Study Guide Final SPA2001 Ch 6 Adult Language Impairments A P H A S I A Aphasia without language Problems in auditory comprehension and word retrieval First signs include loss of Symptoms consciousness headache weak immobile limbs slurred speech occurs in multiple phases as a client recovers Assessment o Overall communication skills expressive language receptive language and all modalities are addressed across all aspects of language Lifespan Issues Goal is to aid recovery and provide compensatory strategies Methods include cross Intervention modality generalization conversational techniques bridging between cerebral hemispheres multimodality stimulation AAC neural plasticity and involve family members Incidence and prevalence Following acute care may need rehabilitative care outpatient rehab or nursing home care Most individuals receive services for at least the first several months May exhibit perseveration disinhibition and emotional problems Course and extent of recovery is difficult to predict The most frequent linguistic gains are in comprehension Population is very diverse affect half a million Americans annually Causes Stroke or cerebrovascular accident Not the result of a motor speech impairment dementia or deterioration of intelligence o Stroke victims are usually middle aged and beyond o First signs o Risk increases with o Incidence and prevalence smoking alcohol use poor diet lack of exercise high blood pressure high loss of consciousness headache weak immobile limbs and slurred speech cholesterol diabetes obesity previous strokes Strokes affect half a million Americans annually As a result of stroke approximately 100 000 people become aphasic each year 1 3 will die from a stroke or soon after Ischemic blockage occlusion of the arteries transporting blood to the brain Cerebral arteriosclerosis Thickening of the walls of cerebral arteries in which elasticity is lost or reduced the walls become weakened and blood flow is restricted Embolism Obstructed blood flow caused by blood clot fatty materials or air bubble Thrombosis Plaque buildup or blood clot formed on site and does not travel causing blood flow to be restricted Transient ischemic attack Temporary condition with symptoms mirroring a stroke blood flow to a portion of the brain is blocked or reduced but then returns after a short interval Noticeable improvement in the first weeks but slows after 3 months Patterns of recovery Hemorrhagic Weakened arterial walls burst under pressure Aneurysm a saclike bulging in a weakened artery wall Arteriovenous malformation poorly formed tangle of arteries and weins malformed arterial walls may be weak and give way under pressure Patterns of recovery Most rapid recovery is at the end of the first month and into the second Accompanying Deficits of Aphasia Hemiparesis weakness on one side of the body Hemiplegia paralysis on one side of the body Hemisensory impairment loss of the ability to perceive sensory information on one side of the body Hemianopsia blindness in the visual field of each eye contralateral to the site of a deep lesion Dysphagia difficulty chewing or swallowing Study Guide Final SPA2001 Seizure disorder or epilepsy is seen in about 20 of individuals with aphasia Agnosia difficulty understanding incoming sensory information Agrammatism omission of grammatical elements Agraphia difficulty writing Alexia reading problems Anomia difficulty naming entities Neologism a novel word Paraphasia word substitutions found in clients who may talk fluently and grammatically Verbal stereotype an expression repeated over and over Jargon meaningless or irrelevant speech with typical intonational patterns C N S I N L A N G U A G E P R O C E S S I N G Linguistic information is processed in the left hemisphere Nonlinguistic and paralinguistic information are primarily processed in the right Incoming auditory information is held in working memory in Broca s area in the frontal lobe while it is processed Most incoming linguistic processing occurs in Wernicke s area in the left temporal lobe assisted by the angular gyrus for words and the supramarginal gyrus for grammar For outgoing information concepts are formed and the angular gyrus and supramarginal gyrus contribute to the overall message formation that occurs in Wernicke s area while held in working memory in Broca s area Broca s area sends programming information to the motor cortex which sends signals to the motor neurons for speech T Y P E S O F A P H A S I A Primary progressive aphasia A degenerative disorder of language with preservation of other mental functions and activities of daily life Progresses from primarily a motor speech disorder to a near total inability to speak Fluent or hyperfluent Aphasia Word substitution neologisms verbose verbal output Causes Often posterior lesions in the left hemisphere o Wernickle s aphasia Verbal paraphasia or unintended words neologisms Auditory visual comprehension Speech Sentence formation Naming capabilities Imitative speech Strings of jargon mild severe impairment mild severe impairment Poor Non fluent Aphasia Slow labored speech struggle to retrieve words form sentences Causes lesion in or near the frontal lobe o Broca s aphasia Damage to anterior parts of the left frontal lobe centered in Broca s area Sentence formation Speech writing Imitative speech Naming capabilities Auditory comprehension anomia short with agrammatism slow and labored Articulation phonological errors problems apparent may be subtly impaired Study Guide Final SPA2001 o Global Mixed aphasia Associated with a large deep lesion involving both anterior speech and posterior language areas of the left hemisphere Profound language impairments in all modalities Auditory visual comprehension Expressive ability Imitative speech naming affected limited to single words or short phrases limited spontaneous expressive ability of a few words stereotypes R I G H T H E M I S P H E R E B R A I N D A M A G E RHBD group of deficits resulting from right cerebral hemisphere injury Paralinguistic information is processed in the RH RH is important for activation of distant word and sentence meanings Difficulties with memory and components of executive function such as problem solving reasoning 50 78 of individuals exhibit one or more communication impairments many do not receive treatment organization planning and self awareness and a wide range of communication impairments Characteristics Attention deficits lack of response to