Language Disorders In Adults Final Exam

Front 1

List 3 reasons why you should do an aphasia assessment.

Back 1

1. Plan therapy
2. Provide info for family counseling
3. Chart progress
4. Estimate prognosis in therapy
5. For research purposes
6. To plan discharge
7. Obtain info regarding competency

Front 2

What information do you need to plan therapy?

Back 2

1. Patient's current communication status
2. What the patient needs to work on to improve quality of life
3. What modalities are most and least affected
4. Patient's strengths and weaknesses

Front 3

Goals need to have _____ outcomes.

Back 3

functional

Front 4

What do families need to be told during family counseling?

Back 4

1. What the patient can understand
2. If the patient will get better (don't predict outcome; give them generalities)
3. If the patient is making progress
4. Ways that they can help

Front 5

Why do we need to chart progress?

Back 5

Need to compare previous performance with current performance because:
1. We need to know if the patient is making progress in therapy
2. Third party reimbursers need proof of cost-efficiency
3. For patient and family counseling

Front 6

What variables do we need to know to estimate prognosis in therapy?

Back 6

1. Biological variables: age and education
2. Medical variables: etiology, time post-onset, site and extent of lesion, physical and mental health problems, medications such as antidepressants and anticonvulsants

Front 7

Which recovers better - stroke or TBI and why?

Back 7

Stroke - because it is more localized

Front 8

What is the best predictor of recovery?

Back 8

Patient motivation

Front 9

Which aphasia tends to recover the best and the least?

Back 9

Best - anomic
Least - global

Front 10

Which has a greater impact on quality of life - language impairment or motor impairment?

Back 10

Language impairment

Front 11

Why is discharge planning important?

Back 11

1. It aids in the proper placement of the patient after leaving facility
2. Will indicate how much assistance the patient will need in the future

Front 12

List the 8 steps of a quick aphasia screening.

Back 12

1. Ask patient to remember 3 words
2. Ask "how are you doing?"
3. Check understanding (ex: press call button)
4. Check naming of high frequency and low frequency words (ex: cup, brush, collar, watch dial)
5. Check repetition - single words, phrases, sentences
6. Ask about recent and past history (ex: who is president of the US)
7. Check reading and writing
8. Ask patient to recall 3 words you stated at beginning of screening

Front 13

Give an example of responsive naming, confrontation naming, and categorical naming.

Back 13

1. Responsive - what do you write with
2. Confrontation - what is this
3. Categorical - name all the animals

Front 14

What is a general difference bt dementia and aphasia?

Back 14

Dementia - problem with memory and cognition
Aphasia - problem with lexical retrieval and language

Front 15

When assessing comprehension of single words, select items that vary in what?

Back 15

1. Number of syllables
2. Emotionality
3. Frequency of usage
4. Semantic class (ex: food vs clothing)
5. Phonemic similarity

Front 16

What are some things you should note during the assessment?

Back 16

1. Fast or slow responses
2. Errors within and across semantic categories
3. Perseveration
4. Relative strengths and weaknesses across and within categories

Front 17

When assessing comprehension of sentences and paragraphs, what are some things to keep in mind?

Back 17

1. Tell a brief story and ask questions about it
2. Select a unique story
3. Select a story with humor and emotionality
4. Ask yes and no questions
5. Assess main ideas and details

Front 18

Why is assessing oral reading problematic?

Back 18

1. Patient may not get the gist of what he is reading
2. Patient may be able to say the words but may not understand them

Front 19

Define graphomotor skills.

Back 19

Letter formation

Front 20

Most patients will use their (left or right) hand due to hemiplegia or paresis.

Back 20

Left

Front 21

Apraxia and dysarthria often coexist with aphasia. Define both.

Back 21

Apraxia - A severe speech disorder characterized by inability to speak, or a severe struggle to speak clearly. Apraxia of speech occurs when the oral- motor muscles do not or cannot obey commands from the brain, or when the brain cannot reliably send those commands.

Dysarthria - Speech that is characteristically slurred, slow, and difficult to understand. A person with dysarthria may also have problems controlling the pitch, loudness, rhythm, and voice qualities of his or her speech. Dysarthria is caused by paralysis, weakness, or inability to coordinate the muscles of the mouth. Dysarthria can occur as a developmental disability. It may be a sign of a neuromuscular disorder such as cerebral palsy or Parkinson's disease. It may also be caused by a stroke, brain injury, or brain tumor. Treatment of dysarthria includes intensive speech therapy with a focus on oral-motor skill development.

Both apraxia and dysarthria have a nervous system aetiology and difficulty in communicating. The investigative methods, management strategies, and complications are common in both. Apraxia is of cerebral origin, whereas dysarthria is cerebral/neural/ muscular, or any combination in between. Apraxia is inconsistent, unpredictable, with islands of clear speech. Dysarthria is consistent, predictable and without islands of clear speech. All aspects of speech are affected in dysarthria, but only articulation is affected in apraxia. In dysarthria, there is a change in muscle tone, whereas there is no such change in apraxia. In apraxia, increased speech rate increases the intelligibility, whereas it has the opposing effect in dysarthria.

Front 22

Aphasia should be distinguished from what other diagnosis?

Back 22

Normal language, dementia, language of confusion, schizophrenia, right hemisphere communication problems, apraxia of speech, and dysarthria.

Front 23

What does this mean? Impairment in language is not the same as impaired communication.

Back 23

People with impaired language, which is a symbol system, may still be able to communicate via drawing pictures, gestures, circumlocusions, etc.

Front 24

"Are the results of the test consistent" refers to test ______.

Back 24

reliability

Front 25

"Does the assessment test what it is supposed to test" refers to test _____.

Back 25

validity

Front 26

What are the 2 most common standardized tests of aphasia?

Back 26

1. BDAE - Boston Diagnostic Aphasia Examination
2. WAB - Western Aphasia Battery

Front 27

Name 3 tests that classify aphasia into types.

Back 27

1. BDAE
2. WAB
3. Bedside Evaluation Screening Test

Front 28

Name 2 tests that do not classify aphasia into types.

Back 28

1. MTDDA - Minnesota Test for Differential Diagnosis of Aphasia
2. PICA - Porch Index of Communicative Ability

Front 29

Which test has acceptable validity data but not reliability data?

Back 29

BDAE

Front 30

List 4 testing guidelines.

Back 30

1. Do not say "correct"
2. Do not show the patient the score sheet
3. Use the same intonation for yes/no questions
4. Take the same amount of time to mark correct and incorrect responses

Front 31

Which test is good for discharge planning?

Back 31

CADL - Communication Activities of Daily Living

Front 32

What is apraxia?

Back 32

A disorder of learned skilled movement that results from neurologic dysfunction. NOT a result of primary sensory motor disorders.

Front 33

Why is limb apraxia important for SLPs?

Back 33

Because we use gestures as a compensatory strategy

Front 34

What form of sign language is another compensatory strategy?

Back 34

AmerInd - American Indian Sign Language

Front 35

A study found that _____ apraxia is the highest predictor of dependency of all the neuropsychological deficits studied.

Back 35

limb

Front 36

List 5 differences between apraxics and normals when eating.

Back 36

Apraxics:
1. Made fewer actions in general
2. Used fewer tools
3. Misjudged tools mechanical advantages
4. Tool actions were often incomplete or imprecise
5. Produced significantly fewer correct actions
6. Less efficient in executing individual tool actions
7. Conceptual errors of misuse and mis-selection
8. Production errors of movement timing and sequencing

Front 37

How common is apraxia in aphasic patients?

Back 37

50-80% (estimated) have apraxia

Front 38

What is the difference between an ideational disorder and an ideomotor disorder?

Back 38

Ideational - disorder of concept
Ideomotor - disorder of production

Front 39

Which aphasia is most likely to have limb apraxia? Where is the lesion?

Back 39

Conduction aphasia; lesion in the parietal lobe

Front 40

What does praxis system mean?

Back 40

Distinct systems with distinct disorders.

Front 41

Skilled movements stored in the brain is called _____.

Back 41

praxicon (similar to lexicon (words) stored in the brain)

Front 42

Language impairment in _____ is associated with less gray matter in the left hemisphere.

Back 42

autism

Front 43

_____ refers to an impairment of the ability to read.

Back 43

Alexia

Front 44

Alexia is most often associated with _____ lesions.

Back 44

posterior

Front 45

The angular gyrus, Brodman area _____, is important for _____ and _____.

Back 45

39, reading and writing

Front 46

Reading activates the graphemic input lexicon which activates what?

Back 46

Word meaning in the semantic system

Front 47

What does reading out loud activate?

Back 47

Phonological output lexicon > phonological buffer (words held in short term memory for output)

Front 48

Describe attentional alexia.

Back 48

Sometimes seen in TBI where the patient may disregard specific words in a sentence

Front 49

Describe neglect alexia.

Back 49

Caused by visual field neglect where they see it but ignore it (ex: basketball could be read as ball)

Front 50

Describe pure alexia.

Back 50

Seen in the absence of aphasia where the graphemic input lexicon and semantic system are intact; however, visual input does not activate the graphemic input lexicon (often leads to letter by letter reading)

Front 51

Describe surface alexia - found in Broca's, anomic, Wernicke's

Back 51

OPC is intact. Pt pronounces nonwords and function words better than content words. Due to breakdown of the graphemic input lexicon.
1. Incomplete or absent activation of word representations
2. Read via the non-lexical route (letter to sound conversion)
3. Words comprehended based on how they sound
4. Regularly spelled words read much more easily than words with irregular spelling

Front 52

Describe phonological alexia - Broca's, anomic, conduction, TSA

Back 52

Word superiority effect along with good word repetition, with a particular problem in reading aloud unfamiliar letter strings. Orthographic-phonological conversion (OPC) mechanism is impaired. Cannot do letter-to-sound conversion due to breakdown between visual analysis and phonological buffer; patient would have trouble with non-words. Need to activate semantic representation before activating phonological output lexicon. Concrete nouns and adjectives easier than function words.

Front 53

_____ alexia is usually seen in AD.

Back 53

Semantic

Front 54

With semantic alexia, impairment in reading is also seen in these other 2 modalities.

Back 54

comprehension and expression

Front 55

Describe deep alexia - Broca's

Back 55

Produce many semantic paralexias. It is phonological alexia plus semantic impairment; cannot read via the phonological route and have problems in the semantic system (ex: tall for short, horse for cow); inability to read pseudowords

Front 56

Can a patient have both alexia and agraphia?

Back 56

Most will have both, but they can be independent of each other

Front 57

_____ agraphia is agraphia in the absence of any other significant language impairment (cannot write at all).

Back 57

Pure

Front 58

Describe surface agraphia.

Back 58

Breakdown in the graphemic output lexicon; write how it sounds (ex: yot for yacht, mite for might); sound to letter conversion may be intact; usually can write pseudowords

Front 59

How does global agraphia differ from surface agraphia?

Back 59

Global cannot use the non-lexical route to write; no regularity effect; cannot write pseudowords; very limited number of correctly spelled words

Front 60

Describe deep agraphia.

Back 60

Breakdown in semantic system and sound to letter conversion; written semantic errors (ex: apple for orange); poor phoneme-to-phoneme conversion (difficult writing sounds); inability to write non-words

Front 61

What is a graphemic buffer?

Back 61

Short-term storage of a word you are going to write down

Front 62

Describe graphemic buffer agraphia.

Back 62

Breakdown in the graphemic buffer; difficulty holding word in memory while selecting graphemes/letters; affects all writing tasks; spelling errors; word length effect

Front 63

What is agrammatism?

Back 63

Defective speech pattern that may lack:
1. Inflectional markers
2. Prepositions
3. Auxiliary verbs (He is working)
4. Copulas (He is big)
5. And sometimes articles (a, the)

Front 64

Agrammatism is usually seen in _____ aphasia.

Back 64

Broca's

Front 65

Where is the usual lesion location for agrammatism?

Back 65

Left frontal lobe (posterior lateral - BA 44-45 - Broca's area)

Front 66

In which theory of agrammatism does the focal lesion destroy the store of sentence patterns in Broca's area?

Back 66

Anatomical Storehouse Theory

Front 67

In which theory of agrammatism...deletion of words not critical to message?

Back 67

Economy of Effort

Front 68

Describe the Contiguity Disorder theory of agrammatism.

Back 68

Impaired ability to relate words to each other (treat each word as a noun-like entity)

Front 69

Describe the Central Syntactic Deficit theory of agrammatism.

Back 69

Loss of central representation of grammatical knowledge affecting processing in all modalities; difficulty understanding syntax; parallel impairments in comprehension and expression

Front 70

In which theory of agrammatism is there voluntary simplification of utterances; they adopt similar syntactic strategies as normals when they need to simplify their speech?

Back 70

Adaptation Theory

Front 71

Describe Elizabeth Bates et al. agrammatism theory.

Back 71

Variability across language types in syntactic processing; suggests that syntactic processing occurs in parallel with other language processing; we cannot separate syntactic processing from other aspects of language processing

Front 72

List 10 ways to create an atmosphere that promotes communication for aphasic people.

Back 72

1. Treat them like adults; don't talk down or use baby talk
2. Empower them; encourage decision making
3. Getting message across is the goal; ignore grammatical errors or mild dysarthria
4. Accept emotional responses
5. Focus on what can be expressed; the modality is less important
6. Accept what the person wishes to share with you; be calm and reassuring
7. Keep background noise to a minimum
8. LISTEN
9. Give undivided attention
10. Lighten up
11. Relax
12. Help to reveal competence; be a scaffold, a support, a buffer

Front 73

List 10 ways to maximize comprehension of YOUR speech.

Back 73

1. Maintain eye contact
2. Speak naturally; they are not deaf
3. Speak slowly; rephrase, repeat if necessary
4. Supplement your speech with gestures
5. Check to be sure you are understood
6. Maximize your own nonverbal behavior
7. Always have paper and pen ready as supplements for speech
8. Ask if you are really being understood
9. Find out and incorporate what the person thinks is helpful
10. Take your time
11. Keep messages focused
12. Change speakers slowly
13. Change topics slowly

Front 74

List 5 ways to maximize communication of needs, thoughts, wishes, and desires.

Back 74

1. Give enough time for a response
2. Ask about timing issues (do you want me to help? do you need more time?)
3. REALLY listening REALLY facilitates talking
4. Respond to all communicative efforts
5. Ask about what helps, then do as you are told
6. Never underestimate the power of yes/no questions and use them liberally

Front 75

List 3 ways to trigger words.

Back 75

1. What is it used for? How does it look? Where is it found? Who has one?
2. Can you write it down or draw it?
3. OK, I'm having a bad listening day; bear with me as I ask some more questions.
4. When all else fails (and you know the word), say it but keep it light - I think I know it...could it possibly be..._____

Front 76

List 2 ways to reduce frustration.

Back 76

1. I know you know...
2. Let's see if I can help...
3. A pat on the hand is worth a thousand words
4. You have not lost your mind; you have a language problem

Front 77

What is the biggest no-no when dealing with a person with aphasia?

Back 77

Never pretend to understand when you really don't

Front 78

List 3 special tips for conversations with aphasic people.

Back 78

1. Aim for parity of interchange
2. Ask real questions, not ones you already know the answer to
3. Accept statements as truthful
4. Do not shape messages into better ways to say it
5. If you do not share, you are not in a conversation

Front 79

T or F: Most patients with aphasia recover to some extent during the first weeks and months following stroke.

Back 79

T

Front 80

What neurological factors may play a role in recovery from aphasia?

Back 80

1. Lessening of edema
2. Clearing up of glutamate (neurotransmitter)
3. Compensation of other cortical areas
4. Changes in cerebral perfusion

Front 81

_____ edema is swelling within cells and occurs within minutes of stroke; can clear up in the first hours and days following stroke without severe neurological damage.

Back 81

Cytotoxic

Front 82

_____ edema is extracellular swelling that occurs in the hours and days following stroke; leads to cell death and increased stroke severity; as it clears it reduces pressure on adjacent neural tissue.

Back 82

Vasogenic

Front 83

Do all stroke victims have spontaneous recovery?

Back 83

No

Front 84

What percentage of stroke patients in acute care have aphasia? Chronic care?

Back 84

33% of acute care patients have aphasia and 13-15% of chronic care patients have aphasia

Front 85

What is the most abundant excitatory neurotransmitter in the CNS?

Back 85

glutamate

Front 86

What happens to glutamate during a stroke?

Back 86

It is released in excessive amounts in and around the infarct; causes cells to fire uncontrollably (close and distal); if it doesn't stop, those cells will die

Front 87

Cerebral diffusion refers to the flow of _____ in the brain.

Back 87

water

Front 88

Does water flow in a Brownian (random) or systematic order through the brain?

Back 88

Brownian (random)

Front 89

What happens to cerebral diffusion during stroke?

Back 89

Cells swell causing a decrease in diffusion across the cortical lesion; diffusion weighted MRI makes use of this principle and can show cortical lesions within minutes of stroke onset

Front 90

What is cerebral perfusion?

Back 90

Refers to blood flow at the level of capillaries and is vital for brain activity; is an indicator of nutrients to neural tissue

Front 91

What is adequate perfusion for gray matter?

Back 91

X > 60 ml/100gr min

Front 92

What is adequate perfusion for white matter?

Back 92

X > 40 ml/100gr min

Front 93

Perfusion less than _____ leads to rapid cell death.

Back 93

X < 20-30 ml/100gr min

Front 94

Perfusion weighted _____ makes it possible to assess cortical perfusion.

Back 94

MRI

Front 95

What is homonyous hemianopsia?

Back 95

Hemianopsia or hemianopia is visual field loss that respects the vertical midline, and usually affects both eyes, but can involve one eye only. Homonymous hemianopsia, or homonymous hemianopia occurs when there is hemianopic visual field loss on the same side of both eyes. Hemianopias occur because the right half of the brain has visual pathways for the left hemifield of both eyes, and the left half of the brain has visual pathways for the right hemifield of both eyes.

Front 96

You should try to make sure that patients are _____% successful during treatment.

Back 96

70-90%

Front 97

Why does a lesion get larger after stroke?

Back 97

Because cells continue to die immediately next to the lesion

Front 98

What aphasia is associated with the following characteristics? Short phrases with intermittent grammatical errors, intact repetition, able to answer yes/no questions and short wh- questions, impaired reading, named 4/5 objects correctly, verbal expression bad, auditory comprehension decent

Back 98

transcortical motor aphasia

Front 99

What aphasia type is associated with the following characteristics? Responded to most open ended questions with I don't know, named 1/5 objects correctly with phonemic cue, repeated 2/5 short phrases and 3/5 single words, auditory comprehension severely impaired

Back 99

global aphasia

Front 100

What aphasia type is associated with the following characteristics? Intermittent fluent phonemic paraphasias in connected speech and object naming, auditory comprehension relatively intact, no problems on silent reading but phonemic paraphasias while reading out loud, repetition impaired

Back 100

conduction aphasia

Front 101

Why might a patient's global perfusion decrease?

Back 101

Blood flow decrease due to low blood pressure; might be over-medicated; heart can't pump enough blood to the brain

Front 102

Preliminary evidence suggests that changes in _____ _____ are related to early aphasia recovery.

Back 102

cortical perfusion

Front 103

When is it best to begin aphasia therapy?

Back 103

When macro brain changes have run their course; during this recovery it may be necessary to emphasize counseling instead of intensive aphasia therapy

Front 104

Does aphasia therapy change brain function? If so, how and where?

Back 104

Several theories:
1. Intact right hemisphere takes over for left hemisphere
2. Peri-lesional left hemisphere areas take over
3. Remaining language areas take over
4. Areas not previously associated with language processing take over

Front 105

Describe errorless learning.

Back 105

Hierarchy
1. Repetition x3
2. Phonemic cue x3
3. Confrontation naming x3
Error at levels 2 or 3 moves the next attempt to the previous level

Front 106

T or F. It is not possible to measure treatment related changes in brain activity using MRI.

Back 106

F, it is possible

Front 107

Can chronic patients improve with aphasia treatment?

Back 107

Yes, but changes in activity are not predictable

Front 108

Why don't researchers use acute patients to study aphasia treatments?

Back 108

Because they will likely get better anyway due to spontaneous recovery

Front 109

Where is the lesion located that results in conduction aphasia?

Back 109

Typically the inferior parietal lobe

Front 110

List the 5 steps of the Phonological Cueing Hierarchy (PCH).

Back 110

1. Confrontation naming (name this picture)
2. Non-word rhyming cue (it rhymes with...)
3. Phonemic cue (it starts with...)
4. Combined cues from 2-3 (it rhymes with...and it starts with...)
5. Repetition of the target word modeled by the clinician (repeat after me - pen)

Front 111

Why is it important to work on naming?

Back 111

The ability to name corresponds with conversational output

Front 112

List the 5 steps for Semantic Cueing Hierarchy (SCH).

Back 112

1. Confrontation naming (name this picture)
2. Verbal description of target or its function (it is used for...)
3. Sentence completion (you write with a...)
4. Sentence completion with a semantically-loaded sentence (you write with a ballpoint...)
5. Repetition of the target word modeled by the clinician (repeat after me - pen)

Front 113

What does the thalamus do?

Back 113

Relays information to other parts of the brain; major sensory component

Front 114

What did the study on PCH and SCH find when used on patients with chronic aphasia (at least 1 year post-stroke)?

Back 114

1. Findings do not easily fit within the left-right hemisphere model of recovery
2. Areas not typically related to language may spur recovery
3. Both participants with non-fluent aphasia had increased precuneus activity
4. Decreased errors may reflect better monitoring of speech production

Front 115

An attempt to teach effective communication strategies to aphasic persons and their communication partners is called _____ _____.

Back 115

conversational coaching

Front 116

What is the format of conversational coaching?

Back 116

A controlled monologue, communicating unknown information; telling stories or daily happenings to non-aphasic partner; summarizing television scripts

Front 117

T or F: You cannot improve communication without improving language.

Back 117

F

Front 118

List 3 advantages of conversational coaching.

Back 118

1. Approximates natural communication in highly controlled setting
2. Modifies both partners' behavior
3. Permits modification of both strategies and content
4. Permits clinician to observe authentic communication interchange and interaction
5. Generalizes to other settings

Front 119

What are the 2 types of conversational coaching?

Back 119

1. Script-based (individually crafted)
2. Video-based (short videotaped news/story segments; more generic in nature/use)

Front 120

List the script-based rules.

Back 120

1. Scripts should be short, at the edge of the person's ability to communicate
2. Scripts should include either speaker/listener features that are emphasized; if you want the patient to learn to use gestures, put in gestural material; to train listeners to guess, build in guessable material; to train skill in finding alternative wordings, have good alternatives available
3. Write scripts in normal speech
4. Place on a page in short units to allow listeners to check their comprehension of each unit
5. Develop an individualized list of useful and unproductive strategies for both partners - through observation

Front 121

List the rules for videotape coaching.

Back 121

1. Choose short, interesting video segments with high visual content (Real People, SNL, Mr. Bean)
2. Check for features to emphasize

Front 122

How can the level of difficulty be varied for both scripts and videotapes?

Back 122

By varying the familiarity of the listener and the content of the material

Front 123

List 9 script strategies for the aphasic person.

Back 123

1. Gesture
2. Gesture and verbalize
3. Use prosodic emphasis
4. Simplify content
5. Stick to the important words
6. Tap out multisyllabic words
7. Use whole or part word writing
8. Point
9. Draw
10. Ask for help
11. RELAX

Front 124

List 3 script strategies for partners.

Back 124

1. Guess - make it clear that you are guessing
2. Confirm information; summarize
3. Ask yes/no questions
4. Suggest the use of production strategies (ex: can you write a bit of it?)
5. RELAX

Front 125

List 5 video strategies for the aphasic person.

Back 125

1. Make your gestures specific (ex: use fingers to represent numbers)
2. Draw pictures in sequence
3. Write whole or part word
4. Pair gestures with drawings
5. Take time before answering yes or no
6. Point to things around the room
7. RELAX

Front 126

List 6 video strategies for partners.

Back 126

1. Ask about main ideas - go for one word or picture
2. Write your questions
3. Keep up good guessing - eliminate wild guesses
4. Stop partner when it doesn't make sense
5. Ask for different strategies (draw, first letter, act out)
6. Confirm yes/no responses
7. Summarize what you know
8. RELAX

Front 127

Is conversational coaching effective?

Back 127

Data suggest continued improvements up to 6 months post-training

Front 128

What is the role of the SLP in acute care?

Back 128

1. Administer frequent, short assessments (probe spontaneous recovery; collect precise data)
2. Provide patient and family counseling (recovery, communication strengths and weaknesses, communication with other medical staff)
3. Administer language treatment when pertinent

Front 129

When is it appropriate to start language treatment?

Back 129

When patient is alert, attending, motivated, emotionally ready; wait 7-10 days post-onset to start treatment; treatment should be doable (70-80% successful) but also have a treatment effect

Front 130

List 3 problems of aphasia treatment efficacy study designs.

Back 130

1. Inconsistent study results
2. Impact of spontaneous recovery
3. Difficulty establishing a control group

Front 131

List 10 variables that may affect treatment outcome.

Back 131

1. Patient's age
2. Premorbid language and literacy skills
3. Education and occupation
4. Nature, extent and location of lesions
5. Presence of past medical or accompanying behavioral disorders
6. Current medical, neurological, and behavioral status
7. Current hearing and visual status
8. Current motor performance (paresis or paralysis)
9. Severity of aphasia
10. Time of treatment initiation
11. Treatment technique
12. Accuracy of treatment application
13. Length of treatment
14. Intensity of treatment
15. Family involvement
16. Improvement or deterioration in general health during the course of treatment
17. Spontaneous recovery

Front 132

T or F: Early treatment helps spontaneous recovery.

Back 132

F, no evidence of this

Front 133

What was the conclusion drawn from Bhogal's treatment study?

Back 133

The more intense the treatment the better

Front 134

Aphasia treatment may be more effective if...(list 4 things)

Back 134

1. Patients have single occlusive infarct
2. Aphasia is mild or moderately severe
3. Therapy is started after 10 days post-onset
4. Therapy sessions are administered often

Front 135

Therapy is less effective in cases of _____ or _____ damage and severe _____.

Back 135

multiple or bilateral damage / severe aphasia

Front 136

List 7 principles of therapy of aphasic patients.

Back 136

1. Careful observation and detailed assessment (baseline)
2. Selection of client-specific target behaviors which will impact functional communication
3. Starting therapy at simpler level and moving to more complex levels
4. Gradual reduction of manipulation of behavior to natural stimulus events
5. Providing immediate, response-contingent feedback to client to increase desirable and decrease undesirable behaviors
6. Training clients in self-monitoring skills
7. Training the significant other to evoke, prompt, support, reinforce, and maintain appropriate communication behaviors

Front 137

What type of reinforcement schedule is best?

Back 137

intermittent

Front 138

The patient and family will need to learn to live with residual aphasia. List 5 special considerations.

Back 138

1. Reduce impact on personal, emotional, social, family, occupation, and other aspects of patient's life
2. Teach compensatory communication strategies
3. Family education and counseling needed
4. Realistic prognosis and expectations
5. Therapy should be structured and target behaviors repeatedly practiced
6. Patient's strength should be used to help weaknesses
7. Clinician should expect to make a judgment about when to discontinue therapy

Front 139

Describe 4 characteristics of patients who are less likely to benefit from therapy.

Back 139

1. Severe auditory comprehension problems coupled with verbal stereotypes (oh boy or me me me)
2. Failure to match identical objects (indicative of cognitive problems)
3. Indiscriminate yes/no responses
4. Jargon and empty speech without self-correction in chronic stage

Front 140

Where is the likely lesion location for someone who produces phonemic paraphasias.

Back 140

Inferior parietal lobe (posterior to Wernicke's area)

Front 141

The best predictor of _____ _____ impairment is a lesion in Wernicke's area.

Back 141

auditory comprehension

Front 142

What does Wernicke's area do?

Back 142

Links lexical items with semantics

Front 143

Which has a better prognosis - a lesion in the posterior superior temporal lobe (PST) or lesion outside the PST?

Back 143

Better prognosis - outside PST
Poorer prognosis - in PST

Front 144

List 5 patterns of auditory comprehension problems presented by Rosenbek et al (1989).

Back 144

1. Slow rise time (performance improves with time)
2. Noise build up (the longer the task, the performance goes down hill)
3. Information processing lag
4. Capacity deficit
5. Retention deficit

Front 145

List 10 factors that promote auditory comprehension.

Back 145

1. More frequently used words over less frequently used words
2. Nouns better than verbs, adjectives, and adverbs
3. Shorter sentences better than longer
4. Syntactically simpler sentences better than complex
5. Active sentences better than passive
6. Personally relevant sentences
7. Better when speakers reduce rate of speech and insert pauses
8. Better when speakers stress important words
9. When no background noise
10. When message is redundant
11. When number of choices is limited
12. Auditory stimuli have appropriate accompanying visual stimuli
13. When speaker's face is visible
14. If alerting stimulus is presented before the message is delivered

Front 146

List 3 factors that do not help or may even hinder auditory comprehension.

Back 146

1. Increased vocal intensity
2. Telephone presentation
3. Audio and videotapes

Front 147

What is the sequence of auditory comprehension therapy?

Back 147

Determine entry level
1. Comprehension of single words
2. Comprehension of spoken sentences (spoken questions, spoken directions, sentence verification)

Front 148

What skills should be addressed during discourse comprehension therapy?

Back 148

Pragmatic skills such as turn taking, topic maintenance, switching roles between the speaker and listener (PACE program can be used at this level)

Front 149

Describe the AC therapy technique Intensive Auditory Stimulation.

Back 149

Auditory bombardment with sounds, words, phrases, and sentences; questionable whether pure auditory stimulation is sufficient to remediate language comprehension and production deficits

Front 150

Describe the AC therapy technique deblocking.

Back 150

Some patients find that difficult responses can be learned if it is preceded by a more easily executed response; use visual stimuli to deblock responses to verbal stimuli (ex: match pairs of similar pictures and then ask for those items); match printed word 'chair' to picture, read word aloud, repeat word 'chair', and then point to picture of 'chair' in group of pictures - printed word deblocks target of pointing to word 'chair' spoken - presentation of word is called 'prestimulation'

Front 151

What do you need to do before initiation of naming treatment?

Back 151

Need to figure out naming baseline, strengths, and weaknesses

Front 152

T or F: Patients with anterior lesions (ex: Broca's) and posterior lesions (ex: Wernicke's) have naming impairments with different underlying reasons.

Back 152

T

Front 153

Improving _____ improves lexical retrieval.

Back 153

naming

Front 154

A lesion in Broadman area _____ is the best predictor of anomia.

Back 154

37

Front 155

Identify the aphasia:
1. Breakdown between lexical and semantic system
2. Breakdown in phonological lexicon - accessing it or degraded capacity
3. Breakdown in phonological lexicon and motor planning
4. Correct lexical retrieval but problem with phonological processing or disconnection between frontal speech areas and posterior comprehension areas

Back 155

1. Wernicke's and TSA
2. Anomic
3. Broca's and TMA
4. Conduction

Front 156

What is the debate on naming about?

Back 156

Debate on whether it is a problem of access (retrieval/lexicon intact) or problem of capacity (storage/lexicon degraded)

Front 157

_____ aphasia patients seem to have greater difficulty in accessing better preserved associations.

Back 157

Broca's

Front 158

_____ aphasia patients seem to have lost semantic association with better accessing capabilities.

Back 158

Wernicke's

Front 159

What stimuli help facilitate a correct naming response?

Back 159

1. High frequency words are easier than low frequency
2. Names of manipulable objects
3. Object easier than pictures
4. Phonemic cueing makes it easier for Broca's but not Wernicke's patients
5. Self-regulation of stimulus better than computer presentation
6. Extra time given for naming improves performance
7. Longer stimulus exposure time (>30 seconds) leads to better performance
8. Seeing object and reading name better than just visual presentation

Front 160

PCH is not good for _____ aphasia because repetition is so impaired.

Back 160

conduction

Front 161

For PCH, do severe patients perform better with a closed class or words or large corpus of words?

Back 161

Closed class of 10 pictures so that you can reinforce the target more often

Front 162

T or F: Errorless learning is a good approach for mild aphasia.

Back 162

F because it is not very effortful

Front 163

What are the 2 primary benefits of errorless learning?

Back 163

1. Decreased errors produces greater success in treatment
2. Increased success produces increased training of target items

Front 164

Some say that PCH and SCH will reinforce _____.

Back 164

errors

Front 165

Spaced retrieval was originally designed for patients with _____.

Back 165

dementia

Front 166

Describe spaced retrieval (SR).

Back 166

Developed by Cameron Camp and coworkers; is an approach to memory intervention that gives individuals with dementia practice at successfully recalling information over progressively longer intervals of time

Front 167

List 4 things SR can be used to remember.

Back 167

1. Compensatory strategies for swallowing
2. Orientation information
3. Names of grandchildren
4. Room location

Front 168

The base for SR is how long?

Back 168

1 minute; if they miss it after 1 minutes it's probably not going to work

Front 169

What is the timing sequence for SR?

Back 169

Base of 1 minute; double time following successful target item; when target is missed, time is reduced by half; up to 32 minutes

Front 170

Describe PACE (Promoting Aphasics' Communicative Effectiveness).

Back 170

Published program for functional language stimulation (addresses communication rather than just language):
1. Clinician and client exchange roles of speaker and listener, conversational turns
2. New information exchanged
3. New stimuli are constantly added to collection of stimuli to promote information exchange
4. Client can use any mode
5. Communication, not accuracy, is emphasized and natural reinforcers are provided
6. Clinician says something that acknowledges the message and helps improve it (I understand...you mean...)
7. Program encourages variations and adaptations to suit the individual clients

Front 171

During therapy, try to keep success at this level.

Back 171

65-85%

Front 172

What type of patients is gestural language best used for?

Back 172

Very severe speech production; no words or 1-2 words

Front 173

What is AmerInd?

Back 173

Gestures based on native American language

Front 174

What type of patients is visual action therapy best suited for?

Back 174

Targeted for global aphasia; very low level patients

Front 175

What skills does a patient need to benefit from visual action therapy?

Back 175

1. Attend during session
2. See stimuli
3. Move at least one hand
4. Sit up in bed

Front 176

List the activities involved in visual action therapy.

Back 176

1. Matching pictures and objects (placing objects on pictures, placing pictures on objects, pointing to objects, pointing to pictures)
2. Object use training
3. Action picture demonstration
4. Following action picture commands
5. Pantomimed gesture demonstration (recognition, production, representation of hidden objects demo, production of gestures for hidden objects)

Front 177

What patients can best benefit from Back to the Drawing Board treatment?

Back 177

1. Severely aphasic patients unable to communicate verbally despite intensive therapy
2. Patients with lesions which may be large or may be located medial subcallosal fasciculus or on other white-matter pathways
3. Patients who show an ability to use their graphic skills (not good for someone with limb apraxia)

Front 178

What are 4 benefits of Back to the Drawing Board?

Back 178

1. Drawing found to be effective tool for communication
2. Found to facilitate verbal utterances
3. May deblock written expression in some patients
4. Provides self-generated communication

Front 179

Describe melodic intonation therapy.

Back 179

Uses musical intonation to facilitate language; developed because we know that some patients can sing better than they can speak

Front 180

What type of patients is melodic intonation therapy primarily used for?

Back 180

1. Severe Broca's aphasia
2. Limited verbal output
3. Auditory comprehension at least moderately preserved, > 45th percentile
4. Repetition poor
5. Articulation poor, >3 on the BDAE speech characteristics
6. Well motivated patient with good attention span

Front 181

List 5 steps of MIT.

Back 181

1. Humming
2. Unison singing and tapping
3. Unison with facing
4. Immediate repetition
5. Response to a probe question
6. Sprechgesang: using changing pitch of normal speech (like choral reading)

Front 182

Define dementia.

Back 182

A clinical syndrome defined by deterioration of memory and at least one other cognitive function that is severe enough to interfere with daily life activities

Front 183

Why are persons with dementia referred to SLPs?

Back 183

Impairments in communicative function resulting from deterioration in higher cognitive processes including executive function, visual-spatial impairment, and memory deficits; some patients also develop dysphagia

Front 184

_____ refers to stored representations and the process of encoding, consolidating, and retrieving.

Back 184

Memory

Front 185

Define short term memory.

Back 185

System that holds information active in consciousness

Front 186

Define working memory.

Back 186

Manipulates information while it is held active in STM (ex: counting backwards by 7's starting at 100)

Front 187

Long term memory can be divided into _____ and _____ memory.

Back 187

declarative and nondeclarative

Front 188

Describe declarative memory.

Back 188

Memory for factual information (semantic, lexical, episodic)

Front 189

What part of the brain is responsible for declarative memory?

Back 189

Hippocampus and adjacent structures and connections of the medial temporal lobe, as well as areas of prefrontal cortex that are active during encoding and retrieval

Front 190

What is the difference between explicit and implicit memory?

Back 190

Explicit - requires conscious control, like remembering these flash cards
Implicit - does not require conscious executive control, such as brushing your teeth; automatic

Front 191

Describe nondeclarative memory.

Back 191

Consists of verbal and motor procedural memory subsystems, reflexes, and habit memory

Front 192

List 4 etiologies of irreversible dementia.

Back 192

1. Alzheimer's Disease
2. Vascular disease
3. Lewy Body disease
4. Parkinson's Disease

Front 193

_____ _____ is the most common cause of irreversible dementia, occurring in 50-70% of cases.

Back 193

Alzheimer's Disease (AD)

Front 194

What is the cognitive profile of AD?

Back 194

1. Early stage deficits in episodic and working memory
2. Later stage impairments in semantic memory
3. Relatively spared procedural memory in early to middle stages of disease

Front 195

What is the prevalence of AD?

Back 195

Estimated 4 million cases in US in 2000; estimated 500,000 new cases per year

Front 196

List 5 relative risk factors for AD.

Back 196

1. Family history of dementia
2. Family history of Down's
3. Family history of Parkinson's
4. Maternal age > 40 years old
5. Head trauma
6. History of depression
7. History of hypothyroidism

Front 197

What does an AD brain look like?

Back 197

Like somebody peeled the cerebral cortex off; greater space; cortex shrunk; more cerebral spinal fluid; gyri and sulci distorted

Front 198

What is the second leading cause of dementia?

Back 198

Vascular disease

Front 199

Describe vascular disease.

Back 199

1. Due to multiple lacunar infarcts (like multiple small strokes)
2. Less homogeneous population than AD
3. Can co-occur with AD
4. Patients usually have history of hypertension, stroke, abrupt onset of symptoms with stepwise deterioration (versus gradual decline with AD)

Front 200

What is the cognitive profile of vascular disease?

Back 200

1. Cognitive signs and symptoms are heterogeneous depending on lesion distribution
2. Cortical lesions are associated with amnesia, visual-spatial deficits, and aphasia
3. Subcortical lesions (common in the periventricular white matter and basal ganglia) are associated with impairments of memory, attention, and motor function

Front 201

Describe Lewy Body disease.

Back 201

1. Increasingly recognized as a cause of dementia
2. May be the second leading cause of dementia
3. Neuropathology is marked by protein deposits (Lewy bodies) in neuronal cell bodies
4. Lewy bodies usually found in frontal and temporal lobes and basal ganglia

Front 202

What is the cognitive profile of Lewy Body disease?

Back 202

1. Fluctuating presentation of cognitive symptoms but overall projection is downhill
2. Procedural memory and learning deficits may occur with subcortical pathology
3. Declarative memory systems may be impaired with cortical pathology

Front 203

Describe Parkinson's Disease.

Back 203

1. Classic signs include rigidity, resting tremor, bradykinesia (abnormal slowness of movement)
2. Due to breakdown of dopaminergic neurons in the basal ganglia
3. Main symptoms associated with motoric function
4. Dementia occurs in 10-20% of cases

Front 204

What is the cognitive profile for Parkinson's Disease?

Back 204

1. Procedural memory impairment
2. Declarative memory deficits when cortical lesions exist

Front 205

How is post-cardiac surgery related to dementia?

Back 205

For people 65 years old and up:
1. 50% develop post-surgical confusion
2. 40% develop dementia 5 years later
3. May be related to anoxic brain injury
4. May be related to narcotic/other medication
5. May occur in those patients who would have developed dementia anyway
6. Cardio-vascular disease and stress may start Alzheimer pathology
7. Other surgeries may have a similar effect related to peri-op or post-op anoxia or vascular stress

Front 206

What are the communication deficits in dementia?

Back 206

1. Early on AD patients get repetitious and forget what they have heard or read
2. Later, discourse becomes impoverished and fragmented
3. Ability to formulate ideas and express them orally and in writing diminishes
4. Phonology and syntax are relatively preserved into the advanced stages of dementia

Front 207

List 5 behavioral problems in dementia patients.

Back 207

1. Mood disorders
2. Psychotic disorders
3. Inappropriate behaviors
4. Aggression
5. Purposeless activity
6. Meal time behaviors
7. Sleep disorders

Front 208

Most AD patients will die within _____ years of diagnosis.

Back 208

9

Front 209

Name 2 screening tools for dementia.

Back 209

1. Story Retelling Subtest of the Arizona Battery of Communication Disorders (ABCD)
2. Verbal fluency tasks (name animals in a category or words that start with specific letter)

Front 210

Name 2 tests for staging severity of dementia.

Back 210

1. The Mini-Mental State Examination (MMSE)
2. Global Deterioration Scale

Front 211

What 2 tests provide a comprehensive evaluation of dementia.

Back 211

1. Arizona Battery of Communication Disorders of Dementia (ABCD)
2. Functional Linguistic Communication Inventory (FLCI) for moderate to severe dementia

Front 212

The dementia treatment _____ _____ training is used to teach new and forgotten information.

Back 212

spaced retrieval

Front 213

Describe spaced retrieval training.

Back 213

Based on progressively increasing the interval between successful recall of specific information

Front 214

List 3 compensatory strategies for dementia patients.

Back 214

1. Development and use of memory books and aids
2. Use of written cueing strategies
3. Approaches to caregiver training

Front 215

_____ in caregivers is extremely high.

Back 215

Depression

Front 216

What can cue card strategies be used for?

Back 216

1. Repetitive questioning
2. Instructions for performing simple tasks
3. Taking medicine
4. Making requests
5. Locating missing objects
6. Using a hearing aid
7. Steps in grooming/toileting

Front 217

What is tip-of-the-tongue state?

Back 217

You know the word, but you just can't retrieve it; starts in 30's and gets progressively worse

Front 218

In normal aging, there is no impairment in _____ processing and _____ processing; only mild impairment in middle and advanced stages of AD.

Back 218

grammatical and phonological

Front 219

In normal aging, there is a mild impairment in _____ processing, usually only seen in those 85 and above; it is very common in all stages of AD

Back 219

semantic

Front 220

Does lexical retrieval decline with older age?

Back 220

Yes; scores on BNT decline; tip-of-the-tongue state

Front 221

Greater density in gray and white matter leads to (better or worse) performance.

Back 221

Better because there are more neurons

Front 222

Anomia in older adults (74 and up) may be due to a _____ decline instead of a memory decline. It also may problem with motor initiation to say the word instead of a _____ problem.

Back 222

language / retrieval

Front 223

What is the significance of BA37?

Back 223

Important for language processing because it supports lexical retrieval; lesions here are strong predictors of anomia

Front 224

Working memory relies on _____ area; it's not just an area for language.

Back 224

Broca's

Front 225

What is a successful treatment for conduction aphasia?

Back 225

Phonological training

Front 226

What is a successful treatment for Broca's aphasia?

Back 226

Lexical retrieval and motor skill activities

Front 227

What are the major differences between the left and right hemispheres?

Back 227

Left hemisphere: serial or sequential
1. Higher temporal processing - complex relational tasks
2. Analytic, rational tasks
3. Almost always dominant for language processing
Right hemisphere: holistic (gestalt) processing
1. Lower temporal processing - whole part tasks
2. Visual and spatial information
3. Emotional affect

Front 228

Does the left hemisphere need the right hemisphere?

Back 228

Right needs left, but left probably doesn't need right

Front 229

Do strokes occur more in the left or right hemisphere?

Back 229

About 50-50

Front 230

The best predictor of hemiparesis is damage in the _____ _____ - white matter that comes from motor cortex.

Back 230

pyramidal tract

Front 231

List 7 symptoms of right hemisphere damage.

Back 231

1. Dysarthria
2. Left hemiparesis
3. Left-sided sensory loss
4. Left visual field cut (homonymous hemianopsia)
5. Neglect or left visual field
6. Left neglect symptoms
7. Prosopagnosia
8. Anosagnosia
9. Communication problems

Front 232

What is dysarthria?

Back 232

Refers to an acquired speech problem where the impairment occurs peripherally from motor planning (type of dysarthria often depends on lesion location and size)

Front 233

Left hemiparesis is due to destruction of the _____ strip. Left-sided sensory loss is due to destruction of the _____ strip.

Back 233

motor / sensory

Front 234

What is another name for a left homonymous hemianopsia?

Back 234

Left visual field cut

Front 235

What causes a left visual field cut?

Back 235

Caused by destruction of neural fibers that relay perceptual information from eyes (via optic nerves; CN II) to the occipital lobes; patients cannot see what is in their left visual field; usually does not coincide with attention problems

Front 236

Describe left hemispatial neglect.

Back 236

1. Damage to any lobe in any hemisphere may produce neglect
2. Right parietal lobe damage produces the most severe and consistent neglect
3. Person can see what is in the left visual field but does not focus attention in that area
4. Due to destruction of neural tissue that processes spatial relationships of what is already perceived
5. Usually have other attention problems and right hemisphere symptoms

Front 237

T or F: Visual neglect does not clear up by itself.

Back 237

F - it does tend to clear up; the brain compensates for it

Front 238

List 5 left neglect symptoms for severely affected patients with right hemisphere damage.

Back 238

1. Fail to perceive left sided tactile or visual stimuli
2. Copy only the right side of a geometric design
3. Read only the right side of the page while complaining that the material makes no sense
4. Bump into things on the left side
5. Deny the existence of paralyzed left arm or leg or say they belong to someone else
6. Fail to correctly localize stimuli
7. Fail to start at the left margin while writing

Front 239

Mildly or moderately affected patients with right hemisphere damage may...(list 2).

Back 239

1. Fail to perceive left-sided tactile or perceptual stimuli when both the sides are simultaneously stimulated, but may perceive left-sided stimulus when presented alone (extinction)
2. May attend to left-sided stimuli when asked to
3. May use only their right-sided pockets or right-sided drawers

Front 240

What is prosopagnosia?

Back 240

Facial recognition deficits:
1. Have difficulty recognizing familiar faces
2. Usually can recognize the person as soon as they speak
3. Difficulty identifying a facial picture they were just shown from a group of friends
4. Difficulty identifying pictures of famous persons

Front 241

Where is the lesion that results in prosopagnosia?

Back 241

Posterior right hemisphere damage; bilateral damage may produce more persistent deficits

Front 242

Describe a constructional impairment.

Back 242

1. Parietal or parieto-occipital damage
2. Patient may have difficulty constructing block designs, reproducing two-dimensional stick figures, drawing or copying geometric designs
3. Patient may completely omit the left side of constructions and drawings or may leave out details on the left side

Front 243

The denial of illness is called _____.

Back 243

anosagnosia

Front 244

List 3 characteristics of anosagnosia.

Back 244

1. Deny the existence of such major problems as paralysis
2. Underestimate the extent or effects of admitted problems
3. Be indifferent to admitted problems or their consequences

Front 245

Right hemisphere damage may result in the following mild communication deficits:

Back 245

1. Naming (abstract items)
2. Auditory comprehension of complex material
3. Oral reading of sentences (due to left visual field neglect)
4. Writing (letter substitution and omissions)

Front 246

More severe communication problems from right hemisphere neglect include:

Back 246

1. Speech prosodic problems - monotonous, emotionally flat speech caused by right frontal lobe damage; impaired appreciation of meaning suggested by emotional cues in other people's speech caused mostly by the right parietal lobe damage
2. Problems in distinguishing significant from irrelevant information - focusing on irrelevant details when describing visual stimuli; focusing on irrelevant details when talking
3. Problems in comprehending implied meanings - focusing on literal meaning of messages; difficulty in interpreting idiomatic expressions, proverbs, figures of speech, and metaphors
4. Pragmatical problems - turn taking, topic maintenance, eye contact, excessive talking, impulsive responses
5. Logical problems - difficulty in identifying absurd statements; reasoning in a logical manner

Front 247

List 3 special concerns with right hemisphere damage.

Back 247

1. Anosagnosia may make it difficult to assess some of the problems through patient report
2. Family members may not appreciate the subtle communication problems
3. Family members may think that the patient is confused (ex: lack of facial recognition)

Front 248

Name 3 standardized tests for right hemisphere damage.

Back 248

1. MIRBI - Mini Inventory of Right Brain Injury
2. The Right Hemisphere Language Battery
3. BIT - The Behavioural Inattention Test

Front 249

Which test is designed for a quick assessment of hemi-spatial neglect?

Back 249

BIT - The Behavioural Inattention Test

Front 250

Who does better in the long run - patients with aphasia or patients with right hemisphere damage?

Back 250

Right hemisphere damage

Front 251

What is the best way to treat right hemisphere lack of awareness impairments?

Back 251

1. Give patient time to get adjusted to new impairment
2. Give immediate, systematic, response-contingent feedback on errors

Front 252

How do you treat right hemisphere impaired attention?

Back 252

Shape sustained attending behaviors with longer durations of attention; include diligence tasks such as letter cancellation and maze solving

Front 253

What's the best way to treat right hemisphere impaired reasoning?

Back 253

Set up examples that require thinking and planning (ex: planning a vacation)

Front 254

How do you treat right hemisphere pragmatic impairments?

Back 254

When patient has had time to adjust to impairments, discuss pragmatic problems and how they can be mediated (eye contact, turn taking, etc.)

Front 255

How do you treat right hemisphere impaired inference?

Back 255

Use pictures that depict situations that require inference (the dog is shaking on the beach...what was he doing?)

Front 256

How do you treat right hemisphere impaired recognition of absurdities?

Back 256

Present a set of absurd and logical statements and ask patient to choose the absurd ones and explain why

Front 257

What's the best way to treat right hemisphere impaired comprehension of metaphors and idioms?

Back 257

State them and ask them to select statements that give literal and metaphoric or implied meanings

Front 258

How do you treat right hemisphere visual neglect?

Back 258

Use printed material as the OT is more likely to treat them through daily activities; work on edgedness

Front 259

_____ _____ aphasia is a progressive disorder of language, with preservation of other mental functions and of activities of daily living, for at least two years (Mesulam et al).

Back 259

Primary progressive

Front 260

PPA commonly appears initially as an impairment of _____.

Back 260

articulation; a less common variety begins with impaired word finding and progressive deterioration of naming and comprehension with relatively preserved articulation

Front 261

T or F: PPA progresses to nearly total inability to speak in its most severe stage.

Back 261

T

Front 262

How do you treat PPA?

Back 262

No known treatment; can use compensatory strategies such as planning ahead for predictable progression and learning AAC device before becoming non-fluent

Front 263

In agrammatism, the term "synchrony reduction" refers to:
a. the patient's lack of semantic priming effects, leading to a lexical-semantic impairment at the automatic level of processing
b. the patient's slowness in activating structural representations, leading to a delay in combining elements of a sentence and complex structures
c. the patient's inability to interpret other than simple active structures or semantically constrained sentences
d. telegraphic speech in which either function words or inflectional endings are removed

Back 263

b. the patient's slowness in activating structural representations, leading to a delay in combining elements of a sentence and complex structures

Front 264

Spontaneous recovery in a patient with ischemic stroke is most likely to occur with significant progress during which time period?
a. first three months of post-onset of CVA
b. between three to six months of post-onset of CVA
c. between six to twelve months of post-onset of CVA
d. does not occur in these types of patients

Back 264

a. first three months of post-onset of CVA

Front 265

The best prognosis for a global aphasic is a lesion in the _____. The worst prognosis for a global aphasic is a lesion in the _____.

Back 265

subcortical area / MCA encompassing anterior and posterior regions

Front 266

Positive prognosis indicators for global aphasics at 1 month post onset include what?

Back 266

Mainly subcortical lesions, no damage to Wernicke’s area, and early improvement in auditory comprehension

Front 267

Most stroke patients show improvement regardless of whether they receive rehabilitation. This is called _____ _____.

Back 267

spontaneous recovery

Front 268

Which of the following is NOT a positive prognostic indicator for patients with global aphasia?
a. lesions that are mainly subcortical
b. absence of damage to Wernicke's area
c. early improvement in auditory comprehension
d. large MCA infarction encompassing anterior and posterior regions

Back 268

d. large MCA infarction encompassing anterior and posterior regions

Front 269

Which statement best describes spontaneous recovery?
a. Temporary suspension of functions that depend on structures remote from the infarct.
b. Improvement following stroke regardless of whether the patient participates in rehabilitation.
c. Care aimed at survival, ensuring that a patient can leave the hospital.
d. Management of residual language impairments after formal treatment is over.

Back 269

b. Improvement following stroke regardless of whether the patient participates in rehabilitation.

Front 270

If a patient with aphasia cannot come up with a response on his own, a clinician can use ____ to elicit words automatically or without training.

Back 270

cueing

Front 271

_______ _________ lead a patient toward activating concepts associated with words.

Back 271

Semantic treatments

Front 272

______ _________ rely on the type of cueing called "lexical”, using phonemic cues and rhyming to facilitate naming.

Back 272

Phonological treatments

Front 273

Is aphasia treatment still available when formal and professional treatment is over?

Back 273

It varies, depending on patient finances, needs, type of residence. Speech and language services may still be available for those that live in a nursing home or assisted living facility. Area recovery groups and/or volunteer-based support groups may also be available in the community.

Front 274

An approach to stimulus adjustment in which the supportive cues are gradually removed so the stimulus becomes more like what would occur in real life is called:
a. diminishing
b. generalization
c. efficacy
d. fading
e. restimulation

Back 274

d. fading

Front 275

Which type of dyslexia has been diagnosed mainly in patients with Broca's aphasia?
a. phonological dyslexia
b. surface dyslexia
c. deep dyslexia

Back 275

c. deep dyslexia

Front 276

Phonological dyslexia has been diagnosed in patients with all of these aphasias except:
a. Broca’s aphasia
b. Conduction aphasia
c. Wernicke’s aphasia
d. Transcortical sensory aphasia

Back 276

c. Wernicke’s aphasia

Front 277

Symptoms of __________________, which is a ____________ hemisphere disorder, includes misreading the left side of words or the left side of a page.

Back 277

neglect dyslexia / right

Front 278

The term ________________ refers to a lack of awareness or recognition of disease or disability.

Back 278

anosagnosia

Front 279

What treatment strategy IS NOT an example of a rehabilitation exercise for a patient with RHD (Right Hemisphere Disorder)?
a. Heightening the patient's awareness of prosody levels
b. Teaching compensatory strategies to improve left neglect
c. Visual Action Therapy (VAT) and communication boards
d. Improving orientation

Back 279

c. Visual Action Therapy (VAT) and communication boards

Front 280

What does the personality of an individual with stage 1 Alzheimer's look like?
a. Apathetic, irritable
b. Restless, tired
c. Depressed, sad
d. Easy-going, hyperactive

Back 280

a. Apathetic, irritable

Front 281

A clinical syndrome defined by deterioration of memory and at least one other cognitive function that is severe enough to interfere with daily life activities is:
a. Dysarthria
b. Dementia
c. Anosagnosia
d. Primary Progressive Aphasia

Back 281

b. Dementia

Front 282

hyperpriming

Back 282

A priming effect that is larger for the experimental group than for a control group, indicating that people with mild DAT engage in extra mental effort when given time to do so

Front 283

morphological agrammatism

Back 283

Emaphsizes problems with grammatical morphemes

Front 284

constructional agrammatism

Back 284

Emphasizes short and simple phrase structure

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automaticity hypothesis

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Researchers concluded that agrammatic pts have a lexical-semantic impairment at the automatic level of processing, which came to be known as the automaticity hypothesis

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cross-modal priming

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Auditory presentation of a sentence along with an online visual lexical decision

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lexical hypothesis

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Agrammatic comprehension is an impairment in accessing function words

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syntactic parsing

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Assignment of structure to a string of words

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linearity hypothesis

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Agrammatic pts use a linear agent-action-recipient order to assign thematic roles for a sentence

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trace-deletion hypothesis

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Agrammatic pts delete traces from structural representations and end up assigning thematic roles randomly

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mapping hypothesis

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Pts with clinical evidence of asyntactic comprehension fail to assign thematic roles to normally realized syntactic representations

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diaschisis

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Loss of function and electrical activity due to cerebral lesions in areas remote from the lesion but neuronally connected to it

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synergestic recovery in bilinguals

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Parallel - two languages progress at the same rate and were similarly impaired at the beginning; nearly identical recovery curves

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rule of Ribot

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Native or first-learned language should be less impaired

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rule of Pitres

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Primary language, most frequently used, should be less impaired because of habit strength

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operant conditioning

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Used to modify volitional behavior; response-reward

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restimulation

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Stimulate the pt again, rather than correct the error, if the pt was wrong

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efficacy

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A measure of effort with respect to time

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forward chaining

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Clinician sequentially models first two words of target response, then remaining words, instructing subject to repeat each portion as it was modeled

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reverse chaining

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Presenting all but the last word as a completion task and then eliciting an increasingly longer form by subtracting words from the carrier phrase toward the first word

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loose training

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Flexibility in stimuli and the response to be reinforced