Study Guide Language Disorders Exam.pdf

Week 1 ➔ Language vs. communication ◆ Language + sophisticated communication make us human and distinct from other animals that communicate ◆ Humans + Animals communicate ◆ Humans have language ➔ Language vs. speech ◆ Speech: Verbal means of communicating...

Week 1 ➔ Language vs. communication ◆ Language + sophisticated communication make us human and distinct from other animals that communicate ◆ Humans + Animals communicate ◆ Humans have language ➔ Language vs. speech ◆ Speech: Verbal means of communicating (articulation, voice, fluency) neuromuscular programming ◆ Language: socially shared rules of expression (semantics, morphology, syntax, grammar, pragmatic considerations) Cognitive process ➔ Basics of the Nervous System o CNS: Brain + Spinal Cord, and brainstem Language and cognitive communication function ◆ PNS: CNs and SNs (everything on the sides) Anatomically divided into cranial nerves and spinal nerves Motor, sensory, volitional function autonomic to/from body - CNS is protected by: bony shell, meninges, and cerebrospinal fluid - Cell Types - Neurons: dendrites, cell body, axon, terminal ending, synapse - Glial cells: helper cells, provide myelination to axons - Gray matter : cell bodies and dendrites inside CNS and PNS what you see when you look at the brain (outside) - white matter: myelinated fibers or axons located in the CN, inside of brain - > also referred to as tracts or fasciculi ➔ Divisions of the Central Nervous System o Major CNS divisions o CNS Divisions ◆ Left Hemisphere: , language production and comprehension functions ◆ right hemisphere: spatial implications, melody, intonation ◆ Four lobes Frontal(front) Parietal (behind frontal) Temporal (on side under frontal and parietal) Occipital (all the way in the back under parietal) ○ The cortex: Brodmann’s areas: delineated based on cytoarchitecture differences, but have functional correlations ◆ Areas 1, 2, 3 = somatosensory functions ◆ Area 4 = motor signal or fine motor commands  ◆ Association vs. primary cortex Primary somatosensory cortex is the first cortical region that receives somatosensory information,information is now sent to the primary cortex for perception, then information is finally sent to the association cortex to identify and recognize what we just perceived. ○ Primary Cortex - perceives information sends it to association cortex ○ Association cortex - identify and recognize what we perceived ○ Adjacent to primary cortex ○ Most of our brain is made out of association cortex - Types of white matter tracts - Projection tracts: interconnect primary cortical areas (primary motor and primary sensory) to deeper structures - Association tracts: most numerous and interconnected regions of the cortex within the same hemisphere - Commissural tracts: interconnect homologous areas in the left and right hemispheres ➔ Blood Supply ◆ Basics of cerebral arteries and blood flow In order for cells to function, they must be provided with O2 and glucose which is carried in the blood MUST have a continuous flow of blood without interruption, this will lead to cell death, cell dealth in CNS means cells won’t rejuvenate themselves in there Cerebral arteries provide blood to the cortex ○ ACA - provides blood to prefrontal area which is in charge of our judgment, inhibition, higher level cognitive processes. Problem solving, sequencing, and planning ○ MCA - provides blood to our specialized language centers in the left hemisphere ○ PCA - blood to ventral surface of the brain + occipital lobe ➔ Types of stroke (CVA) - where you would administer TPA Types of ischemic stroke (blocks arteries): ◆ Transient, might have symptoms of a stroke but symptoms might resolve or not long enough to cause a cell death so it is often assumed that blood flow has returned  ◆ Thrombosis (full stroke) : localized buildup of fatty plaques, platelets, causing occlusion (closed off either completely or partially) ◆ Embolism: blockage in blood vessel caused by traveling cloth ◆ Transient ischemic attack (mini strokes) ◆ Lacunar strokes - small blockages of small vessels that cause cell death usually happens in basal ganglia, leads to motor and sensory deficits ◆ The penumbra - area surrounding the lesion or focal point of dead tissue Types of hemorrhagic stroke ○ Intracerebral: can be within the cranial tissue or cerebral tissue itself, can be lacunar, are associated with hypertension common use = HTN ○ Extracerebral: occur within the meningeal tissue, epidural, subdural (TBI) subarachnoid (related to aneurysm, traumatic brain injuries) Basics of treatment ○ ST/acute: goal is to save tissue of the penumbra with medical treatment to restore brain function ◆ Carotid endarterectomy, stenting, clot retrieval. tPA (tissue plasminogen activator, breaks down clots) administration: used in occlusive ischemic stroke ◆ LT/chronic: rehabilitation ➔ Perisylvian Language Areas and Related Structures ◆ Areas of the cortex in the Perisylvian region related to language and communication Broca’s Area (BA 44 and 45; frontal lobe): language production, syntax, morphology etc. ○ Primary motor cortex: send signals to articulators, articulation and phonology *Wernicke’s area (BA 22; temporal lobe): language comprehension and understanding -Primary Auditory Complex (temporal lobe): auditory perception -Angular and supramarginal gyri (border of temporal/parietal/occipital lobes): implications for reading and writing - visual association cortex (occipital lobe): visual linguistic stimuli ➔ Other structures involved in communication ◆ Prefrontal cortex: executive function/higher-level cognition  ◆ Cingulate gyrus: amygdala, hippocampus, insular cortex: emotion, memory, aggression ◆ Right hemisphere: prosody, affect, formulaic language ◆ Basal ganglia: formulaic language ➔ Neuroimaging ◆ What was used before neuroimaging Postmortem examination of the brain: Doctors would wait until a patient died to examine their brain ➔ Structural neuroimaging ◆ Seeks to understand the in vivo anatomy/structure of the brain Ex. CT Scan (not a diagnostic tool for stroke) ○ Pros: less expensive ○ Able to determine between ischemic (blockage) or hemorrhagic stroke, use tPA or not ○ Ex. MRI ◆ Able to see water concentration differentiation depending on the tissue type, gray or white and tissue densities Perfusion-weighted imagining: Visualization of the ischemic penumbra ◆ Cons: expensive and not appropriate for all because of magnetic fields - Functional neuroimaging: seeks to understand the location or timing of task-dependent neural activity in the brain - Ex. Positron emission tomography (PET) - Pro: method of viewing neural regions during tasks with decent spatial resolution Ex. Functional magnetic resonance imaging (fMRI): measure magic field within brain during rest as compared with during task, no radioactive tracer, but not direct measure ​ Week 2: Basic statistics of neural injury (stroke) People experience neural injury and language impairment Approx. 795,000 people in the U.S have a stroke each year Costs U.S about 34 billion each year In 2011, 1/20 deaths due to stroke Leading cause of serious long term disability Those who arrive at the hospital within 3 hours of first symptoms have less disability than those with delayed care Traumatic brain Injury About 2.5 million sustain TBI each year Children and older adults are at high risk Alzheimer's Disease 5 million people living with alzheimer's in 2013 2013- 6th leading cause of death in the U.S All of these have a bg societal impact but HUGE personal one Social context of disorder Goals of intervention Help people function in their everyday lives ○ What is important and meaningful to each person - Defining “health” - An absence of illness (historical definition) - WHO: the absence of infirmity and disease and a state of physical, mental and social well being ➔ Impact of individual and social network traits on coping and recovery ◆ Huge impact on all domains of life ◆ Family role, financial stability, employment, living environment, leisure activities, social integration ◆ Independence and control ◆ We try to help them to a different way of living, cope with communication impairments, regain a lost function, rebuild their skills Advances in rehab: Rehab is approached with the perspective of altering the function of remaining healthy tissue ○ Neuroplasticity ○ Dendritic spouting following CNS injury New goal: therapy induced long -term reorganization of the brain function to healthy tissue following injury Illness Experience and Stages  Stage 1: uncertainty, suspecting something is wrong, family suspecting something is wrong, they are monitoring behaviors, both are overwhelmed Stage 2: Disruption, relinquishing control, distracting oneself, family is accepting responsibility and being vigilant Stage 3: regaining self, person is trying to make sense of disability, regain oneself, negotiate control, goal setting for rehabilitation, family will try re-negotiate roles, biffering, monitoring activities, supporting Stage 4: regaining wellness, taking charge, attaining mastery, seeking closure, family will be relinquishing control, making it through, and seeking closure Patient-Centered Approach: inform, respect, ask and educate Need empathy and compassion Comorbidity of Mood Disorder and Depression By recognizing and treating depression, quality of life of patient and family can be drastically elevated Role of SLP to advocate for identification and treatment Common in cases of brain injury/ illness Depression: experience of depressed mood or loss of interest that impacts your life and well being almost everyday for at least two weeks Current approach: evaluate and treat the depression/mood disorder rather than “wait and see” Chronicity of Illness ○ What is chronicity of illness The long duration of the impairment Gregg’s (1989) stages of emotional reaction to chronicity of illness ○ shock , realization, denial, mourning, and adaption Adaptation and Coping ○ Individual and outside factors that may impact the individual’s ability to adapt to and cope with illness Individual factors: age, physiologic response to illness, cognitive ability, education level, gender, personality Outside factors: family, community, culture, society Quality of Life ○ Assessment of QoL: you asses not only physical and psychological health but also someones independence level, social relationships, personal beliefs, relationship to environment  o Consideration of QoL in Plan of Care and Intervention of Depression in Aphasia If we suspect depression refer out when needed Week 3 What aphasia is and what it isn’t ○ Acquired neurogenic language disorder due to damage to L-hemisphere NOT aphasia Deficit in sensory, motor, and cognitive function Can co occur with these impairments Crossed aphasia ○ Language impairment due to the nondominant hemisphere Difference between theories and models ○ Theory: statement/idea about the mechanism underlying a particular behavior, can be tested, allow generalization, be falsifiable ○ Model: attempt to visualize/formulize a theory in a way that allows for testability, puts theory to work, can stimulate, explain or predict a phenomenon. Theories of aphasia ○ Classical associative connectionist paradigm Dominant paradigm based on neoclassical connectionist model of aphasia Common classification system derived from this model Work of broca, wernicke, shows centers in brains made up of association cortex, brain centers are responsible for a particular language function ○ Posterior language center: posterior temporal cortex AKA Wernicke’s area ○ Anterior language center: third frontal convolution aka inferior frontal gyrus AKA Broca’s area Aphasia as a unitary phenomenon ○ One core impairment that crosses all modalities and components of language, single unifying impairment, this underlying impairment is auditory processing (schuell) ○ Mcneil underlying impairment: cognitive mechanisms ➔ Brown’s microgenetic theory ◆ A neuroanatomic framework of language that reflects the involvement of neural regions in a sequence dictated by evolution and development Basic language functions controlled by more primitive structures Models of aphasia ○ Cognitive neuropsychological models Single-word processing studies that help identify where the breakdown is in auditory and visual word processing by examining different stages Can be used for hypothesis testing o Computational connectionism models ○ The idea that language can be represented as patterns of activities over interconnected neuron like information No direct connection to neurobiology Signs and symptoms of aphasia ○ Different types of paraphasias Verbal semantic: word errors semantically related to target/intended word Literal/phonemic: word eros phonemically related to target/intended word Neologism/neologistic; paraphasia and jargon Stereotypies, recurrent utterances Preservation: atypical repetitions of words, topics after that stimulus has ceased Anomia ○ Naming impairment: word choice errors(paraphasias), target words that are not retrieved might be substituted by pause filters or a pause in conversation ○ Other signs and symptoms (agrammatism, comprehension impairment, etc.) Agrammatism: reduced functions words, reliance on content words Reduced auditory impairment Alexia Agraphia Classification systems of aphasia ○ Western Aphasia Battery (WAB) Pro: classifies nearly 100% of individuals into one of the categories, more test-retest reliability, reliability is high Cons: forces categorization  Categorization on BDA/WAB is depending on performance on: Fluency Auditory verbal comprehension Repetition Naming/word finding ➔ Pros and Cons of Classification ◆ There’s patterns in aphasia that help put them into categories, but classification might not always be considered helpful because each person is different and they might have different patterns of aphasia that necessarily can’t be put into a certain type of aphasia. It becomes too hard to exactly relate theory to a person's real life situation. ➔ The Western Aphasia Battery and its method of classification of Fluent vs. Nonfluent aphasia classification ◆ Classification of fluent: poor auditory comprehension, speech is naturalistic and fluent in that it has a normal utterance length ◆ Non fluent group: good auditory comprehension, utterance length is very shortened, one to two words per utterance Main features of fluent and nonfluent aphasia ○ Non fluent aphasia: number of words, many paraphrases and lex retrieval deficits ○ Fluency: preserved articulatory facility, prosody, melody over sentences, and preserved grammar Basic neuro geography of fluent and nonfluent aphasia of Schuell’s Classification System ○ Factors produced 5 groups ◆ 1. Simple aphasia ◆ 2. Aphasia with central involvement of visual processes ◆ 3. Aphasia with sensorimotor involvement affecting speech ◆ 4. Aphasia with scattered findings ◆ Aphasia with severe impairments Best practices for classification and intervention goals ○ Describe signs and symptoms of that particular individual's language impairment ○ Describing co-occurring impairments that may impact rehabilitation One of the pros would be that individuals who the test is taken all will fall within one of the classification categories and the classification test is reliable. For example, if I was taken multiple times with the same patient, the patient will have a similar score everytime (test-retest reliability). A con would be that the patients are forced to fall within a category and between the WAB and the BDAE only have a similarity of classification to be 27%