Aphasia Final Exam Information PDF

Knowledge Check #1 1.​ The definition of aphasia includes a.​ Acquired, neurological, impairment of language 2.​ The World Health Organization International Classification of Function framework considers health conditions in the context of which categories? a....

Knowledge Check #1 1.​ The definition of aphasia includes a.​ Acquired, neurological, impairment of language 2.​ The World Health Organization International Classification of Function framework considers health conditions in the context of which categories? a.​ Body Function/Structure, Activities, Participation 3.​ Matching: a.​ Body Function Structure = Decreased word finding ability b.​ Activity Limitations = Going to the coffee shop with friends c.​ Participation = Engaging in conversation d.​ Environmental Factors = Skills and attitudes of conversation partners e.​ Personal Factors = Self-Esteem 4.​ What is an important component that is missing from the Medical Framework? a.​ Focuses on compensation for impairments 5.​ The World Health Organization International Classification of Function framework does not include safety in any of it's components. a.​ False 6.​ If family members are involved, why are they a valuable member of the Assessment team? a.​ To give details on prior living situation b.​ To offer insight into current versus pre-morbid personality c.​ To work with SLP/rehab team to develop the most functional goals for the patient 7.​ It is not within our Scope of Practice to provide counseling to patients, that can only be done by a member of the psych team. a.​ False 8.​ Informal assessment can provide helpful information while building rapport with the patient. a.​ True 9.​ Examples of best practice when assessing a person with aphasia: a.​ Focus on patient's strengths b.​ Include family/caregivers in the assessment process c.​ Explain the purpose of each task you present to the patient Knowledge Check #2 1.​ Anomia: Without words or names for things 2.​ Agrammatism: Telegraphic speech, made up of primarily nouns and verbs 3.​ Paragrammatism: Inaccurate syntactic structure and inappropriate use of pronouns and verb tense. Fluent production that doesn't make sense. 4.​ Paraphasia = Word substitution 5.​ Neologism = Made up word 6.​ Which of the following components of verbal expression are necessary during an evaluation to determine an aphasia classification? a.​ Lexical Retrieval b.​ Spontaneous Speech c.​ Repetition 7.​ Brain lesions located in the anterior areas of the left hemisphere result in non-fluent aphasias. a.​ True 8.​ Briefly describe the difference between an AVM and an aneurysm. a.​ An arteriovenous malformation (AVM) is a rare and uncommon form of hemorrhagic stroke. It is a congenital condition where an individual is born with an abnormal configuration of blood vessels. Overtime, the pressure from the arteries can rupture causing major bleeding in the brain. 9.​ When talking about Fluent Aphasia, the location of these lesions are usually more Posterior in the Left hemisphere 10.​ If a client said "horse" when shown a line drawing of a cow, this would be an example of ____________ paraphasia. a.​ Semantic 11.​ During a picture description task, your client names all items in the picture with clear, single words. This is an example of fluent aphasia. a.​ False Knowledge Check #3 1.​ A loss of meaning and sound associations of written symbols is called: a.​ Alexia in aphasia 2.​ For clients with hemiparesis that affects their dominant hand, we do not assess writing ability. a.​ False 3.​ Matching: a.​ Auditory comprehension = "Point to the chair and then the door" // Complex ‘yes/no’ questions b.​ Reading comprehension = Answer questions to a silently read story // “Match the object that goes with this word” c.​ Written expression = "Write down your mailing address" // Spelling to dictation 4.​ Typically, severity of auditory comprehension is inverse to severity of reading comprehension. a.​ False 5.​ The acquired loss of the ability to communicate through writing is called: a.​ Agraphia 6.​ When evaluating auditory comprehension, the clinician would typically complete these tasks: a.​ ask client to point to environmental objects b.​ ask client to follow multi-step commands c.​ paragraph comprehension of clinician read story Knowledge Check #4 1.​ All aspects of language have a comprehension and production component. a.​ True 2.​ Matching: a.​ Fluent aphasia → Empty speech with paragrammatism b.​ Expressive aphasia → Agrammatism in connected speech c.​ Conduction aphasia → Marked difficulty with verbal repetition 3.​ Select the tests that would be appropriate for a comprehensive assessment of language. a.​ Western Aphasia Battery b.​ Examining for Aphasia c.​ The Boston Diagnostic Aphasia Examination 4.​ Please list two sections of the medical record an SLP may reference when reviewing a medical chart for information about a patient. a.​ Chief complaints & admitting diagnosis b.​ Results of CT scan or MRI of the brain 5.​ Primary Progressive Aphasia is classified as a subcortical aphasia. a.​ False 6.​ Matching: a.​ Wernicke's aphasia → Posterior portion of the superior temporal gyrus b.​ Global aphasia → Large left perisylvian area, including fronto-temporal-parietal lobes c.​ Conduction aphasia → Arcuate fasciculus, supramarginal gyrus d.​ Transcortical Sensory aphasia → Angular gyrus, posterior middle temporal gyrus, temporal watershed areas e.​ Broca's aphasia → Inferior lateral left frontal lobe; frontal operculum Knowledge Check #5 1.​ Non-fluent aphasia typically results from lesions posterior to the central sulcus. a.​ False 2.​ Research has shown persons with chronic aphasia can demonstrate improvements in language more than 6 months post stroke. a.​ True 3.​ All of the following are signs of Apraxia of Speech EXCEPT: a.​ Effortful groping b.​ Slow rate of speech c.​ Smooth, fluent production of phrases and sentences d.​ False starts and attempts at self-correction  4.​ Compare and contrast 4 characteristics of Broca's Aphasia with 4 characteristics of Wernicke's Aphasia. Broca's Aphasia: Lesions are located in Broca's area or surrounding areas and are in the territory of the superior division of the MCA Individuals are non-fluent and characterized by agrammatism, prosodic disturbances, etc. Auditory comprehension is fairly good but has difficulty with passives and complex grammar Reading and writing are similar to verbal output Wernicke's Aphasia: Lesions are located in the Wernicke's area and are located in the posterior portion of the superior temporal gyrus, which is the inferior division of the left MCA. Individuals are fluent, but overall comprehension is weak Auditory comprehension is poor and may struggle to recognize and perceive spoken words or environmental sounds Oral reading, reading comprehension, letter/word recognition, and spelling are impaired and often difficult for someone with Wernicke's Aphasia. Both types of Aphasia have impaired repetition because someone with Broca's may struggle due to them being non-fluent and someone with Wernicke's may struggle due to their auditory comprehension 5.​ When someone says, "a structure in your room that you sleep on" instead of saying "bed", this is an example of a: a.​ Circumlocution 6.​ Global aphasia is characterized by severe impairment in all language modalities. a.​ True 7.​ Fluent aphasia typically results from a lesion in a.​ Posterior superior temporal gyrus 8.​ Describe semantic paraphasia, phonemic paraphasia and neologism. Provide an example of each. a.​ Semantic: a word that is related to the desired target word - jellyfish for octopus b.​ Phonemic: a similar sounding word is substituted - share for chair c.​ Neologism: not 'real' words but model the phonologic structure - brizzle for pretzel Knowledge Check #6 1.​ If your patient demonstrates severe anomia when speaking but demonstrates strengths in graphic modalities, describe what you could target to facilitate communication and stimulate verbal speech. a.​ I would use writing and/or drawing to facilitate functional communication and stimulate their verbal modality. For example, if the target goal was word naming, specifically foods in a grocery store, I would tell my client to write down names of foods they would get at a grocery store (e.g., bread, apple, milk) and I encourage them to say those words aloud, using the written list as a prompt. 2.​ Briefly describe how you would utilize the FOURC model in your practice. a.​ I would utilize the FOURC model in my practice by first identifying communication goals in collaboration with the client and the family so I can ensure that the goals are specific, measurable, and meaningful to their lives. I would create client solutions by developing strategies and interventions that target these goals. I would also collaborate on a plan with the client and family so that in case I need to adjust anything regarding the approaches, the family and client can input their thoughts and feelings about it. Finally, I would complete and continue on the plan as follows. 3.​ When working to reduce perseveration, choose all that apply: a.​ Choose varied semantic content b.​ Start with automatic speech tasks 4.​ Please describe 3 ways you would share assessment results for a client with their family that includes a 12 year old grandchild, 2 adult children, and their 82 year old spouse. a.​ When sharing assessment results with a family that includes a 12-year-old grandchild, 2 adult children, and an 82-year-old spouse, I would use clear and straightforward language to explain the findings in a way that is understandable for everyone and not assume that the terms I normally use would be understood by someone that's not in my field in order to ensure each family member feels informed and involved. I would also provide visuals such as charts of the results so it can better organize the data to where they can see the client's results with where the patient should be in specific areas along with using relatable scenarios and examples to help explain how the results can impact the client's daily life. Additionally, I would encourage the family to ask questions to ensure they fully understand the assessment results and feel comfortable with the next steps in the treatment plan. 5.​ Choose statements that are True about recovery expectations: a.​ Given speech-language intervention, recovery will continue for years after a stroke. b.​ Age, pre-morbid health, and involvement in therapy all impact improvement.  6.​ List and briefly describe 5 best treatment practices when working with people who have an acquired cognitive-linguistic disorder. a.​ Varied practice: I would try to improve generalization by following instructions in a cookbook b.​ Random practice: I would try to provide different tasks in a session rather than practicing one skill repeatedly by going from answering "wh-" questions to a crossword puzzle. c.​ A greater number of repetitions: I would tell my client to practice asking for help by saying "I need help" 8-10 times with different scenarios. d.​ Low frequency of feedback: Whenever my client does a specific task, such as a crossword, I provide feedback once the client is all done rather than on every word the client gets right. e.​ Knowledge of performance: I would focus on providing feedback on the task's performance rather than just the outcome. Instead of saying "Great job" I would say why do I feel the patient did a great job "You did a great job on that task by self-correcting yourself on a few questions.." 7.​ When working to target receptive and expressive language, it is best to start with a field of 8-10 common objects and then either increase or decrease the field as needed. a.​ FALSE 8.​ A primary goal for treatment for a person with Wernicke's aphasia would be to improve auditory comprehension and the ability to self-monitor. Knowledge Check #7 1.​ A restorative treatment approach is one that helps a person compensate for difficulties with language. a.​ False 2.​ When reviewing evidence to support the use of a treatment approach, you should consider: a.​ Efficacy, Effectiveness, and Efficiency 3.​ Matching: a.​ Target: Specific behavior that is expected to change from the treatment. b.​ Ingredients: Specific actions or materials used by the clinician. c.​ Mechanism of Action: How we believe or theorize the treatment works d.​ Aim: Improvement in daily function we expect from our treatment 4.​ Intensive aphasia rehabilitation programs are available for anyone who would like to participate. a.​ False 5.​ Identify 5 contents items to include when writing a good short term treatment goal. a.​ It's important to include the target skill(s) because it underlines the specific thing you want the client to work on such as the articulation of a sound, sentence completion tasks, etc. b.​ It's important to make sure the goal is measurable by knowing if the goal has been achieved or not and the goal should include a way to measure progress, such as the number of correct responses or accuracy percentage (e.g., with an 80% accuracy). c.​ It's important to include the time frame of when the goal should be achieved (e.g., in 2 out of 3 sessions). d.​ It's important to include types of cues such as the hierarchy of cues and how were they given (e.g., verbal, visual, tactile). e.​ It's important to add how the goal will be achieved (e.g., during a structured activity) f.​ It's important that the goal is relevant to the patient and that the goal is meaningful and connects to the client’s overall treatment plan. It's helpful to utilize the SMART acronym as well :) 6.​ Describe a person with aphasia who would be a good candidate for Melodic Intonation Therapy (include the nature of aphasia - fluent vs non-fluent, and language characteristics that would be important to consider) and describe components of the MIT treatment technique. a.​ Melodic Intonation Therapy (MIT) is best for non-fluent aphasics with moderately preserved auditory comprehension, like those with Broca's aphasia. People with Broca’s aphasia struggle with speech production but can usually understand language pretty well. Patients will often speak in short and fragmented phrases while also having difficulty forming complete sentences, and their speech may be slow or effortful. People with non-fluent aphasia typically have difficulty with repetition as well since their comprehension may remain  relatively intact, but their ability to repeat words, phrases, or sentences is often impaired. This is because it affects the speech production areas of the brain which can make it difficult to produce speech smoothly or to repeat what is heard, especially with more complex sentences. Since MIT capitalizes on melody and rhythm, this therapy approach would help individuals with Broca's aphasia by using rhythmic cues and repetition which can encourage smoother and more fluent speech while helping reduce the effort it may take to form sentences. There are 4 levels of MIT such as hand tapping and humming the melodic pattern which helps when introducing single, multisyllabic words, hand tapping and signing target word phrases, progressing to complex phrases or short sentences with delayed repetition and hand tapping, and listening to a sentence and then responding to a relevant question. There is also an MIT therapeutic hierarchy that's followed such as starting with multisyllabic words, and then going with short, high-probability phrases (e.g., I need help) and then increasing phonological complex sentences (e.g., I want a sandwich). Study Guide 1.​ Define the 4 core elements that define aphasia. a.​ Acquired b.​ Neurological deficit c.​ Multimodal (affects reception and production) d.​ Language 2.​ Hallmarks of acquired apraxia 3.​ Identify hemorrhagic versus ischemic stroke. a.​ Hemorrhagic- bleeding in the brain from a ruptured blood vessel b.​ Ischemic- blood clot restricts blood flow in the brain (blocked) 4.​ Describe characteristics of acquired apraxia of speech a.​ Apraxia of speech: impairment in motor programming and sequencing of movements of the articulators for intentional or volitional speech i.​ Articulatory groping ii.​ Inconsistent articulatory errors iii.​ Substitutions, omissions, repetitions, distortions iv.​ Slow rate of speech v.​ Abnormal prosody b.​ Often accompanies nonfluent aphasias c.​ Lesions locations: frontal lobe, pre-motor association zone, anterior parietal areas (left hemi) 5.​ Identify and differentiate linguistic, nonlinguistic and lesion characteristics for the nonfluent and fluent aphasia. Non-Fluent Aphasias Broca’s Aphasia ​ Non-fluent speech with minimal output ​ Impaired auditory and reading comprehension ​ Impaired verbal repetition ​ Severely impaired naming with recurrent stereotypical utterances ​ Auditory comprehension improves more than verbal expression over time ​ Prognosis better if motor abilities are preserved and there is no hemiparesis ​ Lesion: Large left perisylvian area, including frontal, temporal, and parietal lobes Transcortical Motor Aphasia ​ Non-fluent speech with relatively good comprehension ​ Phonemic paraphasias and perseveration common ​ Good confrontation naming ​ Reduced syntax ​ Repetition generally spared ​ May be mute due to reduced initiation of speech ​ Bradykinesia (slow movement) common ​ Deficits most noticeable at conversational level ​ Lesion: Anterior frontal region interrupting link between Broca's area and supplementary motor cortex Global Aphasia ​ Severe impairment across all language modalities ​ Non-fluent speech with minimal output ​ Impaired auditory comprehension, reading comprehension, and verbal repetition ​ Severely impaired naming ​ Stereotypical utterances common ​ Lesion: Large left perisylvian area involving frontal, temporal, and parietal lobes Fluent Aphasias Wernicke’s Aphasia ​ Fluent, effortless, melodic speech with poor auditory comprehension ​ Paraphasic speech with poor self-monitoring ​ Decreased use of real words (empty speech) ​ Paragrammatism and morphological disturbances ​ Lesion: Posterior portion of superior temporal gyrus Transcortical Sensory Aphasia ​ Fluent, well-articulated speech with severe auditory comprehension deficits ​ Empty and circumlocutionary discourse ​ Neologisms and verbal paraphasias ​ Good repetition ​ Word-finding difficulties and echolalia ​ Lesion: Angular gyrus, posterior middle temporal gyrus, or temporal watershed regions Conduction Aphasia ​ Fluent speech with good intonation and auditory comprehension ​ Difficulty with word finding and marked impairment in repetition ​ Paraphasic errors and self-correction attempts (conduit d’approche) ​ Lesion: Arcuate fasciculus or supramarginal gyrus Anomic Aphasia ​ Major impairment in lexical retrieval ​ Delayed responses, self-corrections, circumlocutions, and paraphasias ​ Greatest difficulty with confrontation naming ​ Lesion: Angular gyrus; frontal lesions impact verbs, temporal lesions impact nouns Subcortical Aphasias General Characteristics ​ Symptoms vary based on lesion location ○​ Anterior lesions: Non-fluent speech ○​ Posterior lesions: Fluent speech ​ Impairments include attention, focus, executive function, and declarative memory ​ Commonly results from ischemic stroke  Subcortical Thalamic Aphasia ​ Relatively fluent speech with good auditory comprehension ​ Reduced spontaneous speech Subcortical Non-Thalamic Aphasia ​ Characteristics depend on lesion location: ○​ Anterior: Non-fluent speech, good comprehension, slow production ○​ Posterior: Fluent speech, impaired comprehension, similar output to Wernicke’s aphasia Primary Progressive Aphasia (PPA) ​ Slow degeneration of nerve cells in language centers ​ Initially impacts word-finding in speaking and writing ​ Personality, memory, and cognitive abilities intact initially ​ Affects all language modalities as it progresses ​ Lesion: Left frontotemporal-parietal region, anterior and posterior areas 6.​ Define and describe different types of paraphasias. Phonemic paraphasia: part of the word overlaps phonologically with intended sound -Similar sounding word is substituted -Literal paraphasia -Shrimp instead of shirt -Octagon instead of octopus Semantic Paraphsia: word related to desire target words -Verbal paraphasia, related and unrelated -Related: jellyfish for octopus -Unrelated: chicken for octopus 7.​ Define and describe circumlocution, perseveration, anomia, paragrammatism, agrammatism, agraphia, alexia and agnosia. a.​ Circumlocution: describing something indirectly (It's an animal that barks and is often kept as a pet) b.​ Preservation: Repetition of words, phrases, or actions (Saying "book" even when talking about something unrelated, such as a car, due to difficulty switching topics). c.​ Anomia: Difficulty naming objects or recalling words ("Can you pass me the...the thing you open bottles with?" instead of directly recalling the word "opener.") d.​ Pragmatism: inappropriate or inaccurate syntax, fluent aphasia ("The store I go to today, I buy clothes I like," using disordered word order or sentence structure but still speaking fluently.) e.​ Agrammatism: omission of grammatical elements, nonfluent aphasia (A person might say, "Want coffee" instead of "I want coffee," omitting the subject and auxiliary verb) f.​ Agraphia: acquired loss of the ability to communicate through writing (unable to write simple sentence) g.​ Alexia: loss of meaning and sound associations of written symbols (A person may be unable to read words correctly and might read "dog" as "cat" or struggle to recognize words altogether, even though they can still understand spoken language). h.​ Agnosia: impaired perception and recognition, visual, auditory, tactile (might look at a cup but fail to recognize it as a cup, despite having no vision impairment). 8.​ Difference between aphasia and primary progressive aphasia. a.​ Aphasia is typically an acquired language disorder due to a specific event (like a stroke), with a relatively stable course or improvement over time. b.​ Primary Progressive Aphasia (PPA) is a degenerative condition that leads to gradual language loss, with worsening symptoms over time as the brain's language-related areas deteriorate. 9.​ Considerations for assessment and recovery patterns of individuals with aphasia who are bilingual. a.​ Recovery patterns i.​ Differential: one recovers more than the other  ii.​ Parallel: recovery of language similar to premorbid abilities iii.​ Selective: one language recovers while another does not iv.​ Successive: one language fully recovered while second one starts to recover v.​ Alteration: one language recovers then weakens, other language recovers vi.​ Blended: switching between languages uncontrollably b.​ Considerations for bilingual assessment i.​ Can't assume both languages will be impacted the same way by the aphasia ii.​ Vocabulary representation in both languages iii.​ Must not assume both languages were equivalent in proficiency iv.​ Both languages should be formally evaluated to determine any deficits in each language. This helps inform language targeting and goal setting in therapy, ensuring that the treatment plan addresses the unique needs of both languages and modalities. 10.​ Compare and contrast positive and negative prognostic indicators for recovery of language skills after stroke or brain injury. a.​ Positive: i.​ How soon they receive services (the earlier the better) ii.​ Good general health iii.​ Motivation iv.​ Intelligence/academic history v.​ Professional history vi.​ Access to health care vii.​ Psychosocial support viii.​ How aware are they of their deficit ix.​ Age at time of stroke/injury (young = better) x.​ Frustration tolerance xi.​ Willingness to participate in therapy b.​ Negative: i.​ Size of lesion (larger = worse prognosis) ii.​ Presence of bilateral lesions or subcortical lesions iii.​ Depression iv.​ Past or current drug or alcohol abuse 11.​ Describe the purpose and focus of treatment when working with individuals with aphasia. a.​ Restorative approaches: These focus on helping the brain recover lost or reduced abilities, aiming to restore skills. b.​ Compensatory approaches: These help individuals use their remaining abilities to work around language impairments, improving communication. c.​ Supportive approaches: These provide emotional and social support, helping individuals cope with communication challenges and encouraging them to live as fully as possible. 12.​ General considerations for planning and providing treatment for individuals with aphasia. a.​ Improve comprehension: Use simple instructions, pictures, or objects to help patients understand. Pausing and pacing techniques (like a pacing board) can help manage their speech flow. b.​ Control excessive speech: Teach patients to stop speaking and listen using a gesture or signal, helping to reduce talking too much (logorrhea). c.​ Use cues: Facial expressions, gestures, tone of voice, and pauses can all help improve comprehension. d.​ Focus on functional communication: Use approaches that focus on real-life communication needs, like the cueing hierarchy or life participation approaches. e.​ Build on strengths: Tailor therapy to what the patient can do well. For example, if they’re good at writing or drawing, use these to help with communication. If they’re good at gestures, use them to help with word-finding. f.​ Use an interdisciplinary approach: Work with a team and apply evidence-based methods to create the best treatment plan. g.​ Encourage aphasia-friendly communication: Adjust the environment to make communication easier, and manage any behaviors that might make communication harder. h.​ Rehabilitation based on strengths: Always consider the patient’s preserved skills (e.g., auditory comprehension, graphic skills) to build treatment on what they do best, making it easier for them to reintegrate into society. 13.​ Describe mechanisms of neural recovery after stroke. a.​ Reduction of edema: Swelling in the brain decreases, relieving pressure on the affected brain tissue. b.​ Reperfusion: Blood flow is restored to areas that were previously not getting enough blood.  c.​ Resolution of diaschisis: Brain functions linked to areas far from the injury improve as the brain recovers. d.​ Neuronal regeneration: New branches of nerve cells (dendrites) and additional connections (collateral sprouting) form to replace damaged ones. e.​ Long-term potentiation (LTP): The brain’s ability to transmit signals between nerve cells becomes more efficient. f.​ Unmasking of pathways: Existing but unused neural pathways are reactivated to help compensate for those lost due to injury. g.​ Cortical reorganization: The brain adapts by having other regions take over the functions of the damaged areas. 14.​ List and describe the principles of experience dependent neural plasticity. a.​ Neural Plasticity: The brain's capacity to reorganize and adapt both its structure and function in response to injury and rehabilitation. b.​ Principles of Experience-Dependent Plasticity: 1.​ Use it or lose it: Skills or functions that are not regularly used may weaken or be lost. 2.​ Use it and improve it: Consistently practicing a skill can enhance and refine it. 3.​ Specificity: The kind of activity influences how the brain learns and adapts. 4.​ Repetition matters: Repeated practice is essential for mastering and maintaining new abilities. 5.​ Intensity matters: The amount of effort and focus put into rehabilitation is crucial for progress. 6.​ Timing matters: The timing of practice or therapy significantly impacts its effectiveness. 7.​ Salience matters: Therapy should be engaging and meaningful to motivate the individual. 8.​ Age matters: The brain’s ability to change may be slower in older individuals. 9.​ Transference: Skills learned in one area can help improve related abilities. 10.​ Interference: Learning in one area may hinder the development of other skills. 14. Describe interpretation of assessment results. a.​ Language Modalities: Assess speaking, understanding, reading, and writing to identify the most affected areas and guide treatment. b.​ Aphasia Type: Classify aphasia (e.g., Broca's, Wernicke's) to understand specific deficits and tailor therapy. c.​ Severity and Progression: Determine the severity and track improvement, stability, or worsening to set therapy goals. d.​ Cognitive and Communication Functions: Assess related cognitive skills (e.g., memory, attention) as they affect language recovery. e.​ Error Patterns: Analyze language errors to inform therapy strategies and understand underlying processes. f.​ Functional Communication: Evaluate how well the person communicates in real-life situations to focus therapy on practical use. g.​ Strengths and Compensatory Strategies: Identify preserved skills (e.g., gestures) to help compensate for language impairments. h.​ Impact on Quality of Life: Consider how aphasia affects daily life and emotional well-being to guide comprehensive treatment. 15. Identify and describe a variety of treatment approaches a.​ Semantic Feature Analysis (SFA): This approach helps individuals with aphasia retrieve words by exploring and strengthening their understanding of word meanings. Patients are guided to describe key features (e.g., size, color, function) of target words, facilitating word retrieval. i.​ Example: If someone is trying to say "dog," the therapist may prompt them to describe it by asking questions like, “What color is it?” or “What does it do?” The person might respond, “It’s a pet, it barks, it’s furry,” helping them remember the word “dog.” b.​ Verb Networking Strengthening Treatment (VNeST): Focuses on improving verb production and sentence construction. It encourages patients to generate sentences using action words and their arguments (e.g., who, what, where), enhancing the ability to produce grammatically correct sentences. i.​ Example: If a person struggles to say “The man is running,” the therapist will help them practice by using verbs and the people or things involved in the action. They might practice phrases like “The man runs” or “The woman eats” and slowly build to more complex sentences. c.​ Phonological Component Analysis (PCA): This method helps individuals with aphasia improve word retrieval by focusing on phonological properties of words. Patients work on identifying and producing sound patterns associated with target words to strengthen phonological skills.  i.​ Example: If someone has trouble saying the word “cat,” the therapist might focus on breaking it down to sounds, asking them to repeat the “k” sound, then the “a” sound, and finally the “t” sound to help them say the full word more easily. d.​ Melodic Intonation Therapy (MIT): Utilizes the musical aspects of speech (melody, rhythm) to improve language skills. MIT is often used for individuals with non-fluent aphasia, helping them produce words or sentences through singing and rhythmic tapping. i.​ Example: If someone has trouble saying the word "hello," the therapist might sing “he-l-lo” to a rhythm, encouraging the person to follow along. Over time, they try to speak the word rather than sing it, improving speech production. e.​ Constraint-Induced Language Therapy (CILT): This therapy encourages the use of verbal communication by limiting compensatory strategies, such as gestures or writing. It focuses on forcing the patient to speak in order to increase verbal output and improve language function. i.​ Example: If a person uses gestures to communicate, the therapist might say, “You can’t use your hands, try to say it instead.” The goal is to increase verbal communication, even if it’s difficult at first. f.​ Response Elaboration Training (RET): RET focuses on increasing the length and complexity of verbal responses. The therapist prompts the patient to expand on their answers, helping them generate more detailed and structured language. i.​ Example: If a person says, “I see a dog,” the therapist might prompt, “Can you tell me more about the dog?” The person might then say, “I see a big brown dog running in the yard.” g.​ Treatment of Underlying Forms (TUF): A structured approach that focuses on improving sentence structure by teaching patients to produce grammatically correct sentences. It is often used with people who have difficulty with syntactic processing. i.​ Example: If a person says “The dog ran the street,” the therapist would help them practice saying, “The dog ran down the street,” focusing on word order and sentence structure. h.​ Conversational Coaching: Focuses on improving conversation skills in everyday interactions. The therapist provides coaching on strategies like turn-taking, topic initiation, and maintenance, aiming to improve spontaneous communication. i.​ Example: If a person struggles to keep a conversation going, the therapist might coach them on how to ask follow-up questions like, “What did you do today?” or how to respond to others with “That sounds fun!” i.​ Supported Reading Comprehension: This approach helps individuals improve their ability to read and understand written material. It involves reading aloud with support, and using contextual cues or visual aids to improve comprehension. i.​ Example: If a person is reading a simple story, the therapist might read it aloud with them, asking questions like, “Who is in the story?” or “What happened next?” to guide comprehension. j.​ Visual Action Therapy (VAT): This therapy helps individuals with aphasia who have severe language impairments communicate through gestures, body movements, and visual cues. It focuses on using non-verbal communication to convey meaning. i.​ Example: If a person can’t say “I want water,” they might point to a picture of a cup, use a gesture for drinking, or tap the water bottle to indicate their need. k.​ Communicative Drawing Program: This method combines drawing with speech to support communication. Individuals draw pictures to express ideas and concepts, with the aim of enhancing communication in a non-verbal way and supporting word retrieval. i.​ Example: If a person struggles to say “I’m hungry,” the therapist might ask them to draw a picture of food. The drawing helps communicate their thoughts, supporting word retrieval and expression. 16. Long-term and short-term goal setting for verbal expression and auditory comprehension. a.​ Verbal Expression i.​ LTG: The client will demonstrate verbal expression clearly in complete sentences, using correct grammar and relevant vocabulary with 80% accuracy in spontaneous conversations, both in structured therapy sessions and daily life interactions, with minimal cues. ii.​ STG: The client will produce 5-word sentences with correct syntax and appropriate vocabulary in 80% of structured conversations during therapy, with minimal prompting. b.​ Auditory Comprehension i.​ LTG: The client will demonstrate auditory comprehension of a 8-10 minute conversation about familiar topics (e.g., daily activities, current events) by accurately answering 80% of questions related to the content, with minimal cues or prompts, in both structured and unstructured settings.  ii.​ STG: The client will answer questions related to a short (5 minute) video on relevant scenarios and accurately answer the questions related to the content, with minimal prompts during structured therapy sessions with an 80% accuracy. 17. Identify aspects of consideration for counseling needs of clients with aphasia. ​ The concept of treatment intensity (treatment dosage) includes consideration of different aspect of treatment sessions ○​ Number ○​ Frequency ○​ Duration Optimal intensity depends on several factors, e.g.: ​ Health and wellbeing of the person being treated; personal and environmental support ​ Nature of cognitive linguistic-impairments and their life-impacting consequences ​ Goals of treatment ​ Treatment methods implemented ​ Therapeutic relationship established between the clinician and the person In general, more intense intervention leads to the greatest brain changes as well as the greatest functional abilities In people with neurological disorders, if intensity exceeds one's ability to attend and participate actively, or if it leads a person to tire of or resist treatment, then it is no longer beneficial 18. Describe the various health care settings along the continuum of care an SLP may serve a person with aphasia. (in midterm) 19. Identify a variety of assessment and screening measures that may be used to evaluate the communication skills of a person with aphasia such as: a.​ Western Aphasia Battery b.​ Boston Diagnostic Aphasia Examination c.​ Boston Naming Test d.​ Boston Assessment of Severe Aphasia e.​ Reading Comprehension Battery for Aphasia f.​ Examining for Aphasia g.​ Communication for Activities of Daily Living h.​ Burns Brief Inventory of Communication & Cognition (Left Hemisphere Inventory) 20. Understand and describe the WHO ICF Framework a.​ WHO ICF: conceptual framework for classifying health and health-related domains for clinical and research applications in a consistent way throughout the world to classify health conditions -Important approach led by WHO to classify functional areas of health/disability -ICF means International Classification of Functioning a.​ Functioning = body functions, activities, participation  b.​ Disability = impairments, activity limitations, or participation restriction c.​ Body structure = physiological and psychological aspects of the body d.​ Activity = execution of tasks, involvement in activities e.​ Contextual factors = personal (age, gender) environmental (access to service) Midterm 1.​ Non-Fluent Aphasias are characterized by: a.​ Relatively intact auditory comprehension b.​ Greater difficulty with oral expression c.​ May have co-occurring acquired apraxia of speech 2.​ Components of the aphasia assessment for oral expression that contribute to the differential classification of aphasia are all of the following except: a.​ Singing b.​ Lexical retrieval c.​ Spontaneous speech d.​ Repetition 3.​ An inappropriate or uncontrolled repetition of a previous response that continues after the task requirements have changed and the response is no longer needed is referred to as a a.​ Preservation 4.​ You are preparing the diagnostic report for a patient who you recently evaluated to determine the nature of their aphasia. In your summary of findings section, what pieces of information from your assessment will be important to include in your report? a.​ Oral Motor Exam b.​ Speech/Articulation c.​ Expression d.​ Comprehension e.​ Pragmatics/Social Communication f.​ Summary of impressions, differential diagnosis, prognosis for improvement 5.​ Match the description of the paraphasia with the production of the target word "chair". a.​ Phonemic paraphasia: Share b.​ Semantic paraphasia: Bench c.​ Neologism: Pizzle d.​ Correct production: Chair 6.​ What are four tasks or activities that are used to evaluate auditory comprehension? a.​ Identification of Objects, Pictures, Shapes, etc.​ Task: The clinician says, "Point to the cat" while showing a set of pictures.​ Example: The child is asked to point to a picture of a dog, a cat, and a tree when prompted to select "the cat." b.​ Commands​ Task: The clinician gives a verbal instruction, and the child is asked to follow it.​ Example: "Touch your nose" or "Clap your hands twice." c.​ Yes/No Questions​ Task: The clinician asks simple questions where the child can respond with "yes" or "no."​ Example: "Is the sky blue?" or "Do you like apples?" d.​ Complex Information​ Task: The clinician presents a longer or more detailed verbal instruction.​ Example: "Pick up the pencil, put it on the table, and then touch your toes." This assesses the ability to follow multi-step instructions. 7.​ When exploring the case history of a patient prior to completing an assessment, what are 5 things you should focus on? (Hint: there are more than 5, you only need to provide 5) a.​ Admitting Diagnosis​ This provides the primary reason for the patient’s referral and any initial diagnoses that might influence treatment planning. b.​ Past Medical History​ Understanding the patient's medical background helps identify any conditions or treatments that could affect speech, language, or cognitive function.  c.​ Family Support/Social Support​ Assessing the level of family or social support helps determine external resources that may affect the patient’s treatment and progress. d.​ Work and/or Educational History​ This provides insight into the patient’s cognitive and communication abilities in functional settings and any challenges they may face in these environments. e.​ Results of CT or MRI of Brain​ These results are important for understanding any neurological factors that might impact the patient’s speech, language, or cognitive abilities. 8.​ Multidimensional Frameworks for aphasia recognize relationships between site of lesion and resulting problems in language. True 9.​ A hemorrhagic stroke means that there is bleeding in the brain and an ischemic stroke results in a clot or other blockage of an artery or vessel in the brain. 10.​ A person demonstrating numbness or tingling in the face, right arm or leg, slurring of words, telegraphic speech and difficulty swallowing is most likely demonstrating symptoms consistent with a: Left MCA stroke 11.​ Match the term with the definition a.​ Agraphia​ Acquired loss in the ability to communicate through writing. b.​ Alexia​ Loss of meaning and sound association with written symbols. c.​ Apraxia​ Loss or impairment of volitional control of purposeful movements. d.​ Paragrammatism​ Inaccurate syntactic structure and inappropriate use of pronouns, verb tense, and morphological errors that result in fluent output that doesn't make sense. 12.​ If you walked into a patient's hospital room and needed to do an informal assessment of their language abilities , which of the following items could you use to evaluate reading comprehension? (Choose all that apply) a.​ Hospital Menu b.​ Greeting Cards c.​ Daily newspaper 13.​ A person with aphasia who presents with fluent oral expression characterized by neologistic jargon and difficulty with auditory comprehension most likely has a: Fluent Aphasia like Wernicke’s 14.​ What are the four core elements that should be included in the definition of aphasia? a.​ Language (not a sensory, motor, psychiatric, or intellectual disorder) b.​ Neurological c.​ Multimodal, affecting reception and production d.​ Acquired 15.​ Agrammatism refers to telegraphic expression that is made up primarily of nouns and verbs with the omission of function words and grammatical morphemes evident. 16.​ List 3 tests that could be used as a full, formal assessment of language in an adult with suspected aphasia. a.​ Boston Diagnostic Aphasia Exam (BDAE) b.​ Western Aphasia Battery (WAB) c.​ Examining for Aphasia (EFA) 17.​ If you wanted to specifically evaluate a patient's reading comprehension, which test would you choose? a.​ RBCA 18.​ Anomia means: Without words or names for things 19.​ The ASHA Functional Assessment of Communication Skills is an evaluation that can be used to classify the type of aphasia someone is presenting with. False 20.​ The Circle of Willis allows for the blood flow from the front to the back of the brain and serves as a safety mechanism to maintain blood flow, even if one of the arteries traveling to the brain becomes blocked. True 21.​ List 5 areas of assessment for oral expression: a.​ Speech Fluency (e.g., length of utterances in connected words) b.​ Automatic speech (e.g., commonly used sequences of language such as days of the week, counting months, etc.) c.​ Repetition (e.g., Ability to repeat progressively more complicated and lengthier information d.​ Lexical Retrieval (e.g., ability to name words in a variety of activities) e.​ Syntactic structures (e.g., content and structure of utterances) 22.​ When considering the WHO ICF Framework, which ICF Classification would the following information pertain to? Joe, is a person with aphasia, he has limited involvement in activities outside of his home. He is no longer able to actively engage in his hobbies of playing soccer and reading science fiction. He finds  himself spending more and more time alone and limits his attempts at communication because of other's difficulty understanding what he is saying. a.​ Activity and Participation 23.​ Define apraxia of speech and describe the speech characteristics that accompany apraxia of speech? What type of aphasia is often accompanied by apraxia and what lesions are most likely to result in apraxia of speech? a.​ Apraxia of speech (AOS) impairment in motor programming and sequencing of movements of the articulators for intentional and volitional speech b.​ Speech characteristics include articulatory groping, slow rate of speech, abnormal prosody, and inconsistent articulatory errors. c.​ Non-fluent aphasia may accompany AOS d.​ Lesions locations in the frontal, pre-motor association zone, and anterior parietal areas of the left hemisphere. 24.​ Compare the language characteristics and sites of lesion that would be typical for fluent and non-fluent aphasia. a.​ Non-Fluent Aphasia: Lesions are anterior to the Rolandic fissure (central sulcus) i.​ Characteristics include decreased speech rate, phrase length, prosody, initiation of speech, speech output in general, and increased effort. ii.​ Other terms used are expressive, Broca's, and anterior aphasia b.​ Fluent Aphasia: Lesions are posterior of the superior temporal gyrus i.​ Characteristics include auditory comprehension deficits, paraphasic speech with poor self-monitoring, effortless and melodic speech, decreased use of real words, paragrammatism, and the ability to initiate verbal expressions. ii.​ Other terms used are receptive, posterior, and jargon aphasia. 25.​ All of the following are types of apraxia except: a.​ Facial b.​ Ideational c.​ Limb d.​ Positional 26.​ Which of the following are part of the WHO International Classification of Function? a.​ Body Structure/Function b.​ Activity and Participation c.​ Contextual Factors 27.​ Frameworks focused on interpersonal contexts of communication and the ability of a person to have meaningful interactions in daily life are: Social Frameworks 28.​ The Quality of Life Communication Scale was developed by ASHA to a fill a gap in the measurement of quality of life specific to communication. True 29.​ Provide 4 best practice considerations for the assessment of aphasia and explain why they are important. a.​ Focus on the person: Treating the person as an individual with unique needs and strengths which can help build rapport and relationships b.​ Have a clear purpose: Reduces confusion and makes sure that the information is understood c.​ Speak directly to the person: Demonstrate respect and encourage active participation d.​ Focus on strengths: Boosts confidence and motivates them 30.​ Talking around what is trying to be said or using words to express the meaning of an intended word is referred to as a circumlocution 31.​ Match the different settings where aphasia assessment may occur with the correct description of that setting. a.​ Acute Care​ Short duration of stay with the goal to stabilize patient and determine next level of care. b.​ Long-Term Acute Care Hospital​ Medically fragile patients are admitted for longer term complex care and therapy is provided as tolerated. c.​ Inpatient Rehabilitation​ Goal is to optimize recovery of function and patients are able to participate in at least 3 hours of therapy per day. d.​ Skilled Nursing Facility​ Rehabilitation services provided at a lower intensity for those patients who are not able to participate in 3 hours of therapy per day. e.​ Outpatient Therapy​ Focus on increasing independence for patients who are medically stable and are no longer in a hospital setting.  f.​ Day Rehabilitation​ Combination of individual therapy, group treatment, and independent work in a 6-7 hour day. Patients return to their homes at night. g.​ Home Health Care​ Patients receive therapy in their home where the focus of therapy is on optimizing recovery. 32.​ Reading comprehension and written expression are often very different from oral expression and auditory comprehension in persons with aphasia. False 33.​ The two major arteries that bring blood to the brain are: a.​ Internal Carotid Arteries and the Vertebral Arteries 34.​ List 5 reasons you would conduct an aphasia assessment. a.​ -To diagnose and classify aphasia b.​ -Asses language strengths and weaknesses c.​ -Treatment planning d.​ -Goals that are wanted by the client or their family members e.​ -Recommending any additional services needed 35.​ Match the description of the naming activity with appropriate examples. a.​ Confrontation Naming​ Provide the name of a picture shown. b.​ Sentence Completion​ Hot and _______. c.​ Responsive Naming​ Where do you buy stamps? d.​ Word Fluency​ Name as many states in the United States as you can in one minute. 36.​ You have a patient with aphasia that you would like to gain a better understanding of how they communicate in more functional situations. Which of these tests would you choose to administer? a.​ Communicative activities of daily living (CADL-2) 37.​ What are three available screening tests appropriate for adults suspected of having aphasia? a.​ Burns Brief Inventory of Communication and Cognition b.​ FAST-2 c.​ QAB d.​ MAST 38.​ A person's verbal output that is fluent and characterized by inaccurate syntactic structure and inappropriate use of pronouns and verb tenses making expression nonsensical or sounding like "word salad" would be described as: Paragrammatic