Unit 4_Aphasia and Dysphagia

Question 1

What is an acquired language disorder after a brain injury?

Answer 1

Aphasia

Question 2

What is an acquired swallowing disorder after a brain injury?

Answer 2

Dysphagia

Question 3

About how many patients after a stroke has a language disorder (aphasia)?

Answer 3

About every third patient

Question 4

About how many patients after a stroke has a swallowing disorder (dysphasia)?

Answer 4

About every second, 80% (*depending on how it’s measured)

Question 5

What is the recovery time for patients initially diagnosed with swallowing disorders (dysphagia) following a stroke?

Answer 5

Within the first week

50% do not improve

Question 6

What injury is tough to recover from following a stroke?

Answer 6

UE and language disorders (aphasia)

Question 7

Following a stroke, what injury is represented bilaterally and easier to recover from?

Answer 7

Swallowing disorders (dysphagia)

Question 8

Following a stroke, what injury is represented unilaterally and harder to recover from?

Answer 8

Language disorders (aphasia)

Question 9

Following a stroke, what is the timing of chronic aphasia (language disorders)?

Answer 9

A year after a stroke

Question 10

In order to define which aphasia (language disorder) type, what should you look for?

Answer 10

Do they comprehend/understand

Can they produce fluent speech

Question 11

What is the following:
-Acquired
-Neurological
-Language (not sensory, motor, psychiatric, or intellectual disorder)
-Multimodal, affecting reception and production
-Processing of the language
-Not a speech impediment

Answer 11

Aphasia (language disorder)

Question 12

What is caused by neurological illnesses / injury affecting language-critical brain areas?
For example:
- Stroke
- Traumatic Brain Injury
- Brain Tumors
- Progressive Pathologies, e.g., Alzheimer’s, Primary
- Progressive Aphasia
- Epilepsy
- Infections / Inflammations
Etc.

Answer 12

Aphasia (language disorder)

Question 13

What is the most common cause for Aphasia (language disorder)?

Answer 13

Stroke

Question 14

Language is strongly what?

Answer 14

Lateralized

Question 15

Approximately what percentage of right-hand dominant individuals have left hemisphere lateralization?

Answer 15

> 93% of individuals

Question 16

Approximately what percentage of left-hand dominant individuals have left hemisphere control?

Answer 16

78%

Question 17

Where does visual processing occur in the brain?

Answer 17

Occipital lobe

Question 18

Where does lexical-semantic retrieval and selection occur in the brain?

Answer 18

Frontal Temporal lobe

Question 19

Where does lexical-phonological retrieval and selection occur in the brain and phonetic encoding and articulation occur in the brain?

Answer 19

Sensory-motor portion of the brain

Question 20

Lexical-semantic retrieval and lexical-phonological retrieval can be affected by what disorder?

Answer 20

Aphasia (language disorder)

Question 21

Where is Broca’s area (aphasia) found in the brain (difficulty producing speech)?

Answer 21

Frontal lobe

Question 22

Where is Wernicke’s area (aphasia) found in the brain (difficulty comprehending speech)?

Answer 22

Posterior Temporal lobe

Question 23

Which of the following about swallowing recovery is true?
- Majority of patients with stroke recover swallowing function
- Very few patients with stroke recover swallowing function
- Patients with stroke do not experience a loss or change in swallowing function
- Swallowing and language dysfunction always occur after a stroke

Answer 23

Majority of patients with stroke recover swallowing function

Question 24

Which of the following is a component of the definition for aphasia?
- A loss of coordination of vocal cords
- A developmental inability to learn new sounds
- A loss of hearing sensation
- An acquired loss of language comprehension or production

Answer 24

An acquired loss of language comprehension or production

Question 25

Which hemisphere is more likely to be responsible for speech and language?

Answer 25

Left

Question 26

Which of the following is the first to occur when patients name an object? - Selecting the correct name for an object - Selecting the correct phenome to pronounce the name - Visualization and conceptualization of the object - Verbalizing the name

Answer 26

Visualization and conceptualization of the object

Question 27

What is a connection or list of regions of white matter that work together to achieve a specific function?

Answer 27

Stream

Question 28

What are the 2 streams that make up the Dual Stream Models for vision and hearing?

Answer 28

Where (dorsal: sublexical, unilateral, (“perception”)) and What (ventral: lexical, bilateral (“recognition”)

Question 29

Which of the following "streams" or neural pathways helps us to understand the "what" of language processing? - The posterior stream to the occipital lobe - The dorsal stream to the parietal lobe - The ventral stream to the inferior temporal lobe - The anterior stream to the frontal lobe

Answer 29

The ventral stream to the inferior temporal lobe

Question 30

Why do different groups of aphasia presentations exist after a stroke?

Answer 30

Stroke locations are not random: vascular territories dictate their location

Question 31

Why do we have arteries in our brain?

Answer 31

Oxygen and nutrients (glucose) to keep neurons alive and functioning

Question 32

What artery is responsible for aphasia (language disorder) if impacted by a stroke?

Answer 32

M1 (middle cerebral artery, lower stem)

Question 33

What artery is responsible for dysphasia (swallowing disorder) if impacted by a stroke?

Answer 33

PICA

Question 34

What strategies do you use as an OT if communication is difficult?

Answer 34

- Wait for better “connection” / attention - Give feedback if you did not understand - Simple sentences / avoid “or” questions - (Let) repeat - Speak slowly and clear, allow time - Use / offer other mediums (gestures, writing, ...) - Use / offer mouth / face reading

Question 35

How many times a day do people swallow?

Answer 35

~600 swallows / day

Question 36

How long does it take to move food/liquid from mouth to esophagus?

Answer 36

1-2s from mouth to esophagus

Question 37

How many cranial nerves and muscle pairs are involved in swallowing?

Answer 37

5 CNs >30 muscles/pairs

Question 38

What is the gold standard for assessing swallowing function?

Answer 38

Modified Barium Swallow Study (MBSS)

Question 39

What occurs when a person swallows and residue enters the trachea but there are no visible symptoms from the individual?

Answer 39

Silent aspiration

Question 40

What consequences can dysphagia have?

Answer 40

- Choking, asphyxiation - Aspiration, pneumonia - Malnutrition, dehydration - Reduced quality of life - Death

Question 41

What is the most common consequence of dysphagia and also the most feared?

Answer 41

pneumonia

Question 42

What neurological diseases can cause dysphagia?

Answer 42

- Stroke, TBI - Parkinson, ALS, Myasthenia Gravis, Multiple Sclerosis - Dementia

Question 43

What developmental diseases/ syndromes can cause dysphagia?

Answer 43

- Genetic mutations, e.g. down syndrome - Structural anomalies, e.g. tracheomalazia

Question 44

What ENT / GI / Ortho diseases can cause dysphagia?

Answer 44

Reflux, stenosis, osteophytes

Question 45

Why can head and neck cancer diseases cause dysphagia?

Answer 45

tumor itself; resection of structures, damage due to surgery / Rx

Question 46

Which cranial nerves are involved in swallowing?

Answer 46

- Trigeminal (CNV) - Facial (CNVII) - Glossopharyngeal (CNIX) - Vagus (CNX) - Hypoglossal (CNXII)

Question 47

Where in the brain can dysphagia occur?

Answer 47

Anywhere - not just in both hemispheres

Question 48

Where is swallowing controlled in the brain?

Answer 48

Bilaterally, but have one dominant hemisphere

Question 49

Overall, what hemisphere in the brain is crucial for swallowing?

Answer 49

The right hemisphere

Question 50

What nerve is the most important nerve for larynx for swallowing?

Answer 50

Vagus (CNX)

Question 51

Why do many individuals with cortical lesions (strokes) often recover swallowing function?

Answer 51

Both hemispheres are involved in swallowing

Question 52

Swallowing is controlled by what that spans from cortex, subcortex, to brainstem and cerebellum?

Answer 52

broad bilateral neural network

Question 53

Up to ___% have dysphagia after stroke; half recover within first week

Answer 53

80%