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51 Cards in this Set

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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.

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.

Occipital Lobe

not very relevant to speech and hearing because it is concerned with vision.




Primary Visual Cortex

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.

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.

Hemorrhagic Strokes

Caused by bleeding in the brain due to ruptured blood vessels.




Intracerbral- within the brain




Extracerbral- within the meninges

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.

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

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

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.





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.

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.

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

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

Transcortical Sensory Aphasia

Caused by lesions in the temporoparietal region of the brain.






Sound similar to Wernicke's aphasia except their repetition is intact.

Conduction Aphasia

Damage to the supramarginal gyrus and arcuate fasiculus.








Similar to Wernicke's aphasia but have good auditory comprehension

Anomic Aphasia

damage to different regions including angular gyrus and temporal gyrus.




language functions other than naming are generally normal

Subcortical Aphasia

damage to areas surrounding basal ganglia and thalamus.




Fluent speech but word-finding problems.

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.

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)

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

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

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

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

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

Compensation

Might include:


Using a communication notebook


circumlocuting around a word


learning self-cueing strategies


teaching caregiver strategies

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

Alexia

loss of previously acquired reading skills due to recent brain damage

Agraphia

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

Agnosia

Impaired understanding of the meaning of certain stimuli even though there is no peripheral sensory impairment.

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

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

How TBI patients differ from Aphasic Patients

* more pragmatic problems


* language is more confused or rambling


*more talkative than those with Broca's Aphasia

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

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

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

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

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

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

Right Hemisphere Damage


3 main categories

1. Linguistic deficits


2. Non linguistic deficits


3. extralinguistic deficits

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

Treatment of linguistic deficits

word finding


auditory comprehension

Treatment of non linguistic deficits

memory deficits


macrostructure deficits


selection and integration deficits


deficits in production of informative content


generative alternative meanings

Treatment of extralinguistic deficits

attention


scanning treatments


symptomatic treatments


enlisting voluntary attention


stimulate unconscious perception

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.

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,

Frontotemporal dementia

Includes Pick's disease


Presence of Pick bodies and cells




Symptoms:


behavior changes initially, emotional disturbances, impaired judgement

Vascular dementia

Causes:


ischemia, hemorrhage, small and large vessel disease




Symptoms: deficits in attention, executive function, memory, language and motor skills

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

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

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