1
Q
- Prevalence 2. Incidence
A
- Prevalence is the total number of disease cases at a given period of time 2. Incidence is the number of new cases during some time period
2
Q
Prevalence of Stroke and Aphasia
A
- CVA: 3rd leading cause of death in US
- Mortality rates differ across strokes; 8-12% of ischemic strokes and 37-38% of hemorrhagic strokes result in death
- Leading cause of disability
- Ischemic strokes are more common than hemorrhagic 80% to 20% split
- Broca’s aphasia is more common in younger pts
- Wernicke’s aphasia is more common in older pts
3
Q
Fluent vs. Nonfluent Classification
A
- Pts w/aphasia are grouped according to their fluency of speech
- Some pts have relatively preserved fluency of speech while others have marked difficulty in producing and sustaining fluent speech
- Classification is based on both deficiencies of language but also on anatomical considerations (anterior or posterior to the central sulcus)
4
Q
Receptive and Expressive Aphasias
A
-References deficits in language comprehension and/or production - Receptive, expressive or mixed types -Generally correlated with differing sites of lesion - Anterior cerebral lesions tend to be associated with language production problems - Lesions more posteriorly located in the cerebrum tend to produce more comprehension related issues - Nonfluent aphasias are considered expressive aphasias - Fluent aphasias are considered receptive aphasias
5
Q
Aphasia Symptomatology
A
- Most pts will demonstrate a set of common symptoms:
- Paraphasia (various types)
- Disorders of fluency (not stuttering per se)
- Auditory comprehension
- Repetition
- Agrammatism vs. paragrammatism
- Anomia- word finding -
Writing problems- agraphia
- Reading problems (alexia- can’t read)
- Visual (gestures)
- Apraxia vs dysarthria or both
6
Q
Paraphasias
A
- Errors in speech consisting of unintended words or sound substitutions
- Often considered a central sign of aphasia
- Most are present in all types of aphasia, as such, they are not a significant factor in the identification of specific types of aphasia
7
Q
3 primary types of paraphasia
A
- verbal (global) paraphasias 2. neologistic paraphasias 3. phonemic (literal) paraphasias
8
Q
Verbal (global) Paraphasias
A
- entire word is substituted - unintended word - 2 types 1. semantic paraphasia: substituted word is semantically related to the one intended (e.g., pt says son for daughter) 2. random paraphasia: substituted and intended words are not semantically related (e.g., window for banana)
9
Q
Neologistic Paraphasias
A
- References the use of a meaningless, invented word - Pts may refer to an object by their invented, nonsensical term - aka: neologism
10
Q
Phonemic (Literal) Paraphasias
A
- Substitution of one phoneme for another (loman for woman) or the addition of a phoneme (wolman for woman) - Different diagnosis than apraxia of speech or speech sound disorder -Differentiate from AOS- inconsistent, groping, difficulty with words of increasing length Make sure this is not apraxia and they are substituting easier sounds for harder - Apraxia is MSD - Aphasia- acquired disorder of language -Types of paraphasias are based on context -Paraphasias are more common in fluent aphasias, posterior strokes -not likely that they will occur with Apraxia which is caused by injury to Broca’s (nonfluent aphasias)
11
Q
Disorders of Fluency 1
A
- Aspect of language production; fluent speech flows and is produced with less effort
- It is smooth and devoid of too many interruptions
- Fluency: speech that approximates the normal rate, typical word output, length of sentences and the melodic contour
- Pts who produce 5+ connected words may be judged fluent
- When word output is less than 50 words a minute in conversation, fluency is significantly impaired
12
Q
Disorders of Fluency 2
A
- Pts who are nonfluent, tend to speak with a degree of muscular effort not seen in normally fluent speakers.
- Speech may be slow, deliberate, or limited - Utterances may contain fewer words than normal
- Speech is usually hesitant
13
Q
Auditory Comprehension
A
- Most pts w/aphasia have some degree of difficulty w/auditory comprehension
- Not dependent necessarily upon fluent or nonfluent status
- It is the degree of severity that varies
- Assessed from simple tasks to more complex multi-steps
14
Q
Repetition
A
- Pts imitation of single words, phrases and sentences
- Usually more frequently present in cases of impaired auditory comprehension (posterior, receptive aphasias)
- Must rule out true deficit versus inability to repeat secondary to apraxia, etc
15
Q
Paragrammatism
A
- paragrammatism: seen in fluent aphasias -Think paragrammatism-posterior- fluent - Substitution/addition of inappropriate sequences (verb tense confusions, gender case issues, incorrect choice of prepositions, misuse of inflections, juxtaposition issues -Think “cocktail party speech”
16
Q
Agrammatism
A
- Seen in nonfluent aphasias -Think Agrammatism-anterior- nonfluent - Simplification/reduction of grammatical construction - Omission of articles, connected words, auxilary verbs, inflectional morphemes - Pt’s will use only content words - Think telegraphic speech
17
Q
Anomia
A
- Word finding difficulty usually persists for those that recover - Present in confrontational naming - Divergent: (name 3 fruits) - Convergent: (apple, pear and orange are all _____) - Word frequency and semantic categories - Words that are less frequent in everyday language - Anomia is not particularly useful when differentiating types of aphasia (it’s more of a general problem) - Persistent and severe word-finding and naming difficulties are dominant, pt may have anomic aphasia
18
Q
Grapheme Expression
A
- Agraphia: writing problems associated w/cerebral lesions - Most all pts will demonstrate some difficulty w/writing - Problems will generally reflect problems seen in verbal expression - Agrammatic, effortful, sparse speech seen in pts w/Broca’s aphasia will demonstrate agrammatic, effortful, sparse writing - May exhibit poor letter and/or word formation - May reverse, confuse or substitute letters self-correction may be poor; nonsensical words and poor orthographic skills may be totally unreadable
19
Q
Reading Problems
A
- Variety is noted in pts w/aphasia - Some have difficulty reading secondary to verbal expressive problems - Others may demonstrate poor comprehension of what is read silently or orally - Alexia (loss of or inability to comprehend written language)
20
Q
Aphasia is NOT:
A
- Dementia: progressive neurological disease in which communicative and cognitive skills, along with social and personal behaviors continue to deteriorate - Alzheimer’s disease - Pick’s and Parkinson’s diseases also can cause dementia - Schizophrenia: psychiatric d/o characterized by d/o’d thought, affect and behavior pts exhibit irrelevant speech and disturbed thinking - Disassociation from reality with hallucinogenic qualities - Typically dx’d earlier in life than aphasia onset is usually more gradual
21
Q
*****8 Must Knows*****
A
- Site of lesion- fluent or nonfluent based on anterior or posterior to central sulcus
- Oral Expression- fluency, expressive or receptive, paraphasias (verbal, phonemic, negolistic)
- Repetition- can the patient repeat, how far can they repeat (an appropriate task is 7 digits) simple to complex, words, phrases
- Naming- confrontational naming, divergent, convergent
- Auditory Comprehension- receptive or expressive
- Oral Reading- mirrors expression
- Reading Comprehension
- Grapheme Expression- likely mirrors oral expression
22
Q
Anomia II
A
- Anomia- word retrieval deficit Word finding difficulties
- Broca’s aphasia usually has persisting anomia
- Confrontational naming- in your face. What is this (use object, picture, flashcard)?
- Divergent- name three objects, 3 fruits- take category and branch out
- Convergent- list 3 items in a category and have the patient name the category
- Anomia is present in several aphasias
- When a patient has persistent and severe anomia it is known as Anomic Aphasia- one of the types and it is a fluent aphasia because they have a lot of fillers
Aphasia
flashcards
Decks in class (13)
# Cards
