622 Aphasia Study Guide #2

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Coleman, test 2, aphasia and dementias, 3 study guide terms/information

Diplopia

double vision that prevents the two eyes from fixating on the same point.

Ptosis:

drooping of eyelid caused by paralysis

Nystagmus

abnormal, involuntary movement of the eyes

Hemianopia (hemianopsia):

blindness in one-half of the visual field (B59-61)

Bitemporal hemianopia

blindness in the lateral visual field for both eyes

Homonymous hemianopia

blindness in the same (right or left) half of the visual field in each eye.

Heteronymous hemianopia

blindness in different halves of the visual field in each eye.

Macular sparing

the presence of a small region of intact vision near the center of a visual field

Reflexes

a spontaneous and uncontrollable movement in response to a stimulation (B64)

Superficial reflex:

elicited by touching, stroking, or brushing the surface of body parts; includes gag reflex, swallow reflex, corneal reflex, and plantar flexor reflex.

Deep reflex (tendon or deep tendon reflex):

elicited by tapping or suddenly stretching muscles or tendons, which causes contraction of the muscle whose tendon is tapped or stretched, i.e. knee-jerk reflex (patellar reflex).

Pathologic superficial reflexes (primitive reflexes)

the Babinski reflex, palmar grasp reflex and the sucking reflex.

Muscle tone

the tension remaining in a relaxed muscle or muscle group (B65)

Hypertonia

abnormally high levels of tension in resting muscles

spasticity

abnormally high levels of tension in resting muscles caused by upper motor neuron damage; feels hard to the touch and resists stretching

rigidity

resistance of muscles to movement in any direction; hard to the touch and resists active and passive movement

Hypotonia

abnormally low levels of muscle tension in resting muscles

flaccidity:

decrease resistance to passive movement, can be hyperextended.

Myopathy

disease of muscles (B66)

Plegia:

suffix denoting paralysis (B66)

Monoplegia

paralysis or severe weakness of one limb

Hemiplegia

paralysis of both limbs on the same side

Paraplegia

paralysis of both legs

Quadriplegia

paralysis of all four limbs

Paresis

suffix denoting weakness

Dyskinesia

abnormal and involuntary muscle movements

Hyperesthesia

diminished sensation

Anesthesia

complete loss of sensation

Syncope

fainting spells

Fugue state

temporary disturbance of consciousness lasting from a few minutes to several days; patient engages in normal activities of daily life but later does not remember events; seen in combination with psychiatric illness and epilepsy (rare).

Grand mal (tonic-clonic) seizures

massive discharge of neurons in the brain causing contraction of of almost all muscles in the body followed by a series of intermittent clonic jerks; lasts an average of 1-3 minutes and never remembered by patient. (B, p. 77)

Petit mal (absence) seizures

characterized by a loss of consciousness that lasts only a few seconds; patient usually does not fall but may stare, stop moving and talking, drop things, or move his or her head and limbs aimlessly and involuntarily during the seizure. (B, p. 77)

Aphasia

-Impaired comprehension and production of language, usually caused by damage in the language-competent brain hemisphere (brookshire; 2)
-Language deficits due to traumatic brain injury or damage/lesions in language-specific area

Dysarthria

-Impaired speech production, usually caused by damage in nerves controlling muscles involved in speech or damage in the speech muscles (brookshire; 2)
-Muscle weakness

Apraxia of speech

-a label for several syndromes characterized by difficulty carrying out volitional movement sequences in the absence of sensory loss or paralysis sufficient to explain the difficulty. (brookshire; 314)
-Motor planning difficulties

Ischemic Stroke (also called occlusive stroke)

-occurs when an artery is blocked and part of the brain loses its blood supply.
-Ischemic strokes may be caused by thrombosis or embolus

Hemorrhagic Stroke (also called cerebral hemorrhage)

-caused by rupture or leakage of cerebral blood vessels.

Thrombosis (thrombotic stroke)

an artery slowly is occluded by a plug of material accumulating at a fixed location.

Embolism (embolic stroke)

an artery abruptly is occluded by material that moves through the blood and blocks the artery.

Other causes of brain damage other than CVA

•Intracranial tumors
•Hydrocephalus
•Infections and toxins
•Nutritional and metabolic disorders

Intracranial Tumors

Primary-originating in the brain, most often affect the cerebrum or cerebellum

Secondary intracranial tumors

originating elsewhere and migrating to intracranial locations

Herniation

side effect of very high intracranial pressure by which the brain shifts across structures within the scull.

Hydrocephalus

A condition by which the cerebral ventricles are enlarged, either as a result of increased pressure in the ventricles or as a result of brain atrophy (shrinkage).

Infections and toxins

-Major bacterial infections: bacterial meningitis and brain abscess

Bacterial meningitis

the pia, arachnoid, and CSF become infected with bacteria, causing inflammation, swelling, and fluid exudate from the meninges.

Brain abscess

caused by introduction of bacteria, fungus, or parasites into brain tissues from a primary infection site elsewhere in the body. Primary sources of infection are the nasal sinuses, middle ear, or mastoid cells in 40% of cases.

Toxemia

caused by the introduction into the nervous system of substances that inflame or poison nerve tissue, may be caused by drug overdoses, drug interactions, bacterial toxins (tetanus, botulism, dipheteria), or heavy metal poisoning (lead, mercury).

Metabolic Disorders

common causes of CNS dysfunction, but rarely cause isolated communication disorders.
e.x. Severe hypoglycemia may cause deterioration of cerebral function, leading to confusion, stupor, or coma.

Nutritional disorders

Rare in the US, but cause CNS dysfunction and may occasionally generate cognitive-communicative impairments. (Wernicke's encephalopathy)

5 levels of alertness (attention)

•Sustained Attention (vigilance)
•Selective Attention
•Alternating Attention
•Divided Attention
•Attention In Daily Life

Sustained Attention

typically is assessed with strings of computer-presented auditory or visual stimuli, presented over relatively long and purposely monotonous intervals.

Selective Attention

selective attention typically is assessed with a paper-and-pencil cancellation tasks by which the test taker must scan printed arrays of numerals, letters, or symbols and cross out or circle each occurrence of a designated target

Alternating Attention

tests of alternating attention require the test taker to change attentional focus in response to changing task requirements.

Divided Attention

divided-attention tests come in two forms; one form is when the test taker retains information in memory while performing mental operations on the information. The other form is having divided attention tests (dual-task format) that requires the test taker to perform two concurrent tasks.

Attention In Daily Life

most tests of attention call on cognitive processes in addition to attention (visual search, scanning, tracking, short-term memory, and appreciation of verbal or mathematical concepts).

The divisions of memory

•Sensory register
•Immediate memory
•Working memory
•Long-term memory
•Retrospective memory
•Declarative memory
•Episodic memory
•Semantic memory
•Procedural memory
•Prospective memory

Sensory Register

very brief storage of stimulus traces in modality-specific form. Information cannot be manipulated or maintained by rehearsal

Immediate memory

limited capacity. Information decays in a few seconds unless consciously maintained by rehearsal

Working Memory

contemporary replacement for the concept of short-term mmemory. Active working space in which components of cognitive processes are temporarily stored.

Long-Term Memory

long-lasting storage of information. Information in long-term memory decays slowly, if at all.

Restrospective memory

memory for past experiences, events, and information.

Declarative Memory

memory for what we know about things

Episodic Memory

Memory for past events that are specific to a time and place

Semantic Memory

Organized knowledge of the world, including knowledge gained in educational settings

Procedural Memory

Knowledge of how to perform behavioral routines learned in the past

Prospective Memory

remembering to remember - remembering to carry out previously scheduled actions

Single-Word Comprehension

simplest word-comprehension tests require the patient to point to body parts or objects in the environment; tests patient's ability to comprehend single words and simple spoken directions.

Sentence Comprehension

test could include having patient pointing to one or more items in sets of pictures, objects, or body parts or have the patients manipulate objects or body parts (ring the bell, close the box, and give me the key.)

Sentence Comprehension and Comprehension in Daily Life

Items in most sentence comprehension tests are not very representative of what adults experience in daily life. Listeners in daily life usually need only remember the gist of sentences and not their verbatim form, and they don't have to remember the gist for more than a few seconds. A way to test this is to tell the client directions to activities of daily living and have them perform the actions in their life.

Comprehension of Spoken Discourse

A way to test this is to have paragraphs read aloud by the examiner followed by spoken questions about the paragraph directed to the listener. (use short story-like narratives)

Phonemic paraphasia

(literal paraphasia)-hautch/watch, gum/gun
• Phonetic dissolution - fan (nasal)/fan, ten (dental),/ten
• Verbal Paraphasia - clock/watch, lock/key
• Neologistic - tudo/watch, mara/key
• Circumlocution - temperature/thermometer, cutting/scissors
• Stereotype - bisabee/bisabee, aye aye aye?

Semantic paraphasia

(phonemic error) fliers/wrench, telepon/thermometer

Give an example of part-word paraphasia

therm/thermometer
writer/typewriter

Augmentation

keys/key, blowwhistle/whistle

Phonetic Dissolution

fan (nasal), ten (dental)

Verbal Paraphasia

clock/watch, lock/key

Give an example of Neologistic paraphasia

tudo/watch, mara/key

Circumlocution

temperature/thermometer, cutting/scissors

Stereotype

bisabee/bisabee, aye aye aye

Reasons for referral/ significant history

case history, chart review

Orientation/Memory

Ask what day/year/time it is

Auditory comprehension

single-word comprehension
sentence comprehension
yes/no questions

Reading comprehension

word to picture matching

Automatized sequences

counting

Repetition

having them repeat words and sentences

Confrontation naming:

Pictures: name the dog, broom, desk etc

Oral reading

have them read words and sentences

Rating of connected speech

fluency, word finding, phrase length, take MLU

Writing

test letters and words to dictation, have them copy words

Broca's aphasia: Lesion

Lesion: Posterior inferior frontal lobe

Brocas aphasia: Fluency

Fluency: Nonfluent telegraphic speech

Broca's aphasia: Speech

Speech: phonetic dissolution (fragmented)

Broca's aphasia: Word retrieval

Word retrieval: Fair but misarticulated

Broca's aphasia: Repetition

Repetition: Labored, misarticulated, telegraphic

Broca's aphasia: Comprehension

Comprehension: fair to good

Wernicke's aphasia: Lesion Location

Lesion location: Posterior superior temporal lobe

Wernicke's aphasia Fluency

Fluent, empty

Wernicke's aphasia: Speech

Verbal (semantic) paraphasia

Wernicke's aphasia: Word Retrieval

Poor, with verbal paraphasias

Wernicke's aphasia: Repetition

Fluent, verbal paraphasia; grossly restricted retention span

Wernicke's aphasia: Comprehension

Poor

Conduction aphasia: Lesion Location

Parietal lobe

Conduction aphasia: Fluency

Fluent, sensical

Conduction aphasia: Speech

Literal (phonemic) paraphasic

Conduction aphasia: Word Retrieval

Fair, with literal paraphasias

Conduction aphasia: Repetition

Fluent, literal paraphasia; some restriction of retention span

Conduction aphasia: Comprehension

Fair to good

Anomic aphasia: Lesion Location

Temporal parietal lobe

Anomic aphasia: Fluency

Fluent, sensical

Anomic Aphasia: Speech

Verbal (semantic paraphasia)

Anomic Aphasia: Word Retrieval

Fair, with verbal paraphasia

Anomic Aphasia: Repetition

good

Anomic Aphasia: Comprehension

fair to good

Transcortical motor: Lesion location

Anterior, Superior frontal lobe

Transcortical motor: Fluency

Fluent, sparse

Transcortical motor: Speech

Variable

Transcortical motor: Word retrieval

Variable with delays in imitation

Transcortical motor: Repetition

Good but delays in imitation

Transcortical motor: Comprehension

Good

Transcortical motor:

a.k.a anterior isolation syndrome

Transcortical sensory

posterior isolation syndrome

Transcortical sensory: Lesion

Posterior, superior parietal lobe

Transcortical sensory: Fluency

Fluent, empty

Transcortical sensory: Speech

Variable

Transcortical sensory: Word retrieval

Poor

Transcortical Sensory: Repetition

Good

Transcortical Sensory: Comprehension

Poor

Global: Lesion

Large, Perisylvian

Global: Fluency

non fluent

Global: Speech

Literal, verbal paraphasia, verbal stereotypes

Global: Word Retrieval

Poor

Global: Repetition

Poor, literal, verbal paraphasia; grossly restricted retention span

Global: comprehension

Poor

Six Reading Subtests

Visual matching
Oral reading of words
Oral reading of sentences
Single word comprehension
Comprehension of printed sentences
Comprehension of printed text

Visual matching

match the card with stimulus

Oral reading of words

read aloud words on cards

Oral reading of sentences

read aloud sentences on cards

Single word comprehension

word to picture matching from a group of 3

comprehension of printed sentences

yes/no questions (do eggs come from chickens?)

Comprehension of printed text

match card to photo

Generating automatized sequences

writing over-learned sentences (alphabet)

Copying

copy geometric forms, symbols, letters, printed words etc

Writing to dictation

follow a letter to word sentence progression in dictation

Writing self formulated material

write sentences describing function of everyday objects

What factors might produce incorrect answers on reading and writing tests?

Fatigue
Motivation
Learning effect
Test environment
Administration of test

Neuron

is an electrically excitable cell that processes and transmits information by electrical and chemical signaling, made up of cell body, axon and terminal, can be sensory or motor

Glial cells

supports neurons and nerve fiber tracts may serve other functions like regulating fluid level, removing foreign substances, and participating in brain metabolism

Dendrites

are the branched projections of a neuron that act to conduct the electrochemical stimulation received from other neural cells to the cell body

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