional levels:
Good writing: apply directly to communication Some writing: consider a writing/spelling therapy program No writing, some drawing: consider a communicative drawing therapy program No writing, some gesturing: consider a communicative gesturing therapy program Gestural-verbal training increases naming for some people with aphasia
61
PACE approach
Prompting Aphasics' Communicative Effectiveness; Pulvermuller & Volkbert, 1991 Uses compensatory strategies to facilitate communication: encourages exchange of information; provide a stimuli pic face down b/t pt & clinician & the pt must look at it & use any available means to communicate the message (charades with all modalities) SLP guesses and provides feedback
62
Mapping Treatment
For agrammatism Targets sentence structure & thematic roles by identifying subject & object of sentences Uses pictures
63
Sentence Production Program for Aphasia (SPPA)
Helm-Estabrooks & Nicholas 2000 Used to improve conversation with pts who have nonfluent aphasia & who are agrammatic speakers Attempts to increase phrase length, content, & grammar Focuses on 8 sentence types using a thematic base
64
Melodic Intonation Therapy (MIT)
Sparks & Deck 1986 Approach that uses melodies & intonation patterns of the intact right hemisphere 4 levels: 1: intoning a melodic line; 2: hand tapping saying syllables; 3: answering questions; 4: practice with drilled phrases & sentences Pictures used initially & later program cues reduced
65
Response Elaboration Training (RET); Kearns 1991
Program using loose training w/ pt-initiated responses (without restrictions) Uses simple line-drawn picture stimuli requiring personal interpretation SLP scaffolds responses (doesn't provide corrections to pt responses) 6 steps: 1: Elicit spontaneous response to pic; 2: Model & reinforce pt's response; 3: Provide 'wh' cues for pt to elaborate; 4: reinforce elaboration & model sentence; 5: repeat & have pt repeat; 6: reinforce & provide another model
66
Equivocal Responses
Vague, confusion, ambiguous
67
Treatment for Equivocal Responses
use 2 notecards w/ "yes" on 1 & "no" on other; pt repeats words 5 times each while looking at cards; assist the pt to say word & nod "yes" & then "no" when given a cue; present yes/no ?s for pt responses (request responses to simple ?s) Establish a baseline & begin treatment with personal, environmental, informational ?s Use pics to help understand ?s; chart responses
68
Gestural Response Therapy
Core vocab chosen based on pt needs (begin w/ 5-10 words); Clinician makes gesture while saying a word; clinician repeats word with pt; pt imitates gesture immediately then after brief delay; pt gestures after clinician says and writes the word; pt writes word if possible when seeing gesture
69
Card Therapy/Treatment (Deck of Cards)
Improve sequencing of #s on cards by putting them in order Match cards according to suit & number (use 2 decks) Respond to commands using cards (pick up the ace)
70
Writing Hierarchy
Trace word-->copy word-->say word for pt to identify in writing-->ask pt to write word to dictation-->ask pt to write word given a picture-->ask pt to write word in response to a ?
71
Communication Boards
use communication boards w/ pics & words: alphabet & word boards usually ineffective for individuals w/ global aphasia Include pics of people & familiar objects Use pics of real objects, actions, places
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Teaching Pts to Use Communication Boards
Point when an item is named (immediate then with a delay) Keep board visually simple at 1st & then expose more items with time when success is achieved Consider a more high-tech AAC device if possible and financially feasible
73
Using AAC
When introducing a device, assess device's communicative capabilities & compare it with client's needs; consider operational demands regarding client's motor, sensory, cognitive skills Adapt device to the client's situations & available support Train client & family how to use device Monitor its use for functional language
74
Functional AAC Considerations: How functionally can the patient:
Get someone's attention, give yes/no answers, call for help, indicate understanding of what's being said, respond without words, say the name of person nearby, communicate needs, wants, pain (if any), have social times with friends and family, understand written communication, communicate their emotions, describe something, have 1-on-1 convo, get involved in group talk about self, participate in group convo

Aphasia (8 decks)

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