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51 Cards in this Set
- Front
- Back
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Frontal Lobe |
Contains areas that are critical to speech production. These include primary motor cortex, supplementary motor cortex, and Broca's area. Primary Motor Cortex- located on precentral gyrus and controls voluntary movements of skeletal muscles on the opposite side of the body. Broca's area controls lip, tongue, jaw and laryngeal movements. AKA motor speech area because it controls motor movements in speech production. |
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Parietal Lobe |
Integrates contralateral somesthetic sensations such as pressure, pain, temperature, and touch. Supramarginal gyrus- Damage to this can cause conduction aphasia and agraphia. Angulargyrus- Damage to this can cause writing, reading, and naming difficulties and in some cases, transcortical sensory aphasia. |
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Occipital Lobe |
not very relevant to speech and hearing because it is concerned with vision. Primary Visual Cortex |
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Temporal Lobe |
Contains two general areas that are critical to adequate hearing and speech. 1. Primary auditory cortex- receives sound stimuli from acoustic hemisphere analyzes speech sounds into words and sentences. 2. Herschyl's gyri Wernicke's area is critical to the comprehension of spoken and written language area. A lesion here causes wernicke's aphasia in which a pt produces fluent meaningless speech. |
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Ischemic Stroke |
Caused by a blocked or interrupted blood supply. Blockage caused by: 1. Thrombus- a collection of blood material that blocks flow of blood. 2. Embolus- Traveling mass of arterial debris that gets lodged in artery and blocks the flow of blood. |
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Hemorrhagic Strokes |
Caused by bleeding in the brain due to ruptured blood vessels. Intracerbral- within the brain Extracerbral- within the meninges |
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Aphasia |
neurologically based language disorder caused by various kinds of neruropathologies. CVA's are the most common causes of aphasia. A loss or impairment of language caused by a recent brain injury. Comprehension and expression of language, along with reading and writing may be impaired. |
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Nonfluent Aphasia |
Characterized by limited, agrammatic, effortful, halting and slow speech with impaired prosody. 1. Broca's aphasia 2. Transcortical Motor Aphasia 3. Mixed Transcortical Aphasia 4. Global Aphasia |
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Broca's Aphasia |
damage to Broca's area in posterior inferior frontal gyrus, supplied by the middle cerbral artery. Characterized by: *nonfluent, effortful, slow, halting and uneven speech *limited word output, short phrases and sentences *agrammatic or telegraphic speech *impaired repetition of words and sentences *impaired naming *rarely normal but better auditory comprehension of spoken language |
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Transcortical Motor Aphasia |
Caused by lesions in the anterior superior frontal lobe, below or above broca's. Supplied by the anterior cerebral artery and anterior branch of middle cerebral artery. laborious, halting, telegraphic, akinesia, bradykinesia, apraxia, good repetition. |
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Mixed Transcortical Aphasia |
damage to the watershed areas/arterial border zone. Severe echoloalia and reading and writing difficulties, unimpaired automatic speech, associated with bilateral UMN and visual field deficits. |
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Global Aphasia |
Most severe form of nonfluent aphasia caused by extensive damage to all language areas (perisylvian region) supplied by middle cerebral artery. verbal and nonverbal apraxia, strong neurological symptoms. |
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Fluent Aphasias |
Characterized by relatively intact fluency but less meaningful speech. Good prosody and phrase length. 1. Wernicke's 2. Transcortical sensory 3. Conduction 4. Anomic |
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Wernicke's Aphasia |
Caused by lesions in the wernicke's area (posterior portion of the superior temporal gyrus in left hemisphere) Characteristics: *effortlessly produced speech *rapid rate of speech with normal prosody *intact grammatical structures *severe word-finding problems * paraphasic speech *circumlocution *empty speech *poor auditory comprehension * impaired conversational turn taking May sound confused |
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Transcortical Sensory Aphasia |
Caused by lesions in the temporoparietal region of the brain. Sound similar to Wernicke's aphasia except their repetition is intact. |
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Conduction Aphasia |
Damage to the supramarginal gyrus and arcuate fasiculus. Similar to Wernicke's aphasia but have good auditory comprehension |
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Anomic Aphasia |
damage to different regions including angular gyrus and temporal gyrus. language functions other than naming are generally normal |
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Subcortical Aphasia |
damage to areas surrounding basal ganglia and thalamus. Fluent speech but word-finding problems. |
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Assessment of Aphasia |
1. Standardized Aphasia Test *boston diagnostic, *western aphasia battery 2. Functional assessment tools * functional comm profile, *comm abilities in daily living 3. Assessment of repetion, naming, auditory comprehension, comprehension of single words, sentences, paragraphs, reading and writing, automated speech and singing. |
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Treatment of Auditory Comprehension |
Lesions within posterior superior temporal lobe have better progress Sequenced as follows: 1. Comprehension of single words-understanding nouns and verbs 2. comprehension of spoken sentences- yes/no's, follow simple directions, matching sentence to a picture 3. discourse comprehension- understanding narratives and questions (have client retell a story the clinician narrates) |
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Treatment of Verbal Expression (Naming) |
Important to select words that are client specific and functional. 1. Incomplete sentences 2. Phonetic cues 3. Syllabic cues 4. Silent phonetic cues 5. Functional description of the object |
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Treatment of Verbal expression (expand utterances) |
Involves systematically increasing the length and complexity of target responses. Action filled pictures and stories may be used to teach narratives and discourse |
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Treatment of Reading Skills |
Functional reading skills may be sequenced as follows: *survival reading skills (letters, menus, bank statements) * reading and comprehension of printed words *reading and "" of phrases and sentences * reading and "" of paragraphs and extended material |
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Treatment of writing skills |
Functional writing skills may be sequenced as follows * initially writing functional words (name, family) * writing functional lists (grocery) * writing short notes, reminders, addresses * filling out forms * writing letters |
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Aphasia Treatment |
Takes on 2 Forms 1. Remediation of the problem * stimulation approach * commercially available approaches 2. Compensation for the problem * AAC approaches * caregiver training |
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Compensation |
Might include: Using a communication notebook circumlocuting around a word learning self-cueing strategies teaching caregiver strategies |
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Stimulation approach |
employs strong,controlled, and intensive auditory stimulation of the impaired symbol system. The auditory modality is the foundation. Commercial available treatment programs * melodic intonation * Helm * Visual action * Treatment of Wernicke's aphasia |
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Alexia |
loss of previously acquired reading skills due to recent brain damage |
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Agraphia |
the loss or impairment of normally acquired writing skills due to lesions in the foot of the second frontal gyrus of the brain. |
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Agnosia |
Impaired understanding of the meaning of certain stimuli even though there is no peripheral sensory impairment. |
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Traumatic Brain Injury (TBI) |
Any injury to the brain from an outside source 2 types: 1. Closed head- no disruption of the meninges 2. Open head- disruption of the meninges |
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Language problems associated with TBI |
mutism language of confusion anomia perservation of verbal responses difficulty in initiating conversation difficulty in turn taking lack of narrative cohesion disturbed social interaction |
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How TBI patients differ from Aphasic Patients |
* more pragmatic problems * language is more confused or rambling *more talkative than those with Broca's Aphasia |
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Assessment in TBI |
Rating scales are used to help us reference patients and talk about patients in a conventional manner. * glasgow coma scale Assessment Tools Scales for cognitive abilities in traumatic brain injury Ross information processing Assessment |
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Glasgow Coma Scale |
scores range between 3-15 The scale is more objective and can be used to tell a good rehab candidate ( if they get 10-11 in the first moth or two |
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Ranchos Los Amigos Scale of Cognitive Functioning |
1. No response 2. generalized response 3. localized response 4. confused and agitated, SLP: looks at attention capacity, awareness, orientation 5. confused and inappropriate: family will think is okay and ready to go home, not safe to go home 6. confused and appropriate, family is beginning to understand more 7. automatic and appropriate more safe to be home 8. purposeful and appropriate |
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Traumatic Brain Injury Treatment |
Use hierarchy of treatment 1. basic attention 2. orientation/memory 3. simple relationships and associations 4. simple problem solving 5. abstract reasoning |
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Right Hemisphere Functions |
Arousal, orientation, attention visual perception geometric and spatial information facial recognition body image emotion and expression perception of temporal order musical harmony extralinguistic aspects of communication |
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Common disturbances in RHD |
confabulation: information made up Perseveration: stuck and repeating information Tangentiality: off topic or inability to maintain topic Anogognosia: denial of deficits Hemiplegial/Hemiparesis Neglect- Patient does not adjust to stimuli |
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Right Hemisphere Damage 3 main categories |
1. Linguistic deficits 2. Non linguistic deficits 3. extralinguistic deficits |
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RHD Treatment |
Three approaches 1. Relative level of impairment approach * focus on areas of strengths and weaknesses 2. Fundamental abilities approach * targeted processes that are presumed to underlie a range of deficiencies 3. Functional Abilities approach * focus on daily life competencies and concerns |
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Treatment of linguistic deficits |
word finding auditory comprehension |
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Treatment of non linguistic deficits |
memory deficits macrostructure deficits selection and integration deficits deficits in production of informative content generative alternative meanings |
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Treatment of extralinguistic deficits |
attention scanning treatments symptomatic treatments enlisting voluntary attention stimulate unconscious perception |
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Dementia |
A syndrome which includes the progression of memory loss and deterioration of one or more cognitive functions which impedes the ability to perform activities of daily living. |
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Dementia of the Alzhemier Type (DAT) |
early stage symptoms: subtle memory problems, pronounced difficulty learning new tasks, poor reasoning and judgement, behavioral changes Later stage symptoms: sever problems recalling remote and recent events, widespread intellectual deterioration, hyperactivity, restlessness, agitation Language Problems: verbal and literal paraphasias, problems comprehending abstract meanings, impaired picture description, echolalia, |
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Frontotemporal dementia |
Includes Pick's disease Presence of Pick bodies and cells Symptoms: behavior changes initially, emotional disturbances, impaired judgement |
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Vascular dementia |
Causes: ischemia, hemorrhage, small and large vessel disease Symptoms: deficits in attention, executive function, memory, language and motor skills |
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Lewy Body Dementia |
variation in cognition changes in alertness or attention persistent visual halluciations Features of parkinsonism which come and go confusion, difficulty in making good judgments, and memory loss. Extreme fatigue |
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Principles of Intervention |
1. Decrease demands on working and episodic memory 2. Increase dependence on procedural memory 3. Present activities which reinforce word and concept associations 4. Give visual and audible cues to trigger memories |
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Intervention Techniques for Dementia |
1. Spaced-retrieval training 2. Spared memory approaches 3. Procedural memory stimulation 4. Errorless learning 5. Recognition memory 6. sensory stimulation 7. cognitive stimulation |
