INTRO TO COMD
INTRO TO COMD COMD 2081
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Aphasia is a loss of words not intelligence Cquot quotem qm bysesquot FOR MORE INFORMATION National Aphasia Association 8009224622 httpwwwaphasiaorg Thanks a Catholic Medical Center39s Aphasla Support Group Manchtster NH CAN YOU SEE A DIFFERENCE WHAT IS APHASIA l Aphasia is an impairment of language An I acquired communication disorder that impairs a person s ability to process language but does not affect intelligence Impairment in understanding formulating and expressing language includes reading amp writing DEFINITIONS OF APHASIA Schuell Jenkins amp JImenez Pabon 1964 Aphasla Is a general language deflclt that crosses all language modalities Benson 1979 Aphasla Is the loss or Impairment of language caused by brain damage Darley 1982 lmpalrment as the result of brain damage of the capacity for interpretation and formulation of language symbolsquot McNeil 1982 Aphasia is a multimodality physiological inefficiency with greater than loss of verbal symbolic manipulations Goodglass amp Kaplan 1983 Aphasia refers to a disturbance of any or all of the skills associations and habits of spoken and written langauge Take home message AGE RELATED EFFECTS ON THE BRAIN After age 50 2 loss In braln weight per decade Gyral atrophy gyrus become less pronounced Neuron changes development of neurofibrillary tangles Fatty deposits in neural tissue Wallerian degeneration fatty degeneration of nerve fibers Shrinkage of dendritic arbor treebranch structure of neuron ONSET OF STROKE h www outubeoom watchvM fo mDO FACTS Most common cause of aphasia Is stroke about 23 40 of stroke survivors acquire aphasia However research that spontaneous recovery is evident one year post but at a slower pace 15 deaths is due to stroke Increase prevalence after age 55 It is estimated that about one million people in the United States have acquired aphasia or 1 in 250 people About 15 of stroke survivors need institutional care More common than Parkinson s Disease cerebral palsy or muscular dystrophy About 13rd of severely headinjured persons have aphasia TYPES OF STROKES CEREBRAL VASCULAR ACCIDENTS TIAtransient Ischemlc attack often a precursor for a stroke Ischemic classic stroke blockage of blood flow thrombosis Hemorrhagicbleed out into brain which results with immediate cell death Aneurysmabnormal widening of the brain results In a ballooning effect of the blood vessel httpzzwwwxoutubecomwatchv b2G Hf6TS490ampf Carotid External Carotid Cornn bon Carotid Arteries Vertebral Arteries TYPES OF APHASIA Broca s Aphasia speech output severely reduced limited mainly to short utterances of less than four words Vocabulary access limited Word finding difficultyAnomia Formation of sounds often laboriousclumsy transformation of sounds pan gtman Neologisms made up words gt I m going to the pragost May understand speech and be able to read but limited in writing Halting and effortful quality of speech Telegraphic Lack of words other than content words ie is the am Use of nonspecific words her gt Sara I httpwwwvoutubecomwatchvlaplTvEOBew TYPES OF APHASIA Wernlcke39s aphasia Limited in comprehension of speech Patients typically do not read or write beyond an elementary level Fluent but meaningless Jargonirrelevant or meaningless speech Tangential speech loose connections between topics Ex Where did you go on vacation Aph Pt good you know The ice cream was smooth httpwwwyoutubecomwatchvgKWEAgnuElM TYPES OF APHASIA Anomlc Aphasla Persons who are left with a persistent Inability to supply words for the things that they want to talk about Word finding problems well its umround you know like a circle Red Significant in nouns and verbs I Understand speech well better comprehension Poor writing ability paraphasia word substitution problem Ex may call a hat a cat or spoon a knife Neologisms madeup words Ex nobst for tv TYPES OF APHASIA Global Aphasla Most severe form Produce few recognizable words Understands little or no spoken speech Can neither read alexia or write agraphia Usually seen after patient has suffered a stroke and may rapidly improve if the damage has not been tOO extensive Greater brain damage more severe and lasting dlsabllily WHAT IF FEELS LIKE TO BE AN APHASIC h a haslacornermm a hasIaslmulatlons readln Im alrmentshtml SPOKEN LANGUAGE PROBLEMS 1 anomia difficulty naming things 2 paraphasia word substitution problem often seen with Wernicke39s aphasia phonemic hiss for kiss verbal spoon for knife 3 neologism create new words 39bast39 for ring 4 Aggrammatism omission of certain grammatical elements articles nounsverbs grammatical moprhemes ing ed s speak in short sentences with effortful struggle 5 Jargon relatively fluent language but its meaningless speech neologisms h p wwwdoutubecomwatchvML9YvaDozoampfeaturerelated 6 Visual neglect problems will not attune to sections of visual field Full Vlsual fleld Bilateral Hemianopia BlnasalHemlanopla RECOVERY FROM APHASIA After stroke If symptoms last longer than tWO or three months complete recovery IS unlikely People continue to improve over a period of time spontaneous recovery Acute I Chronic Slow process for both patient and FAMILY family involvement is key Need to learn compensatory strategies for communicating Multiple professional Intervention Speech Physical Occupational goal for all aphasics is Functional Communication multimodalty PROGNOSTIC CONSIDERATIONS General rules but there can be exceptions Larger the lesion 9more severe aphasia Bilateral damage 9 poorer prognosis Multiple lesions 9 poorer prognosis Prevlous stroke 9 poorer prognosis General health if good 9 better prognosis Age under 50 has varied In research 9 better prognosis COMMUNICATIONS DO S AND DON TS Talk to the person as an adult NOT as a child Mlnlmlze or eliminate background noise Make sure you have the person s attention before communicating Encourage and use all modes of communication Speechwritingdrawingyesno responsesgestures Must include family during treatment family support is crucial for tx COMMUNICATION G Ive them tlme to talk and permlt a reasonable amount of tlme to respond Accept all communication attempts Keep your own communication simple but adult Simplify sentence structure and reduce your rate of speech COMMUNICATION Keep your voice at a normal level and emphasize key words Augment speech with gesture and visual aids when possible Repeat statements when necessary Do not attemptto finish the patients statement for them httpwwwxoutubecomwatchvYHzzchBIGk Communication Disorders Exam 1 Class 1 Anatomy and Physiology Respiratory System Ribs Lungs Trachea Diaphragm Inhaling amp exhaling Speak during exhalation Only two words we speak during inhalation Medulla oblongata brain function 12 pairs of ribs that form a cylinder like structure External intercostal lift ribcage when you inhale Internal intercostal compress ribcage when you exhale Lungs compress in and out Carbon dioxide comes out of our system Even system of inhalation and exhalation Neck Muscles Strap Muscles Used in elevating the rib cage for respiration Lun s Lower airway Upper airway Trachea 0 Tube formed about 20 rings of cartilage Starts at lower airway Chest muscles pull breathe in Chest muscles relax breathe out Diaphragm moves up to squeeze air out Diaphragm 0 Thick dome shapes muscles that forms the oor of the thoracic cavity 0 Separates the stomach from the thorax 0 Plays a major role in breather because the lungs rest on it Phonatogy Mechanism The larynx is the valve that Prevents substances from entering the trachea Increasing subglottal air pressure Sound producing mechanism for speech Larmgeal Structures Hyoid bones Cartilages connective tissues that keeps the larynx in place and help it make adjustments Thyroid Cricoid Arytenoid Muscles band or bundles of fibrous tissue that can contract to produce movement or maintain 0 Lateral cricoarytenoid bring vocal folds together adduction o Interarytenoid bring vocal folds together adduction o Posterior cricoarytenoid pulls vocal folds apart abduction Class 2 Neuroanatomy and Physiology CNS central nervous systeml 0 Brain brainstem spinal cord PNS eri heral nervous s stem 0 Spinal nerves cranial nerves The Neuron When neurons are damaged they do not heal well Information comes through the dendrites Peripheral Nervous System Carry sensory information to the brain Receive motor information to the body Collection of nerves outside of the skull and spinal column 0 Why is the cerebellum so important Primary Motor Cortex Primarily responsible for controlling the muscles of the body The L hemisphere controls the R side Contra laterally organized COMD 2081 Final Exam SG 1242011 40400 AM Anatomy Physiology amp Neuroanatomy Anatomy Laryngeal Muscles 0 Lateral cricoar tenoid Rotates arytenoid cartilages to bring vocal folds togetheradduction Intrinsic Muscles of Law Lateral Dissection Argepiglottic muscle Oblique and transverse arytenoid muscles Thymargtenoid muscle Posterior cricoargtenoid muscle Lateral cricoargtenoid muscl Cricothyroid muscle cutaway o Interar tenoid bring vocal folds together adduction I Two sets of muscles that go from one arytenoid cartilage to the opposite cartilage o Posterior cricoar mnoid a pulls voca s arymnoid cartilages lamrally l39ir J o Cricomyroidr lengmens amptenses the vocal folds o Thyroarytenoida vibrams the vocal olds pair of muscles divided into 2 masses a Intrinsic Inmrnal chments are within the larynx aka vocal folds vocal cords or vocalis muscle a Extrinsic External at least one attachmentoulside the larynx o lower and raise larynx indirectly influencing sound production Neuroanatomy o Left Hemisphere 0 Logical information based Stepbystep processing Language Numbers Sequences Parts Symbols Facts Procedures 0 Broca s Aphasia slow effortful telegraphic usually only nouns and verbs no grammatical morphemes nonfluent speech speaking at a slow rate with many pauses usually only mild problems understanding speech 0 Wernicke s Aphasia Fluent speech speech produced at a normal rate and without struggle Lots of talking but it tends to be lacking of important nouns and verbs and does not make much sense Speech likely to contain neologisms nonsense words 0 Arcuate Fasciculus Bundle of white matter fibers a bunch of axons found below the cortex in the region between Broca s and Wernicke s It provides a connection between those two areas Lesions in this area can produce conduction aphasia o Right Hemisphere 0 Creative meaning based Random processing Artistic Patterns Music Intuition Rhythm Big picture overall meaning o Lobesamp Their Functions 0 O O O Frontal Lobe associated with reasoning planning parts of speech movement emotions and problem solving Parietal Lobe associated with movement orientation recognition perception of stimuli Occipital Lobe associated with visual processing Temporal Lobe associated with perception and recognition of auditory stimuli memory and speech o Cerebellum attached to the back of the brainstem and is important for coordination of movements o Brain Stem O O O medullae controls respiration heartrate etc mostly vitalautomatic biological responses m9 acts as a bridge connects the brainstem to the cerebellum midbriane connecting the higher amp lower parts of the brain o Primary Motor Cortex O O The PMC in the L hemisphere shown in book controls the R side of your body The PMC in the R hemisphere controls the L side of your body o Corpus Callosum oThick band of fiber connecting the two hemispheres o carotid amp vertebral arteries are the two main supplies of blood to the brain 0 the external carotid branches into two smaller arteries that supply speechlanguage areas of the brain middle cerebral ampanterior cerebral arteries both Broca s amp Wernicke s area are supplied via MCA frontal lobe is supplied via 0 O Aphasia o Types of Strokes mtransient Ischemic attack often a precursor for a stroke Ischemic classic stroke blockage of blood flow thrombosis Hemorrhagicbleed out into brain which results with immediate cell death Aneurysmabnormal widening of the brain results in a ballooning effect of the blood vessel o Types of Impairments Broca s A hasia speech output severely reduced limited mainly to short utterances of less than four words 0 O O O Vocabulary access limited Aggrammatisme omission of certain grammatical elements a articles nounsverbs grammatical moprhemes ing ed s n speak in short sentences with effortful struggle Word finding difficultyAnomia Formation of sounds often laboriousclumsy a transformation of sounds pan gt man u Neologisms made up words gt I m going to the pragost May understand speech and be able to read but limited in writing Halting and effortful quality of speech Telegraphic Lack of words other than content words ie is the am Use of nonspecific words her gt Sara 0 Wernicke s aphasia Limited in comprehension of speech Patients typically do not read or write beyond an elementary level Fluent but meaningless Jargonirrelevant or meaningless speech Tangential speech loose connections between topics n Ex Where did you go on vacationAph Pt good you know The ice cream was smooth 0 Anomic Aphasi Persons who are left with a persistent inability to supply words for the things that they want to talk about Word finding problems well its umround you know like a circle Red Significant in nouns and verbs Understand speech well better comprehension Poor writing ability paraphasia word substitution problem a Ex may call a hat a cat or spoon a knife Neologisms madeup words n Ex nobst for tv 0 Global Aphasi Most severe form Produce few recognizable words Understands little or no spoken speech Can neither read alexia or write agraphia Usually seen after patient has suffered a stroke and may rapidly improve if the damage has not been too extensive Greater brain damage more severe and lasting disability TBI o After 1St TBI risk of second injury is 3 times greater o After 2 risk of third injury is 8 times greater Bruising of the brain due to forwardeackward movement againstskull Twisting of nerve fibers due to twisting of brain within skull o Nerve fibers are broken or stretched temporary or permanent brain dam In TBI there is preferentially greater damage to the frontal and temgora lobes of the brain Sideeffects 0 Attention Reduced concentration Reduced visual attention Inability to divide attention between competing tasks 0 Processing speed Slow thinking Slow reading Slow verbal and written responses Headaches Dizziness Slowed processing Forgetfulness Fatigue Sensitivity to noise and lights Communication Difficulty finding the right words naming objects Disorganized in communication Dysarthria Confused language ex incoherent Anomia Perseverate verbal responses repeating Poor language comprehension Pragmatic language problems social language facial expressions body language Rambling speech Reading amp writing difficulties 0 Learning and Memory Information before TBI intact O O O O O O O Reduced ability to remember new information Problems with learning new skills Socialemotional differences personality change 0 o Mild vs Severe o M An unknown number of individuals fail to seek any medical attention a Domestic violence a Bar room brawls a Child abuseshaken baby syndrome a Sports injuries These MTBIs remain unidentified o ModerateSevere Documented loss of consciousness Potential skull fractures Significant period days to weeks of coma Significant loss of information for a period of time post event Significant and chronic thinking physical and emotional changes Dysphasia o Swallowing disorders o If your having trouble with motormovements for speech you will likely have problems with swallowing too o Development 0 Infancy Suckling horizontal tongue movements tongue is moving forward amp backward large jaw movements 0 Around 6 months sucking behaviors appears reduced jaw movement lips are more firmly closed tongue begins vertical movements up amp down subatmospheric pressure o Phases 0 Oral Pre arator Phase food is manipulated in the mouth mastication chew sensory awareness begins in the oral cavity a the bolus is being broken down chemically by enzymes need control amp coordination of tongue lip teeth amp palatal muscles 0 Oral Phase initiated when the tongue moves the bolus posteriorly towards the throat tongue movements has been described as a stripping motion which propels the food backward need good labial seal and tongue elevation during this phase 0 Pharyngeal Phase when the pharyngeal swallow is triggered involuntary movement bolus is pushed posteriorly into the orapharynx when triggered 3 things happen a 1 nasal cavity closes palatal muscles n 2 elevation of larynx n 3 closure of the larynx epiglottis o Esophageal Phase when the bolus is pushed into the esophagus peristaltic waves pushes bolus down the esophagus into the stomach Language Development and Disorders o Theories of Language Acquisition o Nativist theor children are born with a mechanism for learning language Chomsky Language Acquisition Device language is not learned from the environmentstimulated 0 Cognitive theory Language acquisition is made possible by cognition and general intellectual processes O Which came first the chicken or the egg Do we learn language first and then knowledge or do we need knowledge to learn language a Piaget Children are lone scientists who experiment and explore the world a Vygotsky Children are little apprentices who receive help and support from their teachers Behaviorist theory Language is learned and shaped by responses to verbal behavior Learning is the key focus Developmental Sequence 0 O O O O 4 to 17 week old infants can discriminate bw pa amp ba 1 to 4 month old infants can discriminate bw va ampsa but not sa amp za 2 month old infants can discriminate bw ba amp ga 6 to 8 month old infants can discriminate bw sa ampza but not fi amp ti This teachability declines around age one Cooing 3 months Babbling 57 months Phonological Processes O O O O O O O O O O O O Epenthesis sapoonspoon noahno weeyulwill Reduplication bababottle ChachaCharlotte coneconeice cream cone bubbabrother Initial consonant deletion oapsoap eepdeep otgot Final consonant deletion hauhouse susome bubook Unstressed syllable deletion tephonetelephone baballbasketball ephantelephant Denasalization madman badmad dicenice Cluster reduction taintrain bublue mellsmell Fronting dotgot tairchair tumcome Omission kacar yeterdayyesterday Substitution toupsoup thussfuss Distortion slushy or noisy sounds for lisp Sylvester Addition cupacup example lateral First Words 0 Should appear between 10 and 16 months of age Learn almost 1 word per day 0 Average 2yearold has a vocabulary of 200300 words Learn 1 12 word per day bw ages 2 and 3 o TwoWord Utterances o Acguisition By 18 months most produce 2word utterances beginning of syntax n Ex mommy hat a all gone a no shoe telegraphic speech will use nouns verbs adjectives but leave out articles aanthe conjuctions and but or inflections ing sed understand ambiguous productions via context of Grammatical Morphemes o Morphology the study of word structure All words are morphemes but not all morphemes are words Free morphemes vs bound morphemes Brown s Stages provide data re typical development of morphemes and syntax children acquire morphemes in roughly the same sequence Ex ing prepositions in amp on plurals cats bugs By age 45 typically developing children have mastered the basics of adult grammar o Pragmatics O O The study of the use of social language speaker s intent Its not only important that childrenadults learn to articulate sounds amp develop a language system but we have to learn how to USE LANGUAGE in a variety of social settings Pragmatics is an important aspect of language for both children and adults it involves both verbal amp nonverbal communication Acquisition of Pragmatic Aspects Social smile appears around age 3 weeks Turntaking begins 89 months peekaboo n Evidence of object permanence Intentional communication appears around 810 months a Serves specific functions o Instrumental to get help o Regulatory to control another s behavior Most 3 yearolds can maintain a topic for a few turns 0 SLI Specific Language Impairment a language disorder with no accompanying neurologicalmental problems 0 Deficiencies include Overall slowness in acquiring language Difficulty understanding spoken language Limited vocabulary semantics Omission or misuse of grammatical features morphology Shorter simpler word arrangements syntax Inadequate or inappropriate use of language pragmatics o In addition will usually see Academic concerns readingwriting problems 0 Semantics Word Meaning Semantic Problems a slow rate of learning wordsword meaning a will use simple amp concrete words more often will often label objects truck ball cookie people mommy daddy spot will not use abstract words phrase yesterday joyfulevil scary vacation holiday etc o Morphology How we change the meaning of a word Morphological problems a Slow acquisition of grammatical morphemes 0 Ex 0 give me two truck trucks 0 Daddy come home Daddy s coming home i Give me two o I runned school I ran to school a only the most critical words are used amp the grammatical elements are omitted telegraphic o Syntax grammar Syntactic problems a difficulty with sentence construction we say grammatically incorrect sentences n will use only simple sentences o declarativese I like candy o questions where s my book a Use of complex sentences amp clauses develop late o In order to see my sister before she left I ran home after school quot9 too complex to produce amp hard to comprehend o Pragmatics speaker s communication intent in social contexts Pragmatic problems a limited conversational skills o difficulty initiating amp maintaining conversations discourse orinappropriate use of social language o poor use of turn taking 0 will interrupt conversations usually with irrelevant statements a difficulty making friends ArticulationPhonological Disorders o Stuttering o Stuttering is a communication disorder characterized by excessive involuntary disruptions or blockings in the flow of speech particularly when such disruptions consist of repetitions accompanied by avoidance andor struggle behavior The term dysfluency refers to many forms of interruptions9 repetitions prolongations interjections pauses amp associated motormovements May facial grimacing increased muscular tension on neck amp face or body movements 0 Occur more commonly on Initial words of phrases or sentences Consonants Longer words Less frequently occurring words 0 Types of Dysfluencies The term dysfluency refers to many forms of interruptions9 repetitions prolongations interjections pauses amp associated motormovements a May facial grimacing increased muscular tension on neck amp face or body movements Repetitions a Part word o quotI am a jjjjunior a Whole word o quotMvMyMy maior is psycholoqy n Phrase o quotI haveI haveI have a coldquot Prolongations n Soundsyllable o quotI have to sssstudy a silent o A struggling attempt to say a word when there is no sound o will see tension in the faceneck Interjections n Soundsyllable o quotI have um um a test a whole word c quotSchool is well fine a phrase o quotThe test was you know hardquot Silent pauses n An abnormally long silent duration between words and sentences o quotI39ve known pause him for years n An abnormally long silent duration within words o quotShe is a Sophpausemorequot o 3 Basic Diagnostics of Stuttering Frequency 39 Type Duration o Cluttering o A disorder of communication with impaired fluency rapid speech disordered articulation and likely disorganized thought and language production Telescoped words JapeseJapanese Spoonerisms many thinkle peep somany people think so Frequent interjections such as like and you know Appear to be unaware of any problem in their speech Jerky rhythm of speech Monotone voice High frequency of articulation errors Poor ability to monitor speech often are unaware of their speech 0 O O O O O O O 0 Hearing Anatomy and Disorders o Structure 0 Outer Ear Pinna Auricle Ear canal External Auditory Meatus the resonating characteristics of our ear canals act like natural amplifiers giving a volume boost to high frequency sounds like speech 0 Middle Ear Eardrumtympanic membrane Ossicles n Malleushammer n Incusanvil n Stapesstirrup Eustachian tube a Opens by swallowing or yawning n Connects middle ear to nasopharynx n Equalizes pressure and aerates middle ear acoustic energysounds is converted to mechanical energy 0 Inner Ear mechanical energy is transferred to electrical energy neural impulses Begins with Oval Window Two primary structures a Three semicircular canals Help maintain balance a Cochlea primary inner ear structure of hearing Vestibular system a The three semicircular canals that help control balance posture and movement o The SemiCircular Canals are the mechanism which detects head movement and helps us to keep our balance The three canals are in different planes and can be thought of as a sort of three dimensional gyroscope Fluid n Cochlea Snail shaped coiled tunnel that is filled with a fluid called endolymph o Endolymph Fluid in the cochlea o Organ of Corti bathes in the endolymph o Contained in the basilar membrane 0 The inner ear39s most important structure of hearing Contains thousands of hair cells or cilia that respond to sound When hair cells are damaged they do not regenerate amp O