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Aphasia test 2

Terms in this set (107)

What are the problems with aphasia categorization?
- different people use different classifications systems
- it's hard to fit many patients into one category (only about 30% of individuals fit neatly in a category)
Aphasia types coinciding with anterior localization
- nonfluent
- broca's
- expressive
Aphasia types coinciding with posterior localization
- fluent
- wernicke's
- receptive
Relatively well preserved fluency, no trouble with grammar, precise articulation, normal prosody, MEANINGLESS words
Fluent speech
Excessively slow rate of speech, struggle to speak, limited phrase length, abnormal prosody (choppy speech), difficulty initiating speech, grammar problems
Non-fluent speech
Fluent aphasias
- wernicke's
- conduction
- anomic
- transcortical sensory

not typically aware of errors
Lesion to left posterior, temporal lobe (often extending into parietal lobe)
- impaired/poor auditory comprehension, reading comprehension and writing skills
- poor word finding/retrieval
- impaired repetition skill
Wernicke's aphasia
- no hemiplegia (no AOS)
Substitutions in fluent speech where little meaning is conveyed
Paraphasias
- verbal/non-semantic: unrelated word substitution
- semantic: related word substitution
- phonemic/literal: sound substitutions (pog/dog)
Utterances that don't make sense in fluent speech where little meaning is conveyed
Jargon
- extended english jargon
- neologistic jargon (not real english words) -- neologisms
Abnormal speech fluency (excessive speech output) and rapid rate of speech - wernicke's aphasia
Logorrhea (press of speech)
Lesion to lower parietal lobe which may involve the arcuate fasciculus, insula or small part of wernicke's area
Conduction aphasia
- good phrase length, syntax and prosody
- variable reading and writing problems
Hallmark: INABILITY TO REPEAT OR IMITATE SPEECH
- auditory comprehension impaired (mildly)
- word finding/naming difficulties
Conduction aphasia
- better recognition of errors and self-monitory (self-corrections)
Paraphasias associated with conduction aphasia
predominantly phonemic type
- may have semantic and verbal paraphasias and neologisms but less frequent
Lesion to the angular gyrus or lower temporal lobes characterized by WORD RETRIEVAL PROBLEMS during spontaneous speech, problems naming pictures or objects
Anomic aphasia
- word finding/retrieval problems (ANOMIA)
- better auditory comprehension compared to other aphasias
- thought formulation difficulties
- repetition intact or mildly impaired
- syntax OK and normal artic
- oral reading and writing intact
- verbal paraphasias most common
Anomic aphasia
lesion to regions more posterior to wernicke's area
- same characteristics of wernicke's aphasia PLUS good repetition
Transcortical sensory aphasia
Lesion to Broca's area AND surroundings (motor strip) or deep to subcortical areas (BG, thalamus) characterized by effortful (short phrased) speech, some impairment in auditory comprehension, word finding problems, thought formulation problems
Broca's aphasia
- impaired confrontation naming, repetition of words/sentences
- SIGNIFICANT difficulty imitating modeled sentences
- may have AOS
- agrammatism
- poor oral reading and writing problems
- most likely hemiplegic
- frustration/depression
Lesion to anterior and posterior areas (covering entire perisylvian region), or deep to subcortical areas
- proufoundly impaired language abilities across all modalities
- poor auditory comprehension
Global
- more preserved use of nonverbal information (gestures, facial expressions, intonation, context...)
No meaningful speech, recurrent utterances, automatic speech, serial speech (counting), may have AOS, probably hemiplegic
Global aphasia
Lesion to supplementary motor area (SMA) or nerves running from SMA to Broca's area
- impaired self-initiated (not imitative) speech
- Broca's aphasia PLUS good repetition
Transcortical motor aphasia
"Watershed" lesion surrounding perisylvian speech and language areas, usually caused by anoxia, global aphasia PLUS good repetition
Isolation syndrome or Mixed transcortical aphasia
- NO fluency
- NO comprehension
- NO repetition
Global aphasia
- NO fluency
- NO comprehension
- YES repetition
Mixed transcortical aphasia
- NO fluency
- YES comprehension
- NO repetition
Broca's aphasia
- NO fluency
- YES comprehension
- YES repetition
Transcortical motor aphasia
- YES fluency
- NO comprehension
- NO repetition
Wernicke's aphasia
- YES fluency
- NO comprehension
- YES repetition
Transcortical sensory aphasia
- YES fluency
- YES comprehension
- NO repetition
Conduction aphasia
- YES fluency
- YES comprehension
- YES repetition
Anomic aphasia
Reading impairment without an accompanying writing disorder
alexia without agraphia
- injury to left visual cortex and splenium of corpus callosum
Reading and writing impairment without significant deficit in oral expression or auditory comprehension
alexia with agraphia
- injury to left angular gyrus
The lesion is posterior to left angular gyrus, left occipital lobe or callosal

Vascular territory (posterior MCA)
Alexia occurs without aphasia
Absent auditory comprehension with error-free spontaneous speech, naming, reading and writing
Pure word deafness
- auditory verbal agnosia (cannot understand language heard, can talk read and write)
Aphasia in right-handed individuals who have had right hemisphere lesions
Crossed aphasia
Language impairment with insidious (slow) onset, gradual progression, without generalized dementia
Primary progressive aphasia (PPA)
Three main variants of PPA
- logopenic
- semantic
- non-fluent/agrammatic
PPA (does/does not?) arise from stroke or other cerebrovascular etiologies
DOES NOT
- anomia and poor sentence repetition
- phonemic paraphasias
logopenic variant of PPA
- anomia with loss of single word meaning
semantic variant of PPA
- verbal output is characterized by trouble with grammar and syntax
- AOS can be present
agrammatic/non-fluent variant of PPA
at least one
- agrammatism
- effortful halting speech
at least two to or three
- impaired comprehension of complex sentences
- spared (impaired) single word comprehension
- spared (impaired) object knowledge
Clinical diagnosis of nonfluent/agrammatic variant of PPA
imaging supporting clinical diagnosis of nonfluent/agrammatic variant of PPA
BOTH MUST BE PRESENT
- clinical diagnosis of nonfluent/agrammatic variant of PPA
- imaging must show predominant left posterior fronto-insular atrophy/hypometabolism on MRI or PET
Left temporal variat of frontotemporal lobar degeneration
PPA semantic variant
BOTH must be present
- poor confrontation naming (pictures and objects)
- impaired single-word comprehesion
At least THREE of the following
- poor object knkowledge
- surface dyslexia and/or dysgraphia
- spared single word repetition
- spared motor speech and grammar
Clinical diagnosis of semantic variant of PPA
Imaging supporting clinical diagnosis of semantic variant of PPA
BOTH MUST BE PRESENT
- clinical diagnosis of semantic variant of PPA
- imaging must show predominant anterior temporal lobe atrophy/hypometabolism on MRI or PET
Right temporal variant of frontotemporal lobar degeneration
Associative agnosia variant of PPA
Core features
- perceptual disorder (PROSOPAGNOSIA: difficulty recognizing familiar faces)
(ASSOCIATIVE AGNOSIA: impaired recognition of object identity)
Clinical diagnosis of associative agnosia variant of PPA
BOTH must be present
- impaired single-word retrieval in spontaneous speech and confrontational naming
- impaired repetition of sentences and phrases
at least THREE must be present
- phonological errors in speech and naming
- impaired single word
comprehension and object knowledge
- impaired motor speech (no distortions)
- syntax intact
BOTH must be present
- clinical diagnosis of logopenic variant PPA
- imaging must show predominant left posterior perisylvian or parietal atrophy/hypometabolism on MRI or PET
Clinical diagnosis of logopenic variant of PPA aphasis
the logopenic variant of PPA is ALSMOST ALWAYS ___.
Alzheimer's disease
Disorder of motor planning and programming that affects speech production
- it can be sole and clinical presenting sign of a neurodegenerative disease
Primary Progressive apraxia of speech (PPAOS)
Core features of PPAOS
- slow rate
- articulatory distortions
- disorted sound substitutions
- segmentation of syllable in multisyllabic words across words
+ Agrammatism
+ AOS
+ Impaired comprehension (syntactially complex sentences)
- impaired naming
- impaired object knowledge
+ paraphasia
+ speech rate significantly reduced
+ impaired repetition of single words
Non-fluent/aggramatic variant of PPA
- agrammatism
- AOS
+ impaired comprehension of single words
+ impaired naming
+ impaired object knowledge
+/- may have paraphasias
- speech rate normal
- impaired repetition
+ (OTHER) surface dyslexia (reading) or dysgraphia (writing)
Semantic variant of PPA
- agrammatism
- AOS
+/- may have impaired comprehension
+/- may have impaired naming
- impaired object knowledge
+ paraphasia
+ moderately reduced speech rate
+ impaired repetition of sentences and phrases
Logopenic variant of primary progressive aphasia
- agrammatism
+ AOS
- imparied comprehension
- impaired naming
- impaired object knowledge
- paraphasia
+ significantly reduced speech rate
+ impaired repetition of single words
Primary progressive apraxia of speech
Localization: left posterior fronto-insular
non-fluent/agrammatic variant of PPA
Localization: anterior temporal
semantic variant of PPA
Localization: left teporo-parietal
logopenic variant of PPA
Localization: superior pre-motor, supplementary motor
primary progressive apraxia of speech
What are the distinct purposed of assessments?
- diagnosis
- prognosis
- research
- planning intervention
- measuring outcomes
Steps involved in assessing aphasia
- obtain case history
- interview client/family/caregivers
- screen hearing
- conduct oral mech exam
- administer language test battery
- assess functional communication skills
- analyze and integrate the assessment results
- share assessment results with patient/family
What is included in the client's case history
- patients biography (age, education, occupation)
- medical history (health history)
- history of previous speech therapy
What are some questions to ask the client?
- what brought you to the hospital/clinic
- do you think you have trouble communicating? How? When did it start)
- What kind of difficulties do you have communicating
- Do you understand what others say? Do you think they can understand you?
- Do you have trouble finding words you want to say?
- Difficulties writing/reading?
What are some questions you would ask the client's family?
- Have you noticed any difficulties communicating? What have you noticed with his/her speech? When did it start?
- Did he/she improve since they arrived here? Or since incident?
- Is he/she back to baseline?
How do we do an evaluation?
- administer test battery
- follow up testing with specialized tests
- select subtests from different batteries or specialized tests
- have patient perform tasks and use clinical judgement
- observe patient in natural environment and use judgment/scales for functional assessment
Aphasia is a MULTIMODALITY language disorder.... what do we evaluate?
- case history
- language components
What language components do we evaluate for aphasic clients?
- auditory comprehension
- verbal expression
- reading
- writing
ALSO EVALUATE
- cognitive/pragmatic
- structural-functional exam
- motor speech exam
Informal assessment for auditory comprehension includes...
FOLLOWING COMMANDS
- one step (point to this, look here, point to you mouth, etc..)
- two step (point to the floor then cieling, make a fist then close your eyes, etc..)
- linguistically complex: multi-step, multi-element (look at the ceiling after you point to the door, when I snap my fingers raise your hand, etc...)
- 2 steps with distracters (touch your nose BUT FIRST stick out your tongue, touch your ear BUT FIRST count to five, etc...)
What tasks would you perform for an informal assessment for auditory comprehension with severe aphasia?
- squeeze my hand (once/twice)
- close your eyes
- smile
- show me your thumb
Informal assessment for verbal expression includes...
- confrontation naming (objects/pictures)
-- what is this?
- responsive naming
-- what do you do with a cup?
- word definition
-- expressing ideas/verbal formulation
- oral spelling
- sentence repetition
- picture description (syntax/word retrieval/paraphasias/content/inferencing
- conversation
-- evaluates: syntax, word retrieval, paraphasias, neologisms, content
- sentence completion
- serial response (automated speech and singing)
-- count to 20, name days of the week, etc...
- gesture (bye, hi, thumbs up/down)
- Word fluency test
What is included in a word fluency test for informal assessment of verbal expression in aphasia?
- letter fluency (give letter of alphabet, name words starting with letter)
- category fluency (give category, name things in category)
- verb/action fluency (name things people do)
What do word fluency tasks assess?
- language (lexical semantic knowledge, lexical retrieval)
- cognition (executive control: self-initiation, verbal retrieval, self-monitoring, inhibition of responses)
- attention
- working memory
What is included in reading tests for informal assessment of aphasia?
- single words
- sentences/directions (touch your nose)
- yes/no questions
- multiple choice questions
- paragraphs
- word/picture matching
What is included in writing tests for informal assessment of aphasia?
- dictated words
- sentences
- self-generated sentence/paragraph
- written picture description
How is writing tested for severe aphasia?
- copy letters
- copy words
- copy sentences
What is included in testing cognitive/pragmatic skills for informal assessment of aphasia?
- proverbs/abstract thinking (don't put all your eggs in one basket)
- reasoning (tell me three things every good citizen should do)
- similarities/differences (difference between watch/calendar)
- problem solve (driving on freeway, run out of gas, what do you do)
- memory (recall after a delay)
- long-term memory (who is the president)
- short-term/working memory (digit recall forward and backward)
What are some pragmatic skills?
- introducing and maintaining topics
- interruptions
- eye contact
- turn taking
- facial expression
- body language
- intonation
What is the WHO ICF
conceptual framework -
A system for classifying health and health-related domains for clinical and research applications in a consistent way throughout the world to classify health conditions, not people
What is Part 1 of the most recent WHO ICF?
Part 1: Functioning and disability
-Body structure and function
-Anatomical parts
Physiological and psychological aspects
-Activity and participation
-Performance
-Capacity
What is Part 2 of the most recent WHO ICF?
Part 2: Contextual factors
- Personal factors
- Environmental factors
Impairment definition
abnormality of structure or function at the organ level
- captures potential
Disability (Activity) definition
functional consequence of an impairment
- captures performance (limitations)
Handicap (Participation) definition
social consequences of an impairment or disability
- captures social implications
- restrictions or barriers to participation
What are the 3 most commonly used standardized test batteries used with individuals with aphasia?
- Boston Diagnostic Aphasia Examination (BDAE)
- Western Aphasia Battery (WAB)
- Aphasia Diagnostic Profiles (ADP)

DO NOT RELY JUST ON TESTS, NOT ALWAYS AGREEABLE, USE CLINICAL JUDGEMENT
Benefits of Standardized Test Batteries
- Give a format to assess various skills
- Provide standard procedures for scoring and interpreting the client's responses
Issues with Standardized Test Batteries
Some standardized tests lack (fall short of) acceptable reliability and validity:
- Insufficient numbers of men vs. women
- Minority groups or bilinguals
- People from lower socioeconomic levels and rural settings
16 point scoring system based on accuracy, responsiveness (amt. of cuing needed), completeness, promptness, and efficiency
Porch Index of Communicative Abilities (PICA)
ADVANTAGES
- estimate recovery
- suggests discharge
DISADVANTAGES
- 40 hours of training/workshops
- descriptive information is limited
- insulting to higher functioning clients
Extensive test with 20 language subtests as well as additional tests for visual and tactile functions.
Evaluates:
Aud. Comprehension, verbal expression, reading, writing, copying, word fluency, digit, sentence repetition, visual object naming, sentence construction, articulation
The Neurosensory Center Comprehensive Examination for Aphasia (NCCEA)
ADVANTAGES
- scores adjusted for age and education
DISADVANTAGES
- LOW CEILING - Does not use difficult or infrequently used items or objects
- Good for severe impairment BUT may can overlook mild impairments
Specialized comprehension tests
- Token test
- Peabody Picture Vocabulary Test (PPVT-IV)
- Reading Comprehension Battery for Aphasia (RCBA-2)
- Discourse Comprehension Test (DCT)
Developed as a test for subtle or minimal auditory comprehension problems. Also used as a measure of severity of auditory comprehension. MANY VERSIONS.
Token Test
- touch a yellow square...
- touch a small white circle
- touch red circle and green square
Has a greater range of difficulty for single word comprehension.
Give every 4 items (correlates well with whole test).
Peabody Picture Vocabulary Test (PPVT-IV)
Administered in 30 minutes, reveals the severity of acquired reading problems. Measures the nature and degree of reading impairments
and overall reading comprehension. Guides the direction and focus of therapy.
Reading Comprehension Battery for Aphasia (RCBA-2)
20 subtests targeting
- Single-word comprehension for visual confusions
- Auditory confusions, and semantic confusions
- Functional reading
- Synonyms
- Sentence comprehension
- Short paragraph comprehension
- Paragraphs
- Morpho-syntactic reading with lexical controls.
Tests both auditory and reading comprehension of texts distinguishing between main ideas and details.
Discourse Comprehension Test (DCT)
Specialized verbal production tests
- Boston Naming Test (part of BDAE-III)
- Connected speech sample
- Story retelling procedure
- Discourse Sampling and Conversational Analysis
60 pictures, short 15 item version. Measures verbal production by evaluating naming ability.
Boston Naming Test (part of BDAE-III)
Measures Correct Informational Units (CIUs) and can be used with a variety of tasks. Evaluates # of intelligible single words in context
# of CIU, those that are accurate, relevant, and informative; including grammatical terms. Reports % CIU's (CIU's/words), CIU's/min.
To best achieve acceptable test-retest stability or consistency, sample size of 300-400 words is needed for measures of verbal expression.
Connected Speech Sample
Patient hears a story and sees associated pictures.
Then they are shown pictures and asked to retell the story.
Does a good job discriminating normal from aphasic.
4 equivalent forms (3 stories each).
Story retell procedures
Interactive use of language, encompassing comprehension and production, regardless of modality (written, spoken, or signed language, and verbal as well as nonverbal communication)
Discourse
- Conversational (social, interactive)
- Narrative (telling and retelling stories)
- Procedural (giving instructions)
- Expository (providing information, explaining ideas or processes, defining constructs)
- Persuasive (convincing, providing evidence to support an opinion or request for action)
- Descriptive (conveying attributes)
Discourse genres
- Linguistic (the verbal form and content)
- Extralinguistic (the environmental context of language use and the roles and backgrounds of the individuals involved in an exchange)
- Paralinguistic (prosodic aspects of intonation, pitch, and stress, use of gestures and facial expressions)
Discourse levels
Why is discourse sampling and analysis important?
- Social use of language, disorder likely to impact discourse abilities
- Determine strengths and weaknesses not evident with other assessments
- Yield critical information for differential diagnosis
- Vital to treatment planning
- Essential aspect of research (EBP)
What are key strategies for sampling discourse?
- Determine goals for sampling
- Consider using standardized tests
- Sample production and understanding during a variety of discourse genres and tasks
- Consider task instructions
What are key measures for indexing discourse competence?
- Surface-level linguistic metrics
- Indices of informativeness
- Symptom and compensatory strategy related metrics
- Indices of discourse comprehension
- Measures of information exchange and pragmatics
- Cohesion analysis indices
- Coherence analysis
What challenges do aphasiologists face in applying discourse analysis in clinical practice and research?
- Time
- Training and mentorship
- Equipment and software
- Clear communication and perceived relevance
- Replicability
- Variability in the evidence base
Types of Functional Communication Assessment
- Assessment of Language-Related Functional Activities (ALFA)
- ASHA Functional Assessment of Communication Skills for Adults (ASHA FACS)
- Bedside Evaluation Screening Test (BEST-2)
- Communicative Effectiveness Index (CETI)
- Communicative Activities of Daily Living (CADL-3)
Evaluates functional communication skills of adults who have sustained traumatic brain injury, right-hemisphere damage due to stroke, and/or aphasia by testing daily communication in everyday situations.
Communicative Activities of Daily Living (CADL-3)
Evaluates:
Reading, writing, and using numbers
Social interaction
Divergent communication
Contextual communication
Nonverbal communication
Sequential relationships
Humor/metaphor absurdity
Bilingual tests for aphasia
- Multilingual Aphasia Examination
- Bilingual Aphasia Test (BAT) - (40 languages)
- BDAE, BNT, and CALD
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