Term
| Cognitive Neuropsychological Models - General Info |
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Definition
Based upon theory of "normal" processes
Model of functional architecture for the behavior of interest
Assess specific components of the behavior based on patient characteristics
Identify the locus of the impairment with respect to the normal model
Target treatment to address or compensate for impairments |
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Term
| Cognitive Neuropsychological Models - Assessment areas |
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Definition
Perceptual Analysis
Recognition
Meaning
Form
Speech
Allows for the breakdown of complex behaviors |
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Term
| Cognitive Neuropsychological Models - Components |
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Definition
Perceptual Analysis - Primary processing
Recognition - Processing advantage to "known" items
Meaning - Semantics; central representation - could be degraded or lost
Form - frequency sensitive
Output - Motor System |
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Term
| Cognitive Neuropsychological Models - Semantic Level |
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Definition
| Activation of semantics - semantic features |
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Term
| Cognitive Neuropsychological Models - Lexical Level |
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Definition
| Recovery of lemma - semantic activation means that related lemmas also get activated |
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Term
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Definition
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Term
| Cognitive Neuropsychological Models - Phonological Level |
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Definition
Activation of phonological form
Phonological neighbors are also activated - may yield phonemic errors or word form errors |
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Term
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Definition
Non-lexical
Lexical Semantic
Lexical nonsemantic |
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Term
| Cognitive Neuropsychological Models - Shortcomings |
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Definition
Components likely underspecified
Detailed assessment can be time consuming
Do not take into account other cognitive capacities that may affect performance
Different deficits may respond to the same treatment
Same deficits don't always respond to the same treatment |
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Term
| Distributed Models - Mesulam |
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Definition
Anatomic substrates of individual cognitive domains take the form of large-scale neurocognitive networks that contain certain interconnected cortical and sub cortical nodes
Each major node of a cognitive network belongs to multiple intersecting networks
Same domain may be affected by different lesions
Single region may yield more than one cognitive deficit |
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Term
| Mesulam - 4 cognitive networks |
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Definition
Left-hemisphere Language network
Right-hemisphere attentional network
Limbic system
Frontal network |
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Term
| Parallel Distributed Processing |
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Definition
network function/knowledge in the connections
deals with representation (STM/LTM)/processes
Pattern associator/one domain to another
Distributed representations: few features activate whole memory
Bottom up and top down processing |
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Term
| Mesulam - left hemisphere language network |
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Definition
Broca's area, Wernicke's area and parts of angular and supramarginal gyri
Interconnected with several perisylvian regions and specific parts of the thalamus and the striatum |
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Term
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Definition
| Loss of impairment of language function caused by brain damage - an umbrella concept combining a multiplicity of deficits involving one or more aspects of language use |
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Term
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Definition
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Term
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Definition
| any "morbid" phenomenon or departure from the normal structure, function, or sensation experienced by the patient and indicative of a disease (headache, pain) |
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Term
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Definition
| an objective symptom (numbness, impaired speech) |
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Term
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Definition
| collection of signs and symptoms that constitute a "picture" of disease (aphasia) |
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Term
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Definition
| cause of disease (stroke) |
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Term
| Behaviors tested for Aphasia |
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Definition
Fluency
Naming
Auditory Comprehension
Repetition |
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Term
| Classical Aphasia Syndromes - Broca |
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Definition
Fluency - Nonfluent
Naming - impaired
Repetition - impaired
Comp. - Preserved |
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Term
| Classical Aphasia Syndromes - Wernicke |
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Definition
Fluency - Fluent
Naming - Impaired
Repetition - Impaired
Comp. - Impaired |
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Term
| Classical Aphasia Syndromes - Conduction |
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Definition
Fluency - fluent (-)
Naming - Impaired
Repetition - Impaired
Comp. Preserved (-) |
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Term
| Classical Aphasia Syndromes - TCM |
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Definition
Transcortical Motor
Fluency - nonfluent
Naming - impaired
Repetition - Preserved
Comp. - preserved |
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Term
| Classical Aphasia Syndromes - TCS |
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Definition
Transcortical Sensory
Fluency - Fluent
Naming - impaired
Repetition - preserved
Comp. - Impaired |
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Term
| Classical Aphasia Syndromes - TC Mixed |
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Definition
Trascortical Mixed
Fluency - nonfluent
Naming - impaired
Repetition - preserved (but not voluntary)
Comp. - impaired |
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Term
| Classical Aphasia Syndromes - Anomic |
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Definition
Fluency - fluent*
Naming - impaired
Repetition - preserved
Comp. - preserved |
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Term
| Classical Aphasia Syndromes - Global |
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Definition
Fluency - nonfluent*
Naming - impaired
Repetition - impaired
Comp. - impaired |
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Term
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Definition
45-60% of patients
Atypical cerebral dominance
Bilateral damage
multiple lesions
progressive neurologic disease
Pre-morbid deficits ex. substance abuse, learning disabilities |
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Term
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Definition
Good starting point
Syndrome evolution
Baseline performance
Need to look for individual's strengths and weaknesses |
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Term
Characteristics associated with aphasia syndromes - Broca's
1. Auditory Comprehension
2. Verbal Expression
3. Typical word retrieval errors
4. Left hemisphere lesion location |
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Definition
1. asyntactic
2. agrammatism, aprosodia, apraxia of speech, poor repetition
3. semantic, verbs worse than nouns
4. inferior frontal operculum extending to subcortical |
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Term
Characteristics associated with aphasia syndromes - TCM
1. Auditory Comprehension
2. Verbal Expression
3. Typical word retrieval errors
4. Left hemisphere lesion location |
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Definition
1. may be asyntactic
2. poor initiation and elaboration; intact repetition, echolalia
3. no response, perseverations
4. dorsolateral frontal: SMA or thamalus |
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Term
Characteristics associated with aphasia syndromes - Global
1. Auditory Comprehension
2. Verbal Expression
3. Typical word retrieval errors
4. Left hemisphere lesion location |
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Definition
1. severe impairment, midline commands may be intact - because both sides of brain are involved
2. limited to retain prosody, stereotypies, poor repetition
3. stereotypies, automatisms
4. large, pre and post rolandic |
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Term
Characteristics associated with aphasia syndromes - TC Mixed
1. Auditory Comprehension
2. Verbal Expression
3. Typical word retrieval errors
4. Left hemisphere lesion location |
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Definition
1. like global
2. limited spontaneous speech, intact repetition, echolalia
3. like global
4. watershed extra-sylvian area |
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Term
| Broca's Aphasia - Characteristics (Fluency, Naming, Repetition, Comprehension, Reading, Writing) |
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Definition
Nonfluent - short phrases, difficulty with ease of production, filling temporal space also dysprosodic and paraphasic
Poor naming - verbs may be worse than nouns, VCN may be better than spontaneous speech
Poor repetition - reflects difficulty with verbal ouput
Auditory Comprehension - relatively good, asyntactic comprehension deficit
Agrammatism
Apraxia of speech
Reading Comprehension - generally parallels with auditory comprehension but reading aloud is typically impaired
Writing also parallels speech - apraxic and linguistic agraphia |
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Term
| Broca's Aphasia Lesion localization |
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Definition
Generally conforms to superior branch of the middle cerebral artery, involving large portions of the frontal and parietal lobes and is most often secondary to a large embolus
Lesion not only in Broca's area but also involves the foot of the sensorimotor cortex, the insula, and extends to the anterior portion of the supramarginal gyrus
Subcortical white matter is also often damaged |
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Term
| Broca's aphasia - associated deficits |
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Definition
Buccofacial apraxia (non-verbal apraxia)
Ideomotor limb apraxia
Right hemiplegia |
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Term
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Definition
| Lesions that are confined to Broca's area: i.e. the third frontal convoluation (area 44, pars triangularis) and 45 (pars opercularis) do not cause persistent Broca's aphasia, but rather start off as mutism and generally resolve to a mild verbal dyspraxia (phonetic disintegration) |
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Term
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Definition
Historically has been viewed as part of the syndrome of Broca's aphasia
Patients with agrammatism typically have been characterized by: haling and effortful fragmented language production, the syntactic complexity of sentences is reduced, content words (nouns and verbs) are used more frequently than grammatical words (articles, prepositions, auxiliary verbs)
Telegraphic |
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Term
| Recovery from Broca's aphasia |
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Definition
Broca's aphasia reportedly has an "intermediate" prognosis
Showed highest rate of recovery, but none "fully" recovered
Greatest degree of improvement occurred during the first three months post onset; still significant during the third and sixth month post onset, and slowed considerably after six months
Some gains were observed after 1 year post onset
Younger patients seemed to show the greatest recovery |
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Term
| Wernicke's Aphasia Characteristics |
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Definition
High fluency
low auditory comprehension, repetition, naming
Usually not hemiparetic
lesion - peri-sylvian, posterior |
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Term
| Wernicke's aphasia auditory comprehension |
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Definition
Severely impaired
Often cannot follow simple, single step commands
Deficit may become more apparent after a few commands have been followed
Whole body commands or "axial commands" may be completed correctly after attention is attained
Generally believed that the comprehension deficit occurs at the level of phonemic processing which is supported by the presence of equally severe repetition in these patients
Have a marked difficulty "switching sets" once a response pattern has been established |
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Term
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Definition
| severely impaired results in phonemic and semantic paraphasias |
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Term
| Wernicke's Spontaneous speech |
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Definition
Fluent output - usually produced effortlessly
Paraphasic - may be semantic, phonemic, both, or approaching neologistic jargon (usually complex combination)
may be normal or excessive in quantity - press of speech or "verbal logorrhea"
Prosodically accurate
paragrammatic |
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Term
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Definition
Impaired
Visual Confrontation naming tasks may yield more phonemic paraphasias than seen in spontaneous speech |
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Term
| Wernicke's additional deficits |
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Definition
Reading is usually severely impaired, often to the degree of spontaneous speech
A subtype of Wernicke's aphasia seems to have somewhat better preserved reading, perhaps due to more limited extensions to the IPL
Writing - parallels spontaneous speech
Linguistic agraphia with handwriting is preserved |
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Term
| Wernicke's other characteristics |
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Definition
Anosognosic for speech - frequently unaware of the errors in speech - lack of insight as to errors and communication deficit
Alientation/suicidal - often misdiagnosed as confused, demented, psychotic
Absence of "associated deficits" as seen in other aphasias |
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Term
| Wernicke's Lesions Localization |
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Definition
Classic - posterior/superior temporal lobe (22) of the left hemisphere (WA area): this is the minimal and sufficient lesion to yield a WA
Lesion may extend to occipital and parietal areas. These lesions (extensive) tend to have more persistent deficits, especially if there is deep temporal white matter, SMG or both involved
Parietal extension will be reflected in greater difficulty in visual/spatial tasks
Middle and inferior temp. gyri extensions will have persistent anomia and alexia |
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Term
Characteristics associated with aphasia syndromes - Wernicke's
1. Auditory Comprehension
2. Verbal Expression
3. Typical word retrieval errors
4. Left hemisphere lesion location |
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Definition
1. Poor; like global
2. non-meaningful logorrhea, jargon, anosognosia
3. neologisms, semantic, phonemic
4. superior temporal |
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Term
Characteristics associated with aphasia syndromes - TCS
1. Auditory Comprehension
2. Verbal Expression
3. Typical word retrieval errors
4. Left hemisphere lesion location |
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Definition
1. milder than global
2. intact repetition, echolalia
3. semantic, phonemic, circumlocutions
4. temporal-parietal or degenerative |
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Term
Characteristics associated with aphasia syndromes - Conduction
1. Auditory Comprehension
2. Verbal Expression
3. Typical word retrieval errors
4. Left hemisphere lesion location |
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Definition
1. asyntactic
2. conduit d'approche (try to fix errors), poor repetition
3. phonemic, semantic
4. parietal insula |
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Term
Characteristics associated with aphasia syndromes - Anomic
1. Auditory Comprehension
2. Verbal Expression
3. Typical word retrieval errors
4. Left hemisphere lesion location |
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Definition
1. intact
2. pauses for word retrieval, intact repetition
3. circumlocutions, no response, semantic; nouns worse than verbs
4. inferior temporal or thalamus or degenerative |
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Term
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Definition
Acutely patient may be euphoric and gesturally hyperactive
Later patient may demonstrate some paranoia
Chronically, these patients usually develop some self-monitoring skills, resulting in a decrease in phonemic paraphasia, semantic paraphasias may go unnoticed
Wide range of recovery: tends to fall into bimodal pattern
1. Some retain their fluent jargon under pressure for many months. over time, phonemic paraphasia resolve and they are left with semantic paraphasia and persistent anomia
2. others with less jargon initially demonstrate better recovery and resolve more quickly in the direction of anomic aphasia, demonstrating gains in comprehension and repetition |
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Term
| Conduction Aphasia - Fluency |
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Definition
fluent but with frequent paraphasic errors: mostly phonemic paraphasic errors
Very aware of errors - makes frequent attempts to correct them (conduit d'aproche)
May anticipate errors resulting in decrease in rate, increase in circumlocutions |
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Term
| Conduction Aphasia - Auditory Comprehension |
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Definition
| Relatively intact: especially if not syntactically complex |
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Term
| Conduction Aphasia - Naming |
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Definition
| almost always anomic: from phonemic paraphasias to inability to retrieve word |
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Term
| Conduction Aphasia - Repetition |
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Definition
| In contrast: marked deficit in repetition, especially for phrases or sentences or unfamiliar words and nonsense words |
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Term
| Repetition conduction aphasia |
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Definition
| Deficits in auditory short-term memory characterized by disturbance in only verbal repetition tasks |
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Term
| Reproduction conduction aphasia |
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Definition
| affects phonologic output processes in general: have difficulty with word production across output tasks |
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Term
| Conduction Aphasia - Additional deficits |
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Definition
reading aloud and writing usually parallels repetition
Writing - ranges from misspellings to profound paragraphia |
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Term
| Conduction Aphasia - associated deficits |
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Definition
Buccofacial apraxia and limb apraxia
May have some hemiparesis, more in arm than leg, not usually hemiplegic |
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Term
| Conduction Aphasia - Lesion Localization |
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Definition
Two possible sites
Arcuate fasciculus of the dominant hemisphere: disconnecting WA from BA (insular) "traditional view" but may not be necessary for CA
Wernicke's area to parietal lobe: posterior superior temporal gyrus to supramarginal gyrus (posterior left planum temporale, important for phonological STM); most current evidence supports this location
May be that the right hemisphere is doing the comprehension and left motor cortex is producing language: lesions disconnect the two areas
Extent of lesion varies: may influence fluency, semantic paraphasias, comprehension |
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Term
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Definition
positive prognosis: many cases demonstrating excellent recovery
CA may be stage of WA recovery
Acute CA: paraphasia decrease, pt. becomes less fluent because anticipates errors and attempts self-correction
Along with BA, CA showed highest rate of recovery, with the greatest amount of recovery occurring within the first three months post onset |
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Term
| Global Aphasia - total aphasia |
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Definition
| Severe disruption of all aspects of speech and language with grossly nonfluent verbal output |
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Term
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Definition
Non-fluent
Typically only a few words or stereotyped, repetitive utterance: "verbal stereotypy"
Fluent global aphasia subtype - poor prognosis
Emotionally charged phrases may be produced fluently, spontaneously
Series speech is severely limited: sometimes may produce the beginning of a series with prompting
Prosody is also impaired |
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Term
| Global Aphasia - Auditory Comprehension |
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Definition
Severely impaired
Variable performance on simple commands
Often patient refuses to participate
In context may be better than formal testing
May folow some gross midline commands
Becomes more sensitized to nonverbal communications: gestures, facial expression, intonation and therefore may appear to comprehend better than they actually do |
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Term
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Definition
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Term
| Global Aphasia - Reading/Writing |
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Definition
Typically severely impaired
Check reading, may be a bit better and a way to support communication |
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Term
| Global Aphasia - Associated characteristics |
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Definition
Praxis is also usually severely involved
hemiplegia
hemianethesia
homonymous hemianopsia
right-sided neglect |
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Term
| Global Aphasia - Lesion localization |
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Definition
extensive lesion in the territory of the left middle cerebral artery
Large, peri-sylvia lesion (pre and post rolandic)
fronto-temporo-parietal cortex
Basal ganglia
motor strip usually
Isolated subcortical lesions |
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Term
| Global Aphasia - Recovery |
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Definition
Generally a poor prognosis especially if significant improvement is not seen within the few few weeks
Many patients will make a slow gradual evolution to severe BA over time
Treatment shows some effects, but as rule, show limited recovery
Comprehension improves more than speech output, especially for social conversation
In some cases, may be transient, quickly evolving to another type
If WA is relatively spared, they will evolve in direction of BA relatively quickly
1 month post onset without improvement is a poor prognosis for substantial recovery
hemorrhagic may show gains later, but after 2 months if still global then prognosis is poor |
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Term
| Global Aphasia - 6 month window |
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Definition
around 6 months post onset some patients show improvements in: nonverbal communication, praxi, alertness and responsiveness
also increasing signs of frustration and despression |
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Term
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Definition
| aphasia resulting from lesions in the watershed or "borderzone" region with striking preservation of repetition |
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Term
| Trascortical Motor Aphasia - Fluency |
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Definition
Nonfluent
may initially present as mute
spontaneous speech: can be "stumbling" repeptitive, even stuttering like
syntax, highly simplified, may be classified as agrammatic
marked reduction in the amount and complexity of spontaneous speech despite retained ability to repeat sentences
may be produced with effort
series speech is performed fairly well once the series is initiated
Differences in output with exo-evoked versus endo-evoked responses |
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Term
| Trascortical Motor Aphasia - Repetition |
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Definition
relatively well-preserved
can repeat full sentences
corrects grammatically incorrect statements
rejects nonsense words when they repeat
may have greater difficulty repeating longer sentences, closed class items, low probability words/sentences
Repetition distinguishes TCM from BA |
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Term
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Definition
"close" the end of the task
ex. no if, ands, or .....TCM person will almost have to finish it. |
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Term
| Trascortical Motor Aphasia - Naming |
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Definition
impaired
difficulty initiating articulation at times
may pair output with another motor response (such as tapping, waving) to help initiat
Prompting with phonemic or semantic cues may help, but can be misled by an erroneous prompt |
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Term
| Trascortical Motor Aphasia - Auditory Comprehension |
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Definition
relatively spared
may have difficulty with syntax-dependent comprehension
yes/no response often unreliable |
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Term
| Trascortical Motor Aphasia - reading/writing |
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Definition
Reading may be relatively better preserved in some; others may have significant alexia
Writing is typically impaired, with apraxic agraphia |
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Term
| Trascortical Motor Aphasia - associated signs |
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Definition
hemiparesis of leg more than arm
mute initially
bilateral ideomotor apraxia
akinesia (paucity of movement)
bradykinesia (slowness of movement)
transient urinary incontinence
contralateral grasp reflex
upper extremity rigidity |
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Term
| Trascortical Motor Aphasia - lesion location |
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Definition
1. large lesion in left anterior waterhsed (borderzone) region which spares Broca's area
2. infarction in the anterior cerebral artery resulting in damage to SMA and its limbic connnections
3. Isolated lesion to Broca's area: rare but potentionally may lead to TCM |
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Term
| Trascortical Motor Aphasia - Recovery |
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Definition
recovered to anomic or non-aphasic on WAB AQ
another study, 80% remained moderately to severely impaired
may have evolved from BA |
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Term
| Different types of perseveration |
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Definition
Stuck-in-set
recurrent
continuous |
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Term
| Stuck-in-set Perserveration |
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Definition
the inappropriate maintenance of a current category or framework
involves an underlying process deficit in executive functioning
related neuroanatomically to frontal lobe damage
ex. wires on a wheel - spokes
to make you laugh, you tell a - joke
white part of an egg - ? usually yolk |
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Term
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Definition
the unintentional repetition of a previous response to a subsequent stimulus
involves an abnormal post-facilitation of memory traces
related neuroanatomically to posterior left hemisphere damage |
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Term
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Definition
the inappropriate prolongation or repetition of a behavior without interruption
involves a deficit in motor output
most common in patients with damage to the basal ganglia |
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Term
| Trascortical Motor Aphasia - differential diagnosis |
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Definition
repetition ability distinguishes it from BA
look for repetition compared to spontaneous speech
two possible variations of TCM
1. free of perseveration
2. great deal of interference of perseveration; i.e. when they do have trouble in word retrieval it tends to be perseverative response |
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Term
| Transcortical Sensory Aphasia - auditory comprehension |
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Definition
severely impaired
deficit at the level of connecting sound to meaning
phonemic processing is intact for both input and output (can repeat)
comprehension may be slightly better than in WA, but is still significantly impaired and very context dependent |
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Term
| Transcortical Sensory Aphasia - Naming |
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Definition
severely impaired
unable to name or describe objects |
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Term
| Transcortical Sensory Aphasia - Reading/writing |
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Definition
reading aloud may be possible, but reading comprehension is even more impaired than in audition
Writing also severely impaired, at least as bad as spoken output |
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Term
| Transcortical Sensory Aphasia - associated deficits |
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Definition
not usually hemiparetic, often misdiagnosed as psychotic
constructional apraxia
ideational apraxia
anosognosia
elements of Gerstmann syndrome |
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Term
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Definition
| Agraphia, left-right confusion, finger identification, acalculia, limb apraxia in absence of aphasia |
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Term
| Transcortical Sensory Aphasia - lesion localization |
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Definition
no great data regarding lesion
thought to be large lesion in the temporo-parieto-occiptal region: watershed (borderzone)
Posterior and deep to Wernicke's area in the borderzone between MCA and PCA territories
more typically seen in post-traumatic cases that in strokes
also seen in dementia (alzheimer's disease) |
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Term
| Transcortical Sensory Aphasia - Recovery |
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Definition
from other etiologies other than dementia usually good though sample size is limited
quickly evolves to anomic picture - these were from head injury
in dementia: deteriorates
Benson: reports that recovery form TCS is guarded. May reflect differences in etiologies |
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Term
| Mixed Transcortical Aphasia - General facts |
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Definition
rare syndrome: characterized by severely impaired auditory comprehesion, limited or absent meaningful spontaneous speech and preserved repetition
Most often found with multi-focal or diffuse pathology that spares the perisylvian region |
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Term
| Mixed Transcortical Aphasia - Fluency |
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Definition
nonfluent
absent propositional speech: no speech initiation
responses are short, meaningless
series speech may be preserved once initiated
completion phenomenon |
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Term
| Mixed Transcortical Aphasia - Auditory comprehension |
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Definition
severely impaired
echololic: repeats the question |
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Term
| Mixed Transcortical Aphasia - Repetition |
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Definition
not normal, but better than spontaneous speech or comprehension
limited by auditory span
may make syntactic but not semantic corrections in sentence repetition |
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Term
| Mixed Transcortical Aphasia - Naming |
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Definition
| severely impaired with semantic paraphasias, neologisms, or no response |
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Term
| Mixed Transcortical Aphasia - Reading/writing |
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Definition
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Term
| Mixed Transcortical Aphasia - associated findings |
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Definition
hemiplegia
hemianesthesia
homonymous hemianopsia |
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Term
| Mixed Transcortical Aphasia - Lesion localization |
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Definition
watershed areas of the cortex (anterior and posterior)
Results from: occlusion o fthe carotid artery, trauma, diffuse encephalopathy |
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Term
| Mixed Transcortical Aphasia - Recovery |
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Definition
may recover some but not as much as TCS or TCM aphasia
only two patients studied: one evolved to severe anomic |
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Term
| 3 basic components of assessment |
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Definition
1. data collection
2. hypothesis formation
3. hypothesis testing |
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Term
| 3 basic components of assessment - data collection |
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Definition
1. formal measures: WAB, BDAE, MTDDA, PICA
2. informal measures
self-report of spouse: CETI, ASHA FACS, FIM
3. observation: structured (formal tests)
unstructured (conversation)
moderately structured (picture description, story retelling) |
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Term
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Definition
published test, standardized test of otherwise; published quantification measure
can be quantitative or qualititative
establish baseline/current level of performance DX, prognosis
consider psychometric properties depending upon goal of assessment
standardization: procedures are standardized, appropriate demographics
Reliability - similar results across repeated administrations in similar testing circumstances
Validity - theoretical, empirical support: content, construct, ecological etc. |
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Term
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Definition
also includes background data gathered from chart, family and caregiver interviews
quantitative or qualitative
hypothesis testing
observation: extent of problem, where does behavior break down? what helps (strategies), underlying mechanism
determine appropriate clinical goals
dynamic assessment
contextualized abilities |
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Term
| International Classification of Functioning: ICF (WHO model) |
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Definition
focus on the impact of the disease or injury on the body and its functions
body structure/body function (impairment)
activity and participation: limitations in personal activities (disability) and restrictions in participation (handicap)
Contextual (environmental) factors |
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Term
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Definition
not just limited to impairment-based assessment
include assessments of activity, participation, and quality of life
functional measures: target real life activities
participation measures: AMT characteristic of daily life
QOL measures: feelings, attitudes, beliefs, satisfaction with life |
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Term
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Definition
Different settings have different requirements - bedside vs outpatient rehab, patient characteristics, setting characteristics, demands/roles may vary
Interdisciplinary team members - who will do what where? |
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Term
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Definition
full PMH: medical (esp. neurologic)
social - education, work, married
current hospitalization
other data from this hospitalization - neuroimaging, neurologic exam, neuropsychology
observation: mental status - A/A (awake, aware) x3 (or 4) (name, date, year, where) memory; motor signs |
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Term
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Definition
| sample a range of behaviors |
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Term
| Western Aphasia Battery (WAB) |
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Definition
severity (aphasia quotient)
with written language (language quotient)
aphasia classification
short form (screening test) |
|
|
Term
| WAB results - Broca's aphasia |
|
Definition
fluency - 0-4
Comprehension - 4-10
Repetition - 0-7.9
Naming - 0-8
N=24
Mean a.q. - 31.7 |
|
|
Term
| WAB results - Wernicke's aphasia |
|
Definition
fluency - 5-10
Comprehension - 0-6.9
Repetition - 0-7.9
Naming - 0-9
N=13
Mean a.q. 34.0 |
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Term
| WAB results - Conduction aphasia |
|
Definition
"fluent"
Preserved auditory comprehension
disproportionately impaired repetition
Fluency - 5-10
Comprehension - 7-10
Repetition - 0-6.9
Naming 0-9
N=15
Mean a.q. 60.5 |
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|
Term
| WAB results - Anomic aphasia |
|
Definition
fluency - 5-10
Comprehension - 7-10
Repetition 7-10
Naming 0-9
N=25
Mean a.q. - 83.3 |
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|
Term
| Formal measures (test names) |
|
Definition
Boston diagnostic aphasia exam 3rd edition
aphasia diagnostic profiles
boston assessment of severe aphasia (basa)
bilingual aphasia exam
pyramids and palm tree
psycholinguistic assessment of language processing in aphasia (palpa)
comprehension aphasia test (cat)
porch index of communicative ability (pica) |
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Term
|
Definition
porch index of communicative ability
pyschometric assessment: scores only: rigid control over other variables: there are 12 subtests
15 point scoring (16, but nobody gets 16)
15: complete/correct
12: correct with repetition
9: self-correction etc.
samples only certain behaviors: not enough information
long; used often in research
need to be formally instructed in administration by someone PICA trained |
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Term
| Formal measures: specific language functions: word retreival |
|
Definition
Boston Naming Test
high to low frequency
stimulus cue to accommodate agnosia
phonemic cue
multiple choice |
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Term
| Formal measures: specific language functions: Discourse |
|
Definition
quantitative production assessment (QPA)
Cinderella retelling
narrative discourse |
|
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Term
|
Definition
communication effectiveness index: CETI
scored by spouse or caregiver "communication partner" |
|
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Term
|
Definition
functional independence measure
rehab outcomes in 6 domains: self-care, sphincter control, mobility, locomotion, communication, social cognition
7-point scale: level of independence |
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Term
|
Definition
functional domains: social communication, communication of basic needs, daily planning, reading, writing, numbers
7-point scale of independence: much larger sample of communication behavior |
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Term
|
Definition
like the ASHA FACS
has been approved as an outcome measure |
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Term
|
Definition
communicative activities of daily living -2
elicit output through structure but functional interactions
role-playing
converational tone
level of functional communication - percentile, stanine score |
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|
Term
|
Definition
assess over-all well being
most are not sensitive or easily used with the communication impaired
a few are specific, but include a combination of function, participation, and satisfaction |
|
|
Term
|
Definition
stroke-specific qol scale
stroke and aphasia qol scale
burden of stroke scale
ASAH quality of communication life scale |
|
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Term
|
Definition
1. 1 in 3 people older than 60 and half of those older than 85 have hearing loss
2. in 2003-2004 16.1% of US adults had speech frequency hearing loss
3. men are 5.5 times more likely than women to have a hearing impairment
4. african americans have a 70% lower chance of having hearing loss than caucasian americans
5. individuals who smoke, have constant noise exposure and exhibit cardiovascular risks have a higher risk of hearing impairment |
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Term
| symptoms of hearing impairment (5) |
|
Definition
1. individuals with HI will have difficulty understanding spoken words and speech sounds are often perceived as mumbled or slurred
2. exhibit more difficulty distinguishing high-pitched sounds
3. background noise makes conversations difficult to understand
4. men's voices are often easier to hear than women's due to their lower fundamental frequency
5. individuals may experience tinnitus |
|
|
Term
| Co-occurrence of aphasia and HI |
|
Definition
in 1 study, 88% of individuals with aphasia had some HL; 44% appeared to have HL in speech frequencies
both HL and aphasia affect men more often than women under 85
risk for both condition increases with cardiovascular disease and smoking
individuals with WA do not often exhibit hemiparesis/hemiplegia, so may be misdiagnosed as having HI or dementia |
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|
Term
| Word recognition with HL - mild |
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Definition
| noise reduces word understanding by up to 50% |
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|
Term
| Word recognition with HL - moderate |
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Definition
| 50-100% of the spoken message is not received |
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|
Term
| Word recognition with HL - severe |
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Definition
| in normal conditions, listeners will not hear any spoken words |
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|
Term
| Word recognition with HL - profound |
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Definition
| in all conditions, listeners will not hear any spoken words |
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Term
| aphasia treatment considerations in individuals with HL |
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Definition
speak loud and directly to the individual
use shorter sentences with simpler syntax for individuals with moderate or severe WA
use a reduced, but natural speaking rate
nonaphasic patients with HL often compensate for reduced reception by situational cues, contextual cues, and lip reading, but aphasic patients cannot retain material long enough to make these adjustments |
|
|
Term
|
Definition
includes background data gathered from chart, family and caregiver interviews
quantitative or qualitative
hypothesis testing
observation
determine appropriate clinical goals
dynamic assessment
contextualized abilities |
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Term
| Informal assessment: used to address |
|
Definition
what is the extent of the problems
where does behavior break down
what helps
what is the underlying mechanism |
|
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Term
| what is the extent of the problem |
|
Definition
the breadth and depth of the functional difficulties
all levels of the ICF model
provide clinically useful information
other behaviors that impact performance e.g. attention, memory, dysarthria |
|
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Term
| where does behavior break down |
|
Definition
what influences performance
what are the characteristics of the deficit
under what circumstances/conditions do they succeed versus do they fail?
what manipulations can be made to alter the deficit (=/-)
clinician generated "assessment" |
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Term
|
Definition
cueing hierarchy
facilitating strategies
manipulate content
dynamic assessment |
|
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Term
| what is the underlying mechanism |
|
Definition
hypothesis testing
assess components of the model (any model)
where should tx efforts be placed?
repair to a damaged component?
exploit preserved components to bolster the process?
assess from general to specific |
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Term
| Naming information assessment tasks |
|
Definition
Confrontation naming - different types of stimuli
differences in imageability
nouns vs verbs
high vs low frequency
modalities: visual, auditory, gesture, definitions
Generative naming (verbal fluency)
Discourse - word retrieval during connected speech
Goal: test processing stages more specifically: based on hypothesis generated from formal testing |
|
|
Term
| Differential DX: naming system |
|
Definition
compare performance across the tasks
task analysis to determine which components are common and which are separate between two tasks
compare and contrast across behaviors
try for the most parsimonious explanation |
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Term
| testing recognition (agnosia) |
|
Definition
processing advantage to known items - distinguish between real and made up items
make tasks more difficult - unusual views, degraded stimuli - people with agnosia have more trouble
simulatanagnosia - difficulty seeing more than one point in space at the same time |
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Term
| testing for semantic deficit |
|
Definition
consistent performance for all tasks that require semantic processing (ex. different modalities of input)
use tasks sensitive to semantic attributes:
category sorting - sort objects based on category membership
level of difficulty can be manipulated
Semantic decision - match items semantically related (button, wheel, zipper)
Naming to definition (or point on definition)
Provide definition |
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Term
| testing for semantic deficit - results |
|
Definition
comparable failures in all tasks
error patterns similar (semantic errors in written and oral)
comprehension should be impaired, especially with semantic distractors
failure on tasks requiring semantic manipulation |
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Term
| testing for output phonologic deficit |
|
Definition
not distinguished by error type - may be semantic paraphasias, phonologically related or similar real words or phonemic paraphasias
test using tasks dependent on output lexicon - match pictures that rhyme
differeing performance across output modes (orthographic output lexicon vs phonologic output lexicon)
may expect different performance between written and spoken output |
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Term
| Fluency information assessment tasks (could be formal measure subtest) |
|
Definition
conversation speech sample - assess not only what is said but how it is said
fluency, word finding, syntax, ease of production
ask - what difficulties are you having? what do you do when that happens?
Picture description
Story telling/retelling |
|
|
Term
|
Definition
more than 4 words per utterance
more than 100 words per miute |
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Term
| What do you look for in fluency? |
|
Definition
morphology - omission of functors and word endings
Prosody - flattened contours
Articulations - struggle initiated, sequencing movements
Initiation/elaboration - lack spontaneous utterances; short, concise verbal responses |
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Term
| informal auditory comprehension assessment tasks |
|
Definition
single words - verbs. vs nouns, different categories
yes/no questions - personal information vs. impersonal, abstract vs. concrete
command following - midline vs. peripheral, effects of apraxia
paragraphs/discourse |
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|
Term
| Repetition informal assessment tasks |
|
Definition
word/sentences
high/low probability
increasing length and complexity
variations in frequency and concreteness
imagability |
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|
Term
| Assessing Repetition routes - non-lexical |
|
Definition
nonsense words
sensitivity to length
not to part of speech or frequency (phonemic paraphasias) |
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|
Term
| Assessing Repetition routes - Lexical semantic |
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Definition
| sensitivity to concreteness and part of speech but not to length (semantic paraphasias, cannot repeat non-words) |
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|
Term
| Assessing Repetition routes - lexical non-semantic |
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Definition
| sensitive to frequency but not concreteness or length (lexicalization errors for non-words) |
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|
Term
| Tasks to assess repetition |
|
Definition
Increasing length
different types of words
concrete vs. abstract
real vs pseudo-words
high vs low frequency
content vs functors |
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Term
| Severe aphasia assessment |
|
Definition
patients with global aphasia will fail most tests, may even refuse to be tested
initially - bedside testing: a few behaviors to monitor improvement
first establish if yes/no responses are reliable: if not, must find a reliable means of responding
Purpose of early assessment - contribute to management, establish a baseline, ID strengths and weakness, ID modalities most likely to evolve
use a measure that can be reliably repeated
use a process approach - record not only a score but how the person performs |
|
|
Term
|
Definition
Do they respond to their name?
family members?
make effort to communication?
able to answer a series of person yes/no questions |
|
|
Term
|
Definition
deficits persist but some recovery is expected
prognosis is more positive with smaller, unilateral lesions sparing frontal sub-cortical white matter
psychosocial factors such as younger age, female gender, higher premorbid abilities, left handedness, positive emotional state, and good family support contribute positively to aphasia recovery, but have a less potent impact |
|
|
Term
| Prognosis for recovery - rate, tx |
|
Definition
most recovery from aphasia occurs in first 6-12 months, improvement can be observed at a slower rate in individuals several years into recovery
evidence from a large body of research suggests that, for most individuals, treatment may be beneficial for helping to improve language and communication abilities beyond what would be expected from spontaneous recovery alone |
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|
Term
| Medical Reimbursement for services depends on: |
|
Definition
accuracy - the proper codes were used
assessment - description of the functional deficits and how they impact upon the patient's independence/ability to work status and ADLS
justification that the stated deficits required the services of a skill professional
improvement: if the use of skilled services resulted in an improvement of function
objectivity - a record of objective and measurable goals and progress made toward them
Details - admission and discharge dates, discharge recommendations and referrals |
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Term
| Cognitive Neuropsychological Model - perceptual processes |
|
Definition
|
|
Term
| Cognitive Neuropsychological Model - input lexicon: recognize object |
|
Definition
recognition is the point in information processing when a stimulus becomes uniquely distinguishable form other physically similar stimuli
activates the representation in the input lexicon |
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|
Term
| Cognitive Neuropsychological Model - Input lexicon |
|
Definition
gives a processing advantage to previously experienced stimuli
thought to be mode and modality independent
system tells in something is familaiar or not
allows recognition from unusual views
full recognition in input lexicon accesses semantic system |
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|
Term
|
Definition
agnosia
different kinds - may occur in visual, auditory, or tactile inputs
within a modality, they can occur for particular classes of input
color - achromatopsia
faces - prosopagnosia
objects - visual object agnosia |
|
|
Term
|
Definition
recognition disorder not accounted for by poor visual acuity, intellectual decline or language impairment
patient still sees things but fails to recognize what they are i.e. failure in achieving activation of the object recognition unites
usually bilateral occipital lesions (PCA lesions) can be unilateral, posterior mesial cortrex lesions |
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|
Term
| Apperceptive stage visual object agnosia |
|
Definition
final stage of purely "perceptual processing: full realization of the shape
considered to be intact if the patient can copy the object but not recognize it
if cannot copy, but could see them, said to have an apperceptive agnosia |
|
|
Term
| associative stage visual object agnosia |
|
Definition
gives the percept meaning by linking it to previous experience
associate form with meaning - can copy but cannot recognize
still great controversy if these distinction exist
all visual agnosias may have some subtle visual perceptual difficulties but
most people agree that visual impairments greater than what you see in agnosia don't result in failure to recognize, and there are some agnosics that do not show any visual perceptual impairment
if they can copy, but can't recognize it, said to have associative agnosia |
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|
Term
| Cognitive Neuropsychological Model - Semantic system: meaning |
|
Definition
distributed system
stored meaning of words, objects etc. that can be accessed by any modality
"central representation"
may be degraded or lost
degraded - unable to derive complete meaning from stimulus
lost - unable to find any meaning |
|
|
Term
| Cognitive Neuropsychological Model - Semantic system |
|
Definition
crosses modalities of input and modes of output
controversy over the structure of the semantic system - unitary vs. specific
may be category specific - living things, body parts, animal names, proper names - suggests storage of semantic info may be along category lines
however, many have deficits that cross all modalities and modes
some may have more output impairment vs. input |
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|
Term
| Cognitive Neuropsychological Model - Output lexicon: phonologic form |
|
Definition
| stored phonologic representation is another form of lexical knowledge |
|
|
Term
| Cognitive Neuropsychological Model - phonologic output lexicon |
|
Definition
activated to call up phonologic representation of the object (lexical retrieval)
organized such that similar items are group together (phonologically or orthographically similar items)
sensitive to word class (nouns easier than verbs) as well as frequency (high easier than low) |
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|
Term
| Cognitive Neuropsychological Model - Motor output |
|
Definition
Motor speech processes
Produce name |
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|
Term
| 3 things that need to be considered in assessment of word retrieval |
|
Definition
1. the task
2. the characteristics of the words being probed in a particular task
3. the levels of processing involved in the performance of the task |
|
|
Term
|
Definition
picture naming, naming to definition
repetition of words and non-words
also word recognition, lexical decision, phoneme discrimination, semantic association etc. |
|
|
Term
| 2. the characteristics of the words being probed in a particular task |
|
Definition
word frequency
word imageability
word length
lexicality
also category, part of speech etc |
|
|
Term
| 3, the levels of processing involved in the performance of the task |
|
Definition
lexical-semantic, phonological encoding
semantic, lexical, phonological
conceptual-semantic, lexical semantic, lexical-form, phonological encoding, articulation
word selection (conceptual-semantic feature-lexical network-phonological network) and phonological encoding (phonological network-phonological encoding-articultion |
|
|
Term
|
Definition
high frequency words are easier to retrieve than low frequency words for everyone
frequency effect - means better performance on high frequency words than low
subtle in normal
in aphaisa, may impact accuracy of performance
may be confounded by word length |
|
|
Term
| Frequency effect in word production |
|
Definition
| indicates difficulty somewhere in the lexical-semantic processing |
|
|
Term
| Frequency effect in repetition |
|
Definition
| indicates dependency on the lexical-semantic system for repetition, pointing to deficit in phonological representations |
|
|
Term
|
Definition
how picturable something is (concrete vs. abstract)
more picturable items are processed more easily
subtle in normals, more evident in person with aphasia |
|
|
Term
| word imageability in word retrieval |
|
Definition
| suggests deficit in spread of activation in semantic-lexical network |
|
|
Term
| word imageability in repetition |
|
Definition
| reveals dependency on lexical-semantic processing for repetition |
|
|
Term
| absence of imageability effect |
|
Definition
| suggest phonological route supports repetition |
|
|
Term
| Word length: phonological processing |
|
Definition
| shorter words are produced more easily than longer words: word length effect |
|
|
Term
| Word length effects in word retrieval and repetition |
|
Definition
| suggests a deficit in phonological processing regardless of the kind of word production task |
|
|
Term
|
Definition
more difficulty with short words
suggests difficulty with input processing, more competition for shorter words |
|
|
Term
|
Definition
|
|
Term
|
Definition
| better performance for real words versus psuedowords |
|
|
Term
|
Definition
| suggest output processing is impaired |
|
|
Term
|
Definition
| suggests input processing is impaired and partial reliance on lexical-semantic route |
|
|
Term
| Pseudo-word repetition relies on the ? route |
|
Definition
non-lexical
if they cannot be repeated, suggest damage to this route |
|
|
Term
| Anomia vs. Anomic Aphasia |
|
Definition
anomia - symptom
anomic aphasia - syndrome |
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|
Term
| Anomic Aphasia - Auditory Comprehension |
|
Definition
generally good
some patients may have some impairment |
|
|
Term
| Anomic Aphasia - Repetition |
|
Definition
| usually good (continuum between TCS and anomic aphasia with mild comprehension impairment) |
|
|
Term
| Anomic Aphasia - Reading/writing |
|
Definition
| may be preserved or impaired |
|
|
Term
|
Definition
visual confrontation naming is poor
subgroup that only has difficulty with low frequency words
this subgroup may do OK with confrontation naming but demonstrate word retrieval difficulties in spontaneous speech or with in-depth testing
Prompting usually does not help in anomic aphasia
may refuse to accept the name when provided
word generativity is impaired (category naming, FAS, verbal fluency)
naming from description usually impaired |
|
|
Term
| Anomic Aphasia - Naming - major characteristic |
|
Definition
word finding difficulties resulting in word-finding pauses and empty speech
frequent circumlocutions - can be to the extent that the meaning of the sentence is lost
paraphasic errors are typically semantic rather than phonemic
"word selection" type of deficit
nouns are particularly difficult to retrieve
frequent substitution of non-specific words to substantives |
|
|
Term
| Anomic Aphasia - distinguish from agnosia |
|
Definition
naming failure usually across all modalities
picture same as objects in anomia: pictures more difficult in agnosia |
|
|
Term
| Anomic Aphasia - associated findings |
|
Definition
variable, but typically absent in anomic aphasia,
may have symptoms of Gerstman's syndrome |
|
|
Term
| Anomic Aphasia - Localization acute anomic aphasia |
|
Definition
left temporal-occipital junction or thalamus
most commonly reported site for anomic aphasia is left temporal-parietal region with sparing most of the superior temporal gyrus
smaller lesions limited to inferior temporo-occipital junction may result in pure anomic aphasia (BA 37)
Thalamic lesions as well may result in AA |
|
|
Term
| acute anomic aphasia - Localization - chronic anomic aphasia |
|
Definition
may be difficult to localize: inferior/middle temporal gyri
evolution/recovery from other types of aphasia means a variety of lesion sites
presence of anomia may also represent diffuse, multi-focal damage, dementia, or neoplasm |
|
|
Term
| acute anomic aphasia - Recovery |
|
Definition
acute AA usually has a very good prognosis
patients with AA frequently recover well, however some difficulty with naming and circumlocutory speech may persist for a long time
AA is often the end stage of recovery from other aphasic syndromes except for global or isolation |
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|
Term
|
Definition
characteristic of all types of aphasia
variety of lesion sites
anterior lesions: more difficulty with verbs
Posterior lesions: more difficulty with nouns
word retrieval errors may vary by classification
some errors occur more often with particular classification of aphasia - looking for consistency with the DX |
|
|
Term
|
Definition
aka verbal
words bearing meaningful relationship target
ex. apple: fruit, pie, orange |
|
|
Term
|
Definition
aka literal
phonologically similar words or non-words
ex. table: pable, stable |
|
|
Term
|
Definition
nonsense word or phrase bearing no apparent relationship to target
ex. robot: butkey, miss mosey |
|
|
Term
|
Definition
Words bearing no apparent relationship to target
ex. car: computer |
|
|
Term
|
Definition
meaningful description of the intended words
ex. baseball: you throw it and hit it with a bat |
|
|
Term
|
Definition
Repeated aberrant response
ex. over: barrel
shirt: barrel |
|
|
Term
|
Definition
Failure to give any response
ex. i don't know |
|
|
Term
|
Definition
Mimicking exactly what the examiner says
ex. What to do you call this? "what do you call this?" |
|
|
Term
|
Definition
verbal responses limited to common phrases or expletives
ex. that one here, I guess
Shucks, I can't |
|
|
Term
|
Definition
Recurrent nonsensical response; perhaps retained prosody
ex. wada wada wada? |
|
|
Term
|
Definition
utterances with grammatical elements omitted
ex. the boy is eating cookies: boy eat cookie |
|
|
Term
|
Definition
| press of speech, normally intoned, sometimes disrupted by paraphasias and neologisms |
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