Neurological Based Communication Disorders

Question 1

Ischemic strokes

Answer 1

caused by interrupted blood supply to the brain.
Thrombosis-due to atherosclerosis, a condition in which cholesterol and other fatty substances build up in the blood, narrowing arteries and obstructing blood flow.

embolism: embolus is a mass of arterial debris or clump of tissue from a tumor that originates somewhere else in the body, travels to the brain and gets lodged in a smaller artery and blocks the flow of blood

Both deprive a focal area of brain tissue of the blood supply causing ischemic stroke or infarct (irreversible cell death that occurs within an hour)

Question 2

Hemorrhagic strokes

Answer 2

caused by bleeding in the brain due to ruptured blood vessels, with hypertension (high blood pressure) being a major risk factor.

Ruptures can be Intracerebral (within the brain) or extracerebral (within meninges, resulting in subarachnoid, subdural, and epidural varieties of strokes).

These strokes have a severe thunderclap headeache. worse prognosis than with ischemic strokes. Surgery is needed to stop the bleeding from a hemorrhage.

Question 3

paraphasia

Answer 3

expressive language error that is not the result of a motor deficit.

semantic: substitution of one word for another (e.g., marker for pencil)
phonemic: error at the sound level (tup for cup)
neologistic: nonwords (skeen instead of pencil)

Question 4

perseveration

Answer 4

word that is repeated inappropriately for the intended word.

Question 5

Logorrhea

Answer 5

excessive and inappropriate production of speech (tangential and often meaningless)

Question 6

empty speech

Answer 6

substitution of general words like this, that, stuff for specific words

Question 7

agrammatic speech

Answer 7

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

Question 8

anomia

Answer 8

naming difficulty

Question 9

circumlocution

Answer 9

production of nonspecific words and “beating around the bush” often due to word finding problems.

Question 10

automatic language

Answer 10

language that is rote or overleared and thus spared (e.g., alphabet, counting, familiar songs)

Question 11

List of nonfluent aphasias

Answer 11

brocas
transcortical motor
mixed transcortical
global

Question 12

Brocas aphasia

Answer 12

involves brocas area in the posterior frontal lobe in the left hemisphere
-impaired naming
-non-fluent, halting speech with limited word output
-agrammatic/telegraphic speech
-Impaired repetition of words/sentences
-better auditory comprehension than expressive communication
-awareness of errors
-co-existing motor speech disorders like apraxia and dysarthria
-impacted writing/reading

Question 13

Transcortical Motor Aphasia

Answer 13

lesions in supplementary motor cortex (area anterior to brocas area)

-absent or reduced spontaneous speech
-non-fluent, paraphasic, agrammatic, and telegraphic speech
-intact repetition (distinguishing characteristic)
-echolalia/perserverations
-attempts to initiate speech with motor activities such as clapping, head nodding, and hand waving
-generally good comprehension
-impaired reading/writing
-apathy/withdrawal/little interest in communication

**Like brocas but intact repetition skills

Question 14

Mixed Transcortical aphasia

Answer 14

somewhat rare nonfluent aphasia. caused by lesions in watershed area (arterial border zone of the brain (between the areas supplied by the MCA, ACA, PCA
-limited spontaneous speech
-automatic, unintentional, involuntary nature of communcation
-severe echolalia (parrotlike repetition). distinctive feature
-nonfluent
-impaired auditory comprehension
-impaired reading, writing

Question 15

Global Aphasia

Answer 15

most severe form of nonfluent aphasia. Caused by extensive lesions affecting all language areas usually due to occlusion of the middle cerebral artery. Widespread destruction of frontotemporoparietal regions is common.
-profoundly impaired receptive AND expressive language, repetition, naming, reading, writing,
-co-existing verbal and non verbal apraxia
-right sided paralysis/paresis and neglect of the left side is common

Question 16

Fluent aphasias

Answer 16

Wernickes
Transcortical Sensory
Conduction
Anomic
Subcortical
Crossed aphasia

Question 17

Wernickes

Answer 17

lesions in wernickes area. superior temporal gyrus in LH of the brain.
-incessant, effortlessly produced flowing speech with normal, or even abnormal (logorrhea), fluency with normal phrase length
-rapid speech rate with normal prosodic features and good artic
-severe anomia
-poor auditory comprehension
-empty speech
-circumlocation
-reading/writing deficits
-anosognosia: inability to recognize or acknowledge deficits
-individuals are generally free from paresis or paralysis

Question 18

Transcortical sensory aphasia

Answer 18

fluent aphasia 2/2 lesions in the temporoparietal region of the brain
-fluent speech
-paraphasic/empty speech
-severe naming problems
-good repetition skills
-normal automatic speech
-good reading (aloud) but poor comprehension

similar to wernickes except repetition is intact whereas it is impaired in wernickes

Question 19

conduction aphasia

Answer 19

lesion in area between broca’s and wernickes area
-diproportionate impairment in repetition (distinguishing characteristic)
-variable fluency across patients but normally less than wernickes
-paraphasic speech
-marked word finding
-efforts to correct errors
-near normal auditory comprehension

*similar to wernickes but CA have good auditory comprehension

Question 20

anomic aphasia

Answer 20

-debiliating word finding difficulties
-generally fluent speech
-good auditory comp
-Normal reading/writing

*most language functions intact except for naming

Question 21

subcortical aphasia

Answer 21

extensive SUBCORTICAL damage (with or without cortical involvement)-basal ganglia, cerebellum, thalamus damage
-BG: anomic, global, wernickes, or TMA
-Thalamic: fluent aphasia
-Cerebellar: more subtle. limited fluency, mild anomia, agrammatism, mild speech comp

Question 22

Crossed aphasia

Answer 22

aphasia that occurs due to right hemisphere lesion in right handed individuals. symptoms include those of MTA in some and transient fluent aphasias in others

Question 23

Aphasia considerations in bilingual populations

Answer 23

The first language or second language may be the most impaired/intact
REcovery of first OR second might be easiest for pt
may mix languages
need to analyze individual patterns and differences

Question 24

Assessment of aphasia

Answer 24

-standardized testing
-functional communication
-repetition
-naming
-sentence production, narration, discourse
-auditory comp
-reading/writing
-assess auto speech and singing
-bilingual assessments with interpreter

Question 25

3 types of aphasia treatment

Answer 25

restorative: regain skills compensatory: compensate skills/behaviors social: assist with social interactions

Question 26

semantic feature analysis

Answer 26

selects words that belong to a particular family because of their shared meanings for each stimulus, ask about group, description, and function (e.g., where do you find it? how do you describe it? what category does it belong to?)

Question 27

Treatment of verbal expression (expanded utterances)

Answer 27

systemically increasing the length and complexity of target responses. conversational speech is final target. expand from phrases-sentences-narrative-conversation

Question 28

alexia

Answer 28

loss of acquired reading skills due to brain damage

Question 29

agraphia

Answer 29

loss or impairment of acquired writing skills due to lesions in the foot of the medial frontal gyrus of the brain

Question 30

agnosia

Answer 30

impaired understanding of the meaning of certain stimuli, without peripheral sensory impairment. auditory agnosia: impaired understanding of the meaning of auditory stimuli, normal peripheral hearing, difficulty in matching objects with their sound, and normal visual recognition of objects auditory verbal agnosia: impaired understanding of spoken words, normal peripheral hearing, normal recognition of nonverbal sounds, normal recognition of printed words, and normal verbal expression and reading visual agnosia: rare. They cause impaired visual recognition of objects, which may be intermittent tactile agnosia: impaired tactile recognition of objects when visual feedback is blocked and impaired naming and description of objects clients can feel in their hands

Question 31

Alzheimers disease

Answer 31

most common form of dementia. Its considered a cortical dementia and accounts for 60-70% of irreversible dementia. More women than men are affected.

Question 32

Frontotemporal Dementia

Answer 32

due to degeneration of the frontal and temporal lobes. includes behavioral variant of FTD and PPA. Degeneration of nerve cells in the L and R frontal lobes, temporal lobe, or both lobes in two hemispheres symptoms of behavior variant of FTD which is most common, is notable behavioral changes, emotional disturbance, and impaired judgment Progressive loss of vocab and anomia, impaired comp of speech and printed material

Question 33

parkinsons disease

Answer 33

basal ganglia and brainstem degeneration presence of abnormal structures called Lewy Bodies frontal lobe atrophy reduced dopamine neurofibrillary tangles like in dementia slow volutary movement hypophonia micrographia masked face

Question 34

huntingtons disease

Answer 34

typical age of onset is 35-40. affects males and females equally. Malformed protein called huntingtin kills the brain cells that control movement. May be misdiagnosed as PD until choreiform movements become evident. chorea: irregular spasmodic involuntary movement of the neck, head, and face incrasingly uncontrollable tic like movements gait disturbance slow movement in later stages behavioral disorders (schizo like behaviors) deterioration of speech/language with muteness in final stages

Question 35

HIV dementia

Answer 35

HIV itself can cause dementia or opportunistic brain infections can impact people with HIV.

Question 36

vascular dementia

Answer 36

vascular diseases may cause damage resulting in dementia. small, cortical ischemic strokes are the most common etiology.

Question 37

lewy body dementia

Answer 37

caused by lewy bodies (excessive protein deposits in neuronal cell bodies) causing similar presentations as PD and alzheimers.

Question 38

Wernicke Korsakoff syndrome

Answer 38

dementia related to alcohol use.

Question 39

treatment of dementia

Answer 39

main concern is to offer intervention that will slow progression. In the early states and intermediate stages, communication, memory, and behavioral management can be targeted in tx. Management of daily activities with funcational tx. Provide family education, counseling, and support.

Question 40

Right hemisphere disorder

Answer 40

left neglect denial of illness confabulation regarding disability facial recognition deficits constructional impairments: attentional deficits disorientation-confusion about space, not knowing where they are visuoperceptual deficits understanding emotional tone of voice and others emotions and expressing their own communication: dif comprehending abstract meanings in speech prosodic deficits: understanding others prosody or producing their own. impaired discourse/narrative skills canfabulation/excessive speech pragmatic difficulties

Question 41

assessment of RH disorder

Answer 41

screen/diagnostic tests talk with family/get baseline

Question 42

treatement of RH disorders

Answer 42

tx targets: denial and indifference impaired attention impulsive behavior discourse problems pragmatics impaired reasoning impaired inference implied meaning/metaphor, etx visual neglect (visual scanning) **needs to be functional and pt specific

Question 43

Traumatic brain injury

Answer 43

injury to the brain sustained by physical trauma or external force. can be open head or closed head or mild TBI (concussion) or blast trauma

Question 44

assessment of TBI

Answer 44

bedisde assessment assessment of memory assessment of executive functions also assess communicative problems post TBI (dysarthria, comprehension, naming, perseverations, pragmatics, reading/writing, daily living skills)

Question 45

treatment of TBI

Answer 45

cognitive rehab and communication treatment. All tx tasks should be pt specific and functional.