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Aphasia Exam 2
types, concomitant disorders
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Other
Graduate
02/27/2010

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Term
Fractionation Assumption
Definition
selective impairments of specific processes can occur; yet stroke rarely affects only one area or process; patients with identical lesions may have varying aphasia profiles
Term
Classification Reliability
Definition
low within and across clinicians; patient can test differently across multiple days
Term
Non-fluent Aphasia types
Definition
Broca's, Transcortical Motor, Little Broca's, Global
Term
Fluent Aphasia Types
Definition
Wernicke's, Conduction, Transcortical Sensory, Anomic
Term
Broca's profile
Definition
Speech and Writing-non-fluent, agrammatic
Aud. comp and reading-mostly preserved (some breakdowns)
Repetition-impaired
Physical Symptoms-R hemparesis, R hemianopia, apraxia
Lesion location-Broca's (BA 44) and surrounding cortical areas
Term
Little Broca's (aphemia)
Definition
relatively rare affecting small circumscribed area of Broca's; acutely mute, hemiparesis; good recovery over time
Term
Transcortical Motor Profile
Definition
Speech and Writing-non-fluent output, acutely mute, hypophonic, echolalic
aud. comp and reading-relatively well preserved
Repetition-relatively intact
physical symptoms-possible R lower hemiparesis or motor involvement
lesion location-deep frontal or anterior or superior to Broca's (anterior watershed; ACA)
Term
Global Profile
Definition
severe impairment across domains with many physical symptoms; major stroke to most or all of perisylvian language zones
Term
Physical Impairments in Global Aphasia
Definition
R hemiparesis, R sensory loss, hemianopia, limb apraxia, dysarthria, apraxia of speech
Term
Wernicke's Profile
Definition
speech and writing-fluent, paragrammatic
aud. comp and reading-impaired
repetition-impaired
physical symptoms rare (possible quadrant visual cut)
lesion location-posterior Wernicke's
possible decreased awareness of deficits
Term
Two variants of Wernicke's
Definition
Primarily temporal lobe lesion-reading less impaired, single word recognition worse than recognition of words in context
posterior lesion (angular/supramarginal)-reading deficits and comprehension worse in context than simple words
Term
Conduction Profile
Definition
speech and writing-fluent (less than Wernicke's)
aud. comp and reading-minor deficits
repetition-impaired (hallmark)
physical symptoms-unlikely
lesion location-arcuate fasciculus
frequent phonemic paraphasias and self-correction affecting fluency
Term
Anomic Profile
Definition
speech and writing-periodic WFD, few grammatical errors
aud. comp-relatively spared
repetition-relatively spared
physical symptoms-rare
lesion location-varies
breakdowns occur with stress or during complex task completion
easy to miss
Term
Transcortical Sensory Profile
Definition
speech and writing-fluent, paragrammatic, echolalic (possibly)
aud. comp and reading-severely impaired
repetition-area of strength
physical symptoms-mild hemianopia if any
lesion location-posterior watershed (between PCA and MCA)
Term
Transcortical Mixed Profile
Definition
Resembles global; very rare; typical after anoxic event; repetition relatively intact, receptive and expressive deficits; possible right side
physical symptoms; damage to anterior AND posterior watershed areas
Term
Subcortical Aphasia-Left Thalamic lesion (hemorrhagic)
Definition
speech and writing-fluent, hypophonic, semantic paraphasias
aud. comp and reading-relatively unimpaired
repetition-relatively unimpaired
physical-right hemiplegia
lesion location-posterior pulvinar nuclei of left thalamus
transient with good recovery (death likely acutely)
Term
Subcortical Aphasias-Left Thalamic lesion (ischemic)
Definition
speech and writing-non-fluent with phonemic paraphasias
aud. comp and reading-impaired
repetition-relatively unimpaired
phsyical-right hemiplegia
lesion location-ventral and anterior thalamus (tuberothalamic artery)
Term
Subcortical Aphasias-Anterior capsular/putamenal
Definition
speech and writing-reduced phrase length, initiation deficits, dysarthria; good grammar
aud. comp and reading-good
repetition-relatively intact
physical-right hemiplegia
Term
Subcortical Aphasias-Posterior capsular/putaminal
Definition
speech and writing-fluent, paragrammatic
aud. comp and reading-poor
repetition-poor
physical-right hemiplegia
Term
Subcortical Aphasias-global capsular/putamial
Definition
resembles global aphasia
Term
Progressive Aphasia
Definition
deterioration for at least 2 years; isolated problem; any profile; symptom, not disease
Term
Crossed Aphasia
Definition
Unusual cerebral dominance (R handed, RH stroke=aphasia); any profile
Term
Paroxysmal Aphasia
Definition
transient aphasia occurring during seizures that affect the perisylvian area (temproal lobe); result in WFD and comprehension deficits
Term
Cortical/Neurogenic Stuttering
Definition
acquired stuttering; disfluencies affect #__ and V_V phones, substantives and functors across all tasks with no 2dary behaviors or adaptation effect
Term
Apraxia of Speech (AOS)
Definition
disorder of execution of learned movements unaccounted for by weakness, incoordination, sensory loss or impaired comprehension/attention; know the sounds but cannot produce
Term
Signs of AOS
Definition
inconsistent articulatory errors, groping for articulatory postures, errors in place
Term
Hierarchy of breakdown in AOS
Definition
vowels easiest
Term
Constructional Apraxia
Definition
impaired ability to draw or make geometric configurations
Term
Pure Alexia (Alexia without agraphia)
Definition
deficits only seen during reading; relatively rare; affected by word length and impaired ability to sound out words=slow reading (can interpret if spelled aloud b/c deficit only in visual domain)
Term
Lesion location for Pure Alexia
Definition
small posterior lesion to primary or visual association cortex in occipital lobe; PCA
Term
Concomitant symptoms of pure alexia
Definition
right hemianopia, acalculia, inability to identify colors, occasional naming problems
Term
Deep dyslexia
Definition
grapheme to phoneme conversion problem (cannot attach sound to letter); compensate through use of whole word reading (often results in semantic or derivational errors); difficulty with functors; inability to read non-words; increased performance with HFreq and concrete words
Term
Surface Dyslexia
Definition
phoneme to grapheme conversion errors (cannot match letter to sound); rely on sounding out words to compensate; phonological errors likely; difficulties with atypical spellings, can read nonwords
Term
pure agraphia
Definition
very rare; purely deficits in writing; associated with damage to supramarginal gyrus
Term
alexia with agraphia
Definition
no spoken errors, but reading and writing deficits
Term
Pure word Deafness
Definition
can't detect meaning in spoken word (discrimination and comprehension errors); cannot repeat; some patients compensate with lip reading; environmental discrimination preserved
Term
lesion location for pure word deafness
Definition
bilateral lesion to primary auditory or auditory association cortex; puretone thresholds WNL
Term
Pure word Blindness
Definition
cannot make out letters at all; bilateral lesions to visual cortex (primary or association)
Term
Agnosias
Definition
"Don't know"; typically the result of bilateral damage to association cortex for that modality
Term
visual agnosia
Definition
no understanding of visual information; cannot apply meaning or label to stimuli; can present like a paraphasia (discriminate by presenting in another modality)
Term
auditory agnosia
Definition
inability to comprehend heard stimuli (both speech and environmental); no meaning in sounds, just noise
Term
Astereognosis
Definition
tactile agnosia
Term
Gerstmann's Syndrome
Definition
Collection of symptoms seen post LH parieto-occipital lesion: acalculia, finger agnosia, right left disorientation (body and environment), agraphia
Term
acalculia
Definition
can result from lesions in any location; severity mirrors that of aphasia, cannot match written number word to symbol and deficits in determining magnitude
Term
Neglect
Definition
inattention (usually to R side stimuli for aphasics); more common and enduring following RH lesion (left neglect), so often not evaluated in aphasics; can perceive stimuli, just don't attend to them; common across multiple modalities
Term
right neglect dyslexia
Definition
affects reading because patient doesn't see the right side of a word
Term
perseveration
Definition
any response which is either repeated or continued beyond the point of completion
Term
recurrent perseveration
Definition
recurrent response withing a task, though not every response; most common type of perseveration seen in aphasics
Term
stuck in set perseveration
Definition
problems shifting to a new set or task, more common with frontal lobe involvement
Term
ideational perseveration
Definition
continued focus on a single topic, idea, or theme, commonly seen in those with dementia
Term
attention disorders
Definition
common across domains: alertness/arousal, sustained attention, selective attention, attention switching, divided attention, resource allocation
Term
executive function disorders
Definition
inability to carry out complex, high level or goal directed activities, which affects ability to live independently, problem solve and to self monitor
Term
Anosognosia
Definition
self-awareness deficits (don't know you don't know); affects perception of strengths and weaknesses or recognition for need of tx; can lead to behavior issues (paranoia, agitation) due to poor comprehension; may be affected by emotional denial of deficits
Term
cognitive affect on recovery
Definition
worse prognosis and increased tx time when cognitive deficits present; always evaluate during dx in order to factor into prognosis; affects planning for tx/candidacy for certain tx (esp. use of compensatory strategies)
Term
Grieving Process (5 stages)
Definition
Kubla-Ross (1969): Denial/isolation, anger, bargaining, depression, acceptance/adaptation
Term
Psychological Problems following stroke
Definition
fear, fatigue, anxiety/stress, depression, feeling of loss of control, sleep disturbances, frustration/embarrassment, aggression, catastrophic reaction
Term
RH v LH damage for emotional complications
Definition
Depression more common following LH damage
Indifference more common following RH damage
Term
WHO Model
Definition
Impairment-structure and function
Activity-impairment in ability to do certain things
Participation-restrictions in carrying out desired ADL
Environmental factors-external factors that help or impede recovery and performance
Term
Caregiver concerns
Definition
Marital problems (stress, sexual changes, role reversal); higher risk for psychological problems (esp. if aphasia dx); female caregiver higher risk; initial assessment not predictive of 6 mo. post
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