Language Development Through Lifespan o Unless there is neuropathology adults continue to refine communication skills o Use Adults are skilled conversationalists Narratives improve until 70s o Content Some words fade and others are added Deficits in accuracy Aphasia Literally means without language Affects over 1 million people in the U S May affect listening speaking reading and writing Range in severity o Related to cause location extent age of brain injury age general health of patient Patterns of behavior can be used to categorize by type syndrome Expressive deficits o Reduced vocab o Omission addition of words o Stereotypic speech o Delayed or reduced output of speech o Hyperfluent speech o Word substitutions Language comprehension o Impaired interpretation of linguistic information Concomitant Deficits Expressive language deficits o Hemiparesis when one side of the body has some weakness different from paraplegia typically occurs because of a unilateral stroke o Hemiplegia total inability to use one side one sided paralysis o Hemisensory impairment reduced or inability to sense or feel things on one side unable to feel heat pain etc can be very dangerous o Hemianopsia knocks out vision on one side of the visual field o Dysphagia abnormal swallowing o Agnosia inability to recognize something o Agrammatism missing grammar ex take dog walk o Agraphia inability to write language o Alexia inability to read language o Anomia inability to name things o Jargon language that has no meaning Real words come out but they have no meaning together o Neologism making up new words for something o Paraphasia words close to an actual word but not quite there ex I need a pen or pencil and a piece of peeper o Verbal stereotype phrase or word repeated over and over again o Aphasia types Fluent Aphasia Wernicke s Aphasia Speech production is fluent or hyperfluent Speech comprehension is impaired to poor Speech characteristics have verbal paraphasias and jargons Reading comprehension is poor Naming is poor Repetition is poor Content is jumbled makes little sense to the listener They don t realize the communication partner is confused by their words Speech production is fluent Speech comprehension is mild to moderately impaired Speech characteristics word retrieval and misnaming but good syntax and articulation Reading comprehension is good Naming is severely impaired in both speech Anomic Aphasia and writing Repetition is good Circumlocutions are prevalent Conduction Aphasia Speech production is fluent Speech comprehension is mildly impaired to good Speech characteristics paraphasias and incorrect ordering of sounds with frequent self correction attempts and good articulation and syntax Reading comprehension is good Naming is usually impaired Repetition is poor Transcortical Sensory rarest Speech production is fluent Speech comprehension is poor Speech characteristics verbal paraphasias and possible preservation Reading comprehension is impaired to poor Naming is severely impaired Repetition is unimpaired Subcortical Speech production is fluent Speech comprehension is relatively unimpaired Speech characteristics paraphasias and neologisms as well as perseverations Reading comprehensions are unimpaired Naming is impaired Repetition is impaired Nonfluent Aphasia slow labored speech There are word retrieval and syntactical error problems Broca s Aphasia Speech production is nonfluent Speech comprehension is relatively good Speech characteristics short sentences agrammatism and slow labored articulation Reading comprehension poor Naming poor Repetition poor Transcortical Motor Aphasia Speech production is nonfluent Speech comprehension is mildly impaired Speech characteristics impaired labored difficulty initiating syntax errors Reading characteristics poor Global Aphasia Speech production is nonfluent Speech comprehension is poor Speech characteristics are limited Reading comprehension is poor Naming is poor Repetition is poor Some aphasias may affect primarily one modality Alexia with agraphia Alexia without agraphia Pure agraphia Pure word deafness Crossed aphasia Causes of Aphasia o Stroke Types Ischemic cerebral arteriosclerosis embolism thrombosis Lack of blood flow to certain areas of the brain Transient ischemic attack mini strokes Hemorrhagic break in the artery Aneurysm Arteriovenous malformation malformation of where the arteries and veins meet Typically go largely unnoticed until they have a stroke Greatest improvement at end of the first month and into second month o Injury to left hemisphere language areas causes aphasia in most people o Aphasia like symptoms seen in other conditions Head injury neural infections degenerative neural disorders tumors o Primary Progressive Aphasia Degenerative disorder of language Lifespan Issues o Most victims of stroke are middle age and beyond o Risk of stroke increases with Smoking alcohol poor diet lack of exercise high BP high cholesterol diabetes obesity previous strokes o First signs Loss of consciousness headache weak immobile limbs slurred speech o will die from stroke or soon after o Those that survive may need services after o May receive services for at least first few acute care stay months o Families often are frightened and confused o Patients may exhibit perseveration disinhibition emotional problems o Course extent of recovery is difficult to predict o Spontaneous recovery o The earlier the treatment the better the o Loss of language can lead to social isolation Assessment for aphasia o Assessment occurs in multiple phases as client recovery recovers o Medical history o Interview with client and family o Oral peripheral exam o Hearing testing o Direct speech and language testing o Counseling is ongoing o Formal testing is postponed until patient is stable o May conduct an informal bedside evaluation o Make recommendations for rehab first Intervention o Goal Aid recovery and provide compensatory strategies o Determined by assessment and client family needs o Cross modality generalization comprehension production o Conversational techniques o AAC o Neural plasticity o Involve family members o Guidelines Treat the client in an age appropriate fashion Keep your language very clear and simple Adjust your language and speaking rate to meet the processing needs of your client Use everyday items and family members Increase the demands placed on the client gradually based on the client s abilities Teach the client to use their strengths to