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Aphasia is a disorder that results |
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from damage to language center of the brain |
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Verbal Communication due to brain damage |
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Aphasia is an acquired loss of what due to what |
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language due to cerebral damage |
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Aphasia is characterized by (3) |
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errors in speech, impaired comprehension, and word finding difficulty |
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aphasia is an ___ disturbance in |
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acquired disturbance in oral language |
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During langauge development (childhood) or after the language acquisition has been completed |
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2 different types of abnormalities in child language |
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Developmental dysphasia and childhood aphasia |
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A delay or disorder in the normal language acquisition |
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an impairment in language due to an abnormal brain condition before the acquistion of language has been completed |
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How was language interpreted before Broca |
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Roman references, 18th century examples, Bouilaud, ALorat, Gall |
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The 1st known reference to a loss of language cuased by brain damage |
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Roman empire - Traumatic alexia - suffered head infury had difficulties in reading |
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18th century publications |
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anomia & jargon(Gesner), agraphia (linn) preserved ability to sing (Dalin), dissociation in the ability to read different languages (gesner) |
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1825-2 types of language disturbances, 1 artic and the other amnesiac (roughly corresponding to the motor/sensory type of aphasia |
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1843 proposed a similar distinction to Bouillaud |
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end of 18th c; phrenlogy:cerebral hemispheres are composed by independent organs that support different intellecutal and moral characteristics |
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In a person with a special ability |
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corresponding brain portion was bigger. Intellect depended on brain ability |
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Language depends on the ____aspect of what lobes |
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orbital aspec of the frontal lobes |
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April 18, 1861 presents at the anthropological society of paris the case of patient tan. Broca oberved that he has lost the language (aphemia) as a result of a frontal lestion, the ability to speak in consequence could be localized in the frontal lobe |
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loss of language became aphasia |
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1874, describes a 2nd type of language impairment due to left temporal damage. Patien couldn't understand spoken languages. |
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There is 1 type of aphasia; wernicke aphasia. Broca aphaisa is an anarthria plus some aphasic sypmtoms, depending upon the extension of the damage |
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Marie's quadirlateral space |
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Anterior:ventricle>caudate.putamen.internal capsule.thalamus::Posterior Damage to this area dysarthria not aphasia. |
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Marie proposed coritcal damange |
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involving practically basal ganglia resulted in articulation defect (dysarthria or anarthria) |
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intro a language area in brain, including the partially frontal, temporal & parietal lobes of the left hemisphere; area around sylvain fissure in left hemisphere |
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Was Dejerine idea accepted |
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According to Dejerine damage results in ____, outside area results in ____ |
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Name the 8 left hemisphere langauge related disturbances |
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Aphasia, Alexia, Agrafia, Acalculia-calculation ability, Ideomotor apraxia, Semantic amnesia, Verbal aud Agnosia - speech, agnosic alexia |
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Name the right hemisphere language related disturbances |
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Aprosoida-prosdy; spatial alexia-difficulty reading; spatial agraphia-writing; spatial acalculia; Constructiona apraxia; episodic amnesia-memory lost nonverbal; non verbal aud. Agnosisa -sounds; prosopagnosia - faces |
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most influential in aphasia proposed different classification. Most important is to find out why patient cannot normally understand or speak langauge. The specific level of language process is impaired |
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Name the 7 proposed aphaisas |
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Acoustic-agnostic; acoustic-amnesic; amnesic; semantic; motor afferent; motor efferent; dynamic |
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Semantic structure of words |
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Understanding logic-grammatical structures |
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Articuleme discrimination |
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Defects in the kinetic structure of speech |
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1960's publishing. human cerebral disconnection syndrome. human brain: left-right asymmetries in temporal speech region |
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60-80's in boston group of apashia with Norman Geschwind - retakes Wernicke's ideas during 19th centruy |
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most influential in US in therotical, assesment and rehab. 1 0f 2 authors of major aphasia battery: boston diagnostic aphasia examination |
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The Boston group propoesed that aphasia can be distinguished according to 3 variables |
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Fluency, repetition, and understanding |
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Non fluent ; repetition poor |
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Understanding poor Global Understanding good Broca |
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Non fluent; repetition good |
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Understanding poor Mixed transcortical Understanding good Motor Transcortical |
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Understanding poor Wernicke Understanding good Conduction |
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Understanding poor Sensory Transcortical Understanding good Anomic |
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What are the Perisylvain pre-rolandic and post-rolandic types |
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Pre: Broca Type I and Broca Type II Post: Conduction, Wernicke type I and II |
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What are the Extrasylvian pre-rolandic and post-rolandic types |
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Pre: Motor Type I and II Post: Sensory Type I and II |
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Neurolinguistics and Psycholinguistics Approach |
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70-90's a difference in aphasia was observed. From cognitive psychology. Models of normal & abnormal language. Special emphasis on alexias and agraphias |
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During the last decade the approach most impacting |
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Computerized acess technology application |
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to find anatomical correlations for aphasic symptoms |
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List 2 influential books in Neuroimaging |
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Localization and neuroimaging in neuropsychology by Kertesz (1) Lesion analysis in neuropsychology by H. Damasio & A. Damasio (2) |
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What is the usual procedures in neuroimaging |
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to have standard templates of brain to find those areas related with langauge areas. With CT you could see lesion which are darker |
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2 areas active in temporal and frontal lobe |
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area used only temporal lobe |
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Aphasia usually associated with damage in which hemsiphere |
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Percentage of left-handers |
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2-12%; 11.6- England; 10.4-Canada; 10.5 female and 13 men in USA; less than 1 in Korea; 9- germany; 6.7-mexico; 3.1-japan; colmbia 7.3 F and 9.4 M |
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98-99% aphasia left hemisphere damage 1-2% aphasia right hemisphere damage |
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70% left hemisphere; 15% right hemisphere; 15% either; have more bilateral representation of language then right-handers |
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Delay in (failure in normal) langauge acquisition developmental dysphasia, not aphasia - because it is loss of language because of brain patholgy |
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dysphasia - can be expressive and sensory; expressive language disorder & Mixed receptive-expresive langauge disorder |
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Childhood aphasia - 3 characteristics |
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Loss of language of child while learning; depend on the age, more expressive |
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depneds upon the type of bilinguism parallel- same in all languages disassociated -different |
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Large population 20-25%. 100yrs ago 50%. Aphasia in cases of left-hemisphere pathology; less severe- as if learning to read and write results in a more prominent lateralization of language |
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Brain area corresponds to the |
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'Sylvain fissure in the left hemisphere damage will be associatged with major aphasic syndromes are broca, werenicke, and conduction aphasia |
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Damange in surround areas results in |
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trans cortical or extra sylvain aphasia |
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Pathologies that affect the nervous system |
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vascular disorders, Traumatic head injury; neoplasms, infections, degenerative conditions, developmental diseases, metabolic diseases, nutritional diseases, drug and chemical agents |
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vasular disorders, traumatic head injury, neoplasms, infections, degnerative conditions |
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About ____of patiens with stroke present aphasia |
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500,000 new cases every year; 10% die; 80% surivive, 50% 10 year survival |
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See Copehhagen aphasia study 270 stroke patients |
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Risk Factors for vascular disorders (stroke) |
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hypertension, age, cardiac disease, diabetes, contraceptive, obesity, smoking |
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Cerebrovascular disease refers to any |
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impairment in the normal brain function due to any pathological condition of the blood vesels; walls of the vessels, accumulation of materials, changes in permeability or rupture |
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cardiovasuclar disease that affects the arteries leatding to and within the brain |
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blood vessel that carries oxygen and nutrients to the brain is either bloced by a clot or bursts. brain doesn't ge oxygen and starts to die |
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What is the symptomatology of vascular disorders |
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A sudden neurological deficit (hemiplegia, aphasia) is observed. In severe cases is asssoc. with coma. The development of the neurological deficit may take seconds to eve days devending upon the type of CVA |
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Loss of consciousness is frequent with what type of CVA |
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hemorrhagic CVA, but infrequent in ischemic |
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As a result of decreasing in edema and diasquisis |
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symptomatology is progresively reduced to focal sequelae. The neurological or neuropsychological deficit reflects the site and the size of the lesion. |
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Types of Occlusive (Ischemic) Stroke |
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occlusion of a vessel from a clot attached to an overgrown vessel wall |
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Occlusion of a vessel by material floating in arterial system |
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Bleeding in the cerebral tissue |
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Different kinds of hemorhage |
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Subarachnoid, Intracerebral, and Arteriovenouse malformations |
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Bleeding within the brain |
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Intracerebral hemmorrhage |
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Anamolis pattern of artery continuation that could bleed |
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arterovenouse malformations |
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To posterior part of the brain, brain stem, and cerebellum |
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To anterior part of brain divided by middle cerebral artery and anterior cerebral artery |
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Basilar arter divided into the 2 posterior communicating arteries; the carotid artery results into the anterior cerbreal artery and the middle cerebral artery; 2 comm. arteries; anterior communicating arter - the right and left anterior coumunication artery and posterior communicating artery - communicating carotid system and vertebral-basilar system |
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Main Trunk of the left middle cerebral artery |
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Global Aphasia - most of the brain |
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Orbitofrontal; pre-rolandic |
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Posterior parietal, angular |
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Dysarthria, subcortical aphasia |
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Aphasia of the supplementary motor area |
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Posterior cerebral artery |
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Other symptoms of mild TBI |
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headache, confusion, lightheadness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, change in sleep patterns, behaviorl or mood changes and trouble with memory, concenration, attention, or thinking |
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Symptoms of moderate or severe TBI |
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headache worsens or does not go away, vomiting, convulsions or seizures, inabilty to awaken form sleep, dialtion of one/both pupils, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessnes, or agitation |
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6 possible productions of TBI |
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Direct damage to the brain, interrupt cerebral blood flow, hermorrhages and hematomas, swelling (edema), infenction/Meningitis, epileptic focus- focal damage in the brain a scar will be observed |
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closed - concussion and contusion; open-penetrating - fracture of skull, rupture of meninges |
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bruise of the brain. softening with puncutate and linear hemmorhages in crowns of the gyri and can extend into the white matter ina triangular fashion with the apex in the white matter |
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brownish stained triangular defectgs in the corex and underlying white matter. they occur on the orbital fronal surfaces and temporal poles in most instances - areas that are most susceptible |
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Areas most susceptible to TBI |
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frontal lobes (orbital), temporal lobe |
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primary - resulting from the impact to the brain; 2nd - response to injury (edema, hypoxia, hypotension, vasospasm) |
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eval severity of TBI; 13 mild; 9-12 moderate; 8 severe. See Response chart |
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in beginning is rapid and progressively slower around 2 and 3 year no significant recovery anticipated |
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Outcome and prognosis of TBI denends on |
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Age, severity, duration of anmesia |
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Speech and language characteristics of TBI |
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Dysarthria in 1/3 cases (60% acure; 10% long term fllow-up; Most often mixed dysarthria; sub-clincial aphasia (word-finding defects, difficulties with complex language) |
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What is the Los Ranchos Scale |
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Recovery of TBI scale. See slide if you want to see scale responses |
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AKA Tumor; any growth of abnormal cells, or the uncontrolled growth of cells |
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start in the brain, rather than spreading to the brain from another part of the body |
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Is a mass of cancerous cells in the brain that have spread from antoher part of the body |
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Brain tumors are classified depending on |
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the exact site of the tumor, the type of tissue involved, benign or malignant tendiencis, and others |
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The cause of primary brain tumors is |
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unknown. takes up space and compresses |
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Clinical manifestations of tumors are |
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variable and depend upon the site of the tumor. ex. seizures; attention difficulties, headaches, languages changes |
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Tumors located in the language areas are associated with |
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aphasic-type symptomatolgy; the slower the growing the milder the symptomatology. faster=severe |
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Types of tumors and percentages |
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Gliomas 45; Menigioma 15, metastic tumors 10, pituitary adenoma 7, neurinoma 7; craniparyngioma 4, angiomas 4; sarcoma 4; others 4 |
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Infections appear when the body is |
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invaded by a pthgenic micro-organism, infectious agents include viruses, bacterias, fungi, and parasites |
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Infection can affect brain tissue because |
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Definition
interefere with the cerbral blood flow; alter the metabloc capacity of the cekll or the characeristics of the cell membrane, or chaning its electric properties |
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The most important aphasic sign in cases of brin infections |
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language word finding difficulties |
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Types of intracraneal infections that produce widespread behavioral symptoms |
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herpes simplex encephalitis - affects the temporal lobe and is assoc. with significant memory disturbance; intracerebral abscss-located in specfic areas of the brain which result in different effects |
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Alzheimer's disease (degenerative); vascular dementia -d ifferent small stroks in the brain; subcortical dementias; other dementias |
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Symptoms of primary dengerative dementia |
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Alzhemier's disease - anomia word finding difficulties, semantic paraphasias, difficulties in complex language; phonological paraphasias; semi-mutism - spontaneous utterances dcrease; dementia; language repetition and grammar are well-preserved. mechanics of reading is also preserved |
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Progressive anomia and agraphia |
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atrophy restircted to left hemisphere in angular gyrus - atrophy will spread resulting in alzheimer's |
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inability to repeat hand gestures. ie. brushing hair - pretending |
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motor planning disorder - have physical ability & desire |
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posterior frontal lobe; 3 frontal gyrus |
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theory; posterior 2/3 temporal lobe; supieror 2/3 1st and 2nd temporal gyrus |
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What are the linguistic defects in aphasia |
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language deviations,repetition, naming |
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What are the 6 levels of analysis of language |
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Phonetic, phonemic, morphemic, grammatic, semantic, Pragmatic |
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/r/ - /R/ pero-perro (phonemic in spanish) |
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Minimal language sound to convey meaning. Universal 14-40; english 34; spanish 23; place, manner, voiced |
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Morphemic Level of language |
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meaningful language unit; Bound or free; |
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Grammar rules governing the use of language. |
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How to assemble words ex: past tense |
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How to assemble sentences |
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uses different types of sensory modalities; House-visual; flower-visual&olfactory |
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Pragmatic level of language |
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how to use langague; Good Morning Sir |
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Extrasylvian Sensory Wernicke |
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Extrasylvian motor aphasia |
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Broca aphasia impairments |
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Definition
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Wernicke aphasia impairments |
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Definition
phonlogical discrimination, verbal amnesia |
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Conduction aphasia impairments |
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Definition
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Extrasylvian motor impairments |
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Definition
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Extrasylvian sensory impairments |
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Definition
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What are phonetic deviations |
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Broca; misproduced phonemes may lead to a foreign accent |
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What is phonemic paraphasias and the 4 types |
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Definition
phonological composition of the word anomalies. May be due to articulatory paraphasias (parietal damage); omissions, additions, displacements, substitutions-pencil example |
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What is verbal paraphasias |
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What are the 4 types of verbal paraphasias |
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formal-cat;can morphemic-summerly ; semantic cat-dog; unrelated cat-pencil |
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What are the different types of semantic verbal paraphasias |
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same semantic hand-foot; antonym small-big; superordiante cat-animal; environmental proximity pencil-paper |
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paraphasia not only single word. The aquarium of the fish-the cage of the lion |
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description instead of the word pencil-for writing |
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Can't find the word - I took IT |
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fluent, well-articulated language output that lacks meaning for the listner. can predominate all these changes; phonemic, semantic, neologistic |
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disruption of the grammtical structure of the language. Broca |
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verbal output that violates the normative rules of morphosyntatic convention. Wernicke |
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Paragrammatism characteristics |
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overuse of grammatical words; erroneous selection of words, absenc of defining limits of the sentences; |
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What type of aphasias have preserved repetition ability |
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Definition
extrasylvian (transcortical) aphasias |
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What type of aphasias have impaired repetition ability |
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Definition
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Difficulties resulting from verbal memory limitations (repetition) |
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Definition
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difficulties at the level of phonologica production |
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Definition
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defects in grammer comprehension |
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Definition
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defects in using complex syntax |
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Definition
extrasylvian motor aphasia |
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Most common defect in aphasia |
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Definition
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difficlties in finding words associated with circumlocutions and semantic paaraphasias are sometimes observed in cases of |
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Definition
temporal-occipital damage corresponding to area 37 |
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Term
5 subtypes of word production anomia |
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Definition
prefrontal anomia; articulatory initiation anomia; articulatory reduction anomia, paraphasic anomia, phonemic disintergration anomia |
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Difficulties in producing words are observed in cases of fronal lesion |
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particulary when braca (brodman area44), supplementary motor area, and the area anterior and superior to the broca's area are involved |
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fragmentation,name just an element of pictures; perservation; extravagant paraphasias |
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Definition
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With extravagant parpahasias, what makes a free association |
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Cannot begin to produce the word. damage in the language motor areas |
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articulatory initiation anomia |
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Paraphasic anomia is found in what aphasia |
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Definition
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Phonemic disintergration anomia is found in what aphasia |
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Definition
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Word selection anomia is associated with |
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Definition
normal lingusitic funcion, normal repetition; nearly normal comprehension; langauge defect is in naming, Inferior portion of the left temporal lobe (area 37) |
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Area 37 is associated with |
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Definition
anomic, amnesic, nominal aphasia |
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Patient not only fails to name objects but also fails to identify the object when name is presented |
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Definition
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2-way deficit of semantic anomia is associated with damage to |
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parietal-occipital, angular lesions |
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inability to recognize objects |
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Definition
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category specific, modality specific, callosal disconnection |
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Points on category specific anomia |
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specific category is difficult than corresponding categories, syntax specific abstract vs concrete; difficulty to name animals , but easier with non animated objects |
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difficulties in naming body parts |
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Definition
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When the corpus callosm is cut |
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Definition
the right and left hemisphere can't communicate |
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What areas are associated with broca |
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Definition
Area 44- well defined; 3rd frontal gyrus |
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Different names used for Broca Aphasia |
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Definition
aphemia, efferent or kinetic motor aphasia(luria), verbal aphasia (Wepman); Syntactic aphasia, broca's aphasia |
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8 Basic langauge charactersitc categories |
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Definition
Conversation, comprehension, repetition, pointing, naming, reading aloud, reading comprehension, writing |
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Broca's langauge characteristics that are below normal |
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Definition
conversation -nonfluent; repetition-abnormal; naming-abn.; reading aloud-abn.; writing abn. |
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Association neurological signs (Broca's with spastic type of dysarthria=overlap) |
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Definition
Motor system=often hemiparesis; abnormal articulation Cortical sensory function-normal or abnormal;Praxis-sympathetic, visual field-normal; visual gnosis-normal |
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Other signs of Broca (indicators) |
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Definition
Non fluent, poorly articualted speech, effortful; short utterances, Tan-Tan; Agrammatism **; speech apraxia; sometimes foreign accent |
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Term
What tasks is agrammatism obeserved (Broca) |
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Definition
Spontenous language, language understanding, repetition, wriing, reading |
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Term
Verbal articulatory errors (broca) |
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Definition
syllabic simplification, Anticipation pencil-cencil; perserveration penpil; substitution of fricative f,s, th,x for stops p,t,k |
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Term
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Definition
reading comp is better than reading aloud. rdg aloud - same defects of spontaneous language. |
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Term
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Definition
difficult to test (hemiparesis - left hand); agrammatism may be more severe; left hand clumsiness |
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Term
Does type 1 Broca result in broca aphasia |
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Definition
no; milder language effect; rare only broca area damage |
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Term
Broca II extends to what areas in the brain |
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Definition
anterior insula, primary motor area, basal ganglia |
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Term
What knowledge of Broca did we gain from a CT Scan |
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Definition
broca area only - mild- decrease fluency and simplifcation of grammer. For real broca's aphasia needs to extend to the motor area |
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Term
What areas of the brain area associated with Wernicke Aphasia |
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Definition
not well defined; Corresponds to 1st and 2nd temporal gyrus; 2/3 posterior part of the temporal lobe |
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Term
Other names for Wernicke Aphasia |
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Definition
Sensory aphasia, receptive aphasia, cenral aphasia |
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Term
Below normal langagua characterstics for Wernicke |
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Definition
Conversation - excess; comprehension, pointin, nameing, reading aloud, rdg comp, writing all abnormal |
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Term
Most of the associated neurological signs are normal - abnormal |
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Definition
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Term
Characteristics of Wernicke speech |
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Definition
excessive language; extrea syllables and words, loss of sentence limits, paragrammatism-over use of grammer (opposite of broca), decrease of meaningful words, empty speech |
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Term
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Definition
Phonological (damage 1 temporal gyrus); verbal (posterior towards temporal occipital area; neologisms, jargonaphasia |
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Term
Language understanding difficulties of Wernicke |
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Definition
Increasing the # of words; fatigue phenomenon; changes in conversational topic, increased effort to understand |
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Term
2 major defects in Wernicke |
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Definition
phoneme discrimination (type I) - feel others are speaking a foreign language; defects in verbal memory (type II) damage to 1st gyrus |
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Term
Wernicke defects in reading |
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Definition
varies depending on damage extended to temporal lobe reading difficulties are more signifcant less severe; word-deafness; word blindness |
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Term
Werenicke defects in writing |
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Definition
no changes in calligraphy; substitution of letters & words, neologisms; jargonagraphia |
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Term
Conductio Aphasias is AKA |
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Definition
Parietal-Insular syndrome |
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Term
conduction aphasia is due to damage in |
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Definition
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Term
Other names of conduction aphasia |
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Definition
Motor or kinethesic afferent aphasia; central aphasia; efferent conduction, |
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Term
What are the 3 basic characterstics of conduction aphasia |
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Definition
fluent, but paraphasic converstational language; almost normal comprehension; significant repetition impairment |
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Term
What are the 5 secondary characteritics of Wernicke's |
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Definition
defects in naming, reading, variable writing difficutlies (apraxic agraphia), ideomotor apraxia; neurological abnormalities |
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Term
Basic language charcteristics of Conduction |
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Definition
Conversation-fluent paraphasic; repetition, naming, reading aloud, and writing abnormal |
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Term
Associated neurological signs for conduction |
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Definition
Motor system - mild hemiparesis; praxis - apraxia |
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Term
Conduction aphasia patients show |
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Definition
successive approaches to the target word; self-correction; sometimes impossible to produce word in repetition, but not in spontaneous language |
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Term
Most common phonologica paraphasias in conduction aphasia |
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Definition
manner of articulation, and substitution, point of articulation |
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Term
Writing in Conduction aphasia |
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Definition
afferent motor agraphia(oral langauge defect); literal paragraphias, apraic agraphia |
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Term
Classic explanation of conduction aphasia |
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Definition
disconnection. Arcuate Fasciculus (pathways that connect werenike and broca's area are impaired. It is the responsible for the ability to repeat |
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Term
Conduction aphasia and verbal apraxia |
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Definition
Conduction is verbal apraxia and has the same language characterstics |
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