Aphasia 113 2024 PDF

APHASIA SPSC 113 Acknowledgements: Catherine Theys, Megan McAuliffe  APHASIA Language impairment caused by brain damage – usually stroke Includes a number of related but separate presentations Largely depend on the site and size of the bra...

APHASIA SPSC 113 Acknowledgements: Catherine Theys, Megan McAuliffe  APHASIA Language impairment caused by brain damage – usually stroke Includes a number of related but separate presentations Largely depend on the site and size of the brain damage People with aphasia were studied to determine the lateralization and organization of language in the brain  WHAT IS APHASIA? from Greek a = not phatos = derivation of ‘to speak’ Most people: dysphasia rather than aphasia Dysphasia = outdated term  WHAT IS APHASIA? Traditionally, considered a language disorder caused by damage to the left cerebral cortex. May affect listening, speaking, reading, writing, naming. Other functions also affected: maths, telling the time, gesturing, counting money, etc.  A FEW TERMS Agrammatism – Agraphia – Alexia – Anomia – Jargon – Neologisms – Paraphasia – Verbal stereotypes –  WHICH LANGUAGE AREAS CAN BE AFFECTED? Verbal expression almost all people with aphasia will have some difficulties retrieving words examples of difficulties: retrieving names of items expressing more complex ideas producing complex sentences using grammatical function words unable to say any words but can use common gestures only able to say a few words difficulties expressing self using words, gestures or drawings  WHAT IS APHASIA? Definition An acquired selective impairment of language modalities and functions resulting from a focal brain lesion in the language-dominant hemisphere that affects the person’s communicative and social functioning, quality of life, and the quality of life of his or her relatives and caregivers Papathanasiou & Coppens, 2017, p. 4  WHICH LANGUAGE AREAS CAN BE AFFECTED? Auditory comprehension Verbal expression Reading Written expression Numbers  WHICH LANGUAGE AREAS CAN BE AFFECTED? Auditory comprehension affected to some degree in almost every person with aphasia examples of difficulties: understanding conversations in groups, telephone conversations, TV understanding normal or fast speech following simple, or longer & more complex commands answers to simple yes-no questions may be unreliable understanding simple gestures  WHICH LANGUAGE AREAS CAN BE AFFECTED? Reading examples of difficulties: reading and understanding signs, single words, sentences, paragraphs or long complex novels understanding grammatical words in sentences reading aloud while being able to understand some simple written words & sentences  WHICH LANGUAGE AREAS CAN BE AFFECTED? Writing examples of difficulties: writing numbers, letters, single words to name things, sentences, paragraphs or text writing grammatical words in sentences LANGUAGE-DOMINANT HEMISPHERE? § 2 areas in dominant hemisphere important for production & comprehension of language § Broca’s area § Wernicke’s area Johns, 2014 LANGUAGE-DOMINANT HEMISPHERE? § Arcuate fasciculus § fibre tract connecting Broca’s & Wernicke’s area § communication between 2 areas necessary for normal language functioning Johns, 2014  APHASIA - BUT STILL COMPETENT AND INTELLIGENT “Those of us who don’t have aphasia cannot truly understand what it is like, although we can do our best to imagine what it might be like. If we try to put ourselves in the shoes of a person with aphasia, we will likely be better communication partners.” http://www.vohaphasia.org/simulation/ Hinckley, 2011  OTHER ISSUES Hemiparesis – weakness on one side of the body Hemiplegia – paralysis on one side Hemisensory impairment – cannot perceive sensory information on one side Dysphagia Impaired mobility, eating, dressing, writing More or less inhibited than previously Loss of power to represent self and family Negative effects on self-concept  AOTEAROA CONTEXT - STROKE New Zealand + 11,000 adults per year that’s 170 per 100k 70-75% +65 years Incidence of aphasia increases with age Under 65 years 15% PWA Increases 4% per year of age Canterbury 2015 181 per 100k Engelter et. Al., 2006 Ranta 2018, NZIER 2020 (https://www.stroke.org.nz/stroke-foundation-and-nzier-research) CLASSIFICATION OF APHASIA  FLUENT APHASIAS In the posterior cortex Reception and processing of language Damage to Wernicke’s area: Difficulty comprehending speech Possible reading problems Normal fluency Normal speech rate and intonation  WERNICKE’S APHASIA Impaired spoken and written comprehension Fluent, well-articulated, phonologically correct speech, press of speech (circumlocution & poor self-monitoring) Speech lacks content – some exhibit jargon (incomprehensible, incoherent utterances that are fluent and well-articulated) https://www.youtube.com/watch?v=3oef68YabD0  ANOMIC APHASIA Normal language with word-retrieval difficulties Auditory and reading comprehension: Usually near normal Anomia exists in other aphasia types as well but only salient symptom in anomic aphasia. Expressive language: Word retrieval difficulties but will recognise word immediately if provided. Repetition usually better than spontaneous speech (see word retrieval problems in written language also)  NON-FLUENT APHASIAS Frontal lobe Contains Broca’s area Responsible for speaking Slow, laboured speech Lacks flow and intonation Word retrieval difficulties Often have co-occurring apraxia  BROCA’S APHASIA Person will often have co-occurring right-sided hemiplegia or hemiparesis Salient features: Paucity of speech Agrammatism: Usually missing function words (the, is, on) and word endings (-ing, - s etc) Word retrieval deficits Slow rate, laborious speech, halting Relatively intact auditory and written comprehension (generally surprisingly better than spoken output would suggest) https://www.youtube.com/watch?v=6zNKz7YoUao  GLOBAL APHASIA Results from lesions in both anterior and posterior speech areas Mixed effects of Broca’s and Wernicke’s aphasias Severe comprehension and production deficits Impaired naming and repetition People usually have a limited number of utterances  ASSESSMENT Obtain medical history Obtain hx from patient or significant other Determine patient’s primary language Determine hearing status and visual acuity Determine patient’s pre-morbid language abilities and educational level Ability to read / write Determine patient’s cognitive function Types of drugs and drug therapies  INFORMAL ASSESSMENTS Screening tool, completed early Does the patient appear to follow conversation? Provides basic information on patient’s language ability Can they follow 1, 2, 3 -step commands Enables therapist/team to pitch communication at the level in which Do they comprehend yes/no patient understands or is able to questions reliably? express Do they understand gestures or non- Provides direction for formal testing verbal communication Many tests available Reading comprehension INFORMAL ASSESSMENT  TREATMENT - RESTORATIVE Counting on the brain to recover some previous skills – cortical reorganisation of damaged hemisphere OR increased involvement of undamaged areas Treatment of auditory comprehension and spoken language - single word, sentence, and paragraph level also reading and writing Broad number of techniques – traditional or psycholinguistic (models of language functioning)  TREATMENT - COMPENSATORY Treatment seldom produces full recovery Work also needs to be done on: Lessening problems Learning to circumvent problems Goal of tx: “develop and train alternative approaches to circumvent the language skills that have been affected by aphasia” (Holland, 2006, p.429)